“Official figures mask A&E waiting times”

“Tens of thousands more patients spent more than 12 hours in A&E waiting for a bed last year than official figures suggest. Doctors and MPs called for a change to how “trolley waits” were reported in England after an investigation by The Times.

Official numbers show that 2,770 A&E patients had to wait more than 12 hours for a bed last year. These NHS statistics only capture the time between a doctor deciding a patient needs to be admitted and then being found a place on a ward. If the time is recorded between arriving at A&E and being found a bed, the number of patients who had to wait in emergency departments for more than 12 hours leaps to at least 67,406 patients, 24 times higher, according to data obtained under freedom of information laws.

The true figure is likely to be even higher, as only 73 hospitals out of 137 replied to the requests. The Times also asked hospitals for details of the longest wait they had recorded each week. Those revealed about 200 patients waiting more than a day for a bed last year. In December a 103-year-old woman spent 29 hours in A&E before she was admitted to the Great Western Hospital in Swindon, Wiltshire. The trust said that it had been one of the busiest months on record. The longest wait reported to The Times, of almost four days, was a 16-year-old boy at Barking Havering and Redbridge NHS Trust.

Sarah Wollaston, Conservative chairwoman of the health select committee, said that long waits in A&E raised patient safety concerns. “When departments are already at full stretch, having to care for individuals who may be very unwell and waiting for transfer to a more appropriate clinical setting reduces the time clinicians are free to assess and care for new arrivals and this can rapidly lead to spiralling delays,” Dr Wollaston said. “The total length of time that people are spending in emergency departments should be recorded alongside the current figures.”

Paul Williams, a Labour member of the committee, said: “If the clock doesn’t start ticking on ‘trolley waits’ until this decision has been made, then hospitals can legitimately have someone waiting for more than three hours to be seen and assessed, and then another 11 hours on a trolley without this leading to a breach of targets.” In Wales, Scotland and Northern Ireland, 12-hour waits are recorded from when a patient arrives in the department.

Rachel Power, chief executive of the Patients Association, said: “It’s clear from this data that many patients are enduring even longer waits with their safety, privacy and dignity compromised than the official statistics show.”

Taj Hassan, president of the Royal College of Emergency Medicine, said: “I think all independent observers would agree that, at the moment, the way we are describing our 12-hour trolley waits is not accurately describing the numbers.”

An NHS England spokesman said: “In the last 12 months to February 2018 the number of 12-hour trolley waits has dropped by more than 20 per cent on the previous year, and this has been achieved while hospitals also successfully looked after 160,000 more A&E patients within the four-hour target this winter compared to last winter.” NHS Digital is set to publish separate monthly statistics on the total number of patients spending more than 12 hours in A&E, whether or not they eventually needed admission. They said there were more than 260,000 during the financial year 2016-17.

Behind the story

Hospitals are expected to treat, admit or discharge 95 per cent of patients within four hours of their arrival at A&E (Kat Lay writes).

However, they have not met that target since July 2015. In January, only 77.1 per cent of people going to larger A&Es were dealt with within four hours.

For patients who require admission — “the sickest group” attending A&E, says the Royal College of Emergency Medicine — it appears to be worse.

At hospitals that provided figures to The Times, on average only 53 per cent of patients requiring admission were found a bed within four hours in January this year.

A lack of social care means that many of the beds that such patients need to be moved on to are taken up by people who do not need to be in hospital any longer, doctors complain.

Source: The Times (pay wall)

Our NHS: Demo at DCC HQ Thursday 22 March from mid-day

Join SOHS demo from midday – County Hall, Exeter – This Thursday 22nd March.

Save Our Hospital Services (SOHS) Devon are lobbying against plans to introduce structural changes in NHS delivery of services from April 1st with the introduction of an Integrated Care System (formerly known as ‘Accountable Care System’). This is yet another reorganisation of Health & Social Care services, which hasn’t been consulted on and is part of the ‘Sustainability & Transformation Plan’ imposed by the government to cut another £550 million off Devon’s Health care and introduce more privatisation…

IF YOU CARE ABOUT THE NHS COME AND JOIN US

We will also address the DCC Health & Adult Care Scrutiny Committee at 2.00pm on Thursday with 12 key questions about Integrated Care Systems (ICS)
planned for introduction by NHS England from April 1st without consultation. SOHS have sent these 12 questions to Dr Tim Burke, Chair of the NEW CCG
which meet also at 1.00pm on Thursday at County Hall.

LEPs – not fit for purpose

Owl says: No accountability, no transparency and yet they are taking over more and more money that used to be supervised by district and county councils. Why and who benefits? Certainly not us.

A group of MPs has told the government to “get its act together” regarding the governance of public-private partnerships set up to boost local economies.

A Public Accounts Committee report on the Greater Cambridgeshire Greater Peterborough Local Enterprise Partnership, released on Friday, found that the LEP had failed to meet standards of accountability and transparency.

