Let’s add the Royal College of Surgeons to that list of NHS change critics

“The Royal College of Surgeons has warned of a chronic shortage of NHS hospital beds in England, after occupancy rates for overnight stays topped 89% for a fourth successive quarter.

The maximum occupancy rate for ensuring patients are well looked after and not exposed to health risks is considered to be 85%, a figure that has not been achieved since NHS England began publishing statistics in 2010.

From July to September this year the percentage of beds occupied in wards open overnight was 89.1%, compared with 87% in the same period last year. That was the last time it was below 89%.

The RCS said the figures, published on Thursday, made for alarming reading and indicated a failure to cope with the increasing number of older patients in hospital.

Ian Eardley, a consultant urological surgeon and vice-president of the RCS, said: “The NHS has been able to reduce bed numbers as medical advances mean more modern surgery can take place without an overnight stay. However, these figures suggest bed reductions have now gone too far in the absence of sufficient social care or community care alternatives. …”

https://www.theguardian.com/society/2016/nov/24/nhs-hospitals-suffer-from-chronic-bed-shortage-surgeons-say

“£7.4 million of NHS funds for ‘reorganisation’ in eastern Devon”

Does Project Omega (see post below) include profligate spending on NHS ‘reorganisation’ to bring it to its knees so it can be privatised?

Health bosses have come under fire for spending £7.4million of NHS funds on ‘reorganisation’ – that campaigners say could have gone towards frontline care.

The Northern, Eastern and Western Devon Clinical Commissioning Group (CCG) is identified as one of the most economically challenged in the country with a predicted £384million deficit by 2020/21.

In response to the crisis, the region was chosen to undergo a drastic ‘transformation’ led by the Success Regime, which is proposing to axe 71 community hospital beds as part of a series of cuts.

Campaigners have hit out at plans that would see Sidmouth lose its inpatient beds and said patients should not suffer as a result of badly-managed finances.

District councillor Cathy Gardner said: “I think it’s shocking that £7.4million can be found for reorganisation but not for frontline care. Many will question how wisely NHS funds are being spent when management consultants and internal managers are using up so much cash.

“Health and social care in Devon has suffered from chronic underfunding. The NHS does need serious reform but not of the kind being undertaken under the guise of improvements.”

The CCG confirmed that the Success Regime in Devon received £1.4million in 2015/16 and a further £6million in 2016/17 – but stated that the money was specifically set to implement changes and was not taken from the region’s £1.1billion budget for health services.

Campaigner and chairman of the Sid Valley patient participation group Di Fuller said: “The additional costs of managing the Success Regime, to try and put right what CCG management had failed to do, have diverted yet more funding from frontline services in the NHS.

“We must not endorse cuts to try and put this right until CCG can prove that alternative provision will be safe and meets quality standards.”

A CCG spokesman confirmed a total of £3.3million was spent on the Success Regime’s first phases of ‘transformation’ in Devon, Essex and Cumbria, with a further £17million budgeted for 2016/17. He added that the Success Regime’s programme aims to transform the way care is provided with a move towards a ‘home-based’ model of care.

This is expected to save between £4.7million and £7million a year after reinvestment into community services.

The CCG says it is continually looking at how to make the administration of care more efficient and streamlined.

http://www.sidmouthherald.co.uk/news/7_4_million_of_nhs_funds_for_reorganisation_in_eastern_devon_1_4791348

Destruction of the NHS planned in Thatcher era National Archive documents show -‘The Omega Project’

“… Another document in the National Archives outlines radical plans to end universal free healthcare.

The document stamped “secret” was called, in keeping with films and books of that era, “The Omega Project”.

Civil servants noted that “for the majority it would represent the abolition of the NHS”.

But in spite of what was described as the nearest thing to a Cabinet riot in the history of the Thatcher administration, the prime minister secretly pressed ahead with the plans – before later backing down”.

http://www.bbc.co.uk/news/uk-38101020

The choice of name is chilling – Omega being the last letter of the Greek alphabet, Alpha being the first. So the phrase ‘Alpha and Omega’ came to mean ‘the beginning and THE END’.

It appears that it has been resurrected.

East Devon Alliance invites local politicians to Exeter health crisis rally

“To: Hugo Swire MP, Neil Parish MP, Mel Stride MP, Sarah Wollaston MP, Anne‑marie Morris MP, Peter Heaton‑jones MP, Gary Streeter MP, Geoffrey Cox MP, Kevin Foster MP, Oliver Colvile MP, Johnny Mercer MP

Cc: Jon Ashworth MP, Jeremy Hunt MP, Ben Bradshaw MP

Dear all,

As a representative of residents in East Devon I am addressing this to Devon MP’s but also to those in senior positions in parliament.

Will you be there when the National Health Service Bill (Margaret Greenwood MP) has its second reading? (By the way, that will be on 24th February 2017)

Will you back this bill? If not, why not?

Be aware: your electorate are watching. We in the East Devon Alliance are doing all we can to let them know how you vote on NHS and other healthcare issues, to counter the messages you try to get out down here that you are ‘against’ the current proposals to close community hospital beds. We know this issue is far bigger than that. We know that the 2012 Health and Social Care Act paved the way for the dismantling of the NHS. It’s taking a while for the public to wake up to what is being done, but they will.

And where is Labour? I am afraid a media blackout might be stopping us from hearing from the ‘opposition’. If you can mobilise your supporters all over the country, we will hit the headlines. Come the next election you might find there are new candidates opposing you in your previously safe seats. Or the person who gave you a run last time is out in front.

Are you prepared to continue with this programme to dismantle the NHS? Or do you have the courage to speak out and vote to reverse the changes?

