NHS: thank heaven for Claire Wright – but will she be listened to by stubborn, uncaring Tories?

Owl says: how will Randall-Johnson and her cronies try to malign Claire Wright on this one with the overwhelming evidence Claire and her committee produced to show that cuts have gone much, much too far – to the point where it seems basic human rights are being infringed every day particularly for the dying?

Could Randall-Johnson and her cronies imagine some of the things described below happening to their parents, partners, siblings, friends?

What happened to this country – and this county – that health care has been allowed (nay, encouraged) to sink so low?

And all a political choice, NOT an economic one.

Shame on you Tory Health and Wellbeing Scrutiny for allowing this to happen.

“A scrutiny review into the system that’s designed to replace community hospital beds is recommending a raft of measures that will be debated at Devon County Council’s Health and Adult Care Scrutiny Committee, on Thursday this week.

I chaired the review, which took place during the summer and found that the care at home (or Rapid Response) service was very stretched and care of the dying in particular was highlighted as an area of concern, especially since community hospital beds had been closed.

Over 200 Devon community hospital beds have been closed in the past five years or so.

We interviewed a range of witnesses, including Dr Paul Hynam, GP and Secretary of the Local Medical Committee, GP, Dr Mike Slot (whose concerns prompted the review), Ann Rhys, Assistant Director of Care at Hospiscare and Richard Westlake, Chair of Exeter Patient and Public Involvement Group.

Also interviewed were various senior managers from Devon County Council and the local NHS.

I proposed the Spotlight Review after Sidmouth GP, Dr Mike Slot, attended the January Health and Adult Care Scrutiny Committee to outline his concerns about how care at home (or Rapid Response) was working.

Dr Slot said that although he supported it in principle, there simply weren’t enough carers available to look after patients.

On Thursday (22 November) health scrutiny councillors will be asked to endorse 12 recommendations, including:

– No further community hospital bed closures
– Consideration of reopening some community hospital beds on a flexible basis to ease pressure on the system
– A review of all intermediate (temporary bed-based) care provision across the county
– A standardised approach to Rapid Response across the county, including having GPs on the team
– A review of Hospiscare’s role in end of life care, with a view to providing more financial support

Sadly, the biggest pressure on the local healthcare system seems to be care of the dying.

This outcome was predicted by some GPs before the community hospital beds were closed.

Hospiscare’s Assistant Director of Care, Ann Rhys, told councillors that since the community hospital beds had closed Hospiscare had seen a significant increase in pressure on the service and a resultant large increase of patients dying in their 12 bedded inpatient unit in Exeter.

In the last three months (reported over this summer) 40 patients have been unable to access Rapid Response.

Worryingly, staff can make phone contact three to four times a day to the Rapid Response service because there is NOT support available. This is very time consuming and has a significant impact on community teams.

Councillors were very concerned to hear that one East Devon Hospiscare nurse had reported that in just one month during the summer there were eight instances where no care was available.

GP feedback revealed that the service has led to a lack of confidence by some GPs who say they spend a long time trying to find carers to support a patient at home, only to find there is no support available.

The result is then an admission to the local acute hospital instead. Something the service was set up to avoid.

The NEW Devon Clinical Commissioning Group did not provide hospital readmission rates to the scrutiny review, despite being asked several times to do so.

A survey to GPs prompted responses mostly from East Devon. Some of the comments are below:

– “Sometimes it can take some time to get a call back informing you that they cannot get the care requested, meaning the patient needs to be admitted much later in the day.”

– “Since the closure of community beds and supposed reallocation of funds the service seems rather worse than better.

– “I take the view when with a patient that I won’t be able to access Rapid Response but if I can it’s a bonus.”

– “Sadly SPOA (Rapid Response) sounds great, but in reality, it’s a time-consuming referral with low probability of delivering the service you want.”

– “I have had three recent episodes where I have called SPOA (Rapid Response) in recent months and they have been unable to put in appropriate care. Patients have been sent to the RD&E for admission. It is a frustrating process – often not staffed well enough so details at the point of contact cannot be taken. Most cases seem to involve two to four calls back to speak to the right person. GPs under pressure are tied up for too long by the service. So long in fact it has made me not want to use the service. It would be easier to admit patients than it is to call SPOA and arrange care – or try to arrange the care…. “

– “Our allocated care agency handed back their contract and we have been left with very little support for care… when we need Rapid Response to support patients and prevent admission we cannot link into subsequent long-term care packages. I had one chap with a neurological condition who had Rapid Response for over a year!”

I am really really glad this piece of work was carried out and I am proud to be the spotlight review’s chair.

