Category Archives: Accountable Care Organisation

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9 Jul 2018

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Accountability, Accountable Care Organisation, Austerity cuts, Health and Social Care (local), Integrated Care Systems, NHS (local)

NHS bed blocking costs £550 per MINUTE says charity

“Bed blocking because of a lack of social care availability is costing the NHS an “eye-watering” £550 per minute, according to research by a charity released today. This equates to £290m a year, Age UK has estimated.

Analysis by the charity also showed that in just two years, the number of older people in England living with an unmet care need has risen by 19%, which translates to 1.4 million over 65s living with unmet care needs

More than 300,000 need help with three or more essential daily tasks like getting out of bed, going to the toilet or getting dressed, the charity found, and of this 165,000 receive no help whatsoever from paid carers, family members or friends.

Caroline Abrahams, Age UK’s charity director, said: “The numbers of delayed discharges to a lack of social care are actually going down, but a lack of social care still costs the NHS an eye-watering £500 every minute – not to mention undermining the chances of older people making a full recovery if they are unnecessarily stuck in hospital for weeks or longer.”

Izzi Seccombe, chair of the Local Government Association’s community wellbeing board, said: “People’s unmet care needs will continue to increase and deepen the crisis in adult social care unless the sector receives a long-term funding settlement, like the NHS, and further funding is made available for council’s public health and prevention services.

“To prevent crises in the NHS, government needs to plug the £3.5bn funding gap facing adult social care by 2025 and reverse the £600m in reductions to councils’ public health grants between 2015-16 and 2019-20.”

Age UK noted that between 2009-10 and 2016-17 spending on adult social care in England fell by 8% in real terms. As a result, in the same period, the average spend per adult on social care fell by 13%, from £430 to £379.

Alex Khaldi, head of social care insights at Grant Thornton, said: “Funding is not the only answer, councils need to focus on monitoring the level of unmet need in their areas more effectively. “If we are to exercise place-based leadership in social care, better data insight that allows councils to identify where and why people have fallen between the cracks is urgently needed.”

The LGA has announced that it would be publishing its own adult social care green paper, after Jeremy Hunt announced the government green paper would be delayed until autumn.

A Department of Health and Social Care spokesperson said: “We expect the NHS to work closely with local authorities to ensure people are treated in the most suitable setting and when they are discharged from hospital they have a care plan in place.”

https://www.publicfinance.co.uk/news/2018/07/bed-blocking-costing-nhs-ps550-minute

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7 Jul 2018

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Accountability, Accountable Care Organisation, Integrated Care Systems, Local Enterprise Partnership

What Shakespeare knew about Integrated Care Organisations and Local Enterprise Partnerships!

Reposting a comment by “The Bard” with apologies to Shakespeare!

“Meantime we shall express our darker purpose.
Give me the map there. Know that we have divided
Our kingdom divers ways: and ’tis our fast intent
To shake all cares and business from our age;
Conferring them on LEPs, they so enriched,
While we, unburthen’d crawl toward electoral death.

………………….Tell me, my Councillors,–
Since now we will divest us both of rule,
Interest of territory, cares of state,–
Which of you shall we say doth owe us most?
That we our largest bounty may extend
Where nature doth with merit challenge. Greg Clark,
Our business secretary, speak first.

King Lear: Act 1, Scene 1 (updated a tad)

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5 Jul 2018

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Accountability, Accountable Care Organisation, Austerity cuts, Integrated Care Systems, NHS (local)

The NHS at 70

“Only one hospital trust met all its main targets over the past year, with dozens failing on emergency treatment, cancer care and routine surgery waiting times, an investigation by The Times has found.

As the NHS prepared to mark its 70th anniversary today with services at Westminster Abbey and York Minster, doctors said the findings showed a system that was teetering “like a giant game of Jenga”.

The Times interactive project to uncover the best and worst of NHS hospitals found that in 2017-18, 25 out of 139 trusts failed to see 95 per cent of A&E patients within four hours, treat 85 per cent of cancer patients within 62 days and offer 92 per cent of non-emergency patients treatment within 18 weeks. Only the Chelsea and Westminster in London hit all three key targets. Inspectors have praised the trust’s leadership and desire to learn from problems.

Over the winter 49 hospital trusts said their beds were full at some point. Saffron Cordery, deputy chief executive of the hospitals’ group NHS Providers, acknowledged that this risked damaging “public faith in the NHS, if it is unable to meet the standards people rightly expect”. The analysis, which looked at data on three key targets plus cancelled urgent operations, Care Quality Commission ratings, ambulance delays, bed blocking and norovirus outbreaks, suggests that Worcestershire Acute Hospitals Trust is performing worst. The hospital, where two patients died on trolleys in A&E in one week in January last year, is rated inadequate and has the third worst casualty performance.

Nigel Edwards, chief executive of the Nuffield Trust think tank, said: “It’s perfectly possible to have a view that the NHS needs more money but being oversentimental about it doesn’t help . . . There is definitely scope for improvement.”

He warned that there was no end in sight to the need for budget rises. Britain spends twice as much of national income on the NHS as in 1948, despite a vastly larger economy.

Theresa May has promised a £20 billion boost over the next five years, which experts have estimated is not enough to allow it to start meeting targets while improving GP, mental health and cancer care.

Taj Hassan, president of the Royal College of Emergency Medicine, said the system had been starved of resources and was “like a giant game of Jenga”.

A national “brand” like the NHS does not exist anywhere else and it profoundly affects how we look at our health service (Chris Smyth writes).