Will you join us in Exeter on 3rd December to parade your support for the NHS as it was?

Please do let me know your position.

Yours sincerely,

Cllr Dr Cathy Gardner
Leader
East Devon Alliance

http://www.eastdevonalliance.org.uk/cathy-gardner/20161124/open-letter-mps-ministers-nhs-reinstatement-bill/

Corbyn finds his voice on NHS and Social Care

Vox Political blog:

“Theresa May consolidated her position as the UK’s most pathetic excuse for a prime minister yet, with a crushing defeat at the Dispatch Box under the questioning of Labour leader Jeremy Corbyn.

(Wasn’t he supposed to be the inept one?)

Mr Corbyn made strong points and supported them with solid facts. Mrs May provided no answers and seemed utterly lost.

Mr Corbyn began: “The government’s sustainability and transformation plans for the National Health Service hide £22 billion of cuts from our service, according to research by the BMA. That risks ‘starving services of resources and patients of vital care’. That comes from Dr Mark Porter of the BMA. When he calls this process a mess, where is he wrong?”

Mrs May ventured this reply: “The National Health Service is indeed looking for savings within the NHS which will be reinvested in the NHS. It is this government which is providing not just the £8 billion which the NHS requested, but £10 billion of extra funding… and sustainability and transformation plans are being developed at local level, in the interests of local people, by local clinicians.”

Oh really?

“It’s very strange the prime minister should say that,” mused Mr Corbyn. “Because the Health Select Committee… says it is actually £4.5 billion, not £10 billion. There’s quite a big difference there.”

So she was being economical with the truth about the amount of money being put into the NHS – and, by the way, is that NHS England or the health service across the whole of the UK? Mrs May doesn’t seem clear about that and the UK Statistics Authority certainly seems confused.

Mr Corbyn continued: “Part of the reason for the strain on our National Health Service is that more than one million people are not receiving the social care that they need. As a result of this there has been an increase in emergency admissions for older patients. What action will the prime minister take to stop the neglect of older people, which ends up forcing them to take A&E admissions when they should be cared for at home or in a care home?”

Mrs May: “The government has introduced the Better Care Fund… the Social Care Precept for local authorities, and we’re encouraging the working together of the health service and local authorities, to deal with precisely the issues he’s raised on social care and bed-blocking,” Mrs May blustered, unaware of the hammer-blow that would shatter her protestations very shortly.

She blundered on: “But I will just say this to the Right Honourable gentleman: Er, we’ve introduced the Better Care Fund and the Social Care Precept. Let’s just look at what Labour did in their 13 years. They said they’d deal with social care in the 97 manifesto, introduced a Royal Commission in 1999, a Green Paper in 2005, the Wanless Review in 2006, said they’d sort it in the CSR of 2007, and another Green Paper in 2009. Thirteen years and they did nothing.”

Here comes the hammer: “As the prime minister well knows, health spending trebled under the last Labour government – and the levels of satisfaction with the National Health Service were at their highest ever in 2010. This government’s choice was to cut social care by £4.6 billion in the last Parliament, at the same time as they found the space, shall we say, to cut billions in corporate taxation bills. That means it’s affecting patients leaving hospital as well. In the last four years, the number of patients unable to be transferred from hospital due to the lack of adequate social care has increased by one-third.”

So it doesn’t matter what Theresa May says her government has introduced; the service it provides is much, much worse than that offered under the last Labour government. That is unquestionable.

Mr Corbyn pressed on: “Will the prime minister ensure her government guarantees all of our elderly people the dignity they deserve?”

“I recognise the importance of caring for elderly people and providing them with the dignity they deserve,” said the prime minister, immediately prior to evading the question completely, going back over her previous assertion and changing the subject (which, as we all know, is a false argument).

“He says this government has done nothing on social care. I repeat, this government has introduced the Social Care Precept, that is being used by my local authorities and by his local authority, and we’ve also introduced the Better Care Fund.” That’s the recapitulation of what she had already said.

Let’s look at that Social Care Precept. It allows local authorities to increase council tax by up to two per cent in order to fund adult social care, meaning that this service has now become a postcode lottery.

Oh, and the Social Care Precept was announced at the same time the Conservative Government said the local government central grant is to be cut by more than half, from £11.5bn in 2015/16 to £5.4bn in 2019/20, a drop of 56 per cent. Meanwhile, councils were expected to increase self-financed expenditure (from revenue and business rates) by 13.1 per cent over the same period, making council services another postcode lottery.

Was it wise of Theresa May to draw attention to this monumental increase in unfairness across the UK?

The Better Care Fund is a pooled budget, initially £5.3 billion, announced in the June 2013 Spending Round and intended to save £1 billion by keeping patients out of hospital. As the number of patients who could not be transferred from hospital due to inadequate social care has increased by one-third in the last four years, it is clear that the Better Care Fund has failed.

In fact, the Chartered Institute of Public Finance and Accountancy and the Healthcare Financial Managers Association surveyed the plans for saving money through integration financed by the BCF in December 2015 and concluded that 80 per cent were likely to fail and that many were hampering progress, “giving integration a bad name”.

Mrs May continued: “But if he talks about support for elderly people I would remind him: Which government is it that has put the triple-lock in place for pensioners, that ensured the largest increase in pensions for elderly people?” And that’s the change-of-subject. Mr Corbyn was not discussing increases in pensions for senior citizens who may be perfectly healthy.

Our verdict can only be that, even though Mr Corbyn didn’t actually say the Conservatives have done “nothing” on social care, the result of their efforts is in fact worse. His response – “The precept is a drop in the ocean compared to what’s necessary for social care” – is mild, in that context.