For years we have been told by senior managers that the system is working well, with just a few minor problems. This report and the conversations we have had with people who work at the coalface clearly shows a different picture. A worrying picture that needs fully examining.

I trust that councillors who sit on Devon County Council’s Health and Adult Care Scrutiny Committee will fully support the recommendations.

Here’s the link to the report, which will be debated and voted on Thursday (22 November) https://democracy.devon.gov.uk/documents/s22439/RR%20Report%20final.pdf

http://www.claire-wright.org/index.php/post/no_more_community_hospital_bed_closures_recommends_devon_health_scrutiny_re

More Guardian letters on poverty, inequality, austerity and political cruelty

The UN envoy’s visit and report concluding that “Austerity has inflicted misery on people” (Report, 17 November) could not be more important. His confirmation that poverty and humiliation has been heaped upon millions of vulnerable men, women and children by this government has to be a spur to action for us all. As Philip Alston said with great clarity, “in the UK poverty is a political choice”. A deeply shameful one. For once, someone listened to those who are struggling to survive and care for children without homes, healthcare or an income. After all, a personal or health crisis can plunge anyone into poverty.

We can all get caught up in the demands, distractions and problems of our everyday lives (including Brexit), but this reflects on our humanity and it is to our shame if every one of us does not continue to fight against these punitive policies with every fibre of our being. Rising destitution and a generation of children suffering deprivation must never become the new normal. Food banks and practical help are essential in the short term, but we have to achieve change and constantly reject government rhetoric denying the devastating impact of austerity policies and denigrating vulnerable people as “undeserving”. All this while tax cuts are given to the rich. None of us can stand by.
Liz Udall
Carshalton, London

• At last, someone has looked behind the curtain of Brexit Britain and found what really fuelled the anger. It took the UN’s rapporteur just two weeks to see the reality, but Labour under Jeremy Corbyn has consistently failed to highlight this issue as a key factor in the Brexit vote, ignoring the reality that has been obvious for years as wages stagnated and working conditions worsened under Tory austerity policies after the financial crash.

Austerity policies have plunged millions of British people into poverty; even in the prosperous part of London where I live we have several regular beggars and Big Issue sellers, as well as rough sleepers in several doorways and in our church halls, all as a direct result of continuing Tory nastiness.

But let’s not worry, the art market is booming and someone just parted with a few million dollars for some trinkets worn by Marie Antoinette, so some of us have plenty. I wonder where they got it from?
David Reed
London

• Your article quotes Philip Alston saying that child poverty in Britain is “not just a disgrace but a social calamity”. I fear that Brexit shenanigans will swiftly drown his voice, but I would nevertheless like to add a caveat to his conclusions. Child poverty is a more palatable way of describing the poverty of parents. This is not just semantics but results in different policies and practice. The former is more likely to lead to stigmatising and humiliating handouts to children, such as free school meals or sanitary provision. If we accept that millions of parents are struggling to do their best for their children then we will seek different solutions, such as a living wage for all (including those under 25) and a benefit system that doesn’t drive people to desperation. It is through adults that we can and must address the poverty of children.
Carole Easton
Chief executive, Young Women’s Trust

• It has become all too clear that it is not enough to describe elephants in the room to government ministers who as a matter of policy do not recognise elephants (Editorial, 19 November). The time has come for the anti-poverty lobby to set our own national objectives to relieve the debt, hunger and ill health of impoverished UK citizens. The good health and wellbeing of every citizen in or out of work must become a national priority.

The level of the statutory minimum wage, unemployment benefits and pensions must be set by referring to minimum income standards research, with particular attention given to maternal nutrition. Rents must be controlled. Such policies for preventing poverty-related mental and physical ill health, infant deaths and shortened lives, with adequate minimum incomes and truly affordable housing, can be paid for by capturing for the public good a small percentage of the large increases in the value of British land. That ought to lead to the abolition of council tax and business rates, and even to a reduction of income tax. Land value is currently captured only for private benefit, much of it by national and international speculators.
Rev Paul Nicolson
Taxpayers Against Poverty

• No surprise that Philip Alston has found the government is in denial about the effects of its welfare policies or that it is now dismissive of his findings. But this latest denial only reinforces Mr Alston’s assessment. It is also yet another example of the complete inability of this government to show any understanding or ability to change policies in the light of evidence.
Judy Stober
Bruton, Somerset

• I have just come back from a session at the local food bank in a small town in Devon. A young homeless man has been sanctioned a whole month’s universal credit (£246). His “crime”: he failed to attend an interview at the jobcentre because he was ill. With him was a friend: sanctioned for 168 days. His “crime”: he started work and failed to let the jobcentre know. They stopped his benefit, but he was still sanctioned.