In particular, the report found that the GCGP LEP failed to publish board papers and reproduce minutes in a timely or accessible manner.

The PAC also found the former chair of the GCGP LEP- Mark Reeve- did not take responsibility for the LEPs failings and did not appreciate the importance of good governance of LEPs.

Consequently, the PAC suggested that the Ministry of Housing, Communities and Local Government, should implement the recommendations of the Mary Ney review, which sets out guidelines to improve governance and transparency of partnerships, for all LEPs.

It also called for all LEP board members to be familiar with the Nolan Principles, which were published by the government in 1995 and set out the basis of ethical standards expected of public office holders.

PAC chair, Meg Hillier said: “Local enterprise partnerships are not an abstract concept on a Whitehall flipchart.

“They are making real decisions about real money that affect real people.

“This troubling case only serves to underline our persistent concerns about the governance of LEPs, their transparency and their accountability to the taxpayer.”

The report also revealed that the MHCLG’s oversight system failed to indentify GCGP LEP as one which should have raised concerns, after Cambridgeshire County Council’s section 151 officer signed off on GCGP LEP’s assurance framework without checking all of its supporting documentation.

As such, the PAC has asked the MHCLG to write to them setting out the results of its compliance checks and annual conversations and for them to publish these results.

Hillier added: “Taxpayers need to be assured their money is being spent wisely and with adequate protections in place to prevent its misuse.

“Central government must move swiftly to ensure the recommendations of the Ney review are fully implemented and we expect to see evidence that this has happened.”

The MHCLG has been approached for comment.”

http://www.publicfinance.co.uk/news/2018/03/government-told-get-its-act-together-over-leps

“The town that’s found a potent cure for illness – community”

What this provisional data appears to show is that when isolated people who have health problems are supported by community groups and volunteers, the number of emergency admissions to hospital falls spectacularly. While across the whole of Somerset emergency hospital admissions rose by 29% during the three years of the study, in Frome they fell by 17%. Julian Abel, a consultant physician in palliative care and lead author of the draft paper, remarks: “No other interventions on record have reduced emergency admissions across a population.”

Frome is a remarkable place, run by an independent town council famous for its democratic innovation. There’s a buzz of sociability, a sense of common purpose and a creative, exciting atmosphere that make it feel quite different from many English market towns, and for that matter, quite different from the buttoned-down, dreary place I found when I first visited, 30 years ago.

The Compassionate Frome project was launched in 2013 by Helen Kingston, a GP there. She kept encountering patients who seemed defeated by the medicalisation of their lives: treated as if they were a cluster of symptoms rather than a human being who happened to have health problems. Staff at her practice were stressed and dejected by what she calls “silo working”.

So, with the help of the NHS group Health Connections Mendip and the town council, her practice set up a directory of agencies and community groups. This let them see where the gaps were, which they then filled with new groups for people with particular conditions. They employed “health connectors” to help people plan their care, and most interestingly trained voluntary “community connectors” to help their patients find the support they needed.

Sometimes this meant handling debt or housing problems, sometimes joining choirs or lunch clubs or exercise groups or writing workshops or men’s sheds (where men make and mend things together). The point was to break a familiar cycle of misery: illness reduces people’s ability to socialise, which leads in turn to isolation and loneliness, which then exacerbates illness.

This cycle is explained by some fascinating science, summarised in a recent paper in the journal Neuropsychopharmacology. Chemicals called cytokines, which function as messengers in the immune system and cause inflammation, also change our behaviour, encouraging us to withdraw from general social contact. This, the paper argues, is because sickness, during the more dangerous times in which our ancestral species evolved, made us vulnerable to attack. Inflammation is now believed to contribute to depression. People who are depressed tend to have higher cytokine levels.

But, while separating us from society as a whole, inflammation also causes us to huddle closer to those we love. Which is fine – unless, like far too many people in this age of loneliness, you have no such person. One study suggests that the number of Americans who say they have no confidant has nearly tripled in two decades. In turn, the paper continues, people without strong social connections, or who suffer from social stress (such as rejection and broken relationships), are more prone to inflammation. In the evolutionary past, social isolation exposed us to a higher risk of predation and sickness. So the immune system appears to have evolved to listen to the social environment, ramping up inflammation when we become isolated, in the hope of protecting us against wounding and disease. In other words, isolation causes inflammation, and inflammation can cause further isolation and depression. …”

https://www.theguardian.com/commentisfree/2018/feb/21/town-cure-illness-community-frome-somerset-isolation

Control of community care in Nottinghamshire falls to controversial US company

“NHS Protectors’ worst fears are being realised as USA’s Centene is likely to control Greater Nottingham Accountable Care System, by taking over the NHS Commissioner’s role in a £206m community services contract.

