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17 Nov 2016

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

Is the “Success Regime” really that successful?

From a correspondent:

“I just took a look at the CCG document “Devon Pre-Consultation Business Case” and found the following:

This document says that NHS England has four tests for service reconfiguration, one of which is “Clear, clinical evidence base”. This seems to come from an NHS England document “Planning, assuring and delivering service change for patients” which says the same thing and says that they are “set out in the Government Mandate to NHS England” however I cannot find anything referring to this in “The Government’s mandate to NHS England for 2016-17” and I can’t find any other similar document.

So “Clear, clinical evidence base” seems to have been made up by NHS England, which does go on to say:

“Service reconfiguration must be evidence-based and this evidence should be publicly available during the consultation and decision making stages.

A clear clinical evidence base

This ensures service reconfiguration proposals are underpinned by clear clinical evidence and align with clinical guidance and best practice. Commissioners should oversee the development of the clinical case for change, as part of the outline case. Medical directors and heads of clinical services of any providers involved can help build the clinical evidence base.”

Indeed this document could be very useful as it is some sort of blueprint for what CCGs need to do – and therefore something we can compare the CCG’s plans to.

NEW Devon CCG’s “Clear, clinical evidence base” is the following:

“The clinical evidence is clear that prolonged hospital stay increases long term physical and psychological dependence”

“The clinical evidence is clear that prolonged hospital stay increases long term physical and psychological dependence” a second time

“The Case for Change sets out clearly the evidence on gaps in existing services which we aim to address through the proposed changes. As part of this diagnostic work clinicians have undertaken a detailed review of care models for four groups of high-impact patients, who currently use significant resources in the community. This is based on identifying good practice both nationally and locally. In particular, the development of services in North Devon following development of community health and social care teams to be a single point of co-ordination for people with complex needs and a reduction in community hospital facilities”

Whilst I have not read in detail the N Devon documents that have been circulated, as far as I can tell the N Devon experience cannot genuinely to be considered to be a positive reference, and in any case the evidence linked to in the CCG documents is not “clinical evidence” but is instead a subjective survey of patients asking them whether the administration of their home visits (i.e. bookings, turning up on time) was satisfactory and says NOTHING (and I mean that in absolute terms – nada, zilch, zero, absolutely nothing) about whether the treatment was clinically effective or indeed as clinically effective as hospital care.

On page 89 there is a table which does provide some anecdotal clinical evidence, but there are no links to the underlying evidence (though we might be able to find it to verify that they have used it correctly if we search for it):

However the only evidence above directly relevant to their home-care proposals relates only to one specific type medical condition (total hip and knee replacement), and they then seem to have made a leap of faith that they can apply this to every medical condition which currently results in a stay in hospital beyond the point that hospital medical care is needed.

So it would seem that one target for “consultation feedback” is whether the CCG has met the requirements set by NHS England for a “Clear, clinical evidence base” that shows that their proposals are 1) effective and safe when considered alone, and 2) are at least as effective and safe as hospital care.

Another target for “consultation feedback” is to look at all the other areas defined by NHS England that the CCG has to meet, and see whether they have in fact done so.”

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17 Nov 2016

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“Elderly failed by ‘shameful’ care system”

“Age UK and the Alzheimer’s Society criticised both the quality of care and the way it was rationed as they published fresh evidence on the state of the care sector.

It includes figures that suggest the number of older people not getting help has risen by nearly 50% since 2010. …

… three pieces of research showed:

There are now an estimated 1.2 million over-65s going without help for care – nearly one in eight of all older people

Some 300,000 of them have difficulty with three or more tasks, including dressing, bating and going to the toilet

Councils agreed to help under half the 1.3 million people who approached them for care last year

The BBC identified 11 councils that rejected more than 75% of applications
Where home care was provided “serious problems” were identified in the way dementia patients were treated

Staff said they had not been given enough training to cope with the complex needs people had

Families reported examples of poor care, including loved ones not being given medication, being left in dirty clothes for days and going missing after homes had not been properly secured

Caroline Abrahams, of Age UK, said she was “extremely worried” about the “shameful” state of the care system.

“The sad irony is that it would be far more effective as well as infinitely more humane to give older people the care and support they need,” she said. …

…Councillor Izzi Seccombe, of the Local Government Association, said: “Unless social care is properly funded, there remains a growing risk to the quality and safety of care, and the ability of services caring for our elderly and vulnerable to meet basic needs such as ensuring people are washed and dressed or helped out of bed.”

http://www.bbc.co.uk/news/health-37992488

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15 Nov 2016

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

Telegraph: “Secret plans to shut hospitals could put lives at risk, say doctors”

“STEALTH NHS plans for sweeping closures of hospitals and accident and emergency departments are “potentially catastrophic” and could put lives at risk, leading doctors have said.

The warning came as a major report by the King’s Fund lambasted health officials for ordering the suppression of proposals that will affect millions of people.