Moving on to specifics, Mr Corbyn said: “I’m sure the whole House will have been appalled by the revelations in the BBC Panorama this week, showing older people systematically mistreated. The Care Quality Commission’s assessment is that care homes run by the Morleigh Group require improvement and has issued warning notices. The commission goes on to say that the owner has allowed services to deteriorate further, and has ‘utterly neglected the duty of care to the residents of these homes’. What action is her government going to take to protect the residents of those homes?”

Look at this stuttered, barely-intelligible response:

“The- the- Right Honourable gentleman mentioned-raises the issue of the quality of care that is provided in homes and the way that elderly people are treated. I’m sure everybody is appalled when we see examples of poor and uh, uh terrible treatment that is given to elderly and vulnerable people in care homes.

“What we do about it is ensure that we have the CQC which is able to step in, which takes action, which has powers to make sure that nobody-nobody in the chain of responsibility is immune from legal accountability. But we know that there’s more that can be done, and that’s why the CQC is looking into ways in which it can improve its processes, increase its efficiency.

“The, er, my-my honourable friend Minister for Community Health and Care is going to be writing to the CQC shortly, to look at how we can improve, to see what they do. It’s the CQC that deals with these issues. Is there more we can do? Yes, and we’re doing it.”

In other words, her government is taking no action at all.

Oh, and the CQC? It deliberately suppressed an internal review that meant it was found unfit for purpose in 2013. Are we sure we want to trust this organisation now?

“Yesterday, the government proposed that patients may have to show passports or other ID to access non-emergency healthcare,” said Mr Corbyn. “Has the government considered the impact of this on elderly people?

“The last census showed that nine-and-a-half million people in this country don’t have passports. Rather than distracting people with divisive and impractical policies, could the prime minister provide the NHS and social care with the money that it needs, to care for the people who need the support?”

Mrs May’s response was very silly indeed: “Over the course of this Parliament, the government will be spending half a trillion pounds on the National Health Service.”

And it is clearly not enough! How much goes into the pockets of private health bosses?

“The Right Honourable gentleman asks about a process to ensure that people who are receiving NHS treatment are entitled to receive NHS treatment. For many years there has been a concern about health tourism, about people turning up in the UK, accessing health services, and not paying for them.”

No, there hasn’t!

And now the UK Statistics Agency criticises NHS funding figures

“The UK Statistics Authority looked into the prime minister’s repeated use of the £10bn claim after Labour and the British Medical Association complained that the figure was misleading and wrong. It has asked the Treasury to overhaul how government spending on both the NHS and health more widely is presented in order to minimise the risk of further “confusion” about the size of budget rises.

The UKSA’s intervention followed an increasingly public disagreement between May and Simon Stevens, the chief executive of NHS England, over how much extra funding the government had pledged to give the health service over the course of this parliament. May has put the figure at £10bn in the House Commons, a newspaper interview and at the Conservative party conference. She said that sum meant her administration was giving the NHS more money than the £8bn it had asked for in 2014 in order to transform how it works and close a £30bn budget gap by 2020.

Jon Ashworth, the shadow health secretary, accused the prime minister of exaggerating the true sum and using “spin” to try to present the government in a better light over the NHS. Dr Mark Porter, chair of the BMA’s ruling council, had also asked the UKSA to look into May’s claim. …

… The UKSA intends to ask the Treasury to “investigate whether in future they can present estimates for NHS England and total health sending separately. I will also explore with officials producing these figures other ways in which they might ensure clarity around sources, time periods and what is being measured, and in what context, when reporting on the level of increase in real budget allocations to NHS England.”

While Hunt has acknowledged that the £10bn was the budget increases over a six-year period, May has yet to do the same.”

https://www.theguardian.com/society/2016/nov/23/government-scolded-by-watchdog-over-theresa-may-nhs-funding-claims?CMP=Share_iOSApp_Other

National Audit Office slams NHS ” transformation” plans

Owl’s summary: you haven’t done your homework, your models are untested, you don’t understand what you are doing and the NHS is underfunded NOT overspent!

Some quotes:

17. Plans to close the estimated £22 billion gap have not been fully tested.

“The Department, NHS England and NHS Improvement used a financial model to estimate the gap between patients’ needs and resources by 2020-21, and the savings their programmes need to achieve to close this gap. We found limited testing by the Department, NHS England and NHS Improvement of their estimates of how much they expect to generate from their savings programmes.

This raises concerns about whether planned savings can be achieved. For example, plans assume that growth in trusts’ acute activity (including specialised acute services) will be reduced from 2.9% to 1.3% through transformation and efficiency programmes such as Right Care, new care models and the Urgent and Emergency Care programme. However, NHS statistics show this will be challenging as hospital admissions, a key driver of activity, grew by 2.8% a year between 2013-14 and 2014-15 (paragraphs 2.4 to 2.7).”

18. The NHS is implementing its plans to make the NHS financially sustainable from a worse than expected starting point.

Plans to achieve financial sustainability were based on trusts ending 2015-16 with a combined deficit of £1.8 billion. The fact that trusts ended the year with an even larger deficit means that the level of deficit to be recovered is significantly greater than expected. This means that the trusts affected will need to catch-up by making more savings than planned to reach the intended starting position. For example, trusts with deficits greater than expected at the end of 2015-16 will need to make operational efficiencies above the 2% savings level applied to all providers of healthcare services in 2016-17 or subsequent years (paragraphs 1.8 and 2.8).

19. National bodies have not assessed the impact of all the wider cost pressures faced by local NHS organisations in plans for achieving financial sustainability.

The Department, NHS England and NHS Improvement expect trusts and commissioners to invest in transformation programmes. But they do not yet know what level of investment is required or whether local bodies will be able to make the changes at the scale and pace needed.

