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25 Aug 2017

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Hawking totally skewers Hunt on NHS!

“The NHS is facing severe crises, from staffing to funding. Hunt misquoting me and misrepresenting research doesn’t help.

The secretary of state for health, Jeremy Hunt, has challenged me on Twitter and in an article for the Sunday Telegraph over a talk I gave recently to the Royal Society of Medicine in defence of the NHS. Having been accused by Hunt of spreading “pernicious falsehoods”, I feel the need to respond.

Hunt doesn’t deny that he dismissed research contradicting his claim of excess deaths due to poorer hospital care and staffing at the weekend. He admits he relied on one paper by Professor Nick Freemantle and colleagues. But even if one accepts its disputed findings, the authors explicitly warn that “to assume these excess deaths are avoidable would be rash and misleading”. The editor-in-chief of the British Medical Journal, Fiona Godlee, wrote to Hunt to reprimand him for publicly misrepresenting the Freemantle et al paper. As a patient who has spent a lot of time in hospital, I would welcome improved services at the weekend. For this, we need a scientific assessment of the benefits of a seven-day service and of the resources required, not misrepresentation of research.

Hunt’s statement that funding and the number of doctors and nurses are at an all-time high is a distraction. Record funding is not the same thing as adequate funding. There is overwhelming evidence that NHS funding and the numbers of doctors and nurses are inadequate, and it is getting worse. The NHS had a £2.4bn shortfall in funding in 2015-16, bigger than ever before. NHS spending per person will go down in 2018-19. According to the Red Cross, the NHS is facing a humanitarian crisis. There is a staff recruitment crisis. The BBC reported that on 1 December 2015 there were 23,443 nursing vacancies, and a 50% increase in vacancies from 2013 to 2015. The Guardian reported in May that the number of nursing vacancies had risen further to 40,000. There are increasing numbers of doctor vacancies and increasing waiting times for GP appointments, treatment and surgery.

Hunt misquoted me, saying that I claimed the government wants a US-style insurance system. What I said was that the direction is towards a US-style insurance system, run by private companies. The increasing involvement of private health companies in the NHS is evidence for this. Hunt chose to highlight – dare I say, cherry-pick – the fact that private companies’ share of NHS contracts rose 0.1% over the last year. This is an anomaly among the data since 2006. The NHS private providers’ share was 2.8% in 2006-7 and rose steadily to 7.6% in 2015/16. The amount of private health insurance has fallen since 2009 as Hunt said, but that is because of the financial crash. We can conclude nothing about health policy from this and in any case, it is now increasing again. As waiting times increase, private companies report an increase in self-pay where patients pay directly for care such as hip and knee replacements.

Further evidence that the direction is towards a US-style system is that the NHS in England is undergoing a complete reorganisation into 44 regions with the aim of each being run as an “accountable care organisation” (Aco). An Aco is a variant of a type of US system called a health maintenance organisation in which all services are provided in a network of hospitals and clinics all run by the HMO company. It is reasonable to expect the powerful US HMO companies such as Kaiser Permanente and UnitedHealth will be bidding for the huge contracts to run these ACOs when they go out to international tender. Hunt referenced Kaiser Permanente as a model for the future budgetary arrangements in the NHS at the Commons health select committee in May 2016.

The NHS is political, but not necessarily party political. I am a Labour supporter but acknowledge that privatisation increased under Labour governments in the past. The question is whether democracy can prevail and the public can make its demands for proper funding and public provision undeniable by any government.

• Stephen Hawking, the author of A Brief History of Time, is director of research at the Centre for Theoretical Cosmology at the University of Cambridge, where he was Lucasian professor of mathematics”

https://www.theguardian.com/commentisfree/2017/aug/25/jeremy-hunt-attack-nhs-stephen-hawking-crisis

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24 Aug 2017

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Accountability, Austerity cuts, Health and Social Care (local), Honiton/ Gittisham, NHS (local), Paul Diviani, Sarah Randall Johnson

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Diviani and Randall-Johnson are satisfied these questions have been answered on bed closures – do you agree?

