“Sidmouth doctor speaks out over struggling GPs and lack of extra funding”

“A struggling Sid Valley GP surgery missed out on extra funding after it all went into secondary care, prompting a Sidmouth doctor to speak out.

Doctor Joe Stych, a practice partners at Sid Valley Practice, has voiced his frustration after a funding bid was denied to redevelop Blackmore Health Centre which was rated as ‘unfit-for-purpose’, by regulators the Care Quality Commission (CQC).

Dr Stych said Sidmouth GPs had been working hard on a plan to future proof GP services in Sidmouth for the last two years.

The latest setback follows the disappointment in 2016-17 when a plan to buy and redevelop the centre was turned down.

Dr Stych said a plan to extend the Beacon Medical Centre and move GP services from Blackmore Health Centre to Sidmouth Victoria Hospital was proposed, helping support the hospital’s medical Ward.

He added: “It was ranked by Devon CCG as the third highest priority project for funding needed locally, but it was overlooked.

“Funding went to the first, second, fifth and eighth ranked projects.

“All funding in Devon has gone to secondary care.

“No funding has been assigned to struggling GPs.

“It is ludicrous that this scheme has been unsuccessful. It makes no sense to me.

“It would increase capacity and improve patient care at the same time as saving the NHS money.

“The overall scheme cost was small at £1.3million but would have made a huge difference.”

Dr Stych said the Government had since revealed its ‘10 year plan’ for the NHS with focus on moving more work out of hospitals into GPs and the community.

He added: “Without the infrastructure to support existing health services, let alone an expansion into the community, even more challenging times lay ahead.

“The reality is that we are already working at capacity and have no room to expand.

“We are already limited in what we can achieve by space constraints.”

He said the practice has an enthusiastic team with GPs in extended roles, operating on skin cancer and performing carpal tunnel operations so patients do not have to travel to Exeter.

They are involved in research to offer new and developing treatments to patients and train medical students and junior doctor.

A Department of Health and Social Care spokesman said: “The latest round of funding applications were highly competitive and the funding was prioritised on the strength of bids received from local NHS teams.

“The Devon STP (Sustainability and Transformation Partnership) will benefit from more than £50million to transform services for patients.”

The spokesman added that the funding was not allocated proportionally but on the strength of bids received.

Each was evaluated against six criteria – deliverability, service and demand management, transformation and patient benefit, financial sustainability, value for money and estates.

The Devon funding will go towards University Hospitals Plymouth NHS Trust – with £29.7million going to transforming urgent and emergency care, £9.3million to Devon imaging facilities and £3.5million to digital histopathology.

A further £8million was given to Devon Partnership NHS Trust for adult acute mental health service across Devon.

The spokesman said: “GPs are the bedrock of the NHS, and the ‘long term plan’ makes clear our commitment to the future of GPs, with primary and community care set to receive £4.5billion more in real terms a year by 2023/24.

“Last year a record 3,473 doctors were recruited into GP training and the new five year contract for GPs will see 20,000 more staff working in GP practices – helping free up doctors to spend more time with the patients who need them.”

A spokesman for the NHS in Devon said: “The Sidmouth scheme was a high priority for the Devon Sustainability and Transformation Partnership and we are still working with the practice and our partners to explore other options.”

https://www.sidmouthherald.co.uk/news/sidmouth-doctor-speaks-out-1-5911840

Twenty minutes a day in an urban park [if you can find one] makes you happier

Owl says: with many urban parks being sold off for poor-quality, high-cost housing it seems “wellbeing” just isn’t a priority.

“… Researchers from the University of Alabama found people who visited their local parks experienced physical and mental health benefits ranging from stress reduction to recovery from mental fatigue.

“Overall, we found park visitors reported an improvement in emotional wellbeing after the park visit,” said lead researcher Hon Yuen. “We did not find levels of physical activity are related to improved emotional wellbeing. Instead, we found time spent in the park is related to improved emotional wellbeing.” …”

https://www.huffingtonpost.co.uk/entry/twenty-minutes-in-an-urban-park-every-day-makes-you-happier_uk_5c750504e4b0bf166202c5d3

Are DCC councillors refusing to let Claire Wright’s star shine before local elections?

Owl says:

Local council elections: 2 May 2019

Greater Exeter Strategic plan:
not going out for consultation until June 2019

Claire Wright’s long-promised inquiry into how Devon carers are coping:
Delayed by at least a year to June 2019 at the earliest

Anyone smell rats (on a sinking ship)?