At the very time that its discredited subsidiary Ribera Salud – which is being kicked out of Spain by the Valencia Green/Podemos/Socialist government – has appointed former New Labour Health Secretary Alan Milburn as a Director and has sent lots of executives to UK to help Centene UK with its plan of buying primary care and mental health companies.

The UK subsidiary of Centene – a US sub-prime health insurance profiteer that has got rich off managing Obamacare’s publicly-funded Medicaid programmes which provide health insurance for people on a low income – is likely to take over the NHS commissioner’s role in the £206m, 7 year contract for out-of-hospital community services, that Nottingham City Clinical Commissioning Group recently awarded to Nottingham City Partnership Community Interest Company. …”

This seems to bear out NHS protectors’ worst fears that Accountable Care Systems or Organisations are Trojan horses designed to import US companies into key controlling positions in these new types of local NHS and social care services.

Centene UK, assisted by executives from its discredited Spanish subsidiary Ribera Salud, is also studying the acquisition of primary care and mental health companies in the United Kingdom, according to recent reports from Valencia Plaza.

Ribera Salud recently appointed the former New Labour Health Secretary Alan Milburn to its Board of Directors, to help it “continue with its expansion plans.” In addition, during the recent visit to Valencia of the United Kingdom’s ambassador to Spain, Simon Manley, a British manager of Ribera Salud contacted him to explain the company’s plans. …

Nottingham City Clinical Commissioning Group will become part of the Nottinghamshire/Greater Nottingham Accountable Care System. This will be:

“a single risk bearing entity to managing [sic] the entire care continuum. The successful provider must form part of the ACS and…will be expected to help shape and deliver its part of the single risk bearing entity.”

This sounds like the Accountable Care Organisation contract – which NHS England is not approving now and which is the subject of two Judicial Reviews in the Spring and a public consultation at some unspecified point in time.

The contract notification says that when the Accountable Care System is implemented, this will require a contract variation which:

“will require the successful provider to provide its consent to the potential future transfer of the CCG’s role under the contract.”

This contract variation will mean transferring the contract from Nottingham Clinical Commissioning Group to another provider, or the Care Integrator (Centene UK).

It seems that Nottingham City Clinical Commissioning Group has taken a gamble on the likelihood that NHS England will be approving the Accountable Care Organisation contract by the time the Sustainability and Transformation Partnership has figured out its business case to consider the options for partner organisations in managing the Accountable Care System components and has secured legal and procurement support to advise on this.”

https://calderdaleandkirklees999callforthenhs.wordpress.com/2018/03/19/usas-centene-to-take-over-nhs-commissioners-function-in-206m-community-services-contract-as-accountable-care-system-sets-up/

“LIST OF SHAME: THE 312 MPS WHO VOTED TO TAKE FREE SCHOOL MEALS FROM 1M POOR CHILDREN”

Of course, it includes Swire and Parish

“In the House of Commons on Tuesday, MPs defeated a Labour motion, moved by Shadow Education Secretary Angela Rayner, to block a planned government move that will take a free, hot school meal from the mouths of around one million children from low-income families.

Tory MPs have attempted to deflect blame for their callousness by selectively quoting a Channel 4 Fact Check article – which said it could not fault the Labour Party’s calculations – in order to claim they are actually giving free meals to an additional 50,000 children and not taking it away from the million.

But that pathetic deflection was laid to rest in the very first exchange of the debate around Labour’s motion:

Chris Philp (Croydon South) (Con)

Does the hon. Lady agree with Channel 4’s FactCheck, which says:

“This is not a case of the government taking free school meals from a million children”.

These are children who are not currently receiving free school meals, and in fact the Government’s proposals ​would see 50,000 extra children receive free school meals. Perhaps the hon. Lady could stop giving inaccurate information to the House.

Angela Rayner

The hon. Gentleman should know that his Government have introduced transitional arrangements, and we are clear that under the transitional arrangements, those 1 million children would be entitled to free school meals. With the regulations, the Government are pulling the rug from under those hard-working families.

In my own boroughs of Oldham and Tameside, a total of 8,700 children growing up in poverty are set to miss out. In the Secretary of State’s own area, the total is 6,500. So much for the light at the end of the tunnel that the Chancellor mentioned over the weekend on “The Andrew Marr Show”!

The UK has one of the worst rates of child malnutrition and ‘food insecurity’ among rich nations – with one in five UK children suffering food insecurity.

In spite of this – and the callousness of depriving hungry schoolchildren of food, with the consequent impact on their health and education – the government defeated the motion.

Not a single Tory MP rebelled – and of the ten DUP MPs, ‘incentivised‘ by a Theresa May pledge to maintain the free school meals for Northern Irish children – only one declined to vote away the provision for children in Britain.

The full roll-call of shame of MPs who voted down Labour’s attempt to protect poor children from hunger is below [includes Swire and Parish]”

https://skwawkbox.org/2018/03/14/list-of-shame-the-315-mps-who-voted-to-take-free-school-meals-from-1m-poor-children/