It is common to hear “the NHS saved my life” but in no other country do people say “our universal taxpayer-funded healthcare financing system saved my life”.

The NHS brand encapsulates the promise of comprehensive treatment, free at the point of use for the richest and poorest.

Yet responsibility lies in Whitehall, which feels remote from the front line. The political control of the NHS is unique and damaging. In Europe regions take responsibility and often find it easier to get things done. It is striking that recent key NHS successes — bringing down death rates by publishing data, centralising stroke care and eliminating surgical inefficiencies — have been led by staff rather than top-down initiatives.”

Source: Times (paywall)

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28 Jun 2018

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Accountability, Accountable Care Organisation, Health and Social Care (local), Integrated Care Systems, NHS (local)

Celebrate 70 years of OUR NHS at Respect Festival Saturday 30 June, Exeter

KEEP OUR NHS PUBLIC (KONP)

The NHS is 70: celebrate and protest to preserve it

Saturday 30th June 2018
In Exeter

KONP will have a stall at the Respect festival (Belmont park, Exeter) to celebrate the NHS and spread the word about KONP campaigns.

This includes information on accountable care organisations, the Friends of the Sidwell Street Walk-in Centre, and others.

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27 Jun 2018

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Accountable Care Organisation, Integrated Care Systems, NHS (local), Tax avoidance

NHS and taxes – it doesn’t need special taxation

Gower Institute for Money:

“Yet again we have politicians saying that taxes need to be increased to “pay for” spending; this time it’s for social care.

In the UK, as many other nations, Government spending comes before taxation. The UK Government creates new money every time it spends and deletes it by taxation. We can spend the necessary money NOW, we do not have to tax first to pay for the spending.

As for borrowing, that is not borrowing at all, it is providing investment vehicles called gilts to investors. These defend the desired interest rate, the money saved in gilts does not pay for anything either. The interest paid on these accounts is a matter of choice too.

The Government should spend the money necessary to provide the service. Taxes collected will increase anyway as the people who do the work providing the service will pay tax and NI on their wages and taxes on their spending.

Of course the tax system needs sorting out; avoidance needs to be tackled. But we can do the spending needed now; the tax issue is an important, but separate, fight.”

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18 Jun 2018

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Accountability, Accountable Care Organisation, Health and Social Care (local), Integrated Care Systems, NHS (local), Post-Brexit Adjustments

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Devon Tory GP MP pours cold water on “extra” NHS funding promise

Owl says: surely “extra” money for the NHS means ALL CCG costings have to be revised? And all the arguments about WHY services have to be cut must be revisited.

“Theresa May has come under fire for promising that a Brexit windfall will provide an extra £400m a week for the NHS. May – who will pledge an extra £20bn in annual real terms from 2023-24 in a major speech – has been ridiculed for linking the money to Brexit savings. “At the moment, as a member of the European Union, every year we spend significant amounts of money on our subscription, if you like, to the EU,” she said on BBC One’s Andrew Marr show. “When we leave we won’t be doing that.”

Two senior Tory MPs, who are also doctors, took aim at May: “The Brexit dividend tosh was expected but treats the public as fools. Sad to see Govt slide to populist arguments rather than evidence on such an important issues,” tweeted Sarah Wallaston, who chairs the Commons health and social care committee. Dr Philip Lee, MP for Bracknell, tweeted: “There is no evidence yet that there will be a ‘Brexit dividend’ – so it’s tax rises, more borrowing or both.”

The PM’s decision to frame extra spending specifically as a benefit of leaving the EU has been widely seen as a sop to hardline Brexiters in her cabinet, echoing Boris Johnson’s suggestion during the EU referendum that Brexit would free up £350m a week extra for the NHS.”

https://www.theguardian.com/world/2018/jun/18/monday-briefing-nhs-windfall-is-brexit-dividend-tosh-says-tory-mp

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14 Jun 2018

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Accountable Care Organisation, Austerity cuts, Health and Social Care (local), Integrated Care Systems, NHS (local), Ottery St Mary, Privatisation, Scrutiny

Ottery Health Matters! Meeting 29 June 2018, afternoon and evening

Ottery St Mary & District Health & Care Forum, in partnership with:
RD&E, Coleridge GP’s, NEWCCG, Devon County Council, East Devon District Council & Ottery St Mary Town Council

Ottery Health Matters!

Health and Wellbeing Community Information Event

Date: Friday 29th June 2018

Time: Two drop-in sessions
2pm – 5pm
6pm – 8pm

Venue: The Institute, Yonder Street, Ottery St Mary, EX11 1HD.

Come along to this informal drop-in event to find out about the care and support available in Ottery and the surrounding areas. It will be a great opportunity to talk to health and care experts plus volunteers about the local services and activities to help people live well.

We need to hear from you about what’s important to you, what you think the challenges and priorities are to improve health and care for people in our community now and in the future.

Refreshments will be provided. Transport to and from may also be available. For any queries or feedback please contact:

Elli Pang via e-mail: ellipang@btinternet.com or Tel: 01404 812268 or Leigh Edwards via e-mail: leighp3@sourcemode.com or Tel: 01404 814889

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12 Jun 2018

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Accountability, Accountable Care Organisation, Austerity cuts, DCC, Health and Social Care (local), Integrated Care Systems, NHS (local)

Adult social care on its last wobbly, fragile knees

“Social care services for vulnerable adults are on the verge of collapse in some areas of England, despite the provision of extra government funding, senior council officials have warned.