30 [plus] questions” that must be asked BEFORE care at home can be implemented:

Pre-implementation

The model of care:

• Does the new model of care align with our overriding ambition to promote independence?
• Is there clinical and operational consensus by place on the functions of the model and configuration of community health and care teams incorporating primary care, personal care providers and the voluntary care sector?
• Is there a short term offer that promotes independence and community resilience?
• Is there a method for identifying people at highest risk based on risk stratification tool?
• Are the needs of people requiring palliative and terminal care identified and planned for?
• Are the needs of people with dementia identified and planned for?
• Is support to care homes and personal care providers, built into the community services specification?
• Is support for carers enhanced through community sector development support in each community?
• Has the health and care role of each part of the system been described?
• Have key performance indicators been identified, and is performance being tracked now to support post implementation evaluation, including impact on primary care and social care?

Workforce:
• Is there a clear understanding of the capacity and gaps in the locality and a baseline agreed for current levels and required levels to meet the expected outputs of the changed model of care?
• Is there a clear understanding of and plan for any changes required in ways of working:
o thinking
o behaviours
o risk tolerance
o promotion of independence, personal goal orientation

• Have the training needs of people undertaking new roles been identified, including ensuring they are able to meet the needs of patients with dementia?
• Do we have detailed knowledge with regards to investment, WTE and skill mix across the locality and a plan for achieving this?
• Are system-wide staff recruitment and retention issues adequately addressed with a comprehensive plan, and where there are known or expected difficulties have innovative staffing models been explored?

Governance, communications and engagement:
• Is there a robust operational managerial model and leadership to support the implementation?
• Has Council member engagement and appropriate scrutiny taken place?
• Is there an oversight and steering group in place and the process for readiness assessment agreed?
• Have providers, commissioners and service users and carers or their representative groups such as Healthwatch agreed a set of key outcome measures and described how these will be recorded and monitored?
• Is there a shared dashboard which describes outcomes, activity and productivity measures and provides evaluation measures?
• Is there an agreed roll out plan for implementation, which has due regard to the operational issues of managing change?
• Is there a comprehensive & joint communications and engagement plan agreed?
• Is there a need for a further Quality or Equality Impact Assessment?

Implementation
• Is there a clinical and operational consensus on the roles of each sector during the implementation phase including acute care, community health and care teams, mental health, primary care, social care, the voluntary care sector and independent sector care providers?
• Is there an implementation plan at individual patient level describing their new pathway, mapping affected patients into new services?
• Are the operational conditions necessary for safe implementation met?
• Have the risks of not implementing the change at this point been described and balanced against any residual risk of doing so?

Post Implementation
• Is there a description of the outcomes for individuals, their carers and communities?
• Are the mechanisms for engagement with staff, users of services and carers in place and any findings being addressed appropriately?
• Is there a process in place for immediate post implementation tracking of service performance including financial impact to all organisations?
• Is longer term performance and impact being tracked for comparison against pre-implementation performance?
• Have we captured user experience as part of the process, and have findings been addressed and recorded to inform the planning of future changes?
• Are there unintended consequences or impacts (e.g. on primary care or social care) which need to be addressed before any further change occurs?
• Is there a clear communication plan for providers and the Public describing the new system and retaining their involvement in community development?”

Source: http://www.newdevonccg.nhs.uk/about-us/your-

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24 Aug 2017

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Accountability, Austerity cuts, Health and Social Care (local), Honiton/ Gittisham, Hugo Swire, Neil Parish, NHS (local), Paul Diviani, Sarah Randall Johnson, Seaton/ Colyford / Colyton

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Now Seaton and Honiton hospital beds are closed, here’s something to look forward to

Better keep fingers crossed that you or your loved ones are not in a similar position to some of the people mentioned here.

But if you are one of the unfortunate ones, remember Paul Diviani (EDDC), Sarah Randall Johnson (DCC), Neil Parish MP, Hugo Swire MP, Minister Jeremy Hunt and Prime Minister Theresa May all put you there. They all have one thing in common: they are Conservative politicians whose decisions led to this situation – and think carefully about whether you would vote for them now or in the future knowing what you know now.

“People who receive care at home have told a health watchdog that a lacklustre service has meant they have had to go two weeks without a shower, eat their dinner at 3.30 in the afternoon and be cared for by workers who can’t make a bed.