Furthermore, the government has made a commitment that the health and social care system in England will be fully joined together by 2020. We have previously reported that local authority spending on adult social care fell by 10% in real terms between 2009-10 (£16.3 billion) and 2014-15 (£14.6 billion). The accounting officer for NHS England told the Committee of Public Accounts that “over the next two or three years, there is likely to be a widening gap between the availability of adult social care and the need for social care. That, will, inevitably show up as delayed discharges and extra pressure on hospitals.” However, in our review of the plans for financial sustainability, we did not see any estimate of the impact of pressures on social care spending on NHS bodies (paragraphs 2.6 to 2.13).

24. The National Audit Office (NAO) perceives differences in the position articulated by the Department – which views the funding for the NHS as having been adequate over the last few years, and in line with what NHS England set out it would need to deliver the NHS Five Year Forward View – and NHS England itself. Confronted as NHS England is by the pressures of rising demand for services, these signs of differences do not help build a confident feel about the future of the NHS.

https://www.nao.org.uk/report/financial-sustainability-of-the-nhs/

Japan: commit crimes to get the ultimate social care – special prisons for elderly

Japan has the largest population of people over 65 (25%). All sorts of theories about why the elderly are committing more major and minor crimes but an interesting point made about those imprisoned for their crimes:

Thousands of [elderly people] are winding up in prisons. National police figures for 2015 show the number of people age 65 and older arrested for criminal offenses makes up 20 percent of all arrests, which totals nearly 48,000.

The Japanese government is spending tens of millions on constructing prison wards specifically designed to cater to a growing number of elderly inmates. But Shinko warns that nicer prison facilities might have the opposite effect of deterring crime.

If you steal and get away with it, you end up with free groceries or money.
But “If you are arrested, you still get a roof over your head, you’re fed three times a day and you get health checkups. So it’s sort of a win-win situation either way,” says Shinko.

It’s a vexing policy problem for Japan, and a glimpse of yet another difficult challenge as more and more of its population ages past retirement.”

http://www.npr.org/sections/parallels/2016/11/22/500040363/golden-years-iron-bars-japan-sees-rise-in-crime-by-the-elderly

About ….. turn! Councillors doing contortions?

With the proposal to severely cut community hospital beds and totally close some community hospitals (Owl STILL insists a ” community health hub” with no beds is NOT a hospital) comes some interesting behaviour from majority party councillors in East Devon.

For example”

Suddenly, they have become “experts” on consultation, loudly stating that the CCG consultation is “flawed” because users of NHS services were not consulted.

They check numbers and find some don’t add up and some are missing.

They ask for “more evidence” on some of the CCG’s wilder claims.

They suddenly discover their voices and some, who have been mute for many a long month or even years, decry the whole project – even though their own party is 100% responsible for it.

They complain bitterly about the amount of money spent on so-called consultants who seem ready to tell the CCG what it wants to hear – for a price.

Well, councillors, welcome to our world – the world of residents battling some of YOUR sillier decisions (so many of them) and profligate spending. Now YOU know how WE feel – if only for a fleeting moment and because it is YOUR health and YOUR families that will suffer from these decisions. Especially as so many of our majority councillors are of the age and lifestyle that often makes most demand on community hospital services.

Just one caveat: Councillor Leader Diviani HAS stayed true to his principles and has tacitly agreed to CCG proposals to close Honiton hospital – having not spoken out AND voting against the motion from Councillor Claire Wright at DCC to “stop the clock” on the plans until Honiton and Okehampton hospitals (both due to close under CCG proposals) could have their viability assessments checked and included in the plans.

Expect some rousing speeches when the head of the CCG comes before the EDDC Scrutiny Committee on Thursday this week at 6 pm. But do watch out for any majority councillors crossing their fingers behind their backs.

Yes, welcome to our world indeed – if only for a very short time.

Services outsourcing firm to drop health care and concentrate on commercial cleaning

“Mitie has published its second profit warning in two months after the outsourcing company’s customers continued to reduce spending due to rising costs and economic uncertainty.

The company also said it would withdraw from its healthcare business, which provides home care for the elderly. The £128m cost of writing off the business drove Mitie to a £100m pre-tax loss for the first half of the year. …

… Mitie put its healthcare division under review in September and will now look for a company to take over the business or allow its contracts to wind down. Local councils have been seeking price cuts from the loss-making business, prompting Mitie to conclude it was unviable.”

https://www.theguardian.com/business/2016/nov/21/mitie-withdraws-healthcare-second-profit-warning-shares

One-third of doctors say they have not heard about projected NHS cuts!

Are they all working so hard they have no time to read newspapers?

“The BMA, which today reveals the £22billion spending shortfall, said a survey found two-thirds of doctors had no input in the plans and a third had not even heard of them.

Its council chairman Dr Mark Porter added: “Given the scale of the savings required, there is a risk these plans will be used as a cover for delivering cuts… starving services of resource and patients of vital care. It is extremely concerning that the majority of doctors have not been consulted on the plans, particularly as ministers have been so keen to insist that all ­stakeholders would be involved.”

The Lib Dems demanded an urgent £4billion cash injection for the NHS and social care services to stop the crisis getting worse. Health spokesman Norman Lamb said: “NHS and care services are on the precipice as we approach the winter months.

“Waiting lists are growing, deficits hit record levels this year and staff are under unsustainable pressure.

“In social care, thousands of people are seeing services withdrawn and 15-minute visits have become the norm as councils struggle to make ends meet.”

A report by health think-tank the Kings Fund blasted the secrecy surrounding the Sustainability and ­Transformation Plans, which are being finalised by health chiefs around the UK.