The respected think tank suggests the plans – being drawn up behind closed doors in every part of England – may be doomed to fail patients.
Secrecy about the process, combined with “breakneck” timescales and a lack of funding for new services means patients could bear the brunt of brutal cuts, they suggested.

Two weeks ago, The Daily Telegraph disclosed that half of NHS leaders are planning bed cuts, with one third intending to close accident and emergency departments.

It follows orders to produce “sustainability and transformation plans” (STPs) to tackle the greatest financial crisis in the history of the NHS and meet unprecedented patient demand.

On the critical list:

Some of the plans floated so far

♦ South West London: closure of one of five major hospitals
♦ North West London: closure of two A&E units
♦ North East: Darlington Memorial Hospital or North Tees Hospital to lose A&E unit
♦ Devon: cuts to almost 600 beds, with the loss of maternity and paediatric services from north Devon site
♦ Cheshire and Wirral: downgrade of at least one A&E department
♦ St Helens and West Lancs: possible closure of two A&E units

The country has been split into 44 areas, with each told to produce proposals to balance the books and change the way care is delivered.
NHS leaders have pledged to shift more care into the community, and to strengthen GP services, in efforts to boost health.

But cost-cutting has now taken precedence in many of the plans, the head of the King’s Fund warned. Today’s report criticises NHS England for telling local leaders not to publish plans until the details have been checked by senior officials.

In recent days, increasing numbers of NHS bodies and councils have broken ranks, publishing or leaking documents that set out plans for major changes to their services, arguing that the public deserves honesty.
The plans issued so far warn of the closures of whole hospitals as well as A&E and maternity units.

The King’s Fund criticised health officials for keeping patients in the dark, warning that the public has been “largely absent” from debate.
As well as telling local NHS managers not to publish their proposals, health officials also told them to block Freedom of Information requests seeking the information, the report says.

“National NHS leaders wanted to be able to ‘manage’ the STP narrative at a national level – particularly where plans might involve politically sensitive changes to hospital services,” the report says.

Local managers in the study said the approach was “ludicrous” and meant that controversial plans were being drawn up with no local involvement – which was likely to end in a “massive fight.”

Dr Tajek Hassan, president of the College of Emergency Medicine, said: “Secretly producing plans without involving those who are – or should be – at the heart of the NHS; the patients, is wholly unacceptable and will not result in effective or sustainable services.

“Transparency is also needed to address the current speculation regarding the potentially catastrophic closure of emergency departments, which – if true – would only add to the substantial difficulties emergency medicine faces and put lives at risk.”

Chris Ham, chief executive of the King’s Fund, said the NHS had been told by Government that “we don’t want too much noise” about the controversial plans.

Sir Bruce Keogh, the NHS medical director, said changes were needed to meet the needs of the country’s ageing population, and to ensure specialist care was available round the clock.

“We are talking about steady incremental improvement, not a big bang. If we don’t, the problems will only get worse,” he said. ”

http://digitaledition.telegraph.co.uk/editions/edition_1mboe_2016-11-14/data/239163/index.html

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15 Nov 2016

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“Fears that secretive NHS reforms will put savings before patients”

“Widespread bed cuts, closures of accident and emergency units and even shutting hospitals have been proposed by NHS bosses

A “secretive” plan to reorganise the NHS risks failing patients, a report warns.

Widespread bed cuts, closures of accident and emergency units and even shutting hospitals have been proposed by NHS bosses who are often more focused on saving money than improving care, the King’s Fund think tank says.

Simon Stevens, head of NHS England, has conceded that managers in many areas are not up to the job of implementing his vision for the health service and is warned today that it risks failure in most of the country.

Mr Stevens is attempting to undo Andrew Lansley’s 2012 NHS reforms without the need for another structural reorganisation, and has divided England into 44 areas where local bosses have been told to come up with “sustainability and transformation plans (STPs)” to move care closer to home.

He insists that doing more in local clinics will keep older people with long-term illness out of hospital. The report published today endorses that aim, but says that STPs are the “right thing being done badly”. Short-term savings are being prioritised over long-term improvements as the NHS faces a £22 billion black hole by 2020, it says.

Plans have been drawn up behind closed doors with patients “largely absent” and with little input from frontline staff, the King’s Fund says. Uncertainly over accountability for the plans is hampering the ability to get anything done, it adds. Chris Ham, chief executive of the fund, estimated that a third of plans were likely to succeed, a third had little hope and the rest would need more help.

“I don’t think the deliverability of STPs is something we can be confident about,” he said. “If STPs do not work then there is no plan B.”

Katherine Murphy, chief executive of the Patients Association, said the plans were “more about saving money”, adding: “They cannot axe services in a secretive way and expect the public to be happy.”

Professor Ham said that cutting hospital services was unlikely to work without money for local clinics to replace them. “GPs and district nurses are under massive pressure. It’s unrealistic to expect them without more staff and resources to take on more of the workload,” he said.