The fragile state of many council social care budgets – coupled with growing demand for services, increasing NHS pressure, and spiralling staff costs – is highlighted in research by the Association of Directors of Adult Social Services(Adass).

It says councils “cannot go on” without a sustainable long-term funding strategy to underpin social care and warns that continuing cuts to budgets risk leaving thousands of people who need care being left without services.

“The overall picture is of a sector struggling to meet need and maintain quality in the context of rising costs, increasingly complex care needs, a fragile provider market and pressures from an NHS which itself is in critical need of more funding,” the annual “state of the nation” survey says.

It reveals English councils plan to push through social care cuts of £700m in 2018-19, equivalent to nearly 5% of the total £14.5bn budget. Since 2010, social care spending in England has shrunk by £7bn.

A government green paper on adult social care funding is expected in the next few weeks, and while councils are hopeful this could put budgets on a firmer footing over time, they warn that extra funding is needed to shore up services in the short term.

“Social care is essentially about making sure we not only look after people with profound and increasingly complex needs, but also help many transform their lives. Sadly, however, this budget survey reveals, once again this essential care and support is just not being given the resources it needs,” said the president of Adass, Glen Garrod.

He added: “We cannot go on like this. How we help people live the life they want, how we care and support people in our families and communities, and how we ensure carers get the support they need is at stake – it’s time for us to deliver the secure future that so very many people in need of social care urgently need.”

A government spokesperson said: “We know the social care system is under pressure — that’s why we’ve provided an extra £9.4bn over three years. We will shortly set out our plans to reform the system, which will include the workforce and a sustainable funding model supported by a diverse, vibrant and stable market.”

The Adass survey says the social care market is “increasingly fragile and failing” in some parts of the country, with almost a third of councils reporting that residential and nursing home care providers have closed down or handed back contracts.

Although councils are spending an increasing proportion of their total budget on adult social care – almost 38p in every pound in 2018-19, compared with 34p in 2010 – social care directors admit they will have to continue to reduce the number of people in receipt of care packages.

The survey reveals councils are increasingly reliant on so-called “self help” or “asset-based” approaches to care – in effect using networks of family and neighbourhood groups to provide volunteer support for some social care recipients.

Half of local authorities overspent on adult social care budgets in 2017-18, the survey finds, with half of these drawing on council reserves to meet the overspend.

The National Audit Office has warned that about 10% of councils will exhaust reserves in three years at current rates of deployment, putting them at risk of insolvency.

Ministers acknowledged the financial crisis facing council adult social care services last year, when they provided £2.6 billion, enabling councils to raise extra social care funds locally through a council tax precept.

Adass says this injection of cash helped stave off financial collapse in some council areas. But it warns that the additional funding has “temporarily relieved, rather than resolved” the long-term funding needs of the sector and there is a danger council services could collapse before any new arrangements are in place.

Although councils have a legal duty to ensure there is a functioning care market in their area, nearly four in five say they are concerned that they are unable to guarantee this because of the fragility of many care firm balance sheets and rising care staff wage bills.

Councillor Izzi Seccombe, the chair of the Local Government Association’s community wellbeing board, said: “Councils and providers are doing all they can to help ensure older and disabled people receive high quality care, but unless immediate action is taken to tackle increasingly overstretched council budgets, the adult social care tipping point, which we have long warned about, will be breached and councils risk not being able to fulfil their statutory duty under the Care Act.”

Richard Murray, the director of policy at The King’s Fund, said: “This latest evidence, from every council in England, lays bare once again the need for, as the prime minister put it herself, a proper plan to pay for and provide social care.

“Older and disabled people and their families and carers continue to be let down by a system that is on its knees.”

https://www.theguardian.com/society/2018/jun/12/adult-social-care-services-collapse-survey-england-council

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8 Jun 2018

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Accountability, Accountable Care Organisation, Austerity cuts, DCC, Health and Social Care (local), Integrated Care Systems, Martin Shaw (Seaton), NHS (local), Transparency

Devon CCG refuses to reveal crucial figures to independent county councillor

“Beds, beds, beds – Devon’s NHS couldn’t or wouldn’t give me their overall occupancy figure for the recent winter: but they were forced to buy in more capacity and there were ’12-hour trolley breaches’

Devon NHS’s Sustainability and Transformation Partnership (STP) admitted in a report to Health Scrutiny yesterday that they had been desperately short of beds during the recent winter. They had to buy in extra beds to keep up with more patients staying longer, because of complex conditions. There were ’12-hour trolley breaches’, where patients had to wait more than 12 hours to be seen.

Despite my asking them directly, they did not give a figure for overall occupancy levels, although they did not deny my suggestion that they had been as bad as or worse than the nationally reported level of 95 per cent. (The nationally recommended safe level is 85 per cent.)

Jo Tearle, Deputy Chief Operating Officer for the Devon CCGs, rebutted my suggestion that cutting community beds had contributed to this crisis, saying that these were not the kind of beds they had needed, and that there had been capacity in community hospitals most of the time. However this suggests that there was no capacity some of the time. It is difficult not to believe that extra community beds wouldn’t have given them more leeway.

Meanwhile, Kerry Storey of Devon County Council indicated the strains that the ‘new model of care’ at home had been under. She said that maintaining personal care at home during the winter had been ‘a real challenge’, requiring ‘creativity and innovation’ – you don’t need much imagination to see that it will have been a real crisis time with frail people at home in isolated areas, care workers and nurses struggling to get through the snow, and staff themselves suffering higher levels of illness.

