Category Archives: Health and Social Care (local)

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14 Jan 2018

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Accountability, Health and Social Care (local), NHS (local)

A GP speaks from the very, very sharp end with shocking information

A Devon GP shared this on the Save our Hospitals website:

“I put this post on my constituency [Labour] womens FB group.

I am an NHS GP- ex partner at ELM surgery- went off with burnout 2014- locuming since 2015 including at 2 practices that have handed back their contracts one has closed and the other in merging with Mount Gould.

I went to an important meeting last night- Arranged by GPs worried about the situation in Primary care in Plymouth and looking for a way forward.

About 30-40 GPs turned up (not bad for a short notice meeting on a Friday night which started when most of us would normally be at work!) We also had some patients representing their practices’ Patient participation groups and someone from Health Education England (responsible for workforce planning in the future/training GPs etc). Luke Pollard- Labour MP was the only MP to turn up. I know it was short notice (I think the venue was only confirmed on 2/1/18) but even so you would have thought may be the potential collapse of Primary Care in your constituency may be quite important to any MP?

It was a great opportunity for us to share issues and think about what could solve them and this is the summary:

Firstly – our wonderful NHS is one of the more cost-effective, safe and efficient health systems in the World and GPs are very cheap and cost effective within that.

Primary Care throughout the UK is being overstretched because of major cuts to services that support particularly our most vulnerable patients- cuts to: Mental Health Teams for adults and children, MIND and other charities, Drug and Alcohol services, Probation, Health visiting, School nurses, District nurses (40% vacancy rates in Plymouth), Social Care and unfair benefit cuts and sanctions etcetc.

Plymouth has a population with higher levels of deprivation than the UK average. These cuts are therefore more severely affecting our Primary care services (but there are similar problems in many similar areas).

Secondly: The NHS and Social Care have been severely underfunded for the past 7 years and now this has reached a tipping point.

GPs are working longer hours, seeing more patients and trying to continue to provide excellent, cost-effective care but are becoming burnt out and demoralised and therefore are retiring early, leaving permanent positions or leaving the UK or medicine.

It is also harder to recruit practice nurses as there is a massive shortage of nurses nationally. As practices are becoming more short staffed the remaining clinicians become even more pressurised and eventually become ill or leave or hand back their contracts.

Now 12-13% of Plymouth patients are from “failed practices”. We have a shortfall of between 26 (LMC figures) and 35 (Healthwatch figures) Full time equivalent GPs in Plymouth. Caretaker organisations – which look after these patient populations until new providers are found- are paid much more per patient than GPs are- I have heard unsubstantiated quotes of £300 per annum compared with GPs £115 per annum if we tick all the Government’s boxes and claim everything we can.

This works sort of as an insurance system where those that need little care sort of subsidise us for the patients that need a lot of care. Yet there is no money or help from NHS England forthcoming to go to practices before they fold. Also neighbouring practices are being put under extreme pressure because NHS England is not allowing any planning for the new patients. Adjoining practices must just keep their lists open without any inkling of how many patients could ultimately join their list. (my friend’s practice may have to take between 0 and 1800 patients within the next 3 months as an adjacent practices closes- when a similar thing happened in 2006 they were allowed to have a planned list of patients and recruit staff to serve those extra patients, WELL in advance)

We are also not allowed to move notes direct to the adjoining practice and Capita is taking 6 months to move notes between practices (much less when NHS run) and the GP2GP computer transfer is only working for 1 in 3 patients. Most patients who move before their practice closes are the ones that require the most care and are the most complex. The other patients, who maybe only see a GP every few years do not move until they need care again therefore effectively financially disadvantaging the new practice too.”

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14 Jan 2018

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Council tax, EDDC, Health and Social Care (local), Public Open Space

Green spaces – use them or possibly see them flogged off

Owl says: health benefits of public open spaces? Pah! Flog ‘em, flog ‘em!

“ Corporate Green Space policy 1 –

Survey, plot and categorise all council managed green/open space across the district (including housing land, and allotment sites)
assess sites based on a range of criteria including;

strategic importance,
accessibility,
alternative or additional use,
levels of use, amenity value,
ability to protect our outstanding environment and cost.

Identify which sites are suitable for retention, community transfer or disposal taking into account our corporate policies, our Local Plan and open space study.

Click to access 170118-joint-overview-scrutiny-agenda-combined.pdf

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13 Jan 2018

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Accountability, Austerity cuts, Health and Social Care (local), NHS (local)

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“French hospital offers to do cancelled NHS operations”

“A French hospital has invited NHS patients whose operations have been cancelled because of winter overcrowding to be treated free in Calais.

Despite a flu outbreak even worse than the one in Britain, France has said it has plenty of space for British patients for routine surgery paid for by the NHS.

As NHS hospitals warn that people are dying on corridors, and abandon a three-month waiting time target for routine operations, Calais Hospital is trying to tempt Britons with private rooms, en suite bathrooms, free parking, English-speaking staff, wi-fi and waits of less than a month.

