Should be required watching for everyone in Devon – made on a shoestring by campaigning group Save our Hospital Services. A starring role for Independent DCC Councillor Claire Wright – our only hope for common sense in East Devon.
Please watch NOW and pass the link to everyone and anyone, inside and outside Devon who can amplify this message.
“… For two years, George has paid £96 a month for the patch, plus a one-off cost of £133 for the reader. But, like many, he can’t always afford it.
In theory, it is now available on the NHS. On November 1 last year, the FreeStyle Libre patch was added to the NHS drug tariff, meaning it can be prescribed subject to local health authority approval.
But a postcode lottery seems to be emerging. Prescribing committees have given it the green light in Wales, Greater Manchester, Cumbria and Brighton. Hampshire and London committees are believed to be deciding in the next few weeks.
However, George’s clinical commissioning group (CCG), Cambridge and Peterborough, is among those that have previously said there isn’t enough evidence the Libre is effective, and George says he hasn’t heard yet if this has changed. …”
“Four out of five homes on NHS land sold by government too expensive for nursing staff and only one in 10 offered at social rent”.
“BBC presenter Andrew Marr confronted Theresa May over the state of the NHS, suggesting he could have died if he had waited five hours for an ambulance following his own stroke.
The political broadcaster, 58, who suffered a stroke in January 2013, pressed the PM on the crisis, which has led to thousands of routine operations being cancelled in January as the health service struggles to cope with winter pressures.
It comes after the East of England Ambulance Service apologised following the death of a pensioner, 81, in Essex who was left waiting nearly four hours for a crew of paramedics.
Appearing in a pre-recorded interview on the BBC’s Andrew Marr show on Sunday morning, the Prime Minister acknowledged more needs to be done, telling the interviewer: “Of course nothing’s perfect and there is more for us to do.”
Mr Marr claimed funding was not the sole issue facing the service and said the cancelled operations were “part of the plan”.
Presenter Mr Marr challenged her, saying he would not be interviewing her if he had experienced the same delays following his stroke.
“If I’d been waiting for five hours before I’d seen a doctor after my stroke I would not be here talking to you,” he said.
“This is about life and death and up and down the country people are having horrendous experiences of the NHS,” he added, before asking what the PM would say to the daughter of an elderly woman who waited hours to see a doctor.
Mrs May replied: “Obviously you’ve raised an individual case with me which I haven’t seen the details of and I recognise that people have concerns if they have experience of that sort.
“If we look at what is happening across the NHS, what we see is that actually the NHS is delivering for more people, it is treating more people and more people are being seen within the four hours every day than has been a few years ago.
“But of course nothing’s perfect and there is more for us to do.”
On funding, it was suggested to Mrs May that she had done nothing to address increased pressure on the social care system.
The PM replied: “Well yes, we have done something about it, Andrew. I’m sorry, you’re wrong in that.
“We have put extra funding into the social care system and we have worked with hospitals and with local authorities to identify how we can reduce those delayed discharges, ie patients being kept in hospital when they shouldn’t be.”
Mrs May said the Government is working on its long-term plans for social care but would not be drawn on whether there is a need for a brave and radical look at how the NHS is funded.
Asked about whether she agreed with Mr Hunt’s suggestion of a 10-year funding plan, Mrs May replied: “Of course what we’re operating on at the moment is the five-year forward view for the NHS which is the forward view that the NHS themselves came forward with.
“They brought those proposals together.”
Pressed further on cash, Mrs May said: “You keep talking about the money but actually what you also need to look at is how the NHS works, how it operates.”
Shadow health secretary Jon Ashworth said of the PM: “She hasn’t got a plan to get those people off the trolleys and corridors.”
He added to the same programme: “Her only plan apparently is to promote this Health Secretary. They should be demoting this Health Secretary.
“If she promotes this Health Secretary tomorrow it’s a betrayal of those 75,000 people in the back of ambulances.”
Franz Ferdinand drummer Paul Thomson, performing at the end of the programme, appeared to show his support for the health service by wearing a t-shirt with the NHS’s logo above the Nike tick.”
“OPINION:
More money and tighter integration can save Britain’s NHS
The Chair of the House of Commons Health Select Committee, Sarah Wollaston, writes that integrating social care with health, and providing more sustainable funding, is crucial, arguing that “it is time to stop viewing health as a bottomless pit but rather as one of our greatest successes.
Investment should be a source of national pride. I cannot think of a better way for Mrs May to celebrate the 70th anniversary of the NHS than by helping to make sure that it has a sustainable long-term future.”