About a quarter of the plans have now been published or leaked and many include centralisation or shutting hospital units or cutting beds. In southwest London, one of Epsom, St Helier, Kingston and Croydon hospitals would be shut entirely.

Taj Hassan, president of the Royal College of Emergency Medicine, said that shutting A&E units would be “potentially catastrophic” and put lives at risk. “Furtively producing plans without involving patients is unacceptable,” he said.

Mr Stevens has acknowledged problems, telling NHS bosses last week that councils might need to take over from health service managers. “In some parts of the country the reality is we are short of leadership that is capable of engaging in the task ahead,” he said.

Sir Bruce Keogh, medical director of NHS England, insisted the plans would be “making it easier to see a GP, providing more specialist services in people’s homes, speeding up the diagnosis of cancer and offering help faster to people with mental ill health”.

He conceded that “to realise these benefits some communities might need to make choices about where to put resources and the NHS will need to be clear with the public about the options” but argued: “Claims of secrecy have been overtaken by the fact that we’ve asked that all STPs are now published over the next few weeks.”

Analysis

Most patients would agree that it makes more sense to keep elderly patients well at home rather than letting them tip into crisis and have to go to hospital (Chris Smyth writes).

In essence, this is what Simon Stevens’s “sustainability and transformation plans” are trying to achieve: getting the local NHS to pay more attention to preventing illness, improving mental health and working with social care.

Of course, it is not quite that simple. Nothing brings patients out on to the streets faster than plans for hospital closures. When Theresa May met Mr Stevens for the first time, she warned him not to use the threat of closures as a weapon to try to prise extra cash out of the government.

Often, there are good clinical reasons for shutting poorly performing units. But when so much emphasis is put on saving money, many in the NHS understandably fear this will mean cost-cutting masquerading as better care.

Among the possible cuts…

Southwest London One of St Helier, Epsom, Kingston or Croydon hospital to shut.

Northeast Stockton or Darlington could lose A and E.

Devon Cut 600 hospital beds and A and E, maternity, stroke and children’s services are deemed “not sustainable”.

Northwest London Ealing and Charing Cross hospitals to be downgraded.
Merseyside Merger of four Liverpool hospitals.

Cheshire Downgrade Macclesfield A and E.”

Source:Times (paywall)

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14 Nov 2016

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

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Don’t ask NHS employees or patients what’s wrong – ask consultants (in secret)

“NHS plans that could lead to hospital and A&E closures have been kept secret from the public and barely involved frontline staff, a thinktank has said.

NHS England has told local health leaders not to reveal the plans to the public or the media until they are finalised and have been approved by their own officials first, according to published documents and a new analysis by the King’s Fund.

The national body even told local managers to refuse applications from the media or the public to see the proposals under the Freedom of Information Act.

Local managers accused NHS England of being intent on “managing the narrative” about the plans.

The sustainability and transformation plans (STPs), some of which have been published or leaked, could see some hospitals, A&E units or maternity units close, and other services merged.

The proposal for Cheshire and Mersey includes the downgrading of at least one A and E department, while in south-west London the number of acute hospitals could be cut from five to four.

In north-west London there are plans to reduce the number of sites offering a full range of services, while Birmingham and Solihull’s STP proposes a single “lead provider” for maternity care.

NHS England and some health experts say the changes will improve patient care and are necessary to fulfil the plan of the health secretary, Jeremy Hunt, for full seven-day services. Opponents argue they are just a way of cutting services.

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

The report from the King’s Fund, based on a review of plans and interviews with local managers, says NHS England set very tight timescales, which is partly to blame for patients and doctors being shut out.

Expensive management consultants have been brought in but clinical teams and GPs have often been only “weakly engaged in the process”, it says.

The report says: “It is clear from our research that STPs have been developed at significant speed and without the meaningful involvement of frontline staff or the patients they serve … Patients and the public have been largely absent from the STP process so far.”

One local manager said of the lack of public involvement: “I’ve been in meetings where I’ve felt a little bit like, you know, where are the real people in this?” Another described the secrecy demanded by NHS England as “ludicrous”.

The report says: “As well as the timeline creating a barrier to meaningful public engagement, national NHS bodies had also asked STP leaders to keep details of draft STPs out of the public domain. This included instructions to actively reject Freedom of Information Act requests (FoIs) to see draft plans.”

On management consultants, the report says some leaders “felt that STPs had ‘created an industry’ for management consultants – and questions were raised about why money is being invested in advice from private companies instead of in frontline services”.

However, the King’s Fund said STPs still offered the “best hope” of improving health and care services.

Sustainability and transformation plans are ‘least bad option’ for NHS
Chris Ham, chief executive of the thinktank, said: “The introduction of STPs has been beset by problems and has been frustrating for many of those involved, but it is vital that we stick with them.