Under a deal struck in 2015, patients can opt for surgery in France and the NHS in Kent will pay standard rates to Calais Hospital. The hospital can take 400 NHS patients a year, it says. “When the NHS is forced to cancel all non-urgent surgery until February, NHS patients can turn to the Centre Hospitalier de Calais.”

NHS England told hospitals last week to cancel routine operations to make space for rising numbers of winter patients. This week the heads of half of England’s A&E departments told Theresa May that hundreds of patients were being treated in corridors.

Santé Publique France, the French health service, reports 423 GP consultations for flu-like symptoms per 100,000 people, more than ten times the rate in England. However, fewer end up on wards, with 1,265 admissions to hospital, compared with an estimated 4,000 in England.

Thaddée Segard, a businessman who helped to broker the deal with Calais, said he did not expect flu to cause difficulties. “The difference between UK and French hospitals’ capacity is merely a question of state policies,” he said.

South Kent Coast Clinical Commissioning Group said it had yet to see an upsurge in referrals.

The Royal College of GPs said yesterday that flu had “taken off” in Britain, with twice as many consultations as last year. It warned that flu was so unpredictable it was impossible to know whether it would become an epidemic.

Pat Cattini, of the Infection Prevention Society, advised people who catch flu: “The best thing to do is take yourself away from other people until you feel better, which can take a week. If you do bring it into GP waiting rooms you’re potentially going to infect others.”

Source: The Times (pay wall)

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12 Jan 2018

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Accountability, Austerity cuts, Claire Wright, DCC, Health and Social Care (local), Inequality, Martin Shaw (Seaton), NHS (local), Scrutiny

Claire Wright gets debate on NHS winter care crisis at next DCC Health and Adult Care Scrutiny meeting

From the blog of Claire Wright:

“I have asked the chair (Sara Randall Johnson) that a report on Devon hospitals winter pressures – ie A&E waits, delayed discharges, how many patients are waiting to be discharged etc, is presented at the next

Devon County Council Health and Adult Care Scrutiny Committee on
Thursday 25 January.

This has been agreed.

The agenda papers are out next week so we will know more then.

Also on the agenda is a presentation from NHS Property Services/NEW Devon CCG on the future of our community hospitals – asked for by Cllr Martin Shaw and I at the November meeting ….”

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

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12 Jan 2018

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Accountability, Accountable Care Organisation, Austerity cuts, Health and Social Care (local), Inequality, NHS (local), Privatisation, Scrutiny, Transparency

Judicial review of Accountable Care Organisations allowed

“A judge has granted permission for national campaign group 999 Call for the NHS to bring a Judicial Review of NHS England’s draft Accountable Care Organisation contract.

The group believe this is not only unlawful under current NHS legislation, but would threaten patient safety standards and limit the range of available treatments. The case will be held in Leeds High Court on 24th April 2018.

‘999 Call for the NHS’ and internationally recognised public law firm Leigh Day are launching the third and final stage of their crowdfund on 12 January, in order to cover all the costs of bringing the Judicial Review, and are appealing for £12,000. This amount, when added to existing funds donated by hundreds of generous members of the public in 2017, will cover the £37,000 cost of the Judicial Review.



The link to crowdfund is: Crowd Justice Healthcare4All Stage 3 . Please give what you can – any amount is useful.

 The crowdfunding starts at 6pm this evening.

Recognising that it is in the public interest to establish if the Accountable Care Organisation contract is lawful or not, the Judge has awarded 999 Call for the NHS a capped costs order of £25K. This limits the costs that the campaign group would have to pay NHS England, were they to lose the case.



999 Call for the NHS – originally well known as the Darlo Mums who organised a 300 mile Jarrow to London People’s March for the NHS in 2014, culminating in a rally in Trafalgar Square attended by 20,000 people – are challenging NHS England’s introduction of a model contract for use by new local NHS and Social Care organisations, known as Accountable Care Organisations (ACO).

We can help https://www.crowdjustice.com/case/healthcare4all-stage3

Interestingly Dudley Clinical Commissioning Group “is in the process of trying to establish …perhaps the only example of an advanced ACO type model”, according to the Health Service Journal (HSJ), and had hoped to award the Accountable Care Organisation contract by April 2018. Now however, they have confirmed they are planning to award the contract after guidance by NHS England and NHS Improvement (the Regulator with Dido Harding as ‘Chair’) with a start date in April 2019.

Has the 999 Call for the NHS Judicial Review put a spanner in the works? We can only guess!

According to the HSJ, the Dudley Clinical Commissioning Group had planned that the contract would take forward the “multispeciality community provider” (MCP) new care model, (a form of Accountable Care Organisation). Worth £5bn, the contract would incorporate a capitated (per person) budget to cover much of the health and some social care for the population in the area. This is not the usual current form of payment for NHS treatments, which is based on the actual costs of treatments that are provided.