Cheshire and Merseyside is one of the largest affected areas. Three hospitals could be axed and “merged” on to a single site to plug its black hole. Birmingham and Solihull trusts face a £712million ­shortfall, putting services at risk of closure.

Somerset’s two main hospitals in Yeovil and Taunton may merge key departments including cancer and maternity wards. In Berkshire, Oxfordshire and ­Buckinghamshire, bosses are planning to cut the staff payroll by £35million to help meet a £479million deficit.

It is a similarly depressing story in most other regions as Tory austerity continues to batter services, morale and patient safety.

But NHS medical director Professor Sir Bruce Keogh insisted: “We are talking about steady incremental ­improvement, not a big bang, tackling things doctors and nurses have been telling us for years.”

The Department of Health added: “The NHS already has its own plan, designed by NHS leaders, which sets out how we can transform services and improve standards of care in building a more responsive, modern health system.”

http://www.mirror.co.uk/news/uk-news/secret-plan-22billion-nhs-cuts-9299803

Daily Telegraph says street protests could reduce NHS bed losses

The Labour Party has a national day of action on Saturday 26 November 2016.
Devon has a county-wide non-political protest (“Draw a Red Line”) on Saturday 3 December midday Bedford Square, Exeter (see above for information)

Hospital closures planned to shore up NHS finances could be derailed if enough people take to the streets in protest, a health service chief has said.

Chris Hopson, leader of England’s hospitals sector, said public unrest and opposition by local MPs could scupper so-called Sustainability and Transformation Plans (STPs), which are billed as crucial to the long-term viability of the health service.

On Monday the respected think tank The King’s Fund heavily criticised health bosses for trying to organise the sweeping closure of hospitals and NHS units in secret, moves which it said could put lives at risk.

Yesterday Mr Hopson, Chief Executive of NHS Providers, said architects of the schemes were so far failing to engage local communities, which “have the ability to sink plans they don’t support”.

“It’s very difficult for the NHS to proceed with wholescale change if you’ve got people out on the streets marching with placards and banners and saying “don’t do this”,” he said.

“Fundamentally you can’t make big changes to service provision without taking local people with you.”

The plans follow an admission in May that the provider sector overspent by a historic £2.45 billion in the last financial year.

The country has been divided into 44 areas, with each ordered to come up with a proposal that both closes the gap and caters for booming patient demand.

So far the plans involve the closure of one of five major hospitals in South West London, an A&E unit in the North East of England, the loss of almost 600 beds in Devon and the possible closure of two A&E units in St Helens and West Lancashire.

Mr Hopson yesterday said unit closures were too widely being regarded as a “silver bullet” to make the “overambitious and undeliverable” plans conform to tight budgets.

“We have become obsessed by the money and not got the public engagement right,” he said.

“We are also trying to do it too quickly.”

But Sir Bruce Keogh, the NHS medical director, has this week there was “plenty of time” for the public to shape the changes.

NHS cuts on EDDC scrutiny agenda – 24 November 2016, 6 pm

The full consultation document begins on page 9:

Click to access 241116-scrutiny-agenda-combined.pdf

Ottery St Mary NHS cuts public consultation meeting, 29 November, King’s School, 6 pmh

There will be a public meeting at the King’s School in Ottery St Mary on Tuesday 29 November, to consult residents on plans to shut 72 community hospital beds in Eastern Devon – and on introducing a new model of care on looking after more people in their own homes.

Last year NEW Devon Clinical Commissioning Group made a decision to shut all the general medical beds at Ottery Hospital as well as Crediton and Axminster. We now have 15 temporary stroke beds at Ottery but they are set to transfer to the RD&E in due course.

The CCG was not planning to hold a meeting in Ottery but myself, Cllr Elli Pang and Ottery Town Council all wrote requesting that a meeting be held in the town to update people on the new model of caring for people in their own homes and what plans there are for the hospital.

The meeting at the King’s School is from 6-8pm on Wednesday 29 November.

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

The REAL-LIFE Devon NHS cuts

“The proximity of North Devon district hospital to Anne-Marie Wiles’ home – it is less than five minutes away – is crucial.

Her twin sons, Jed and Peirce, were given just six months to live after being born with multiple complex health needs. They are now doing well, aged 16, thanks in large part to the efforts of a loving family, but also the dedicated staff at the hospital in Barnstaple.

“I intentionally live opposite the hospital because when the boys stop breathing there is not enough time to call an ambulance,” said Wiles. Jed has been resuscitated three times at the NDDH and both have been nursed countless times at the Caroline Thorpe children’s ward.

“If these services end then my boys will for certain die once they become ill,” said Wiles. “I am fearful of losing my children.”

She is one of thousands who have joined marches, written to local MPs, organised benefit gigs, signed petitions over the Wider Devon STP – sustainability and transformation plan – which is proposing radical changes to healthcare in the county.

If the plan comes to fruition in its present form, 600 community and acute beds across this sprawling, largely rural county will be gone within five years.

Cherished community hospitals at Honiton in the east – nicknamed the Honiton Hilton because it so beloved – Okehampton in central Devon and Paignton and Dartmouth in the south would go. There have been howls of protest everywhere – but nowhere more than in and around Barnstaple.

Here there is deep alarm that the plan may lead to the shutting down of maternity, neonatology and paediatric services as well as triggering the loss of other departments, including A&E. The Royal Devon and Exeter hospital is 50 miles away – an hour and 10 minutes by car down a winding road if conditions are good, much more if not.