Source: FT Online, Express p26
Health spokesperson David Willets says it isn’t a crisis – just a bit uncomfortable for patients who have had operations cancelled!
“A crisis is when you haven’t got in place mitigations and you haven’t got a plan to deal with it. We’ve gone into this winter in a way that we’ve never prepared before, so we went into the winter before Christmas having cancelled fewer elective operations than we had previously, discharges from hospital were at a lower level than they had been previously, so we were better prepared.
We’ve also set up a national, regional and local structure – if you like, a winter pressures protocol – which we are invoking now and we are monitoring a whole series of things, activity in the service and the pressures.
We are monitoring the weather alerts in anticipation of weather changes because we know that’s important, and we also monitor the seasonal illnesses like flu.
Asked if what was happening would feel like a crisis to patients, he replied:
I fully accept that for the individual that will be really very uncomfortable, but what we know is if we don’t have a plan in place and we don’t do this in a structured way, what will happen, as we’ve had in previous winters, is lots of last-minute cancellations which is really distracting for patients, it’s inconvenient, it upsets the plans they’ve put together with their family, particularly for elderly patients where their care needs are often quite significant.
He said it was possible that further delays to non-urgent operations could be announced. Asked if there could be further postponements, he said:
That’s certainly a possibility … Intention always is not to cancel patients or postpone patients more than once – that’s one of the principles we try to follow – but clearly it is unpredictable, we don’t know what the weather we do, we don’t know the pressures in the system, we’re taking precautionary action here. …”
FROM: Crowdjustice
Press Release
Website for donations:
http://999callfornhs.org.uk/999-judicial-review/4593838706
“Update on Our NHS – comprehensive healthcare for all – STAGE 2
We have some very good news!
On Thursday 21st December our lawyers, Leigh Day, contacted us to tell us that a judge had considered our papers and those of NHS England and we now have permission for our JUDICIAL REVIEW to go ahead, at some time after 16th February 2018!
This is fantastic news as it means our papers and those of NHSE have been examined and the judge has recognised our legal arguments as a case that is important for public interest.
This is a real Christmas present.
And… despite NHS England stating that we should not be considered for a Capped Costs Order (the amount we have to pay the courts if we lose) the Judge has also agreed to a Capped Costs Order of £25,000.
Although this is more than than the £15,000 we had hoped for, the fact remains that the judge has agreed to it, which shows that he considers it is in the public interest for our case to be heard. It is a very positive gift for all of us. Capped Costs are not granted freely.
So the 999 Call Team have made the ONLY decision possible
We all voted unanimously that this was an opportunity we could NOT afford to turn down. We have notified Leigh Day we are going ahead and will campaign hard to raise the extra £12,000 to meet the £25,000 CCO and extra court procedure costs.
What this means is that we are going to have to open a new Round 3 of CrowdJustice fundraising to raise the extra money. We will be launching towards New Year’s Day as people begin to think of new opportunities, new adventures and new HOPE. Because that is what our Judicial Review offers all of us.
WE HOPE you can help us launch and promote it.
Today, just as we enter Christmas, you could forward and share this email with 3 or more of your friends – adding any personal message to help explain that Round 3 of our Healthcare For All Judicial Review fundraising is about to launch.
You could send them to visit our website page: 999 Judicial Review
You could highlight the fact that this case is not about one group or one region – it affects all of us, everyone up and down the country. Our JR is a real opportunity to bring into the open NHS England’s contentious contract for a new form of local NHS and social care organisation that is based on a business model used by the USA’s Medicare/Medicaid system. A system which only provides a limited range of healthcare for people who are too poor to pay for private health insurance.
Exposing this new NHS England contract to a review of its lawfulness is a vital step in protecting the NHS as a source of comprehensive healthcare for all who need it.
Thank you for all your support so far and we wish you and your loved ones a happy festive week ahead.
Please be on standby for the launch of Round 3. We need all of us now.”
Thanks from all the 999 Call for the NHS Team”
“Over the past 30 years Stan Brock has set up hundreds of massive temporary clinics across America, bringing dentists and eye doctors to the country’s poorest people.
Now this former cowboy hopes to bring his army of volunteer medics to a new region he believes is in urgent need: Britain.
Mr Brock contacted The Times after an investigation found that millions of Britons had no local dentist willing to take on new NHS patients. There are 24 local authorities in which every dentist is taking on only private patients, with stories of people resorting to pulling their own teeth out, drugged up on alcohol and over-the-counter painkillers.