“My efforts to get a spotlight review into how Devon carers are faring seems to have hit another delay.

I first proposed a review at the April Health and Adult Care Scrutiny Committee meeting of last year, but the vote was delayed until councillors had visited the contractors who look after the service, Westbank League of Friends.

My interest in the subject was sparked after reading a report which indicated that many carers were feeling exhausted, ill and short of money. Here is the background –

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

After a useful meeting at Westbank, I duly proposed a spotlight review once again at the September meeting. It was agreed this time.

I have now enquired twice when this review is going to have its first meeting but have had unsatisfactory answers.

At yesterday’s committee meeting I asked again when the first meeting was going to take place.

I was told that it wouldn’t take place until at least June as more information was needed.

I pointed out that this was almost a year after I had proposed the review (actually it is longer as I originally proposed it last April but it was not agreed then).

But the chair said the information was required before a spotlight review was held.

This is deeply disappointing and feels as though the issue is being kicked into the long grass.

I know many carers out there are struggling and to defer this issue is unfair and wrong in my view.

I will definitely be pursuing this.”

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

Chilling report on NHS sustainability – it isn’t sustainable

Owl says: anyone who cares about the NHS should read EVERY PAGE of this 58-page report, which is written in clear and accessible language.

Every page signals a death-knell for the NHS sooner rather than later.

It is hard to pick out anything – every page tells a story of (deliberate?) mismanagement, underfunding and chaotic accounting.

For example:

“Key findings

The funding settlement for the NHS long-term plan

8 The long-term funding settlement does not cover key areas of health spending. The 3.4% average uplift in funding applies to the budget for NHS England and not to the Department’s entire budget. The Department’s budget covers other important areas of health spending such as most capital investment for buildings and equipment, prevention initiatives run by Public Health England and local authorities, and funding for doctors’ and nurses’ training. Spending in these areas could affect the NHS’s ability to deliver the priorities of the long-term plan, especially if funding for these areas reduces. The government will consider proposals in these areas as part of its 2019 Spending Review. In addition, without a long-term funding settlement for social care, local NHS bodies are concerned that it will be very difficult to make the NHS sustainable (paragraphs 2.27 and 2.28).

9 There is a risk that the NHS will be unable to use the extra funding optimally because of staff shortages. Difficulties in recruiting NHS staff presents a real risk that some of the extra £20.5 billion funding will either not be used optimally (more expensive agency staff will need to be used to deliver additional services) or will go unspent as even if commissioners have the resources to commission additional activity, health care providers may not have the staff to deliver it (paragraphs 1.19 and 2.29).

10 From what we have seen so far, the NHS long-term plan sets out a prudent approach to achieving the priorities and tests set by the government, but a number of risks remain. The long-term plan describes how the NHS aims to achieve the range of priorities and five financial tests, set by the government in return for the long-term funding settlement, which NHS England believes are stretching but feasible. As with all long-term plans, it provides a helpful indicator of the direction of travel, but significant internal and external risks remain to making the plan happen. These risks include: growing pressures on services; staffing shortages; funding for social care and public health; and the strength of the economy. Our reports have highlighted how previous funding boosts appear to have mostly been spent on dealing with current pressures rather than making the changes that are needed to put the NHS on a sustainable footing (paragraphs 2.24 to 2.26).

Financial and operational performance of NHS bodies

11 In 2017-18, NHS commissioners and trusts reported a combined deficit of £21 million. This was made up of:

The combined deficit of £21 million does not include adjustments needed to report against the Department’s budget for day-to-day resources and administration costs.

12 It is not clear that funding is reaching the right parts of the system.
The overspends by trusts and CCGs were broadly offset by the underspend by NHS England. In 2017-18, NHS England’s underspend included: £962 million from non-recurrent central programme costs, including efficiencies from vacancies;

a £280 million contribution to the risk reserve and £223 million from centrally commissioned services, mostly specialised services (paragraphs 1.4 and 1.8).

13 Most of the combined trust deficit is accounted for by a small number of trusts, while the number of CCGs in deficit increased in 2017-18. The net trust deficit hides wide variation in performance between trusts, with 100 out of 232 trusts in deficit. In 2017-18, 69% of the total trust deficit was accounted for by 10 trusts. NHS Improvement has committed to returning the trust sector to balance in 2020-21, but it is difficult to see how this will be achieved for the worst-performing trusts under current arrangements. Although support provided to trusts in NHS Improvement’s financial special measures programme has been successful in improving the position of some trusts (by £49 million in 2017-18), the financial performance of the 10 worst-performing trusts deteriorated significantly in 2017-18. Between 2016-17 and 2017-18, the number of CCGs reporting overspends against their planned position increased from 57 to 75. The NHS long-term plan sets out the national bodies’ aim that no NHS organisation is reporting a deficit by 2023-24 (paragraphs 1.6 and 1.11).