What happens if the Accountable Care Organisation budget for the population does not meet the costs of the treatments that patients need? Who gets treatment then?

Please help us fight the dismantling of the NHS, to save healthcare for all. https://www.crowdjustice.com/case/healthcare4all-stage3

Sign and share

https://you.38degrees.org.uk/petitions/stop-the-plans-to-dismantle-our-nhs
Many thanks”

Source: 38 Degrees

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10 Jan 2018

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Accountability, Austerity cuts, Health and Social Care (local), Inequality, NHS (local)

Four million people affected by NHS cancellations and waiting times

“Four million people have been directly affected by NHS cancellations and long waiting times, a poll has suggested.

It also found the majority of the public (65%) believe the Government is badly managing the current pressures on the NHS.

And almost half (44%) blame No10 for the crisis, the YouGov survey showed….”

http://www.mirror.co.uk/news/uk-news/four-million-people-directly-affected-11826172

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9 Jan 2018

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Accountability, Austerity cuts, Health and Social Care (local), Inequality, NHS (local), Scrutiny

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Powerful new video: SOHS – Care Closer to Home isn’t Working

Should be required watching for everyone in Devon – made on a shoestring by campaigning group Save our Hospital Services. A starring role for Independent DCC Councillor Claire Wright – our only hope for common sense in East Devon.

Please watch NOW and pass the link to everyone and anyone, inside and outside Devon who can amplify this message.

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7 Jan 2018

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Accountability, Austerity cuts, Health and Social Care (local), NHS (local), Sleaze, Spin

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Andrew Marr defends NHS and confronts May

“BBC presenter Andrew Marr confronted Theresa May over the state of the NHS, suggesting he could have died if he had waited five hours for an ambulance following his own stroke.

The political broadcaster, 58, who suffered a stroke in January 2013, pressed the PM on the crisis, which has led to thousands of routine operations being cancelled in January as the health service struggles to cope with winter pressures.

It comes after the East of England Ambulance Service apologised following the death of a pensioner, 81, in Essex who was left waiting nearly four hours for a crew of paramedics.

Appearing in a pre-recorded interview on the BBC’s Andrew Marr show on Sunday morning, the Prime Minister acknowledged more needs to be done, telling the interviewer: “Of course nothing’s perfect and there is more for us to do.”

Mr Marr claimed funding was not the sole issue facing the service and said the cancelled operations were “part of the plan”.

Presenter Mr Marr challenged her, saying he would not be interviewing her if he had experienced the same delays following his stroke.

“If I’d been waiting for five hours before I’d seen a doctor after my stroke I would not be here talking to you,” he said.

“This is about life and death and up and down the country people are having horrendous experiences of the NHS,” he added, before asking what the PM would say to the daughter of an elderly woman who waited hours to see a doctor.

Mrs May replied: “Obviously you’ve raised an individual case with me which I haven’t seen the details of and I recognise that people have concerns if they have experience of that sort.

“If we look at what is happening across the NHS, what we see is that actually the NHS is delivering for more people, it is treating more people and more people are being seen within the four hours every day than has been a few years ago.

“But of course nothing’s perfect and there is more for us to do.”

On funding, it was suggested to Mrs May that she had done nothing to address increased pressure on the social care system.

The PM replied: “Well yes, we have done something about it, Andrew. I’m sorry, you’re wrong in that.

“We have put extra funding into the social care system and we have worked with hospitals and with local authorities to identify how we can reduce those delayed discharges, ie patients being kept in hospital when they shouldn’t be.”

Mrs May said the Government is working on its long-term plans for social care but would not be drawn on whether there is a need for a brave and radical look at how the NHS is funded.

Asked about whether she agreed with Mr Hunt’s suggestion of a 10-year funding plan, Mrs May replied: “Of course what we’re operating on at the moment is the five-year forward view for the NHS which is the forward view that the NHS themselves came forward with.

“They brought those proposals together.”

Pressed further on cash, Mrs May said: “You keep talking about the money but actually what you also need to look at is how the NHS works, how it operates.”

Shadow health secretary Jon Ashworth said of the PM: “She hasn’t got a plan to get those people off the trolleys and corridors.”

He added to the same programme: “Her only plan apparently is to promote this Health Secretary. They should be demoting this Health Secretary.

“If she promotes this Health Secretary tomorrow it’s a betrayal of those 75,000 people in the back of ambulances.”

Franz Ferdinand drummer Paul Thomson, performing at the end of the programme, appeared to show his support for the health service by wearing a t-shirt with the NHS’s logo above the Nike tick.”

https://www.standard.co.uk/news/politics/bbcs-andrew-marr-confronts-theresa-may-on-nhs-crisis-as-he-warns-he-could-have-died-without-fast-a3733866.html

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7 Jan 2018

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So, who knows best? May or GP Sarah Wollaston?