His charity, Remote Area Medical (RAM), has put on nearly 900 such events, mostly in the US. The Times visited a clinic in Baltimore where 1,234 patients were seen in two days. A giant convention centre was filled with 100 dental chairs, supplied by RAM. Some 1,842 bad teeth were removed. Another 433 patients had eye examinations and 398 of them were given free prescription glasses.
At another recent event in rural Virginia 2,416 patients were seen in two days. The majority had no insurance cover to pay for dental work and nowhere else to go.
Mr Brock said: “It doesn’t take a rocket scientist to equate the healthcare situation in Britain to that here in the United States. Healthcare for millions of Americans is accessible but not affordable. This dilemma reaches deep into the middle class when it comes to dentistry and vision care.”
In 2015-16 in Britain, tooth decay was the most common reason for hospital admission for children aged five to nine.
Mr Brock is confident that he has a corporate donor willing to transport his organisation’s medical equipment to Britain from the US. He believes he can round up scores of American and Canadian dentists and doctors who would be willing to pay their own travel expenses and work without payment.
But he faces regulatory hurdles. If bringing in American volunteers proves too complicated he is ready to try to attract doctors from across the EU.
For Mr Brock the project would be a homecoming. He was born in Preston, Lancashire. In 1953, aged 17, he travelled to what is now Guyana in South America and for 15 years lived as a vaquero, or cowboy, with the Wapishana Indians. One day his horse threw him and his colleagues brought unwelcome news. “They told me I was 26 days away from the nearest doctor.”
Mr Brock, a spry 81, was struck by the inaccessibility of healthcare across much of the planet. In 1985 he founded RAM, a non-profit organisation that now has seven donated aircraft and a fleet of trucks. Aided by some 140,000 volunteers, it has provided millions of eye exams, dental treatments, mammograms, cervical smears and chest x-rays to poor Americans. He still ferries supplies, piloting a donated Douglas C-47. He takes no salary and sleeps on the floor of RAM’s headquarters in Knoxville, Tennessee. “As a loyal British subject it’s time for me to help out my home country,” he said.”
The Times (pay wall)
Devon has to find £560 million if it wants to avoid savage cuts to its NHS.
Owl has found the money! Now all it has to do is find a way of getting it back from the BRITISH Virgin Islands (note: does that mean they belong to Branson!) to Devon!
“Toys R Us was last night accused of funnelling £584million into an offshore tax haven as it teetered on the brink of collapse – putting 3,200 jobs at risk.
The ailing retailer, which could go into administration today, has been criticised for the write-off of a mystery £584.5million loan to a company in the British Virgin Islands, a territory commonly used by firms for tax avoidance purposes.
Tax experts have called for an investigation into the accounts, accusing Toys R Us of secrecy and tax dodging. …”
Interesting that the IMF says that another £20 billion of spending cuts will be needed. That’s roughly how much Hunt wants to cut spending on the NHS.
The long game of 100% privatising the NHS – bringing with it rationing, post code lotteries and American-style health care approaches, appears to be nearing its conclusion.
As regards harmonising VAT at its higher rate – currently 20% – this would mean a 15% VAT increase on heating costs, all food and drink, charitable fundraising, equipment for disabled people, water, materials to insulate homes, boilers, children’s clothes …. the full list is here:
https://www.gov.uk/guidance/rates-of-vat-on-different-goods-and-services
“Taxes will have to rise if the government is to balance the books by the middle of the next decade and the NHS may have to be privatised, the International Monetary Fund has warned.
Property taxes, the removal of preferential VAT rates for goods such as pasties, and higher national insurance contributions by the self-employed need to be considered if Britain is to have any chance of eliminating its budget deficit by 2025 because spending cuts have gone about as far as they can, the global economic watchdog said in its annual review of the UK.
Weak productivity and the increasing care demands of an ageing population will make deficit reduction harder. Public services such as the NHS may have to be scaled back or privatised, it added.
The warnings are a reminder of the persistent problem of Britain’s public finances almost a decade after the financial crisis caused borrowing to soar. National debt is 87 per cent of GDP and spending on public services exceeds revenue from taxes by more than 2 per cent of GDP.
“Continued deficit reduction is critical to create further room to respond to future shocks,” Christine Lagarde, managing director of the IMF, said. “There is not much space for additional spending cuts and the revenue side of the equation has to be looked at.”