I and others predicted that because of the closure of community beds, there would be severe pressure on beds in a bad winter or a flu epidemic (and actually, this was not overall a bad winter and the snow episodes were late and short; despite higher levels of flu, there was no epidemic this winter).”

Beds, beds, beds – Devon’s NHS couldn’t or wouldn’t give me their overall occupancy figure for the recent winter: but they were forced to buy in more capacity and there were ’12-hour trolley breaches’

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8 Jun 2018

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Accountability, Accountable Care Organisation, Austerity cuts, DCC, Health and Social Care (local), Inequality, Integrated Care Systems, Martin Shaw (Seaton), NHS (local), Privatisation

Shock revelation suggests the NHS’s ‘new model of care’ is more about switching intermediate care from community hospitals to ‘block bookings’ in private nursing homes – saving costs and freeing up assets

Martin Shaw, East Devon Alliance councillor for Seaton and Colyton, Devon County Council:

Press release:

“There was a staggering revelation yesterday at Health Scrutiny from Liz Davenport, Chief Executive of South Devon and Torbay NHS Foundation Trust, that they had made ‘block bookings of intermediate care beds in nursing homes’ when they introduced the ‘new model of care’. South Devon has closed community hospitals in Ashburton, Bovey Tracey, Paignton and Dartmouth and is currently consulting on the closure of Teignmouth – where I spoke at a rally last Saturday.

The ‘new model of care’ is supposed to mean more patients treated in their own homes, and there does seem to have been an increase in the numbers of patients sent straight home from the main hospitals.

But the idea that all patients can be transferred directly from acute hospitals to home is untrue. There is still a need for the stepping-down ‘intermediate care’ traditionally provided by community hospitals – the only difference is that now it’s being provided in private nursing homes instead.

It’s likely to be cheaper to use private homes, because staff don’t get NHS conditions, and crucially it frees up space in the hospitals so that the CCGs can declare buildings ‘surplus to requirements’ and claim the Government’s ‘double your money’ bonus for asset sales. It seems NEW Devon CCG has also made extensive use of nursing home beds, but we don’t yet know if there were ‘block bookings’.

However the private nursing home solution may not last – DCC’s chief social care officer, Tim Golby, reported that nursing homes are finding it difficult to keep the registered nurses they need to operate, and some are considering reversion to residential care homes.

This may be where the South Devon trust’s long term solution comes in – it had already been reported that it is looking to partner with a private company in a potential £100m dealwhich will include creating community hubs that contain inpatient beds.

The new model of care is also about privatisation.”

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7 Jun 2018

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Accountability, Accountable Care Organisation, Austerity cuts, Claire Wright, DCC, East Devon Tories, Health and Social Care (local), Martin Shaw (Seaton), NHS (local), Scrutiny

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Devon County Council Tories kill off community hospitals

From the blog of Claire Wright:

“Seven Conservative councillors today block voted down my proposal to “strongly support” retaining all Devon community hospital buildings and to “strongly oppose” any potential plans to declare them surplus to requirements.

And in what became a rather heated debate, one conservative, Cllr Richard Scott, disgracefully accused the assiduous and polite Independent Seaton councillor, Martin Shaw of abusing his right to address councillors.

I had requested an item on community hospital buildings at today’s Health and Adult Care Scrutiny Committee meeting, as there is a continual threat in the air of the possibility that the buildings may be declared surplus to requirements and be sold off. There remains anxiety and concern in local communities as a result.

Last month, NEW Devon Clinical Commissioning Group was forced to deny they had “any plans” to declare Honiton and Seaton Hospitals surplus to requirements, following comments made at a campaign meeting.

Dr Simon Kerr, the GP who was quoted in the notes published, later said his comments had been misinterpreted.

The Estates Strategy, which will set out what is proposed to be done with the buildings owned by the local NHS, is due out soon, possibly as early as next month.

In presenting my case I set out how the committee had been unable to secure assurances from health service managers for a long time that buildings were safe, that Dartmouth Hospital is being sold off and that the ownership of 12 community hospitals in Eastern Devon was in the hands of NHS Property Services which was charging over £3m rents for the upkeep of the buildings.

I believe these rents are still being met by NHS England, but this is only a temporary measure and soon the bill will fall on the doormat of the deeply in deficit NEW Devon Clinical Commissioning Group.

Cllr Brian Greenslade seconded my proposal.

Speaking in support were also Cllr Carol Whitton (Labour) and Cllr Nick Way (Libdem).

For some reason the conservative councillors were all opposed to my proposal. Several said there was no evidence, that it was just speculation that there was even a risk to the buildings.

Conservative councillor, Jeff Trail, didn’t appear to like my proposal but said he thoroughly supported Cllr Carol Whitton’s position, which was rather confusing as she had just said she backed me!

Cllr John Berry didn’t like my recommendation because the committee didn’t own the buildings. He wanted us to write to the CCG to ask what the status of the buildings was instead.

Cllr Sylvia Russell thought she had heard an NHS manager say at some point at today’s meeting that the buildings were safe so there was nothing to worry about. No one else seemed to recall this.

Cllr Richard Scott dismissed my proposal as “speculation” and claimed there was “no evidence” to back up my concerns.

Referring to Cllr Martin Shaw, who had just set out calmly and eloquently the concerns of his own community of Seaton, Cllr Scott added: “In some respects this is an abuse of a right to speak at this committee. There’s nothing here to consider.”

Chair, Sara Randall Johnson, wanted to take account of Paul Crabb’s view, which was that some hospitals might be old and in a poor state of repair, but I said we should have a simple and clear proposal or the CCG would drive a coach and horses through it.