14 There are indications that the underlying financial health in some trusts
is getting worse. In 2017-18, trusts reported that their combined underlying deficit was £4.3 billion, or £1.85 billion if the Provider Sustainability Fund (which replaced the Sustainability and Transformation Fund in 2018-19) is allocated to trusts in future years. There is no historical data on the underlying deficit that takes account of one-off savings, emergency extra cash and other short-term fixes that boost the financial position of the NHS, so it is not clear whether this position is getting better or worse. However, indicators such as cash support and one-off efficiency savings suggest the position has not improved. For example, in 2017-18, the Department gave £3.2 billion in loans to support trusts in difficulty, up from £2.8 billion in 2016-17. In 2017-18, 26% of trusts’ savings were one-off. Trusts will need to make additional savings in 2018-19 to replace these one-off savings (paragraphs 1.13, 1.14, 2.13, 2.17 and 2.18).”

https://www.nao.org.uk/wp-content/uploads/2019/01/NHS-financial-sustainability_.pdf

“Andrew Lansley law that forced hospitals to compete could be axed”

Note: this 10-year plan does not tackle the crisis in social care nor the bigger crises of not having enough staff for either service.

[Andrew Lansley’s 2012 act made local GP groups “customers” to buy services from competing hospitals]

“Implementing the new ten-year plan could involve the reversal of market-based reforms introduced in 2012 by the former health secretary Andrew Lansley.

More than 100 local bodies would be merged under proposals to move away from internal health service competition and make parts of the NHS work more closely together.

The request for new laws by Simon Stevens, head of NHS England, sets the government up for a battle in the Commons. The reversal of the reforms is also likely to prove embarrassing for the Conservatives. Labour has already demanded an apology for a “bureaucratic disaster” that it says wasted billions.

The Health and Social Care Act 2012 made local GP groups “customers” to buy services from competing hospitals and other providers. It provoked opposition from health unions who said that it would fragment care. Senior Tories came to regard it as the coalition government’s biggest mistake.

Ministers will seek to present the changes as commonsense tidying up measures requested by the NHS. They hope that this will avoid a divisive political battle, but while opposition to privatisation was a key Labour objection to the act the party is unlikely to back a Conservative NHS reform.

In the ten-year plan Mr Stevens argues that there are too many NHS institutions working autonomously when they need to work together to join up care for patients. While arguing that his plan could be achieved in current structures, he said that changes to the law “would support more rapid progress”.

Matt Hancock, the health secretary, said: “We want to foster a culture of ambition and innovation in the way our health sector organises the services it delivers. I am prepared to make the changes necessary for this to become a reality, including changing the law.”

Jonathan Ashworth, the shadow health secretary, said: “The fact NHS bosses are now proposing significant changes to the Health and Social Care Act confirms what a wasteful, bureaucratic disaster it was in the first place.”

Source: The Times (paywall)

NHS – inequality between regions

“The government must show more urgency in addressing regional health funding imbalances, MPs have warned.

The Public Accounts Committee has also expressed concern about the Department of Health and Social Care’s lack of planning for staffing and medical equipment after Brexit, in a report out today.

The MPs noted there was “significant regional variation” in funding of NHS providers and clinical commissioning groups. DHSC’s 2017-18 annual report and accounts suggest an improvement in finances when taken as a whole but this “masks the underlying deficits at local level”, the PAC report said.

MPs said the department was performing a “balancing act” by offsetting NHS providers’ deficits with a surplus from NHS England’s finances. In 2017-18, 101 of 234 NHS providers were in deficit, although this was mitigated by NHS England’s surplus, the report said. Although, 75 of the 207 CCGs reporting an overspend in the same year.

PAC chair, Meg Hillier, said the number of CCGs overspending was “concerning”.

She added: “The Department of Health and Social Care must show far more urgency in getting to grips with regional funding imbalances and demonstrate it understand the effects these have at the frontline.”

The report was also critical of DHSC’s planning for Brexit, especially around staffing and medical equipment.