Britain is already forecast to be paying 34.3 per cent of GDP in tax by 2022, more than at any time since the 1950s, but economists estimate that at least £20 billion of extra austerity will be needed to hit the government’s target of balancing the books.
Ms Lagarde said population changes were adding to the problem. “Population ageing is expected to lead to material increases in spending on healthcare, pensions and long-term care, while productivity growth has been slow. And a slowly growing economy means fewer resources will be available to meet increased spending,” she said.
The public spending burden will soon make Britain face some hard choices, the IMF added. “The UK may face difficult decisions about the desired size of its public sector, as well as the mode of delivery and financing of public services. Brexit-related effects may exacerbate the challenge.”
To address the problem, Britain needs to boost productivity. Ms Lagarde welcomed the chancellor’s £31 billion fund for infrastructure investment and focus on technical qualifications because “the UK underinvests in infrastructure and falls short in human capital development”. But she said that more needed to be done “such as easing planning restrictions and reforming property taxes to boost housing supply”.
As well as introducing a land tax, the government should harmonise VAT for goods that get preferential rates and better “align the tax treatment of employees and the self-employed”. Both proposals have proved a poisoned chalice for chancellors. George Osborne tried to harmonise VAT rates for hot food in his “omnishambles budget” and Philip Hammond had to backtrack this year on raising national insurance for the self-employed. The IMF also recommended “reducing the tax code’s bias towards debt” and scrapping the triple lock on state pensions.
John McDonnell, the shadow chancellor, said: “The IMF has played the role of the ghosts of Christmas past, present and future to remind the chancellor that seven years of Tory failure is undermining our economy.”
And before anyone whinges about time-wasters going to A and E remember Health Secretary Jeremy Hunt has been one of them:
“Doctors who trained abroad account for almost half of all those working in parts of the UK as the profession faces “crunch point” and more young doctors take time out due to stress.
The General Medical Council’s annual report said that many regions and specialities relied on foreign-trained doctors, who could leave the UK. It added that there were too few doctors to treat rising numbers of patients, and doctors were being “pushed beyond their limits”.
The State of Medical Education and Practice showed that 54 per cent of junior doctors took a break after finishing foundation training, a rise from 30 per cent in 2012. “Goodwill and commitment to always go the extra mile” kept the NHS running, it said. “This level of sacrifice is neither right nor sustainable.”
The number of doctors on the medical register has grown by 2 per cent since 2012. Over the same period in England there has been a 27 per cent increase in patients going to A&E, and the GMC said that an ageing population was putting pressure on services.
While the number of UK graduates on the medical register rose by more than 10,700 between 2012 and this year, the rise was offset by a fall of 6,000 in foreign-trained doctors.
Charlie Massey, chief executive of the GMC, said: “We have reached a crucial moment — a crunch point — in the development of the workforce. The decisions that we make over the next five years will determine whether it can meet these demands.”
A fifth of doctors in training said they felt short of sleep while working. In 2014, when 43 per cent of new doctors took a break from training, 22 per cent took a one-year break and 8 per cent took a two-year break. Others may never return. More than half of those taking a break said that it was because of burnout, and most wanted a better work-life balance.
The GMC said that reducing the pressure on doctors and improving the culture and making jobs and training more flexible would be vital to recruiting and retaining doctors.
In the east of England 43 per cent of doctors were trained overseas. In the West Midlands the figure is 41 per cent, and 38 per cent in the East Midlands. More than half, 55 per cent, of specialists in obstetrics and gynaecology trained overseas.
About 14 per cent of doctors in the UK trained in south Asia, but their numbers have dropped by 7 per cent since 2012. The number of doctors from Africa, Australia, New Zealand and North America also fell.
The Department of Health said: “The NHS has a record number of doctors — 14,900 more since May 2010 — and we are committed to supporting them by expanding the number of training places by 25 per cent.” The department was working to improve retention, it added.
BEYOND THE STORY
The health service turned to Britain’s former colonies in South Asia during labour shortages in the 1960s and again in the 2000s when there were too few homegrown recruits.
Today, too, it leans heavily on overseas doctors. A third of doctors in the NHS trained outside the United Kingdom. The reliance has raised concerns that the NHS may be fuelling a “brain drain” in poorer countries where doctors are desperately needed, although others argue that training in the UK can improve those doctors’ skills.
It comes down to the simple fact that the UK does not train enough doctors to meet the demands of its population.