“For all the difficulties over the last few months, their focus on organisations in each area working together is the right approach for improving care and meeting the needs of an ageing population.

“It is also clear that our health and care system is under unprecedented pressure and if STPs do not work then there is no plan B.”

Ham said it was a “heroic assumption” to say out-of-hospital services and GPs could take on more of the work currently done by hospitals, given how under pressure they were.

He said there was “mixed evidence at best” that moving services closer to home improved care.

The NHS medical director, Prof Sir Bruce Keogh, defended the plans. “Advances in medicine mean it is now possible to treat people at home who would previously have needed a trip to hospital. It also means those with the most serious illness need to be treated in centres where specialist help is available around the clock,” he said.

“So this is not a moment to sit on our hands. There are straightforward and frankly overdue things we can do to improve care. We are talking about steady incremental improvement, not a big bang. If we don’t, the problems will only get worse.”

http://www.theguardian.com/society/2016/nov/14/patients-and-staff-shut-out-of-nhs-transformation-plans-says-thinktank?CMP=Share_iOSApp_Other

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13 Nov 2016

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Health and Social Care (local)

Care at home? Good luck with that!

A report on the national care company Mears and its operation in Torbay:

“”It [also] highlighted a growing breakdown in the carer-service user relationship – the basis of trust and wellbeing – largely due to the miscommunication and lack of empathy from Mears office staff.”

Examples reported by clients include:

Not knowing who will visit and at what time. One client said: “We are never informed when changes are made and when we do have a rota late arrivals are always blamed on “sickness”,”

Care workers are always rushed and not always prepared or provided with adequate client information.

Clients have to instruct care workers what is required during their visits.
Inexperienced and inadequately trained care workers unable to undertake basic tasks.

Lack of understanding in administering medication at the correct times.

Clients at risk due to minimal reference to Clients’ Care Plans.

Clients’ and family members’ concerns aren’t being listened to.

Clients have lost faith and confidence in the support being provided by Mears.Staff reported demoralisation through reduced job satisfaction and concerns for clients’ safety.

Staff in turn reported demoralisation through reduced job satisfaction and concerns for clients’ safety.

These are the report’s main conclusions:

A lack of continuity in care and inadequate response to complaints or concerns from Mears’ office staff are common themes to the feedback.

The majority of clients highlight care workers arriving at the wrong times, or, in the worst cases, not arriving at all. There appears to be an ‘erratic rota system’.

A common complaint is that same-sex care workers were requested but the requests were ignored.

A lack of ‘familiar’ faces causes concern especially for those with dementia.

Inconsistency of rotas having too many ‘unallocated’ slots together with ‘poor’ communication, leading to stress and anxiety for clients and their families.

Many feel that care workers lack ‘appropriate training’ with regard to specific medical conditions and even in such basics as food hygiene.

Many also feel that care workers are often in a hurry to complete tasks.

In particular, both care workers and clients want consistency. Many expressed disbelief at the way the rota system is managed.

Both clients and care workers request that a more consistent and structured approached is used when putting together clients’ rotas, rather than the chaotic and random system currently being experienced.

Further, travel time is part of a carer’s working day and care workers want to be paid for it. (If travel time is included in the wage calculations most care workers are not being paid the minimum wage.)

Evidence collected from current and former staff members of Mears highlighted that they are hugely dissatisfied with the way in which they, and the clients, are being treated, while a typical comment is that the office is not ‘helpful’.

Incomplete Care Plans, together with care workers having insufficient time to read them, impacts on the care needs of the clients, with concerns that complex care is often not met.

New staff are given insufficient support and are leaving due to lack of care in the system.

Care staff feel untrained for the care tasks they are asked to undertake

Healthwatch is recommending an audit of the ways in which Mears complies with National Institute for Health and Care Excellence guidelines. It is sending a formal letter of concern to Mears’ clients and will review the service again in six months to make sure its recommendations have been met.

Mears is a nationwide organisation which provides care for older and disabled people in their own homes.”

http://www.torquayheraldexpress.co.uk/damning-new-report-from-torbay-health-watchdogs-blasts-care-company/story-29891566-detail/story.html

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12 Nov 2016

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

“GP defends plans to cut hospital beds across eastern Devon” – or does he?

Another example of post-truth journalism, this time from the Sidmouth Herald. Under the above quoted headline, this is what the GP ACTUALLY says:

“I share the concern that there won’t be enough provision in the community – that would be my number one concern. We can only reduce beds when we see corresponding change in the community. The timescale will centre on getting the services in place.

“I understand the huge financial pressures within the system, but it’s not in anybody’s interest to do it badly. Getting it wrong will inevitably cost the system a lot more. Moving our services in that direction is the right thing to do and trying to make sure we get the capacity right is very important. It will be a disaster if we do not.”