So the rise in food bank use is nothing to do with universal credit?
Angela Ford
Devon

• Gateshead council is not the first to find a link between universal credit and suicide (Report, 16 November). Activists have been raising this issue for years now, often carrying a banner listing the names of the dead. Nearly everyone in the mental health field – as well as those who work in social care or for the police – recognises the link between the current benefits system and suicide risk.

There are aspects of universal credit that seem almost designed to produce or exacerbate mental health problems, from the anxious, shame-provoking initial six-week wait which drives so many people to food banks, to the frequent loss of income, to the relentless pressure for even those whho are seriously ill or disabled to display constant work readiness, to the allocation of household income to one person, even if that is someone who has been convicted of domestic and financial abuse. I could go on.

If the government is serious about promoting mental health and preventing suicide, it would scrap universal credit as an urgent priority before more people die. It may only be one factor in a suicide attempt, but that one factor is often the final straw.
Dr Jay Watts
Consultant clinical psychologist

• Thank you for using the front page of Saturday’s Guardian to highlight the findings of the UN’s poverty envoy, particularly as this has featured little elsewhere in the media. Other news including the turmoil over Brexit, though massively important, must not let us lose sight of the harsh realities in the lives of many in our desperately unequal society.
Jan Westwood
Chapel-en-le Frith, Derbyshire

• Did you pray for forgiveness in church on Sunday, Mrs May? You should hang your head in shame.
Anne Page
Shoreham-by-Sea, West Sussex”

https://www.theguardian.com/society/2018/nov/19/angered-by-the-damage-that-austerity-does-to-the-poor

“Huge amount of taxpayers’ money’ used for gagging orders at East Devon council”

Owl says: 10 people with some very interesting stories we will never know ….. and which will never be scrutinised.

“Figures obtained using a Freedom of Information request show that East Devon District Council has spent more than £200,000 on gagging orders over the past four years.

A total of £205,074 has been spent by East Devon District Council on gagging orders for former members of staff since 2014, according to figures obtained by the Journal.

The information, obtained through a Freedom of Information request, reveals 10 settlement agreements, or gagging orders, were agreed by EDDC between 2014 and October 31, 2018.

Gagging orders are often referred to as confidentiality clauses and are usually agreed when an employee leaves an employer due to redundancy, a work place problem or a disagreement.

A number of opposition councillors have said they are shocked by the amount of money spent on gagging orders.

Independent group leader at EDDC, Ben Ingham, said: “When any one of us is thinking about how we can afford to pay our latest council tax bill, I do not believe we expect one penny to be spent on gagging orders.

“If we did, non payment may become a real expectancy. As Leader of EDDC Opposition, I can tell you at no time has the current leadership contacted me to discuss this issue at all.

“This is not acceptable, but to me not surprising. Merely another piece of evidence against an exhausted regime.”

A spokeswoman for EDDC said: “Settlement agreements are legally binding contracts that waive an individual’s rights to make a claim covered by the agreement to an employment tribunal or court.

“The agreement must be in writing. They usually include some form of payment to the employee and may often include a reference. They are voluntary and have therefore been entered into on that basis by the individuals.

“Part of the agreement is that they must seek independent advice from an employment lawyer.”

Exmouth district councillor Megan Armstrong said: “I am extremely concerned at the huge amount of taxpayers’ money, which should have been used to provide services for the people of East Devon, which has been spent on gagging orders.

“The council has a duty to be open and transparent; yet over £200,000 – a vast sum – has been spent on suppressing information. Exactly what is the Conservative administration trying to hide?”

http://www.exmouthjournal.co.uk/news/gagging-orders-at-east-devon-district-council-1-5785868

Penalised if you live near small branches of big supermarkets

“If you’ve ever suspected that popping into your local supermarket rather than heading to a bigger superstore is damaging your wallet, then your hunch is correct.

Big brands are cashing in on the convenience and accessibility of their in-town locations and charging around £10 more per shopping trolley.

The BBC investigation looked at Tesco, Sainsbury’s, Marks & Spencer and Waitrose and found huge variations in prices. For example, in a regular Tesco you would pay 9p for a banana versus 25p in express stores.

The supermarkets say that the price difference is due to the higher cost of running the smaller branches, but the findings offer food for thought for customers who are deciding where to pick up their shopping.

Not only are the bananas pricey but the investigation found Tesco customers would pay 91p for a bag of mixed peppers in a superstore versus a hiked price of £1.15 in the store closer to their door.

In Marks & Spencer, a banana in a regular store costs 18p versus 40p in their local stores, while red seedless grapes are £2 versus £2.80 in a local branch.

And this all has a big impact on your total bill. At Marks & Spencer the same trolley of shopping cost £103.26 at the Birmingham High Street store and £112.44 at Simply Food in Birmingham New Street Station.