I reminded the committee (yet again) that our committee was the only legally constituted check on health services in the county and it is our job to act on issues of public concern, which this very much was.

I added that it was important to take a position now and before the Estates Strategy was published so our views could inform the strategy.

My words fell on deaf ears. I had genuinely thought, that despite all the past political shenanigans on that committee – and there have been many – that the Conservatives might have backed this one, as not a single member of their own communities would have surely wanted them to vote a different way.

There was every reason for the entire committee to be unanimously in favour of my proposal.

What a huge shame.

Voting in favour: Me, Brian Greenslade (LibDem – Barnstaple North), Nick Way (LibDem – Crediton), Carol Whitton (Labour – St David’s and Haven Banks).

Voting against: (All Conservative): John Berry (Cullompton and Bradninch), John Peart (Kingsteignton and Teign Estuary) Sylvia Russell (Teignmouth) Richard Scott (Lympstone and Woodbury), Paul Crabb (Ilfracombe), Andrew Saywell (Torrington Rural), Jeff Trail (Lympstone and Woodbury)

The debate is available to view at item 10 from this link – https://devoncc.public-i.tv/core/portal/webcast_interactive/325480

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

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2 Jun 2018

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Accountable Care Organisation, Austerity cuts, Integrated Care Systems, NHS (local), Privatisation

A surgeon speaks on community hospitals and NHS privatisation

“David Halpin FELLOW OF THE ROYAL COLLEGE OF SURGEONS knows what is needed – see his letter………

LETTER sent by DAVID HALPIN FRCS to the WESTERN MORNING NEWS

Dear Letters Editor, 25th April 2018

I reply to the letter from B Gelder (WMN April 23rd) entitled ‘Cottage Hospitals ease strain on the NHS.’ I have written before on this vital subject and listed their functions.

Recovery from serious illness or major operations requires loving and professional care, good nutrition and sound sleep. These were provided in good Community Hospitals. The last thing patients might get in the District General Hospital is a good night’s sleep. The noise, the moving of beds and the distress of disorientated patients do not allow sleep.

This retreat, supposedly for economy, from past high standards is part of what I call the ‘atomising’ of all that we hold dear. The dogmas of capitalism win out all the time. ‘Private good, public bad’. So with the privatisation of OUR railways under the Major government, the wheels were stupidly separated from the tracks to meet EU competition rules. There are about 3000 separate contractors working on the permanent way. There are probably more ‘contractors’ working in OUR NHS.

This is a sign of these shabby and confused times. Walking to Paddington Station past St Mary’s Hospital where I qualified as a doctor in 1964, I saw an ambulance – ‘NHS working in partnership with DHL.’

I understand that Teignmouth Community Hospital is likely to be closed completely. That catch phrase ‘not fit for purpose’ is being applied – ‘going forward’. The Philistines who order this will know that the original hospital was bombed by the Luftwaffe. Seven patients and three nurses were killed. They do not ‘remember them’. The first hospital to be built by the NHS, when the UK was on its uppers, was Teignmouth Hospital. Patients were treated for acute illness there by good GPs, nurses and physiotherapists, and others taken for further care from the big hospitals. It is being bombed again.

When this good hospital, with its views over Lyme Bay, becomes a 5 storey block of ‘luxury’ flats and second homes, the capital from the sale of the site will disappear in a puff of smoke. Taxpayers money is being burned in the NHS. The non-clinical staff in one Devon hospital now outnumber the clinical staff – nurses, physios, doctors etc. Watch BBC’s ‘Hospital’ from Nottingham as a quart fails to be squeezed into a pint pot. The proliferation of managerial personnel with unusual titles is excruciating and the distress of patients likewise.”

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30 May 2018

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Accountability, Accountable Care Organisation, Integrated Care Systems, NHS (local), Privatisation

“8,900 checks on NHS ‘health tourists’ find just 50 liable to pay”

It almost certainly cost more to find the 50 than to leave this alone.

So, knock on the head – it is underfunding to speed privatisation that is bringing our NHS to its knees NOT health tourism!!!

https://www.standard.co.uk/news/health/8900-checks-on-nhs-health-tourists-find-just-50-liable-to-pay-a3850121.html

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17 May 2018

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Accountability, Accountable Care Organisation, Austerity cuts, Integrated Care Systems, NHS (local), Privatisation

“NHS England and Capita misunderstood the risks in outsourcing primary care support services …” says hard-hitting report

“Summary:

NHS England and Capita misunderstood the risks in outsourcing primary care support services resulting in services to 39,000 GPs, dentists, opticians and pharmacists that were a long way below an acceptable standard. Capita’s performance against the contract has improved but widespread failures are still being experienced by primary care practitioners, says today’s report by the National Audit Office (NAO).

In August 2015, NHS England entered into a seven-year, £330 million contract with Capita to deliver primary care support services. NHS England aimed to reduce its costs by 35% from the first year of the contract and provide a high-quality and standardised service. Capita expected to make a loss of £64 million in the first two years of the contract, which it planned to recoup in later years.

NHS England’s decision to contract with Capita both to run existing services but also simultaneously to transform those services, was high risk. Capita was incentivised through the contract to close existing services to minimise its losses but the interaction between running, closing and transforming services was more complex than Capita or NHS England had anticipated.

Performance issues emerged in 2016 shortly after Capita started closing primary care support offices and making other changes to the service. Capita acknowledges that it made performance issues worse by continuing to close support offices in summer 2016 even though it was aware the customer service centre was struggling to meet demand at that time. NHS England was contractually unable to stop Capita’s aggressive office closure programme, even though it was having a harmful impact on service delivery.