Dr Mejzner admitted there will always be people who require non-acute hospital care, but argued this could be provided in remaining community hospital beds, or with private sector contracts in nursing and residential homes.

He stressed the importance of responding to the public consultation to inform decision-making and raise issues that might have not been previously considered.

The GP added that if respondents do not agree with any of the four options presented – which each propose bed cuts – it is important that they state why the proposals are wrong in order to help health bosses determine the main concerns and issues.”

http://www.midweekherald.co.uk/news/gp_defends_plans_to_cut_hospital_beds_across_eastern_devon_1_4770586

Does that sound like he defends current bed cuts?

We have no system in place, and very little chance of getting it in place in a largely rural community where the costs will be very high and suitably qualified staff are difficult to find and will become more so with immigration controls.

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11 Nov 2016

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Accountability, Austerity cuts, Health and Social Care (local), NHS (local), Scrutiny, Spin, Virgin Healthcare

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North Somerset and Bath: Goodbye NHS, hello Virgin Healthcare

Set to commence on April Fool’s Day next year

“Sir Richard Branson’s health firm, Virgin Care, has won a £700m contract to deliver 200 types of NHS and social care services to more than 200,000 people in Bath and north-east Somerset.

The contract, which was approved on Thursday, has sparked new fears about private health firms expanding their role in the provision of publicly funded health services.

Virgin Care has been handed the contract by both Bath and North East Somerset NHS clinical commissioning group and Conservative-led Bath and North East Somerset council. It is worth £70m a year for seven years and the contract includes an option to extend it by another three years at the same price.

It means that from 1 April Virgin Care will become the prime provider of a wide range of care for adults and children. That will include everything from services for those with diabetes, dementia or who have suffered a stroke, as well as people with mental health conditions. It will also cover care of children with learning disabilities and frail, elderly people who are undergoing rehabilitation to enable them to go back to living at home safely after an operation.

NHS campaigners warned that the history of previous privatisations of NHS services in other parts of England may mean the quality of care patients receive drops once Virgin takes over.

“This is obviously part of a big push by Virgin to dominate the supply of community health across England. The experience so far from NHS outsourcing is that companies struggle to deliver the level of service that patients need and make a profit,” said Paul Evans, co-ordinator of the NHS Support Federation, which monitors NHS contracts being awarded to firms such as Virgin.

“In too many instances outsourced healthcare has resulted in care being compromised to cuts costs. Patients need secure services that they can trust and rely on,” Evans added.

The collapse of the £725m UnitingCare contract in Cambridgeshire meant Virgin’s newly acquired contract would be the most lucrative ongoing deal for providing NHS care, he said.

Eleanor Jackson, a Labour member of Bath and North East Somerset council, told the Mirror she was “horrified” by the decision. “Make no mistake about it, what has happened here is the beginning of the privatisation of the NHS in this country. Woe betide you getting ill in this area if you are old, disabled or have learning difficulties in the next seven years. It is just a horrifying decision,” she said.

There are concerns that handing the work to Virgin Care will take important income away from the many local NHS, voluntary, charitable and housing bodies that currently provide some of the services. They include the Royal United hospitals Bath NHS foundation trust, Great Western hospitals NHS foundation trust and the Avon and Wiltshire mental health partnership NHS trust. Charities affected include Age UK’s Bath branch and the Alzheimer’s Society.

Virgin will also run the urgent care facility at Paulton community hospital, which is 12 miles from Bath, and subcontract a number of other services to other providers, including the provision of dementia and end of life care and a “hospital from home” service for recently discharged patients.

“I am pleased that we can now start the process of transferring services. Following extensive consultation with local people and a very rigorous procurement process, the CCG board is assured that Virgin Care is the right organisation to deliver the personalised and preventative care that local people have asked for,” said Dr Ian Orpen, the clinical chair of Bath and North East Somerset clinical commissioning group.

“We will be working closely with the council and our new partners, Virgin Care, over the coming months to ensure that services and staff are transferred across safely on 1 April 2017 and to minimise disruption to the care and support that people currently receive.”

A spokesman for Virgin Care said: “We are really pleased to have been chosen by the council and CCG to deliver more joined-up care for people across Bath and north-east Somerset. We have a strong track record over the last decade of overseeing integration and improvement of NHS services across England and we’re looking forward to working with the many outstanding professionals, and a range of great partners, to provide and oversee high quality, easy-to-navigate services which are shaped by the people who use them.”

http://www.theguardian.com/society/2016/nov/11/virgin-care-700m-contract-200-nhs-social-care-services-bath-somerset

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9 Nov 2016

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Accountability, Austerity cuts, Consultation, DCC, EDDC, Health and Social Care (local), Independent Councillors, NHS (local), Paul Diviani, Scrutiny

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Diviani votes against Claire Wright DCC motion to re-examine Honiton hospital closure

Reblogged from the site of Claire Wright, indefatiguable independent councillor fighting non-stop on health service cuts.