It said there is a “lack of a clear plan” for recruiting staff post-Brexit and added: “We are not reassured by the department’s assertion that it has not seen a large exodus of staff since the referendum and that the number of people from the EU working in the NHS has increased.”

Health bodies recently warned that the NHS workforce shortfall could jump from 100,000 at present to almost 250,000 by 2030 without effective planning.

Despite the NHS procuring 56% of medical consumables (gloves, dressings, syringes) from, or via, the EU, DHSC is not putting specific contingency measures in place to stockpile this type of equipment, the PAC revealed.

Hillier said: “The department’s lack of clear Brexit planning could threaten the supply of medical equipment. Staff shortages could deepen. The potential consequences for patients are serious.

“These and other uncertainties are amplified by the continued absence of the government’s promised 10-year plan for the NHS, its promised plans for social care, and its promised plans for immigration.” A DHSC source has confirmed to PF the social care green paper and NHS 10-year plan are now likely to be published in the new year, rather than by the end of this year, as originally intended.

Regional variances in staff vacancies could also be overlooked, the PAC noted. The NHS examines vacancy rates at a national level – rather than a local level – which “hides underlying disparities in specific specialisms and local areas and does not allow them to fully understand the impact of staff shortages,” the report said.

The report also expressed concern that the NHS staff pay rise announced earlier this year would not be distributed fairly. By funding pay awards through the National Tariff the PAC is concerned that NHS Providers in more affluent areas will receive “disproportionately higher share of funding” because the tariff accounts for the cost of operating in different geographical locations.

DHSC has been contacted for comment.”

https://www.publicfinance.co.uk/news/2018/12/government-must-address-health-funding-imbalances-say-mps

“NHS commissioning ‘needs period of stability to transform’ “

Owl says: You cannot make it up – body set up to transform the NHS needs time to transform itself before issuing its transformation policies to transform anything else!

“NHS commissioning needs a prolonged period of organisational stability after almost three decades of change, according to the UK’s spending watchdog.

Continued organisational restructuring causes major upheaval and commissioning in the health services needs stability to transform, the National Audit Office urged in a report released today.

Amyas Morse, head of the NAO, said: “We have seen almost three decades of change to NHS commissioning.

“It would be a huge waste if in five years’ time NHS commissioning is undergoing yet another cycle of reorganisation resulting in significant upheaval.”

He added: “The current restructuring of Clinical Commissioning Groups must deliver balanced and effective organisations that can support the long-term aims of the NHS and deliver a much-needed prolonged period of stability.”

A period of stability would allow commissioning groups to focus on transforming and integrating health and care services rather than on reorganising themselves, the report said.

Since CCGs replaced primary care trusts in April 2013, there have been eight formal mergers, reducing their numbers from 211 to 195 in April this year. Further mergers are expected.

The report also highlighted an increasing number of NHS commissioning bodies in England were exceeding their planned expenditure.

A total of 75 of 207 (36%) CCGs went over their budgets in 2017-18, the NAO noted. The total overspend across the groups was £213m.

This compared to 57 CCGs over spending on their budgets in 2016-2017 and 56 in 2015-2016.

“Many CCGs are struggling to operate within their planned expenditure limits despite remaining within their separate running cost allowance,” the report warned.

Increased pressures, the uncertain futures of CCGs and a lack of access to training and development were cited as reasons for the continuing issue of commissioning bodies being unable to attract and retain high-quality leaders.

Even though “both NHS England and the CCGs stressed [to the NAO] the importance of high-quality leadership”.

The watchdog also warned with further mergers there was “a risk that working across greater areas will make it more difficult for CCGs to design local health services that are responsive to patients’ needs”.

The total net expenditure of CCGs in England in 2017-18 was £81.2bn with net running costs at £1.1bn. Staff costs made up 57% (£693 million) of CCGs’ running costs, the NAO noted.

A 10-year long-term plan for the NHS and how it will spend an extra £20.5m a year was expected to be released by the end of this year.

A source from the Department of Health and Social Care has confirmed to PF it is now “likely” this plan will be release next year.

Responding to the report, chair of the Public Accounts Committee Meg Hillier said: “We should be concerned that increasing numbers [of CCGs] are overspending against their budgets.

“Like previous changes to NHS commissioning, CCGs are going through more change and the NHS is crying out for stability.”

She added: “It is vital that further restructuring supports the 10-year plan and isn’t an unnecessary distraction to addressing the real challenges in the health service.”

https://www.publicfinance.co.uk/news/2018/12/nhs-commissioning-needs-period-stability-transform