The failings highlighted in a report by Healthwatch England drew on the experiences of more than 3,000 people who receive care at home. Other problems described in the document include care workers coming at different times to those scheduled, not having enough time to fulfil all their duties and some missing appointments altogether.

Across England there are more than 8,500 home care providers, collectively helping an estimated 673,000 people with tasks such as washing, cooking, dressing and taking medication. The report suggested that home care was “in a fragile state” and that care packages were being “designed to meet the needs of the service provider rather than the service user”.

One home care user in Redcar and Cleveland said: “Sometimes they give me a shower but they go over their time. Most of the time they haven’t got the time to give me one so I go a couple of weeks without one and that is not right. I feel dirty.”

A woman in her 80s told Healthwatch Bradford her care workers were unable to boil an egg or make the bed, while another said staff needed to be taught “home care common sense”.

A care user in Barnet, north London, said: “I am diabetic and sometimes carers are late or don’t show up and that really affects my medications and insulin administration.”

However, Healthwatch, the health and care consumer champion, stressed that most people had positive things to say about their domiciliary care – with many older people praising the service because it enables them to remain in their own home and to maintain as much independence as possible.

Neil Tester, the deputy director of Healthwatch England, said: “We heard examples of compassionate care from dedicated staff, but people also talked about care that doesn’t meet even basic standards. Given the challenges facing the social care sector, it is more important than ever that people’s voices are heard.”

Izzi Seccombe, the chairwoman of the Local Government Association’s community wellbeing board, said: “This report shows that while most people report that their services are good there is a need to improve services.

“The financial pressure facing services is having an impact and even the very best efforts of councils are not enough to avert the real and growing crisis we are facing in ensuring older people receive the care they deserve.

“The continuing underfunding of adult social care, the significant pressures of an ageing population and the ‘national living wage’ are combining to heap pressure on the home care provider market.”

She added: “This study shows the strain providers are under, and emphasises the urgent need for a long-term, sustainable solution to the social care funding crisis.

“While the £2bn announced in the spring budget for social care was a step in the right direction, it is only one-off funding and social care services still face an annual £2.3bn funding gap by 2020.”

A Department of Health spokesman said: “Everyone deserves access to high-quality care, including those who receive it in their home. This is why we have introduced tougher inspections of care services to drive up standards, provided an additional £2bn for adult social care, and have committed to consult on the future of social care to ensure sustainability in the long term.”

https://www.theguardian.com/society/2017/aug/24/report-highlights-failings-of-home-care-services-in-england

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22 Aug 2017

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

Hunt v Hawking – no contest!

Guardian letters:

“• Jeremy Hunt’s tweeted dismissal of Hawking’s article (How to solve the NHS crisis – scientifically, 19 August) is revealing: “Stephen Hawking is brilliant physicist but wrong on lack of evidence 4 weekend effect.2015 Fremantle [sic] study most comprehensive ever”.

If Hunt bases policy on a single publication (which no serious observer would do) then he should read it, and he would see Freemantle’s warning: “It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.”

Freemantle found that patients admitted over the weekend are more seriously ill and more likely to die. Nobody denies that the “weekend effect” exists, but one must not jump to the facile and unsubstantiated conclusion that it reflects quality of care.

Hunt cherrypicks not only the evidence but even the authors’ interpretation.
Dr Richard O’Brien
Highbridge, Somerset

Jeremy Hunt accuses Stephen Hawking of ‘pernicious falsehood’ in NHS row

• Privately provided services, with their bank loan costs, dividend payments and management add-ons, cost far more than state-funded ones. The administration of privatisation, with the consultants, lawyers, accountants, billing agents etc involved in franchising NHS services, also add substantial costs. Hospital PFIs (private finance initiatives) have evidenced the billions that privatisation is costing the NHS and taxpayer.

Yet the government’s and NHS England’s “reconfiguring” of the NHS is using regional accountable care organisations (ACOs) which allow for extended involvement of the private sector in the running and provisioning of NHS services. This not only accepts the continuing financial burden of privatisation to the taxpayer, but allows further costs to that burden.