“OPINION:

More money and tighter integration can save Britain’s NHS
The Chair of the House of Commons Health Select Committee, Sarah Wollaston, writes that integrating social care with health, and providing more sustainable funding, is crucial, arguing that “it is time to stop viewing health as a bottomless pit but rather as one of our greatest successes.

Investment should be a source of national pride. I cannot think of a better way for Mrs May to celebrate the 70th anniversary of the NHS than by helping to make sure that it has a sustainable long-term future.”

Source: FT Online, Express p26

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3 Jan 2018

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Accountability, Austerity cuts, Health and Social Care (local), Inequality, NHS (local)

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NHS crisis isn’t a crisis because the government has a plan!!!

Health spokesperson David Willets says it isn’t a crisis – just a bit uncomfortable for patients who have had operations cancelled!

“A crisis is when you haven’t got in place mitigations and you haven’t got a plan to deal with it. We’ve gone into this winter in a way that we’ve never prepared before, so we went into the winter before Christmas having cancelled fewer elective operations than we had previously, discharges from hospital were at a lower level than they had been previously, so we were better prepared.

We’ve also set up a national, regional and local structure – if you like, a winter pressures protocol – which we are invoking now and we are monitoring a whole series of things, activity in the service and the pressures.

We are monitoring the weather alerts in anticipation of weather changes because we know that’s important, and we also monitor the seasonal illnesses like flu.

Asked if what was happening would feel like a crisis to patients, he replied:

I fully accept that for the individual that will be really very uncomfortable, but what we know is if we don’t have a plan in place and we don’t do this in a structured way, what will happen, as we’ve had in previous winters, is lots of last-minute cancellations which is really distracting for patients, it’s inconvenient, it upsets the plans they’ve put together with their family, particularly for elderly patients where their care needs are often quite significant.

He said it was possible that further delays to non-urgent operations could be announced. Asked if there could be further postponements, he said:
That’s certainly a possibility … Intention always is not to cancel patients or postpone patients more than once – that’s one of the principles we try to follow – but clearly it is unpredictable, we don’t know what the weather we do, we don’t know the pressures in the system, we’re taking precautionary action here. …”

https://www.theguardian.com/politics/blog/live/2018/jan/03/nhs-crisis-brexit-theresa-may-needs-to-get-a-better-grip-on-nhs-crisis-says-senior-tory-politics-live

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21 Dec 2017

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Accountability, Accountable Care Organisation, Austerity cuts, Economy, Health and Social Care (local), Inequality, NHS (local), Privatisation

The price of Tory policies: tax and VAT rises and privatising NHS says IMF

Interesting that the IMF says that another £20 billion of spending cuts will be needed. That’s roughly how much Hunt wants to cut spending on the NHS.

The long game of 100% privatising the NHS – bringing with it rationing, post code lotteries and American-style health care approaches, appears to be nearing its conclusion.

As regards harmonising VAT at its higher rate – currently 20% – this would mean a 15% VAT increase on heating costs, all food and drink, charitable fundraising, equipment for disabled people, water, materials to insulate homes, boilers, children’s clothes …. the full list is here:

https://www.gov.uk/guidance/rates-of-vat-on-different-goods-and-services

“Taxes will have to rise if the government is to balance the books by the middle of the next decade and the NHS may have to be privatised, the International Monetary Fund has warned.

Property taxes, the removal of preferential VAT rates for goods such as pasties, and higher national insurance contributions by the self-employed need to be considered if Britain is to have any chance of eliminating its budget deficit by 2025 because spending cuts have gone about as far as they can, the global economic watchdog said in its annual review of the UK.

Weak productivity and the increasing care demands of an ageing population will make deficit reduction harder. Public services such as the NHS may have to be scaled back or privatised, it added.

The warnings are a reminder of the persistent problem of Britain’s public finances almost a decade after the financial crisis caused borrowing to soar. National debt is 87 per cent of GDP and spending on public services exceeds revenue from taxes by more than 2 per cent of GDP.

“Continued deficit reduction is critical to create further room to respond to future shocks,” Christine Lagarde, managing director of the IMF, said. “There is not much space for additional spending cuts and the revenue side of the equation has to be looked at.”

Britain is already forecast to be paying 34.3 per cent of GDP in tax by 2022, more than at any time since the 1950s, but economists estimate that at least £20 billion of extra austerity will be needed to hit the government’s target of balancing the books.

Ms Lagarde said population changes were adding to the problem. “Population ageing is expected to lead to material increases in spending on healthcare, pensions and long-term care, while productivity growth has been slow. And a slowly growing economy means fewer resources will be available to meet increased spending,” she said.

The public spending burden will soon make Britain face some hard choices, the IMF added. “The UK may face difficult decisions about the desired size of its public sector, as well as the mode of delivery and financing of public services. Brexit-related effects may exacerbate the challenge.”