Even some branded products, like Mr Kipling’s French Fancies, varied in price depending on the size of store. In Sainsbury’s the cheaper location charged £1.60 versus £1.95 in the smaller, pricier shop.

Shops were visited between September and October this year, and prices were analysed. At Sainsbury’s and Marks and Spencer stores in Birmingham, and Waitrose shops in Shropshire, 45 of 50 items cost more in the convenience location. And at the Tesco Express, 39 of 50 items cost more than in the superstore.

Although the big chains say the varied pricing is a business decision based on overheads at different locations, for those customers who are not able to access larger facilities out of town (for example, if they don’t have a car), the impact is real.”

https://www.huffingtonpost.co.uk/entry/supermarkets-hike-up-prices-in-local-branches_uk_5bf2914be4b0f32bd58b37aa

“East Devon PCSO numbers to be slashed to five ‘by 2020’ “

“East Devon’s PCSO numbers are set to fall again by 2020 – bringing to the total number of officers to just five across the region.

Honiton PCSO Rich Shelton revealed the cuts at the meeting of Honiton Town Council last Monday.

He said: “PCSO numbers are going down to 200 by March 2020.

“That was from a figure of 360 a couple of years ago, across Devon and Cornwall.

“In East Devon now, we currently have nine.

“They are stationed at Honiton, Sidmouth, Seaton and Axminster.

“That figure we believe will go down to five.”

A spokesman for Devon and Cornwall Police said: “The total number of PCSOs across Devon and Cornwall will be 200 by 2020, instead of the original figure which was 150 by 2021.

“That originally was changed in response from the feedback we received from our partners and the general public.”

http://www.midweekherald.co.uk/news/east-devon-pcso-numbers-to-be-slashed-to-five-by-2020-1-5784000

“UN inspection highlights “gutted” local government”

“Local government in the UK has been “gutted” by government policies reflecting the “dismantling of the social safety net”, a United Nations report has found.

Since the onset of austerity, cuts to local government funding have transferred service costs to users who are “least able to pay”, according to Philip Alston, the UN’s special rapporteur.

Alston, who examined UK poverty on a 12-day tour, said local authorities are “even struggling with the basic services they are statutorily obligated to provide”.

This, he said, was just one of the ways the “overall social safety net is being systematically dismantled”.

The UN official referenced the National Audit Office’s finding that local government has incurred a 49% cut in funding since 2010-11, and highlighted the effect this has had, with Northamptonshire County Council’s unprecedented section 114 notices.

Alston said: “Local authorities, especially in England, which perform vital roles in providing a real social safety net have been gutted by a series of government policies.

“Libraries have closed in record numbers, community and youth centres have been shrunk and underfunded, public spaces and buildings including parks and recreation centres have been sold off.

Alston claimed that 14 million people – one fifth of the population – live in poverty, and noted that Institute for Fiscal Studies calculations predict a 7% rise in child poverty between 2015 and 2022.

Despite these factors, Alston claimed ministers were in “a state of denial” about UK poverty.

“The ministers with whom I met told me that things are going well – this is not the story I heard in my travels through Wales, Scotland, Northern Ireland and in quite a few cities in England,” he said.

Other areas in which social security have been undermined include cuts to legal aid and benefit reductions.

A government, however, said it “completely” disagreed with the UN’s analysis.

“With this government’s changes, household incomes have never been higher, income inequality has fallen, the number of children living in workless households is at a record low and there are now one million fewer people living in absolute poverty compared with 2010.

“Universal credit is supporting people into work faster, but we are listening to feedback and have made numerous improvements to the system including ensuring 2.4 million households will be up to £630 better off a year as a result of raising the work allowance.”

Alston’s full report will be presented to the UN Human Rights Council in Geneva next year.”

https://www.publicfinance.co.uk/news/2018/11/un-inspection-highlights-gutted-local-government

Priorities: Work and Pensions Minister – fifth one in just over 2 years

“Amber Rudd has replaced Esther McVey as secretary of state for work and pensions, becoming the fifth person to be appointed to the position since Iain Duncan Smith resigned in March 2016.

McVey relinquished her post after quitting Theresa May’s cabinet in disagreement over the Brexit deal, which she says “does not honour” the result of the referendum.

Over the past two and a half years, the work and pensions secretary role has resembled a game of musical chairs: Stephen Crabb, Damian Green, David Gauke, Esther McVey and now Amber Rudd have all been in the hot seat. On average, since March 2016, the secretary of state for work and pensions position has swapped hands every six and a half months. …”

https://www.moneyobserver.com/news/amber-rudd-becomes-fifth-work-and-pensions-secretary-march-2016