Tina Day’s son, Jaiden-Lee, was born at the NDDH with a collapsed lung and spent a week in the special care baby unit for a week before developing type 1 diabetes. “It terrifies me if services like maternity and A&E are re-located. People will die, guaranteed,” said Day.

John Tate claimed his wife and daughter would both have died had the NDDH not been near. “My daughter had her umbilical cord wrapped around her neck. She had breathing problems and was trapped head down. This caused my wife life-threatening problems. An emergency cesarean saved their lives. Both would have died if Barnstaple was not there.”

Crystal Steinberg said the closure of the maternity department would make her think twice about having a second child. She underwent an emergency caesarean section because her unborn baby, Dylan, was in distress. “I do not want to be stranded at the side of the road while my uterus ruptures and my baby and I die.”

It is not just mums who are worried. Tracy, 46, suffers from a mental health condition that leaves her suicidal. “I have been to A&E three times this month after being picked up by police.” Should the A&E close she believes she would be held in a cell or have to head to Exeter. “I’d have no way of getting there but to walk or hitch. Both are a scary.”

Jacob Egan, seven, was so concerned when he got wind of the proposals that he dictated a letter to Theresa May. He has brittle asthma, which can result in severe attacks, and has been admitted to the NDDH around 10 times.

“Dear prime minister,” he said. “Just think about it, every time any child in our area of north Devon needed to go to hospital they would have to go to Exeter. Exeter is a long distance away and if your heartbeat stopped you couldn’t just wait for a train or car to get you there.”

At the heart of the plan is a “new model of integrated care” that will “reduce reliance on bed-based care and enable people to live healthy independent lives for longer, closer to where they live”. In other words the idea is to look after people at home rather than in hospital.

According to the latest draft of the report, which is up for consultation, every day more than 600 people in Devon are medically fit to leave hospital beds but do not.

The plans argues change must take place. Health and social care services in Devon are likely to be £557m in deficit in 2020/21 if nothing is done, the plan says. It also says the system as it stands isn’t working. The 95% standard for patients being seen in A&E within four hours is not being met – the Devon system is currently achieving 91.6%.

Devon’s demographics also have to be taken into account. There are more elderly people here than in other parts of the UK – in one area of Torquay almost one in 10 are aged over 85. Some need a lot of care – in north, east and west Devon, 40% of people use almost 80% of health and social care.

Angela Pedder, lead chief executive for the plan, said she understood people’s concerns. “But if we sit back and say let’s just let things happen, that’s a much bigger risk not just for the whole of Devon.

“We have to be pro-active. We have responsibilities to make sure the service is safe and sustainable two, five, 10 years down the line. That’s what we’ve got to plan for. That’s the framework we are trying to put in place.”

Politicians, activists and patients are not impressed.

The East Devon Tory MP Hugo Swire said: “We are in danger of putting the cart before the horse. Until we can absolutely ensure that we have got social care right, we should not look at unnecessarily closing community beds.”

Jan Goffey, the mayor of Okehampton, called the proposals cruel and claimed the NHS was being “dismembered”. If the people who actually live in Barnstaple are worried, those that live even further north – and so even further from Exeter – are even more concerned.

Sarah Vander, who runs a shop in the cliff-top village of Lynton, 20 miles north-east of Barnstaple, said her mother had been saved from a stroke and her husband from a diabetic hypo – a drop in blood glucose level – because they got to the NDDH quickly. “We are incredibly remote and we must be able to rely on the excellent services of NDDH otherwise the simple fact is, people will die unnecessarily.”

The seaside town of Ilfracombe, 12 miles north of Barnstaple, suffers a double whammy. The town is isolated and some areas are deprived: life expectancy in central Ilfracombe is 75 compared with 90 in parts of east Devon.

Rebecca McGarry, from Ilfracombe, the mother of daughters aged two and three, said she felt sick thinking about the prospect of losing services. Both her children have received excellent treatment in Barnstaple including for severe croup, which makes it difficult for them to breathe.

McGarry’s husband is a carer and needs the car for work so she often has to take her children to the hospital on the bus. “I honestly don’t know how we would manage if these appointments were moved even further away. The idea that such a remote region should lose these vital services is totally absurd. People will lose their lives if these closures do happen.”

https://www.theguardian.com/society/2016/nov/18/nhs-cuts-in-devon-if-these-services-end-my-boys-will-for-certain-die

Two tier social care: rich and cared for or poor and neglected, says Conservative council leader

“A Conservative council leader says dozens of social care providers are cancelling contracts with local authorities and instead offering their services solely to wealthy private clients.

Izzi Seccombe, who is the Local Government Association’s spokesperson for social care, said the chancellor needed to take urgent action in the autumn statement to tackle a growing crisis in the sector.

She told the Guardian that a failure by Philip Hammond to plug a multibillion-pound financial black hole would result in elderly and disabled people no longer receiving help to get dressed, showered and fed.

“The challenge is we are underfunded and the concern is that if we cannot bridge those gaps with some funding through the autumn statement, we will not be able to address the needs of people who are vulnerable,” said Seccombe, the Tory leader of Warwickshire county council. She said people would instead have to turn to their GPs or local hospitals for help, resulting in a larger cost to the taxpayer in the long run.

Her comments come alongside a written warning to Hammond that councils across England and Wales are facing a £5.8bn funding gap by 2020. A document submitted by the LGA suggested there would be a serious squeeze on spending for social care, children’s services, homelessness, local parks and libraries. …”

https://www.theguardian.com/society/2016/nov/18/care-providers-shunning-local-authorities-tory-councillor-claims

Public authority accountants not impressed with ” transformation” plans

“Some sustainability and transformation plans are unrealistic and lack substance, a CIPFA (Chartered Institute of Public Finance and Accountancy) analysis has revealed.