Historically, NHS workforce planning has suffered because it needs to happen over a much longer period than the average lifespan of a government. Last week Health Education England set out the first NHS staffing plan in 25 years, admitting that 190,000 extra frontline staff would be needed.
Source: The Times (pay wall)
“Figures obtained under Freedom of Information rules have shown that the NHS is spending £3bn a year on agency staff to fill staffing gaps caused by 100,000 unfilled vacancies.
The highest vacancy rate, of 12.2%, was for nurses, leaving hospitals and care homes short on qualified staff and reliant on less experienced healthcare assistants.
Janet Davies from the Royal College of Nursing said: “Hospital wards and care homes alike increasingly rely on unregistered healthcare assistants, especially at night. The Government must no longer allow nursing on the cheap – patients, particularly vulnerable and older individuals, can pay the highest price.”
Source” The Independent, Page: 3 Independent i, Page: 5
“Dear Journalists,
As an A&E consultant I am writing to ask for your help.
Up and down the country our A&E departments are in meltdown, our staff are at breaking point and we need your help.
Patients are being left in corridors because there are no ward beds for them to go to, staff are leaving shifts demoralised and exhausted and most importantly our patients are not getting the care they deserve.
We need the public to know about this, not to scaremonger, but for the truth to be out there – as the only way to get politicans to change – is by voters knowing the reality and prioritising the NHS at the ballot box.
But without the public understanding what is going on, we will continue to have this crisis year after year after year. This is where we need your help. We need you to report the reality and not peddle the propaganda from our politicians.
The crisis is much worse than what you report. We all talk about the 4 hour target and that we get around 90%. But that includes all the patients who don’t need admission. But for the ones who need admission, the % who get admitted within 4 hours is so so so much lower than that. And for those patients, it is crucial for their well being, that they get admitted within four hours.
Why are you not asking for these figures? That would help reveal the truth.
Then you report 12 hour breaches. But in England (but not the rest of the UK) the clock starts ticking when a specialist senior has seen them. So they can be in A&E for 18 hours and not be a 12 hour breach.
Why are you not asking for the figures of patients who stay in A&E for more than 12 hours? That would help reveal the truth
And what about asking how many patients are spending time in corridors?
Because if you did reveal these figures – you would soon see the real extent of the crisis. And it is a crisis. One which will lead to a breaking point soon unless something changes.
The fault does not lie with the patients. Yes a few inappropriately attend – but they are not the problem; they can be quickly turned around and discharged.
The fault is not with the staff. They are working tirelessly and doing an amazing job despite the conditions they are working in.
The fault does not lie wth managers and hospital executives. They are working relentlessly to make things work as well as they can.
And despite what the governmnet peddle it certainly is not the fault of the GPs. Although there is falling numbers of GP surgeries, they are doing an amazing job at reducing the number of A&E attendances. Most importantly, the fault does not lie with the ‘system’ of the NHS – a model of care which utilities its resources to maximal effect.
The fault lies with the government.
Years of failed austerity depriving NHS and councils of vital monies and investment is taking its toll. A&Es are struggling because of the frail elderly who need a ward bed but cant get one.
They can’t get one because there are not enough beds within our hospitals (we have one of the smallest numbers of bed per capita in the whole of Europe) and because those that need to get out of hospital can’t because of a lack of social care.
In addition some money which has been spent on the NHS had been wasted on pointless reorganisations designed to start the process of NHS privatisation.
Please start reporting that. Please start reporting the truth. Please start reporting how close we are to melt down and please help get the public worked up about what is going on.
Because sadly our government don’t seem that bothered. They and their friends can afford private health care and therefore don’t rely on it. Even worse many would be happy to see our NHS privatised.
But for everyone else we need the NHS. The staff will battle on (and it is a battle at the moment). We will continue to do everything we can. We will continue to adapt, modernise and reform. We will continue to provide the most amazing possible care despite the conditions. But there is only so much our staff can take. And if we lose our staff we lose the NHS.
Journalists -we need your help. Please help.
And if you are not a journalist reading this, please share (publicly), or tweet it or send onto your friends in the hope that journalists will pick this up and start reporting the truth.