To address the problem, Britain needs to boost productivity. Ms Lagarde welcomed the chancellor’s £31 billion fund for infrastructure investment and focus on technical qualifications because “the UK underinvests in infrastructure and falls short in human capital development”. But she said that more needed to be done “such as easing planning restrictions and reforming property taxes to boost housing supply”.

As well as introducing a land tax, the government should harmonise VAT for goods that get preferential rates and better “align the tax treatment of employees and the self-employed”. Both proposals have proved a poisoned chalice for chancellors. George Osborne tried to harmonise VAT rates for hot food in his “omnishambles budget” and Philip Hammond had to backtrack this year on raising national insurance for the self-employed. The IMF also recommended “reducing the tax code’s bias towards debt” and scrapping the triple lock on state pensions.

John McDonnell, the shadow chancellor, said: “The IMF has played the role of the ghosts of Christmas past, present and future to remind the chancellor that seven years of Tory failure is undermining our economy.”

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20 Dec 2017

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Austerity cuts, Health and Social Care (local), NHS (local)

Foreign doctors [and nurses] – we need them more than they need us

And before anyone whinges about time-wasters going to A and E remember Health Secretary Jeremy Hunt has been one of them:

http://www.independent.co.uk/news/uk/politics/jeremy-hunt-i-took-my-children-to-ae-because-i-didnt-want-to-wait-for-gp-appointment-9882814.html

“Doctors who trained abroad account for almost half of all those working in parts of the UK as the profession faces “crunch point” and more young doctors take time out due to stress.

The General Medical Council’s annual report said that many regions and specialities relied on foreign-trained doctors, who could leave the UK. It added that there were too few doctors to treat rising numbers of patients, and doctors were being “pushed beyond their limits”.

The State of Medical Education and Practice showed that 54 per cent of junior doctors took a break after finishing foundation training, a rise from 30 per cent in 2012. “Goodwill and commitment to always go the extra mile” kept the NHS running, it said. “This level of sacrifice is neither right nor sustainable.”

The number of doctors on the medical register has grown by 2 per cent since 2012. Over the same period in England there has been a 27 per cent increase in patients going to A&E, and the GMC said that an ageing population was putting pressure on services.

While the number of UK graduates on the medical register rose by more than 10,700 between 2012 and this year, the rise was offset by a fall of 6,000 in foreign-trained doctors.

Charlie Massey, chief executive of the GMC, said: “We have reached a crucial moment — a crunch point — in the development of the workforce. The decisions that we make over the next five years will determine whether it can meet these demands.”

A fifth of doctors in training said they felt short of sleep while working. In 2014, when 43 per cent of new doctors took a break from training, 22 per cent took a one-year break and 8 per cent took a two-year break. Others may never return. More than half of those taking a break said that it was because of burnout, and most wanted a better work-life balance.

The GMC said that reducing the pressure on doctors and improving the culture and making jobs and training more flexible would be vital to recruiting and retaining doctors.

In the east of England 43 per cent of doctors were trained overseas. In the West Midlands the figure is 41 per cent, and 38 per cent in the East Midlands. More than half, 55 per cent, of specialists in obstetrics and gynaecology trained overseas.

About 14 per cent of doctors in the UK trained in south Asia, but their numbers have dropped by 7 per cent since 2012. The number of doctors from Africa, Australia, New Zealand and North America also fell.

The Department of Health said: “The NHS has a record number of doctors — 14,900 more since May 2010 — and we are committed to supporting them by expanding the number of training places by 25 per cent.” The department was working to improve retention, it added.

BEYOND THE STORY

The health service turned to Britain’s former colonies in South Asia during labour shortages in the 1960s and again in the 2000s when there were too few homegrown recruits.

Today, too, it leans heavily on overseas doctors. A third of doctors in the NHS trained outside the United Kingdom. The reliance has raised concerns that the NHS may be fuelling a “brain drain” in poorer countries where doctors are desperately needed, although others argue that training in the UK can improve those doctors’ skills.

It comes down to the simple fact that the UK does not train enough doctors to meet the demands of its population.

Historically, NHS workforce planning has suffered because it needs to happen over a much longer period than the average lifespan of a government. Last week Health Education England set out the first NHS staffing plan in 25 years, admitting that 190,000 extra frontline staff would be needed.

Source: The Times (pay wall)

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19 Dec 2017

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Accountability, Austerity cuts, Health and Social Care (local), NHS (local)

“£3bn NHS spend due to unfilled vacancies”

“Figures obtained under Freedom of Information rules have shown that the NHS is spending £3bn a year on agency staff to fill staffing gaps caused by 100,000 unfilled vacancies.

The highest vacancy rate, of 12.2%, was for nurses, leaving hospitals and care homes short on qualified staff and reliant on less experienced healthcare assistants.

Janet Davies from the Royal College of Nursing said: “Hospital wards and care homes alike increasingly rely on unregistered healthcare assistants, especially at night. The Government must no longer allow nursing on the cheap – patients, particularly vulnerable and older individuals, can pay the highest price.”