Failure to deliver key aspects of the end-to-end service, delivered by Capita and other organisations, impacted primary care services and, potentially, put patients at risk of serious harm. For example, 87 women were notified incorrectly that they were no longer part of the cervical screening programme; processing issues led to an estimated 1,000 GPs, dentists and opticians being delayed from working with patients and some of these practitioners lost earnings. No actual harm to patients has been identified.

Users continue to experience poor delivery with seven severe service failures in February 2018. A number of organisations have contributed to underperformance as Capita relies on other organisations to provide some services.

NHS England has made savings, in line with expectations, of £60 million in the first two years of the contract, as the financial risk of increased costs sits with Capita who have made a £125 million loss over this period. To date, NHS England has deducted £5.3 million from payments to Capita as penalties for poor performance but it expects it may have to pay up to £3 million in compensation to primary care providers.

NHS England has not yet secured all the benefits it wanted to achieve as Capita’s transformation programme was halted while it focused on operational issues. NHS England remain concerned about three of the services – the national performers lists, payments to opticians and GP payments and pensions but recognises that some of the issues with them pre-date the contract with Capita.

Two and a half years into the contract basic principles are still not agreed, which limits NHS England’s ability to hold Capita to account. NHS England and Capita have still not agreed how to calculate 11 performance measures, and how these data should be used to calculate payments owed to Capita for delivering the services.

The NAO recommends that NHS England should determine whether all current services within the contract are best delivered through that contract or be should taken in-house by NHS England.

“Neither NHS England nor Capita fully understood the complexity and variation of the services being outsourced. As a result, both parties misjudged the scale and nature of the risk in outsourcing these services. “While NHS England has achieved financial savings and some services have now improved, value for money is about more than just cost reduction. It is deeply unsatisfactory that, two and a half years into the contract, NHS England and Capita have not yet reached the level of partnership working required to make a contract like this work effectively.”

Amyas Morse, the head of the NAO, 17 May 2018″

https://www.nao.org.uk/press-release/nhs-englands-management-of-the-primary-care-support-services-contract-with-capita/

Full report here:

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17 May 2018

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“Inpatients at Exmouth Hospital to be temporarily relocated during fire safety improvement project”

Owl adds: Did you know there were closed wards at Exmouth Hospital?

“News Release 16 May 2018

Inpatients at Exmouth Hospital are being temporarily relocated to another ward on the site while building owner NHS Property Services invests in fire safety improvements.

Beds on Doris Heard Ward are being moved to the vacant Geoffrey Willoughby Ward while a £50,000 project to safely remove asbestos and improve fire resistance takes place. A deep clean and air testing will also take place.

The works, carried out by Integral, will be undertaken from 21 May with the ward planned to be fully reopened during the week commencing 11 June 2018.
Due to the constraints of Geoffrey Willoughby Ward, the number of available beds will be temporarily reduced from 16 to 12 during this period.

Rosemary Kearney, Senior Facilities Management Business Manager for NHS Property Services (NHSPS) in the South West, said: “We’re working closely with our partners at the hospital to ensure services can, as far as possible, continue as normal.

“We’re sorry for any inconvenience but this is an essential project that will ultimately improve the fabric of Exmouth Hospital for patients for years to come.”

Donna Robson, Royal Devon and Exeter NHS Foundation Trust’s Matron at Exmouth Hospital, added: “Maintaining continuity of care for patients is our top priority. We’ve been working with NHSPS to ensure that any disruption is kept to a minimum during these necessary maintenance works. We’d like to thank our patients and visitors for their understanding during this time.”

All other services at the hospital are unaffected and patients should continue to attend their appointments as normal.

The need for the work was identified as part of a survey undertaken by NHSPS.”

The press release also includes background information for editors on NHSPS. This is not usually published with the press release but is information in the public domain, so Owl reproduces it here:

“NHS Property Services brings property and facilities management expertise to thousands of sites across the NHS estate.

At a time of major change and increasing demand for the NHS, NHS Property Services is reducing costs, creating a more fit for purpose estate and generating vital funds that are being reinvested to support improvements in frontline patient care.

The company’s portfolio consists of 3,500 properties – worth over £3 billion – which represents around 10 percent of the entire NHS estate. The vast majority of our sites are used for clinical, local healthcare and fall into one of three categories:

Health centres and GP surgeries; Hospitals/hospital- related properties; or Offices.

The company has a major role as both landlord and service provider for its NHS customers. Services fall into four main business areas:

1. Strategic estates planning – supporting our customers to deliver healthcare premises that meet future needs for patient services

2. Asset management – proactive asset management to create value and reduce overall costs of property

3. Construction project management – managing the development of new buildings and refurbishment of existing buildings, along with investment in our estate

4. Facilities management services – including health and safety, maintenance, electrical services, cleaning and catering.”

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17 May 2018

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“NHS outsourcing ‘put patients at risk’ “

THIS IS EXACTLY WHAT OUR CCG IS ATTEMPTING TO DO – SLASH COSTS AND IMPLEMENTING NEW MEASURES AT THE SAME TIME YEY OUR DEVON TORIES ARE HAPPY FOR THE CCG TO EXPERIMENT ON US UN THIS WAY!

“Incompetent staff may have been allowed to carry on practising, the watchdog warned

“Patients were put at risk of cancer and other serious harm because of a botched £330 million NHS outsourcing deal, the spending watchdog has found.