Rob Galloway A&E Consultant
@drrobgalloway
Last week, desperate Tories put a much-too-little! much-too-late motion to East Devon District Council:
“To ask the Leader of East Devon District Council to request Sarah Wollaston, Chair of the Parliamentary Health Select Committee, to investigate the effects on Rural Communities of the STP actions and to test if Rural Proofing Policies have been correctly applied to these decisions in order to protect these communities”
As Owl noted at the time, this is somewhat rich, as their Leader, Paul Diviani, voted at Devon County Council AGAINST sending the document to the Secretary of State for Health (where this could have been highlighted in the covering submission) against the instructions of his EDDC Tory Councillors and never having consulted other Devon Tory councils he was supposed to represent. He was ably assisted in this by former EDDC Chairman Sarah Randall Johnson, who as Chair of the DCC committee, railroaded their choice of action by effectively silencing any opposition (EDW passim)
This led to the accelerated closure of community beds in Honiton and Seaton, following on from earlier closures in Axminster and Ottery St Mary.
A subsequent vote of “No Confidence” in Diviani at EDDC (brought by non-Tory councillors) was defeated by the very Tory councillors he had defied!
Now we read that “Social care postcode gap widens for older people” and that social care is breaking down in deprived areas – many of which are inevitably rural.
“… The knock-on effects for the NHS see elderly patients end up in hospital unnecessarily after accidents at home, while they cannot be discharged unless they have adequate community care in place. Among men, 30% in the poorest third of households needed help with an activity of daily living (ADL), compared with 14% in the highest income group. Among women, the need for such help was 30% among the poorest third and 20% in the highest third.
There is a growing army of unpaid helpers, such as family and friends, propping up the system. Around two-thirds of adults aged 65 and over, who had received help for daily activities in the past month, had only received this from unpaid helpers, the figures revealed.
Spending on adult social care by local authorities fell from £18.4bn in 2009-10 to just under £17bn in 2015-16, according to the respected King’s Fund. It represents a real-terms cut of 8%. It estimates there will be an estimated social care funding gap of £2.1bn by 2019-20.
While an extra £2bn was provided for social care over two years, a huge gap remains after the latest budget failed to address the issue. Theresa May was forced to abandon plans to ask the elderly to help pay for social care through the value of their homes, after it was blamed for contributing to her disastrous election result. The government has promised to bring forward some new proposals by the summer, but many Tory MPs and Conservative-run councils are desperate for faster action.
Ministers have dropped plans to put a cap on care costs by 2020 – a measure proposed by Sir Andrew Dilnot’s review of social care and backed by David Cameron when he was prime minister.
Izzi Seccombe, the Tory chair of the Local Government Association’s community wellbeing board, said: “Social care need is greater in more deprived areas and this, in turn, places those councils under significant financial pressures. Allowing councils to increase council tax to pay for social care, while helpful in some areas, is of limited use in poorer areas because their weaker tax base means they are less able to raise funds.
“In more deprived areas there is also likely to be a higher number of people who rely on councils to pay for their care. This, in turn, puts even more pressure on the local authority.
“If we are to bridge the inequality gap in social care, we need long-term sustainable funding for the sector. It was hugely disappointing that the chancellor found money for the NHS but nothing for adult social care in the autumn budget. We estimate adult social care faces an annual funding gap of £2.3bn by 2020.”
Simon Bottery, from the King’s Fund, said: “We know that need will be higher in the most deprived areas – people get ill earlier and have higher levels of disability, and carry that through into social care need.
“We also know that the councils that have the greater need to spend are, on average, raising less money through the precept [earmarked for funding social care].”
https://www.theguardian.com/society/2017/dec/16/social-care-for-elderly-postcode-gap-grows
“
Owl says: if you believe that Accountable Care Organisations are a good thing you will believe anything. Back-door privatisation a la USA and a ruthless way of enforcing rationing and post code lotteries rather than proper funding.
“Accountable care organisations have many strengths but should be openly debated before being implemented.
The war over the future of the NHS is being fought on multiple fronts. Campaigners, the Labour party, the government, NHS England and even Stephen Hawking are locked in combat over the structure, funding, transparency, accountability and legality of the current wave of reforms, along with the never-ending fight about privatisation – real or imagined.
The famous physicist has joined campaigners in a high court bid to block the introduction of accountable care organisations to oversee local services without primary legislation, arguing they could lead to privatisation, rationing and charging.
Meanwhile, the shadow health secretary, Jon Ashworth, has tabled a Commons early day motion after the government announced plans to amend regulations to support the operation of accountable care organisations. Ashworth argues that they are a profound change to the NHS that should be debated in parliament.
Accountable care – a term imported from the US, where it plays a key role in Obamacare – can take many forms, but it typically involves an alliance of providers with a fixed budget collaborating to manage the health needs of their local population. NHS England wants to see sustainability and transformation partnerships (STPs) evolving into accountable care systems in which integrated care supports good physical and mental health.