NOTE: EDDC Tory Leader Paul Diviani sabotaged her effort to “stop the clock” on cuts to re-examine the effects of closing Honiton and Okehampton hospitals.

REPORT FROM CLAIRE WRIGHT, DCC HEALTH SCRUTINY COMMITTEE

“• CCG does not know how many more staff it needs

• No answer (yet) to public health stated assumption that care at home costs the same as care in big hospitals

My proposal at yesterday’s health and wellbeing scrutiny committee meeting to suspend the consultation which proposes to halve the remaining community hospital beds in Eastern Devon, fell by two votes.

There was a packed public gallery. Several members of the public, including Di Fuller, chair of Sidmouth’s patient and public involvement group and Cathy Gardner, EDDC Independent councillor for Sidmouth spoke powerfully, expressing deep concerns about the bed losses.

Di Fuller said the consultation should be rejected as “invalid.”

Cathy Gardner called on the committee to demand more funding from central government.

Councillors, Kevin Ball and James McInnes from Okehampton made strong representations on behalf of the town relating to the hospital being excluded from the consultation.

(I am part of a sub-committee of health scrutiny that meets tomorrow to scope an investigation into the funding formula for Devon’s health services, which many people, including me believe is unfair, despite the government’s claims that Devon receives more funding than its fair share).

Staff from the NEW Devon Clinical Commissioning Group presented to the committee. They were Rob Sainsbury, Jenny McNeill and GPs – Joe Andrews and Simon Kerr.

We were shown a video of patients happy with the hospital at home scheme which operates in Exmouth and Budleigh Salterton only, as evidence that care in people’s homes work.

This to me didn’t seem to be adequate evidence given that hospital at home is limited to Exmouth and Budleigh Salterton, is consultant led and mirrors the kind of care one might expect in a hospital. It is a good service but expensive to run.

This is not what is being proposed for the remainder of Eastern Devon.

The four presenters tried their best to sell us their new model of care. Some of us weren’t convinced.

Cllr Andy Boyd was critical of the plans and other members asked questions about housing and various NHS procedures.

I asked how many more staff they would need to operate their new system. We heard they needed more “therapy staff” and other disciplines, but not how many more of each. We were told that a staff analysis was currently being carried out.

I said I was surprised that this information was not known, halfway through the consultation, with an expected figure of savings at around £5-£6m. How can the CCG be confident that the new system will save money when basic information is not known, such as how many staff are required?

Under the previous agenda item I had turned to page three of the October 2015 public health acuity audit – a document used by the CCG to back up its case for shutting beds, where it states as an assumption: “Caring for a patient in an acute care setting is either more expensive than, or at least as expensive as, caring for a patient in alternative setting, including at home.”

I asked for a reaction to this statement. Angela Pedder, Success Regime chief, said she would get back to me about it.

It is surprising that in a document the CCG is using to back up its case, where they say caring for people at home will save money, it states that this care costs the same as acute care (such as the care provided at the RD&E for example).

I raised the issue of Devon County Council’s adult social care budget being £5m overspent and how this overspend will need to be brought back to zero by April 2017. This will surely have a potentially significant impact on any NHS care that is provided in people’s homes.

But Rob Sainsbury said that social care packages could be organised in a different way to support care in people’s homes.

I said that earlier NHS (incorrect) statements about a third of community hospital beds not being used has now morphed into third of bed space not being used. If this is the case surely it is due to previous community hospital bed cuts over the years!

And the other CCG claim relating to Eastern Devon having far more beds than other parts of the county is surely because they have been cut in other parts of the county!

According to a public health audit from last year, there are 94 per cent bed occupancy levels in Eastern Devon. They are far from being half empty.

Finally, I raised the issue of a government watchdog – the Independent Reconfiguration Panel – that examined the Torrington Hospital case for bed losses. It stated in its response that communities must feel they have a genuine opportunity to influence the outcome of a consultation.

I proposed that the consultation be suspended while the CCG included both Honiton and Okehampton in the options to retain beds.

The proposal was seconded by Brian Greenslade but unfortunately was lost 5-7.

Instead, chair, Richard Westlake asked for urgent talks between the CCG and Honiton and Okehampton communities.

In other news, two motions calling for more funding to Devon’s NHS and for the Success Regime to be paused, were agreed by the committee and will go before full council in December.

To view the webcast see – https://devoncc.public-i.tv/core/portal/webcast_interactive/244717

To comment on the consultation email: d-ccg.yourfuturecare@nhs.net
The deadline is 6 January.

http://www.claire-wright.org/index.php/post/proposal_to_suspend_plans_to_cut_71_east_devon_community_hospital_beds_fail

Posted by

East Devon Watch

Posted on

8 Nov 2016

Posted under

Accountability, East Devon Alliance, Health and Social Care (local), Neil Parish, NHS (local)

Seaton public meeting on bed cuts: East Devon Alliance asks MP troublesome questions!