Source” The Independent, Page: 3 Independent i, Page: 5

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18 Dec 2017

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Accountability, Austerity cuts, Health and Social Care (local), Inequality, NHS (local), Scrutiny, Spin, Transparency

An A and E consultant speaks … and begs for our help

“Dear Journalists,

As an A&E consultant I am writing to ask for your help.

Up and down the country our A&E departments are in meltdown, our staff are at breaking point and we need your help.

Patients are being left in corridors because there are no ward beds for them to go to, staff are leaving shifts demoralised and exhausted and most importantly our patients are not getting the care they deserve.

We need the public to know about this, not to scaremonger, but for the truth to be out there – as the only way to get politicans to change – is by voters knowing the reality and prioritising the NHS at the ballot box.

But without the public understanding what is going on, we will continue to have this crisis year after year after year. This is where we need your help. We need you to report the reality and not peddle the propaganda from our politicians.

The crisis is much worse than what you report. We all talk about the 4 hour target and that we get around 90%. But that includes all the patients who don’t need admission. But for the ones who need admission, the % who get admitted within 4 hours is so so so much lower than that. And for those patients, it is crucial for their well being, that they get admitted within four hours.

Why are you not asking for these figures? That would help reveal the truth.

Then you report 12 hour breaches. But in England (but not the rest of the UK) the clock starts ticking when a specialist senior has seen them. So they can be in A&E for 18 hours and not be a 12 hour breach.

Why are you not asking for the figures of patients who stay in A&E for more than 12 hours? That would help reveal the truth

And what about asking how many patients are spending time in corridors?

Because if you did reveal these figures – you would soon see the real extent of the crisis. And it is a crisis. One which will lead to a breaking point soon unless something changes.

The fault does not lie with the patients. Yes a few inappropriately attend – but they are not the problem; they can be quickly turned around and discharged.

The fault is not with the staff. They are working tirelessly and doing an amazing job despite the conditions they are working in.

The fault does not lie wth managers and hospital executives. They are working relentlessly to make things work as well as they can.

And despite what the governmnet peddle it certainly is not the fault of the GPs. Although there is falling numbers of GP surgeries, they are doing an amazing job at reducing the number of A&E attendances. Most importantly, the fault does not lie with the ‘system’ of the NHS – a model of care which utilities its resources to maximal effect.

The fault lies with the government.

Years of failed austerity depriving NHS and councils of vital monies and investment is taking its toll. A&Es are struggling because of the frail elderly who need a ward bed but cant get one.

They can’t get one because there are not enough beds within our hospitals (we have one of the smallest numbers of bed per capita in the whole of Europe) and because those that need to get out of hospital can’t because of a lack of social care.

In addition some money which has been spent on the NHS had been wasted on pointless reorganisations designed to start the process of NHS privatisation.

Please start reporting that. Please start reporting the truth. Please start reporting how close we are to melt down and please help get the public worked up about what is going on.

Because sadly our government don’t seem that bothered. They and their friends can afford private health care and therefore don’t rely on it. Even worse many would be happy to see our NHS privatised.

But for everyone else we need the NHS. The staff will battle on (and it is a battle at the moment). We will continue to do everything we can. We will continue to adapt, modernise and reform. We will continue to provide the most amazing possible care despite the conditions. But there is only so much our staff can take. And if we lose our staff we lose the NHS.

Journalists -we need your help. Please help.

And if you are not a journalist reading this, please share (publicly), or tweet it or send onto your friends in the hope that journalists will pick this up and start reporting the truth.

Rob Galloway A&E Consultant
@drrobgalloway

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16 Dec 2017

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Accountability, Accountable Care Organisation, DCC, East Devon Tories, EDDC, Health and Social Care (local), Inequality, NHS (local), Paul Diviani, Sarah Randall Johnson

“Social care postcode gap widens for older people”: EDDC tries to claw back its mistakes too late

Last week, desperate Tories put a much-too-little! much-too-late motion to East Devon District Council:

“To ask the Leader of East Devon District Council to request Sarah Wollaston, Chair of the Parliamentary Health Select Committee, to investigate the effects on Rural Communities of the STP actions and to test if Rural Proofing Policies have been correctly applied to these decisions in order to protect these communities”

https://eastdevonwatch.org/2017/12/13/effect-of-sustainability-and-transformation-plans-on-rural-communities-east-devon-tories-miss-the-boat-then-moan-about-it/

As Owl noted at the time, this is somewhat rich, as their Leader, Paul Diviani, voted at Devon County Council AGAINST sending the document to the Secretary of State for Health (where this could have been highlighted in the covering submission) against the instructions of his EDDC Tory Councillors and never having consulted other Devon Tory councils he was supposed to represent. He was ably assisted in this by former EDDC Chairman Sarah Randall Johnson, who as Chair of the DCC committee, railroaded their choice of action by effectively silencing any opposition (EDW passim)

This led to the accelerated closure of community beds in Honiton and Seaton, following on from earlier closures in Axminster and Ottery St Mary.