In June, NHS England announced that eight areas would be leading the accountable care drive. Greater Manchester is also adopting this approach, and many others are starting to use the accountable care language.
Accountable care has the potential to address many of the criticisms the most vociferous supporters of the NHS have made for many years. It goes a long way to replace competition with collaboration, and the NHS England chief executive, Simon Stevens, said it could mark the end of the infamous purchaser/provider split, which weighs down the health service with costly and often pointless bureaucracy.
Locally led, integrated systems are essential if we are going to shift the NHS from a 1970s-style hospital service to one that provides a community-based health and wellbeing service. Pooling budgets across the local area is not a ruse to disguise cuts. It is the most effective way to manage public money, irrespective of the level of funding.
The court case confuses the issue of how the NHS is organised with its funding and the role of the private sector. These are three different issues.
But the legal basis for accountable care is shaky. Faced with the wreckage left by Andrew Lansley’s infamous 2012 reforms, NHS England introduced STPs because trying to plan services through more than 200 clinical commissioning groups was never going to work.
As demand climbed, funding flatlined in the aftermath of the 2008 crash and managing long-term conditions became the dominant challenge; it was imperative to move from competition to collaboration and set a long-term goal of population health management. That is where accountable care comes in.
STPs and accountable care are operating under legislation meant for clinical commissioning groups – so collaborative systems typically serving 1.2 million people in which local government and all parts of the NHS have a say are underpinned by a legal framework for GP-managed competition overseeing populations of 250,000.
This is such a precarious legal balancing act that the 2017 Conservative manifesto promised to tidy up the legislation and regulations. But introducing an NHS bill now would be political harakiri for Theresa May, and most health service staff would prefer legal ambiguity to yet another round of organisational upheaval that would inevitably follow legislation.
So the choice is to either continue to find legal bodges to allow the NHS to collaborate and plan or – if the high court challenge succeeds – to return to the Lansley dream-turned-nightmare of full-blooded competition.
But although the thinking behind the legal challenge is muddled, that campaign and Labour’s early day motion highlight the major problem: a profound change in the management and leadership of the NHS is being introduced without informed public and parliamentary discussion.
The new approach has many strengths, but introducing it under the radar only serves to feed anxieties and misconceptions about the objective. NHS England needs to get the discussion about accountable care out in the open.”
What an excellent idea! Something for other towns to copy.
“Honiton’s Health Matters – Going Forward Together
Thursday 18th January 2018,
Beehive Main Hall,
9.30 for 10am start – 1.30pm
Book a place here:
https://docs.google.com/forms/d/e/1FAIpQLSeJj_8YEemYo6ktVy7VQz1kZSiVHpMPbpqOoZrH2M3IIOQkQQ/viewform?usp=send_form
Context: This event is the start of a community conversation with key stakeholder organisations around the future health and wellbeing of residents in response to the new landscape affecting Honiton and its environs as a result of NHS and Government policies advocating placed-based health provision and cross-sector collaborative working.
The aim: To discuss what we know, where there are gaps/challenges and how, as a community we will address these to ensure collaborative approaches to co-design and co-produce local health services/activities that meet the needs of all the people in our communities.
Invitees: Management and senior level employees / volunteers / trustees across the public, private, community, voluntary and social enterprise sector.
Speakers:
Ø Professor Em Wilkinson-Brice – Deputy Chief Executive / Chief Nurse RD&E
Ø Dr Simon Kerr – Chair, Eastern Locality New Devon CCG
Ø Julia Cutforth – Community Services Manager, Honiton and Ottery St Mary
Ø Ways2Wellbeing – Social Prescribing, Speaker to be confirmed
Ø Charlotte Hanson – Chief Officer, Action East Devon
Ø Heather Penwarden- Chair, Honiton Hospital League of Friends
Organised by Action East Devon.
Motion at today’s EDDC full council meeting.
Recall that EDDC council leader voted AGAINST submitting the Sustainability and Transformation Partnership’s plan to the Secretary of State for Health at the meeting of Devon County Council’s Health Scrutiny Committee AGAINST the wishes of his own district council.
Now, that same district council, whose Tory members absolved him of blame for this act are making a TOKEN fuss about its consequences!
“Motion – The effects on Rural Communities of the Sustainability Transformation Partnership (STP) actions in East Devon
“To ask the Leader of East Devon District Council to request Sarah Wollaston, Chair of the Parliamentary Health Select Committee, to investigate the effects on Rural Communities of the STP actions and to test if Rural Proofing Policies have been correctly applied to these decisions in order to protect these communities”.