“MP Neil Parish came under pressure to oppose the Chancellor’s Autumn Statement unless more money is allocated to the NHS to prevent community hospital bed closures when he attended a public meeting in Seaton on Friday.

The MP would not commit to a “Yes” or “No” answer, and said he is “hopeful” of not having to make that choice.

Having spoken passionately against a proposed reduction of beds in East Devon’s community hospitals at a packed Gateway last Friday, the MP was challenged by Colyton resident and former East Devon Alliance chairman Paul Arnott.

Mr Arnott said: “If in the Autumn Statement later this month more money is not provided [for the NHS], will you vote against that Autumn Statement?”

Mr Parish said he liked the question’s sting in the tail and went on to say: “The answer is that I will very much put pressure on both the Chancellor and the Secretary of State for Health to provide more money for Devon, and I will endeavour to get some more money.”

He stressed he had voted against the government before, and added: “I’m hopeful that we can get them to give some ground, so therefore it won’t put me in the position to have to vote against the government – but if they don’t budge at all, then you might find me in the other lobby.”

The public meeting had been called by Seaton doctors, town councillors and hospital league of friends members concerned about the possible closure of beds at Seaton Hospital.

The meeting was chaired by town councillor Martin Pigott and the panel included, among others, NEW Devon Clinical Commissioning Group (CCG) Chief Officer Rebecca Harriott and Seaton Hospital League of Friends chairman Dr Mark Welland.

Councillor Pigott explained that the purpose of the meeting was “to raise questions and perhaps get answers”.

Currently there are a total of 143 beds spread across eight community hospitals in the area covered by NEW Devon CCG.

But health bosses announced drastic proposals that would see only 72 beds concentrated to three sites, with a shortlist of four options, and launched an ongoing public consultation.

It is this announcement that sparked campaigns around Devon to save the beds.

Mr Parish, for example, was heading to a similar meeting in Honiton straight after the Seaton one.

The CCG needs to save money and also says that many patients lose their independence, and could deteriorate physically if in a hospital bed, so would benefit from being cared for in their homes instead.

Campaigners and the CCG do agree that community hospital beds are needed, but are poles apart when it comes to numbers.

Ms Harriott told the meeting: “We rely on beds far more than other places in the country do.”

The concept of caring for patients at home as opposed to in hospital is being questioned by campaigners, but the CCG says it has evidence from around the UK that it works.

The CCG will have its own consultation sessions in Seaton on Thursday, November 24th. These will also be held in The Gateway, from 2pm-4.30pm and from 5.30pm to 8pm.

The four options presented by the CCG are:

Option A Beds at Tiverton (32), Seaton (24) and Exmouth (16)
Option B Beds at Tiverton (32), Sidmouth (24) and Exmouth (16)
Option C Beds at Tiverton (32), Seaton (24) and Exeter (16)
Option D Beds at Tiverton (32), Sidmouth (24) and Exeter (16).
A petition organised by the meeting organisers, supporting Option A, had amassed 800 signatures by last Friday.”

http://www.eastdevonalliance.org.uk/in-the-press/20161108/pulmans-seaton-colyton-neil-parish-pressure-beds-protest-meeting/

Posted by

East Devon Watch

Posted on

8 Nov 2016

Posted under

Accountability, Exmouth, Health and Social Care (local), NHS (local), Sidmouth/ Sidford/ Sidbury

Feedback from bed cuts meetings: Sidmouth and Exmouth

SIDMOUTH (Robert Crick):

“The evening session in Sidmouth saw a chastened CCG and a more confident community pushing back relentlessly.

“CCG abandoned their Powerpoint sequence halfway through and never even put their Options forward for discussion or vote; but acknowledged that the NHS is in chaos and that the Health and Social Care Act had fragmented the system but added that the community care provision had been outdated and broken for a good 20 years. All agreed this needs urgent attention.

“Much scepticism about the way forward and anger about NHS Property Company stripping community assets entrusted to the Secretary of State in 1948, whose successor in 2012 kept the property but dropped the responsibility for delivering the care.

“Sterling work by James and Momentum Barnstaple with some support – in words – from Conservative Councillors, although the lead was taken by the Independent East Devon Alliance in the meeting. Many efforts made by the ‘facilitators’ to rule any ‘political’ questions out of order. Claims about the success of the ‘Sick Regime’ in North Devon were dropped and instead we were told that Plymouth has a good integrated health and social care package. Any evidence available?

“How do you provide care at home for those who are homeless or visiting or living in poverty? And many other trenchant questions. Much food for thought for the unfortunate CCG. Local GP challenged the 80 wise clinicians who had reached the absurd conclusions in the proposal. Much embarrassment.