An attempt at cost-cutting has led to more than two years of chaos in back-office services for GPs, opticians and dentists, the National Audit Office said.

Dozens of women were wrongly told that they no longer needed cervical cancer screening and incompetent staff may have been allowed to carry on practising, the report concludes.

The outsourcing company Capita and NHS England are still bickering about the deal, leading to failures including a backlog of half a million patient registrations, the NAO warns.

“Trying to slash costs by more than a third at the same time as implementing a raft of modernisation measures . . . potentially put patients at risk of serious harm,” Meg Hillier, chairwoman of the public accounts committee, said.”

Source: The Times (pay wall)

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16 May 2018

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Accountability, Accountable Care Organisation, Austerity cuts, Health and Social Care (local), Honiton/ Gittisham, Integrated Care Systems, Martin Shaw (Seaton), NHS (local), Seaton/ Colyford / Colyton

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CCG somewhat opaque on future of Honiton and Seaton hospital closures

Owl says: This is the sort of Press Release the CCG excels at. Telling us what the situation is at present but giving no guarantees that there will not be future cuts to current services (some of which, such as dermatology in Seaton, have already been closed.

Owl would also like to know how many of the extra 20,000 deaths noted in the first quarter of this year were in East Devon.

From EDA DCC Councillor Martin Shaw:

“NEW Devon CCG have issued the attached statement criticising ‘inaccurate information’ about Honiton and Seaton hospitals, after Dr Simon Kerr, Chair of the CCG’s Eastern Locality, was credibly reported as saying that these two hsopitals are ‘at risk’ in their Local Estates Strategy due this summer.

I welcome the CCG’s statement that it has no plans to close either hospital. However it has not denied that Dr Kerr said that they were at risk.

The CCG could end this controversy today if it gave an unequivocal assurance that both hospitals will continue for the foreseeable future with the present or enhanced levels of service. People in Honiton and Seaton were badly let down by the CCG over hospital beds and they won’t trust them now without a clear statement that our hospitals are safe in the coming Local Estates Strategy.”

The statement from the CCG reads:

“There have been reports today that the future of Honiton and Seaton Hospitals is under question.

NHS Northern, Eastern and Western Devon Clinical Commissioning Group wishes to make clear that there are no plans to close Honiton and Seaton hospitals.

In March 2017, the Governing Body of NHS Northern, Eastern and Western Devon Clinical Commissioning voted to implement a number of changes following a 13 week public consultation. This included the decision to close inpatient beds at both Honiton and Seaton hospitals.

Beds were closed in both hospitals in August 2017 as more care was introduced to look after people at home. Both hospitals are still open, thriving buildings providing more than 50 day services and clinics combined.”

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15 May 2018

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“NHS has lost 1,000 GPs since Jeremy Hunt set workforce target”

Pulse is the newsletter for GPs:

“The GP workforce in England is continuing to decline, as official statistics reveal that 316 full-time equivalent GPs have left the profession in the last three months.

The figures released by NHS Digital today also reveal that the number of FTE GPs in the workforce has decreased more than 1,000 since September 2015 – when health secretary Jeremy Hunt announced he would increase the number of FTE GPs in England by 5,000.

NHS England is recruiting from overseas in a bid to boost GP numbers, but Pulse revealed last month that they had only managed to recruit 85 by April – despite originally touting the figure of 600.

The latest statistics show that in the last three months, the workforce has fallen from 33,890 FTE GPs in December 2017 to 33,574 as of 31 March 2018.

Meanwhile, the workforce is 1,018 GPs worse off than it was in September 2015.

This is despite the success of NHS England’s induction and refresher scheme, which has tempted 546 GPs back into the workforce since its launch in 2015.

The news comes as a Pulse investigation, published earlier this month, showed a steep rise in the number of GPs claiming their pension early. Since 2013, almost 3,000 GPs have claimed their pension before the age of 60.

The BMA has previously warned the Government that continued sub-inflation uplifts to GP pay is going to further exacerbate GP workforce shortages, having asked the independent review body on doctor’s pay to recommend a 2% uplift for 2018/19.

Dr Richard Vautrey, chair of the BMA’s GP Committee, said the latest workforce statistics are ‘extremely concerning’.

He said: ‘It’s more than two and a half years since the health secretary promised to recruit 5,000 more GPs before 2020, and these figures are a damning progress report. With less than two years until this target date, the trend is clearly going the other way and it’s a sign that a step change in action needs to be taken.

‘As GPs struggle with rising demand, increasing workloads and burdensome admin, and are expected to do so with insufficient resources, it’s no surprise that talented doctors are leaving the profession and although the number of GP training places have increased, this is not enough to address the dire recruitment and retention crisis.’

RCGP chair Professor Helen Stokes-Lampard said: ‘These figures are yet another hammer blow for family doctors, for whom going the extra mile is now the norm, and for our patients. The stark truth is that we are losing GPs at an alarming rate at a time when we need thousands more to deliver the care our patients need, and keep our profession, and the wider NHS, sustainable.

‘It is clear that substantial efforts to increase the GP workforce in England are falling short – and we need urgent action to address this. We have made great strides over the past couple of years encouraging more medical students and foundation doctors to choose general practice, but these efforts will be futile, if more GPs are leaving the profession than entering it.’

She said this comes as ‘GP workload is escalating, both in volume and complexity, and the hardworking GPs we do have are burning out as we try to cope without the resources and support we need’.