The institute examined nine published STPs, of the 44 currently being developed in England. They aim to improve services and reduce cross by ushering in a cross-systems approach to health and social care.

But CIPFA said some of the plans failed to set out a credible case on deliverability. In particular, they failed to quantify some of the risks of additional pressures that may emerge and of savings not being delivered.

In some cases savings targets are over-optimistic as savings as the targets lack context.

CIPFA is urging more contingency planning to ensure the STPs are achievable as well as greater use of integrated working and a cross-sector approach to social care pressures.

Commenting on the findings, CIPFA chief executive Rob Whiteman, who chairs the North East London STP, said: “In order to improve care for local communities, STPs will have to make tough choices to deliver meaningful change.

“However, it is of vital importance that STPs fully assess whether the actions proposed can actually meet savings targets and boost the quality of services by doing robust financial planning. …”

http://www.publicfinance.co.uk/news/2016/11/some-sustainability-and-transformation-plans-unrealistic-says-cipfa

“Promised £8bn extra for NHS is not enough, says hospitals boss”

Theresa May will have to rip up the government’s financial plans for the NHS and commit more than the promised £8bn extra by 2020, a hospitals boss has said.

Chris Hopson, the chief executive of NHS Providers, said ministers must come up with a new plan to fix the health service’s crumbling finances or risk it becoming unable to function properly.

In a submission to the Treasury before next week’s autumn statement, NHS Providers, which represents 96% of NHS trusts in England, says a rethink is necessary because the calculations underlying the government’s £8bn pledge are flawed.

It says demand for care is rising faster than envisaged in the blueprint drawn up by NHS bosses in 2014, the Five-Year Forward View, and social care has deteriorated.

Hopson said: “Some of the key assumptions in the Five-Year Forward View, on which the current financial and NHS delivery plans for this parliament are based, have turned out to be wrong. There is now a clear and widening gap between what is being asked of the NHS and the funding available to deliver it.

“The NHS simply cannot do all that it is currently doing and is being asked to do in future on these funding levels.”

Andrew Lansley, the health secretary from 2010 to 2012 in the coalition government, recently said the NHS needed a “Brexit bonus” of £5bn on top of the £8bn already pledged, given the widespread public demand for higher NHS funding revealed by the EU referendum.

NHS Providers does not specify how much more it wants invested. But Hopson said more than £8bn was justified because “demand for care is a lot higher, social care is in a much worse state, general practice is turning out to be more unstable, and the starting point for the deficit among hospital, mental health, community and ambulance trusts has turned out to be much larger.”

He said the overall health budget would go up by only £4.5bn by 2020, not the £8bn ministers pledged last year, because money was being taken from key areas such as public health in order to give the NHS its promised increase. Independent experts agree £4.5bn is the true increase that healthcare will get.

The NHS’s inability to deliver the £22bn of savings it had promised to make by 2020 – a target that had always been “too ambitious” – further underlined the need for more money to be found before the end of this parliament, said Hopson.

May has been under pressure recently over her repeated claims that the government is giving the NHS £10bn more, and more than the NHS England chief executive, Simon Stevens, asked for in 2014. Sarah Wollaston, the Conservative chair of the Commons health select committee, and other members of the committee wrote to the chancellor Philip Hammond to say the claims were untrue. Labour has asked the UK Statistics Authority to rule on whether the £10bn claim is justified.

Jeremy Hunt, the health secretary, has subtly distanced himself from the £10bn figure and said the NHS will need a lot more money after 2020, at the end of its unprecedented decade-long budget squeeze.

Ministers have already told Stevens that the NHS will not receive a funding boost in the autumn statement. But NHS and local council leaders hope the chancellor may find some extra money to prop up the ailing social care system.

“NHS funding increases from next year onwards are not enough to maintain standards of care, meet rising demand from patients and deliver essential changes to services,” said Richard Murray, director of policy at the King’s Fund thinktank.

“If additional [NHS] funding is not forthcoming later in the parliament, the government will need to be honest with the public about the impact on quality of care and access to services.”

The Department of Health did not respond directly to Hopson’s comments. A spokesman said: “This government has taken tough economic decisions that have allowed us to invest in our NHS, which is meeting record patient demand whilst improving standards of care. We have prioritised funding for the NHS with £4bn extra this year.”

https://www.theguardian.com/society/2016/nov/17/promised-8bn-extra-for-nhs-is-not-enough-says-hospitals-boss

Sidmouth meeting on NHS bed and services cuts – 9 December 2016 7.30 pm

OUR FUTURE CARE!

Sid Valley patients and carers invite all residents to a public meeting in the Parish Church, Sidmouth Church Street,
on Friday 9th December at 7.30 pm

The Consultation (ending 6th Jan)
“YOUR FUTURE CARE”
proposes closing 600 hospital beds all over Devon, including at Honiton, Okehampton, Seaton, Exmouth, Barnstaple, Exeter and Sidmouth.

Beds have already gone from Axminster, Ottery St Mary, Budleigh Salterton and Torrington – without consultation

Let us talk about this urgently with friends, family, clubs, churches, WI groups, etc. and bring ideas from all in our valley to the meeting on 9th December

For more information call 01395 519292

Health transformation “fantasy”: For Norfolk read Devon and the rest of the country

“… In Norfolk and Waveney, the latest Sustainability and Transformation Plan (STP), under guidance from NHS England, has only been seen by a small group of health chiefs.

It has been kept from MPs, councillors, NHS staff, GPs, unions and some hospital board members.

An initial version of the plan was published in June, which warned there would be a deficit of £440m by 2020 in the NHS and social care budget, if action was not taken.