“Please let Exmouth and other towns know that it was not a victory for Sidmouth Hospital but a successful push by Sidmouth community to rejectall proposed cuts until and unless the alternative is in place and tried and tested, which will require investment in staff recruitment, training and retention, morale restoration with full review of pay differential between managers and clinicians.

“Analogy: we are burning too much fossil fuel – so we will close down all the power stations next year while we consider how to invest in massive insulation and renewable energy programmes.”

EXMOUTH (Louise McAlister)

“Had to leave early but lots of critical questioning from participants.

Much anger (from me anyway) when we were told we have a rep from the CCG at our table to ‘help us frame our questions’. I immediately told her that we don’t require that. Instead we bombarded her with our own questions and then helped her consolidate them.

The CCG would be hard pressed to make claims for any support from the event.

Dr Mezjner (who I have met before as he is responsible for the non-existent Budleigh health hub) did a long speech basically demonising hospitals. Lots of claims, no evidence.”

Posted by

East Devon Watch

Posted on

8 Nov 2016

Posted under

Accountability, Democracy, Devolution, EDDC, Health and Social Care (local), Knowle/Honiton/Exmouth relocation, Local Enterprise Partnership

How many tiers can “Local” Government take before it collapses?

Owl has lost count of the number of tiers and organisations and partnerships currently interfering in so-called “local” government, see:
https://eastdevonwatch.org/2016/11/03/unitary-councils-save-money-yet-a-few-years-ago-they-didnt/

Which leads to the question: just how many tiers of government do we NEED and how many can we AFFORD? And how many is too many?

For example, the savings by eliminating district councils, regional super-authorities and makeshift arrangements such as Greater Exeter would almost certainly be huge. You could still have flexible cooperative arrangements such as Strata, without having all the paraphernalia and bureaucracy.

Anyone campaigning for the County Council who includes on their platform local government reorganisation, with County and Parish Councils as the only tiers of local government might well be very popular. It would be possible to combine such a package with maximum localism/subsidiarity. For example, if the District Council was dissolved, all its responsibilities, where practicable, could be transferred to the lower tier councils for truly local management.

Removing two or three tiers of government would almost certainly produce enough savings to eliminate local NHS cuts and debts at a stroke. “Save the NHS by cutting local government bureaucracy” would be a heck of a slogan!

And the elimination of all that bureaucracy and repetitive form-filling and buck-passing could bring enormous efficiency savings and productivity.

In East Devon we would probably be immediately £15-20 million better off just with the cancellation of the new HQ at Honiton.

Whilst many staff would be transferred to town councils to continue to do the jobs that they presently perform, there would probably be a loss over time through natural wastage of perhaps 100 to 200 jobs, representing a cost saving of £3-5 million per annum. Plus reduced operational running costs of around £2 million.

This means a cash windfall of about £300-400 per household to everyone in the District, and average council tax bills would be about £130 lower.

But the big benefit would be in greater efficiency and local connectivity. A huge democratic boost.

Discuss!

Posted by

East Devon Watch

Posted on

7 Nov 2016

Posted under

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

Comments

1 Comment

Health Select Committee: winter pressures unsustainable

Is our CCG crazy when it tries to cut community hospital beds? It would seem so from the report quoted below. So why is it happening? Because the NHS is underfunded and not overspent but our CCG is too lily-livered to say so. Or too well-recompensed for the cuts.

Please don’t go down the “immigrants taking our beds” route! Immigrants in the NHS are fighting this battle with us and for us as front-line staff, and no-one is saying that Hinkley C is being built to keep immigrant lights on!

Our NHS is being destroyed under our noses.

“… The increase in attendances in the last 5 years is equivalent to the workload of 10 medium sized departments in England alone–none of which have been built. Moreover, during the last 5 years the number of beds available for admission of acutely ill and injured patients has continued to fall and we now have the lowest number of beds per capita in Europe and England has the lowest number within the UK.” …

“… This is the figure recorded at midnight—daytime occupancy rates frequently exceed 100% in many hospitals. Such occupancy levels mean there is no surge capacity, rendering hospitals hostage to fortune.” …

… “Whilst increasing bed capacity is not regarded as a viable option by the Nuffield Trust, their evidence identified further utilisation of capacity within the community as being a mechanism for easing pressure in acute trusts. They said that “investment in new rehabilitative ‘step-down’ beds, where patients can recover outside hospital, could deliver substantial gains”. It was therefore encouraging that the Minister said in evidence that as part of the process of developing sustainability and transformation plans:

“we will see the whole healthcare economy players look to develop a more integrated pathway and rehabilitation beds. Intermediate care beds, I am sure, will form part of that”.

During the seminar we held with national policy experts the point was made that there is often an emphasis on community rehabilitation beds to enable discharge from acute hospital. There is, however, less attention paid to the ‘step-up’ element of community provision which can prevent emergency attendance and admission. …”

http://www.publications.parliament.uk/pa/cm201617/cmselect/cmhealth/277/27706.htm#_idTextAnchor027

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