‘Longer and longer days in clinic is what our members are telling us they face when they come to work in the morning, exacerbated by a mountain of bureaucracy and paperwork. This isn’t safe for GPs, our teams, or our patients, and if it isn’t tackled GPs will continue to leave the profession early, and new GPs will be put off from joining,’ she added.

Labour’s shadow health secretary Jonathan Ashworth said the data marked ‘yet another broken promise on NHS staffing from ministers’.

‘It’s an embarrassing failure for the secretary of state that far from delivering the extra GPs primary care desperately need, there are now 1,000 fewer family doctors than in 2015.

‘The truth is that the Tories have failed to bring forward a sustainable long term plan for the NHS. The consequence is the biggest financial squeeze in its 70-year history and a failure to recruit the frontline doctors and nurses we need to care for patients.’

A department of health and social care spokesperson said: ‘We are committed to meeting our objective of recruiting an extra 5,000 GPs by 2020. This is an ambitious target and shows our commitment to growing a strong and sustainable general practice for the future.

‘More than 3,000 GPs have entered training this year, 1,500 new medical school places are being made available by 2019 and NHS England plans to recruit an extra 2,000 overseas doctors in the next three years.’

http://www.pulsetoday.co.uk/news/gp-topics/employment/nhs-has-lost-1000-gps-since-hunt-set-workforce-target/20036703.article

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15 May 2018

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Accountability, Accountable Care Organisation, Austerity cuts, Claire Wright, Health and Social Care (local), Honiton/ Gittisham, Inequality, NHS (local), Seaton/ Colyford / Colyton

Claire Wright responds on threat to close Honiton and Seaton hospital day services

“Seaton and Honiton Hospitals may be at risk, local GP and chair of the NEW Devon CCG’s Eastern Locality, Dr Simon Kerr reportedly revealed at a meeting with health campaigners last month.

Dr Kerr was apparently speaking of the long-awaited Estates Strategy, which will list all the assets held by the local NHS and what it plans to do with them.

NEW Devon CCG is in considerable financial difficulty. Devon is one of three most financially challenged health trusts in the country.

The background is that 12 community hospitals across Eastern Devon were acquired by the private company (wholly owned by the Secretary of State for Health) NHS Property Services, last year.

As yet, we haven’t heard about the fate of the remaining 10 community hospitals now in the ownership of NHS Property Services. This of course, includes our beloved Ottery Hospital, as well as Exmouth, Sidmouth, Whipton, Okehampton and Crediton.

Many of these hospitals, including Seaton, Honiton, Ottery St Mary and Okehampton and Whipton, have sadly now been stripped of their beds in cost cutting measures. But they still are home to a range of services and clinics that are very much needed locally.

Up until now, NHS England has been picking up the tab for the extortionate rents charged by NHS PS, of well over £3m a year, across the area.

A stupid stupid system, set up to fail. All over the country health trusts are being forced to sell off estate because it can’t afford the ridiculous rents charged by NHS PS for a building that used to be in NHS ownership.

Honiton Hospital has a treatment centre and is home to East Devon’s out of hours GP service.

The idea that the building could be lost and with it the treatment centre and out of hours service is totally ludicrous and appalling. The RD&E’s A&E department is full to capacity much of the time and staff are struggling to manage the volume of patients.

It means someone unwell living in the far east of the area – Axminster, for example, would have to travel around an hour to Exeter, to be seen by a GP if they were unwell out of working hours. It is quite unacceptable.

The amazing maternity unit which has been ‘temporarily’ closed for the best part of a year, was also based at Honiton Hospital.

There are so many cuts to the health service now it is difficult to keep up with them, let alone fight them.

Cllr Shaw has written to the CCG chair, Dr Tim Burke demanding assurances that the buildings remain open.

I have asked for an urgent item on the next Health and Adult Scrutiny Committee agenda, which is held on Thursday 7 June.

I will keep you posted.

Here’s Cllr Shaw’s blog – https://seatonmatters.org/2018/05/14/ccg-chair-says-seaton-and-honiton-hospitals-at-risk-of-closure-in-local-estates-strategy/

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

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“Suspension of birth services at Honiton Hospital extended”

“The suspension of birth services at Honiton maternity unit has been extended.

The Royal Devon and Exeter NHS Foundation Trust (RDE) has today delayed its reintroduction until mid-September 2018.

The Trust took the decision last year to temporarily suspend births and subsequent in-patient stays at Honiton Hospital.

It said the step was taken to maintain patient safety due to a combination of factors affecting the stability of the services at this site and the other units it operates in Tiverton and Exeter.

Zita Martinez, head of midwifery at the RDE, said: “We are sorry for this continued suspension in services. Although we have successfully recruited to a number of our midwifery vacancies, we are still managing a high level of staff absence, including maternity leave.

At the same time, the positively received implementation of national policy in the Better Births and Saving Babies’ Lives guidance has meant that the complexity and acuity of women and babies we are caring for has significantly increased.

“This means that our main maternity unit in Exeter is experiencing greater levels of demand on the specialist care that we provide.

“In the context of increasing complexity, re-opening Honiton maternity unit for births and in-patient stays would result in the Trust stretching our workforce too far and potentially compromising safety in our other delivery units.”

The Trust has agreed with NEW Devon Clinical Commissioning Group to extend the suspension of births and subsequent in-patient stays at both Honiton and Okehampton until mid-September 2018 in order to ensure the safety of services across a wider geographical footprint and therefore, for more women and babies.

All antenatal and post-natal appointments, support clinics and home births will continue as normal in both communities.”

http://www.midweekherald.co.uk/news/suspension-of-birth-services-at-honiton-hospital-extended-1-5517432