A subsequent vote of “No Confidence” in Diviani at EDDC (brought by non-Tory councillors) was defeated by the very Tory councillors he had defied!

Now we read that “Social care postcode gap widens for older people” and that social care is breaking down in deprived areas – many of which are inevitably rural.

“… The knock-on effects for the NHS see elderly patients end up in hospital unnecessarily after accidents at home, while they cannot be discharged unless they have adequate community care in place. Among men, 30% in the poorest third of households needed help with an activity of daily living (ADL), compared with 14% in the highest income group. Among women, the need for such help was 30% among the poorest third and 20% in the highest third.

There is a growing army of unpaid helpers, such as family and friends, propping up the system. Around two-thirds of adults aged 65 and over, who had received help for daily activities in the past month, had only received this from unpaid helpers, the figures revealed.

Spending on adult social care by local authorities fell from £18.4bn in 2009-10 to just under £17bn in 2015-16, according to the respected King’s Fund. It represents a real-terms cut of 8%. It estimates there will be an estimated social care funding gap of £2.1bn by 2019-20.

While an extra £2bn was provided for social care over two years, a huge gap remains after the latest budget failed to address the issue. Theresa May was forced to abandon plans to ask the elderly to help pay for social care through the value of their homes, after it was blamed for contributing to her disastrous election result. The government has promised to bring forward some new proposals by the summer, but many Tory MPs and Conservative-run councils are desperate for faster action.

Ministers have dropped plans to put a cap on care costs by 2020 – a measure proposed by Sir Andrew Dilnot’s review of social care and backed by David Cameron when he was prime minister.

Izzi Seccombe, the Tory chair of the Local Government Association’s community wellbeing board, said: “Social care need is greater in more deprived areas and this, in turn, places those councils under significant financial pressures. Allowing councils to increase council tax to pay for social care, while helpful in some areas, is of limited use in poorer areas because their weaker tax base means they are less able to raise funds.

“In more deprived areas there is also likely to be a higher number of people who rely on councils to pay for their care. This, in turn, puts even more pressure on the local authority.

“If we are to bridge the inequality gap in social care, we need long-term sustainable funding for the sector. It was hugely disappointing that the chancellor found money for the NHS but nothing for adult social care in the autumn budget. We estimate adult social care faces an annual funding gap of £2.3bn by 2020.”

Simon Bottery, from the King’s Fund, said: “We know that need will be higher in the most deprived areas – people get ill earlier and have higher levels of disability, and carry that through into social care need.

“We also know that the councils that have the greater need to spend are, on average, raising less money through the precept [earmarked for funding social care].”

https://www.theguardian.com/society/2017/dec/16/social-care-for-elderly-postcode-gap-grows

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16 Dec 2017

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Accountability, Accountable Care Organisation, Austerity cuts, Health and Social Care (local), Inequality, NHS (local), Scrutiny, Transparency

Accountable Care Organisations: angels or devils?

Owl says: if you believe that Accountable Care Organisations are a good thing you will believe anything. Back-door privatisation a la USA and a ruthless way of enforcing rationing and post code lotteries rather than proper funding.

“Accountable care organisations have many strengths but should be openly debated before being implemented.

The war over the future of the NHS is being fought on multiple fronts. Campaigners, the Labour party, the government, NHS England and even Stephen Hawking are locked in combat over the structure, funding, transparency, accountability and legality of the current wave of reforms, along with the never-ending fight about privatisation – real or imagined.

The famous physicist has joined campaigners in a high court bid to block the introduction of accountable care organisations to oversee local services without primary legislation, arguing they could lead to privatisation, rationing and charging.

Meanwhile, the shadow health secretary, Jon Ashworth, has tabled a Commons early day motion after the government announced plans to amend regulations to support the operation of accountable care organisations. Ashworth argues that they are a profound change to the NHS that should be debated in parliament.

Accountable care – a term imported from the US, where it plays a key role in Obamacare – can take many forms, but it typically involves an alliance of providers with a fixed budget collaborating to manage the health needs of their local population. NHS England wants to see sustainability and transformation partnerships (STPs) evolving into accountable care systems in which integrated care supports good physical and mental health.

In June, NHS England announced that eight areas would be leading the accountable care drive. Greater Manchester is also adopting this approach, and many others are starting to use the accountable care language.

Accountable care has the potential to address many of the criticisms the most vociferous supporters of the NHS have made for many years. It goes a long way to replace competition with collaboration, and the NHS England chief executive, Simon Stevens, said it could mark the end of the infamous purchaser/provider split, which weighs down the health service with costly and often pointless bureaucracy.

Locally led, integrated systems are essential if we are going to shift the NHS from a 1970s-style hospital service to one that provides a community-based health and wellbeing service. Pooling budgets across the local area is not a ruse to disguise cuts. It is the most effective way to manage public money, irrespective of the level of funding.