The plan proposed keeping patients out of hospital by expanding community and social care, but little detail has been given so far about what that action might be or how they hope to save a proposed £160m.

The full STP plans have been published in several areas of the country, but Norfolk and Waveney STP is following NHS England guidance by not making their proposal public yet.

Managing director of Norfolk County Council Dr Wendy Thomson, who is leading on the STP, said their plan was “at an earlier stage in its development compared to many others around the country.”

““Plans are not yet at the point where they have clear messages about things the public want to know”
Dr Wendy Thomson, Norfolk County Council
“Plans are not yet at the point where they have clear messages about things the public want to know,” she said.

“As service plans are developed, EDP readers can be assured that changes will be subject to the right public engagement and statutory consultation.” The Norfolk and Waveney STP is expected to be published in late November, but it is understood there will still be little detail in the document about what health chiefs propose to do with Norfolk an Waveney’s health system to plug the financial blackhole.

North Norfolk MP and former health minister Norman Lamb said there would be little hope of the getting the public involved in the plans if they were presented as a “fait accompli”.

He said he supported the idea of saving money by having more people being cared for in the community and joining up health and social care, but said the idea that hundreds of millions of pounds could be saved through STPs was fanciful.

“It is in the realms of fantasy to imagine this is achievable,” he said. “I don’t think when it is published people will get that excited about it. It will not say anything significant in terms of detail of changes. What lies beyond that is much more disturbing for many.”

Jeff Keighley, Unison regional organiser, said STP leaders should have consulted the public “at the earliest possible opportunity”.

Although the union said it was not against “sustainable transformation”, Mr Keighley said he was concerned the proposals would not be sustainable.

“If they had found a wonderful way of saving this money by enhancing the services it would be amazing – and they would have not been keeping it a secret,” Mr Keighley said. …

… What’s happening in other areas

Some councils have objected so strongly to the lack of public involvement they have ignored NHS England’s demand to keep the documents private until a later stage and have published them on their websites.

The plans on how local NHS areas will move forward over the next five years focus on several key themes.

These include cutting costs, moving care closer to home, putting a greater emphasis on preventing people becoming ill in the first place and concentrating services in a smaller number of units or hospitals.

Some argue this will enable increased access to consultants around the clock and make the best use of specialist NHS staff and resources. There are also plans to streamline back-office functions.

So far, more than a dozen plans have been published or leaked. Here are details from some of the key ones:

•The plan for Durham, Darlington, Tees, Hambleton, Richmondshire and Whitby set out how either Darlington or North Tees could lose their emergency department, with one becoming a “specialist emergency hospital” and another becoming a “local hospital”.

The plan says this will drive up standards, ensure a seven-day consultant presence with at least 16 hours per day consultant specialist access. More than 75% of patients could be assessed by a specialist consultant on admission and 100% assessed within 12 hours by a consultant.

Consolidating these services, together with other departments, could save millions of pounds, the plan said.

•The south-west London document outlines plans to cut the number of acute hospitals on the patch from five to four. Currently there are five hospitals at Croydon, Epsom, St Helier, St George’s and Kingston.

The plan says: “The only site which we believe is a ‘fixed point’ is St George’s Hospital in Tooting since it provides hyperacute stroke, major trauma and other services which are serviced by highly-specialised equipment and estates, which would be very expensive to re-provide elsewhere in south-west London.”

The document says reduction in sites is necessary to provide seven-day services with enough doctors and consultants – one of Health Secretary Jeremy Hunt’s main aims.

“We are very unlikely to be able to deliver services that meet clinical quality standards across five acute hospital sites. In particular, clinicians do not believe that we will be able to recruit or pay for sufficient workforce to deliver seven-day services at five acute sites.”

•In Birmingham and Solihull, the plan states that by 2021 there could be a deficit of £712 million across the health and care sector if nothing is done to address issues in the local health economy.

It says it will establish a single “lead provider” for maternity care and look to “immediately” implement a shared service for back-office functions across its four main acute providers and create a centralised laboratory for routine pathology work.

There are currently two main providers of maternity care – Birmingham Women’s Foundation Trust and at the Heart of England.

Plans to merge Birmingham Women’s and Birmingham Children’s Hospitals by next year have already been announced while University Hospitals of Birmingham and Heart of England FT announced in September the intention to create a “single organisation”.

•North-west London’s draft STP, seen by the Health Service Journal (HSJ) last month, aims to “consolidate acute services on to five sites” from the current nine.

Two London councils – Ealing and Hammersmith and Fulham – have said they cannot agree to a plan that assumes Charing Cross Hospital will be downgraded.

Stephen Cowan, leader of Hammersmith and Fulham council, said: “At the heart of the STP is an acceptance that Charing Cross Hospital will be demolished and replaced with significantly downgraded facilities, with the capital receipts from the sale of much of the hospital’s land intrinsic to the delivery of the STP. 1/8We are 3/8 strongly opposed to this, and therefore the STP.”

•The Cheshire and Mersey plan includes the downgrade of at least one A&E department along with a major consolidation of elective care.

The A&E at Macclesfield hospital would become a minor injuries unit. According to the Health Service Journal (HSJ), there will be a formal “major service review” at Southport and Ormskirk Hospital Trust, and the document includes options that could reduce the number of 24-hour A&E departments across three acute trusts.

•The north central London document sees officials over the next year examining whether some key services “would benefit from consolidation or networking”.

These services include maternity, out-of-hours emergency surgery, orthopaedics, mental health crisis care and dermatology.

http://www.edp24.co.uk/news/health/bid_to_transform_nhs_in_norfolk_and_waveney_and_save_160m_in_realms_of_fantasy_1_4774673