Proposer Councillor Mike Allen Seconded by Councillor Ian Hall
Supported by:
Councillor Dean Barrow; Councillor Stuart Hughes; Councillor Brian Bailey; Councillor Mark Williamson; Councillor Mike Howe; Councillor Iain Chubb; Councillor Simon Grundy’; Councillor Graham Godbeer; Councillor Tom Wright; Councillor Jenny Brown”
Click to access 131217-combined-council-agenda-and-minute-book.pdf
“Sustainability and transformation partnerships should tell NHS England if it is “getting in the way”, the HFMA annual conference heard yesterday.
Matthew Style, director of strategic finance at NHS England, encouraged local areas to adopt accountable care systems (ACSs) – which evolve from STPs – where possible.
But, speaking at the conference in London, he added: “I am conscious some things we [NHS England] do make local relationships at a local level more strained.
“We get in the way. You do and should keep us to account on that.”
NHS England was committed to ACSs, he said, and areas that did not have them – if they feel ready – should adopt the principles.
“The finance community has a pivotal role to play to drive forward this agenda,” he added. He advised the audience that any investments they made should “show demonstrably [they] are sustainable as a whole”.
Style also told the conference the Budget package “hasn’t taken away stark challenges we are facing” and that NHS England would not be changing the way fund was allocated next year.
Philip Hammond promised £10bn of capital investment to the health service by 2020 in the Budget last month.
Style also predicted there would be clinical commissioning group mergers in the future.
Bob Alexander, the deputy chief executive and director of resources at NHS Improvement, also addressed the conference. He told delegates they were doing a “tremendous job” but warned there was still a reliance on “non-recurrent stuff”. The Treasury stipulates NHS commissioners set aside 1% uncommitted spending at the start of a financial year as a buffer for ‘non-recurrent’ health economic priorities.
Alexander also warned NHS finance managers not to let “risks hang in the air” and advised: “Some of the best help comes from those colleagues who are a little bit removed from the day to day”.
This was Alexander’s last speech to the conference as he is leaving his role to become chair of Sussex and East Surrey STP next year.”
http://www.publicfinance.co.uk/news/2017/12/tell-us-get-out-way-nhs-england-finance-chief-tells-stps
Any bets on this hospital re-opening!
“A group of campaigners have launched a legal bid to try and prevent the temporary closure of a community hospital in Somerset.
Shepton Mallet Community Hospital Supporters Group have submitted a pre-action protocol letter to the Somerset Partnership Trust in an effort to reverse the temporary closure of the town’s community hospital.
A pre-action protocol letter is sent from one party to another in a dispute to narrow any issues or to see if litigation can be avoided.
Ten in-patient beds were closed temporarily in October due to staffing issues with the trust saying that they hoped to reopen them in March 2018.
Confirmation of the decision to temporarily close the hospital came after an email to staff was leaked on social media, saying that the plans would “proceed”.
This was despite a previous statement which said that it was “considering its next steps”.
The partnership later insisted that “nothing has changed” and that it remains focused on reopening the hospital towards the end of March 2018.
In a statement, a spokesman for the supporters group said that the letter aimed to challenge the alleged “unlawfulness” of the trusts decision and to “achieve the re-opening of the in-patient beds as quickly as possible.”
Paul Turner said: “We have asked the Trust to rescind its decision before a Court quashes it, and if it wants to take any such decision in the future or any other decision on a change in service at SMCH, the Trust must undertake a prior proper public consultation.
“This is nothing new and the point has been made before in meetings with SOMPAR representatives.”
He added: “We are of course also prepared to take part in alternative dispute resolution to avoid going to court.
“We have asked to be kept up to date concerning developments in this dispute.”
Somerset Partnership Chief Executive, Peter Lewis said: “We have received the letter and we are considering our response.
“In the meantime, I want to reassure the Shepton Mallet community that we remain committed to re-opening the community hospital inpatient ward as soon as we can, although we do not expect this to be before the end of March 2018.”
The issue of the temporary closure was raised at a debate in Westminster Hall last month by the MP for Wells, James Heappey.
Mr Heappey said: “The overall nurse rota statistics for both day and night shifts were 100 per cent in Shepton.”
http://www.somersetlive.co.uk/news/somerset-news/shepton-mallet-community-hospital-883030
East Devon Watch 