The court case confuses the issue of how the NHS is organised with its funding and the role of the private sector. These are three different issues.

But the legal basis for accountable care is shaky. Faced with the wreckage left by Andrew Lansley’s infamous 2012 reforms, NHS England introduced STPs because trying to plan services through more than 200 clinical commissioning groups was never going to work.

As demand climbed, funding flatlined in the aftermath of the 2008 crash and managing long-term conditions became the dominant challenge; it was imperative to move from competition to collaboration and set a long-term goal of population health management. That is where accountable care comes in.

STPs and accountable care are operating under legislation meant for clinical commissioning groups – so collaborative systems typically serving 1.2 million people in which local government and all parts of the NHS have a say are underpinned by a legal framework for GP-managed competition overseeing populations of 250,000.

This is such a precarious legal balancing act that the 2017 Conservative manifesto promised to tidy up the legislation and regulations. But introducing an NHS bill now would be political harakiri for Theresa May, and most health service staff would prefer legal ambiguity to yet another round of organisational upheaval that would inevitably follow legislation.

So the choice is to either continue to find legal bodges to allow the NHS to collaborate and plan or – if the high court challenge succeeds – to return to the Lansley dream-turned-nightmare of full-blooded competition.

But although the thinking behind the legal challenge is muddled, that campaign and Labour’s early day motion highlight the major problem: a profound change in the management and leadership of the NHS is being introduced without informed public and parliamentary discussion.

The new approach has many strengths, but introducing it under the radar only serves to feed anxieties and misconceptions about the objective. NHS England needs to get the discussion about accountable care out in the open.”

https://www.theguardian.com/healthcare-network/2017/dec/15/under-radar-nhs-reforms-fuelling-public-anxiety

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15 Dec 2017

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Accountability, Austerity cuts, Health and Social Care (local), NHS (local)

Honiton Health Matters: a conversation with stakeholders 18 January 2018 9.30-13.30

What an excellent idea! Something for other towns to copy.

“Honiton’s Health Matters – Going Forward Together
Thursday 18th January 2018,
Beehive Main Hall,
9.30 for 10am start – 1.30pm

Book a place here:
https://docs.google.com/forms/d/e/1FAIpQLSeJj_8YEemYo6ktVy7VQz1kZSiVHpMPbpqOoZrH2M3IIOQkQQ/viewform?usp=send_form

Context: This event is the start of a community conversation with key stakeholder organisations around the future health and wellbeing of residents in response to the new landscape affecting Honiton and its environs as a result of NHS and Government policies advocating placed-based health provision and cross-sector collaborative working.

The aim: To discuss what we know, where there are gaps/challenges and how, as a community we will address these to ensure collaborative approaches to co-design and co-produce local health services/activities that meet the needs of all the people in our communities.

Invitees: Management and senior level employees / volunteers / trustees across the public, private, community, voluntary and social enterprise sector.

Speakers:
Ø Professor Em Wilkinson-Brice – Deputy Chief Executive / Chief Nurse RD&E
Ø Dr Simon Kerr – Chair, Eastern Locality New Devon CCG
Ø Julia Cutforth – Community Services Manager, Honiton and Ottery St Mary
Ø Ways2Wellbeing – Social Prescribing, Speaker to be confirmed
Ø Charlotte Hanson – Chief Officer, Action East Devon
Ø Heather Penwarden- Chair, Honiton Hospital League of Friends

Organised by Action East Devon.

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13 Dec 2017

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Accountability, East Devon Tories, EDDC, Health and Social Care (local), NHS (local), Paul Diviani, Rural communities

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Effect of Sustainability and Transformation plans on rural communities – East Devon Tories miss the boat then moan about it!

Motion at today’s EDDC full council meeting.

Recall that EDDC council leader voted AGAINST submitting the Sustainability and Transformation Partnership’s plan to the Secretary of State for Health at the meeting of Devon County Council’s Health Scrutiny Committee AGAINST the wishes of his own district council.

Now, that same district council, whose Tory members absolved him of blame for this act are making a TOKEN fuss about its consequences!

“Motion – The effects on Rural Communities of the Sustainability Transformation Partnership (STP) actions in East Devon

“To ask the Leader of East Devon District Council to request Sarah Wollaston, Chair of the Parliamentary Health Select Committee, to investigate the effects on Rural Communities of the STP actions and to test if Rural Proofing Policies have been correctly applied to these decisions in order to protect these communities”.

Proposer Councillor Mike Allen Seconded by Councillor Ian Hall
Supported by:
Councillor Dean Barrow; Councillor Stuart Hughes; Councillor Brian Bailey; Councillor Mark Williamson; Councillor Mike Howe; Councillor Iain Chubb; Councillor Simon Grundy’; Councillor Graham Godbeer; Councillor Tom Wright; Councillor Jenny Brown”

Click to access 131217-combined-council-agenda-and-minute-book.pdf