ACOs, and other NHS England plans such as the move from the family GP practice model to a system of commercially driven super-clinics called multi-speciality community providers, originate from the US’s notoriously costly and flawed healthcare system. The plans have been drawn up by business consultants with extensive US interests like McKinsey and Optum, a subsidiary of US private health provider/private health insurer United Health. NHS England’s CEO Simon Stevens is a former UnitedHealth senior executive.

Professor Hawking’s concerns about the privatisation and Americanisation of the NHS are therefore unsurprising. Removing all the privatisation apparatus from the NHS would allay such concerns, which are shared by many. The savings that this would make would cover the lion’s share of the costs of the extra demands facing the NHS (the ageing population etc) which are blamed for making the NHS “unaffordable”.
John Furse
London

• I am 100% behind Stephen Hawking’s attack on the Tories over the plight of the NHS. As a nurse for the last 40 years, I think that the NHS is by far the best health system in the world and it is only surviving because of the deep commitment of thousands of medical and admin staff to a worthy cause. I know for a fact that after the referendum results, scores of foreign doctors and nurses started to leave our large local hospital, for fear that they would not be allowed the freedom to stay. This has left our hospital grossly understaffed and under tremendous pressure. Others have gone off sick with severe stress after all the extra hours they are expected to put in to care for patients.

The Tories’ recent promise to provide training for thousands of medical students and nurses in a few years’ time is of no use whatsoever. Something drastic is needed now and that is to give the nurses the pay rise that others are getting. With conditions and pay at such an all-time low, how else are they going to recruit any new nurses?
Sue Ingleby
Gloucester

• What wise words from Prof Hawking and what a pathetic response from Jeremy Hunt. Hawking is right to draw attention to the vast amounts of public money going into the coffers of private organisations for services that could be handled better and cheaper in-house. The question of agencies providing nurses to fill gaps is analogous with those providing supply teachers. Previously hospitals relied on their own “banks” to provide cover for absentees, usually drawn from any of their own staff who requested extra shifts. The advantage of employing their known staff is obvious. Schools requiring temporary help could contact their local education authority (now sadly almost defunct) which kept a list of qualified teachers requesting temporary work. No money was exchanged, unlike today where in many cases the agency charges both the professional worker and the employer. How did we allow this to happen?
Ruth Lewis
Potters Bar, Hertfordshire

• Stephen Hawking’s article is so wonderfully simple and beautiful it made me want to cry. How precious the NHS is and how much it means to us. Thanks to him for writing it and to the Guardian for printing it. It should be printed in all the newspapers.
Jenny Bushell
London”

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22 Aug 2017

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Accountability, DCC, Health and Social Care (local), Honiton/ Gittisham, NHS (local), Seaton/ Colyford / Colyton

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County councils say they cannot meet bed-blocking targets

Owl bangs on: Closing Seaton and Honiton hospital beds was NOT about patient care it was simply about THIS. And no use whinging Devonians – if you voted Conservative (and you did in sufficient numbers to ensure a majority on EDDC and DCC) this IS what you voted for and the buck does stop with YOU as much as them – and if you keep voting them in, it will get even worse:

“County council leaders have written to health secretary Jeremy Hunt asking him to reconsider proposals to withhold social care funding if bed-blocking targets are not met.

Under new guidance produced by the Department of Health last week, county authorities would have to reduce delayed discharges from hospitals by an average by 43% within the next few months – double the target of London.

Herefordshire has a target of a 69% reduction whilst Suffolk has a target of 67%, which county leaders have called “undeliverable” and “arbitrary”.

Colin Noble, County Councils Network health and social care spokesman, described the targets as a “backwards step” and said the resulting lack of funding would push services to breaking point.

“It is perverse that this money – designed to ease pressures – could be taken away if we cannot hit virtually undeliverable and arbitrary targets within a very short time period,” he said.

Noble highlighted that counties are the least well funded councils for social care and urged the government to draw up a sustainable solution not a “double whammy” of underfunding and the prospect of funds being withdrawn.

The CCN notes that the problem facing rural councils is even more acute because they contain the fastest growing elderly populations yet are the worst funded councils for social care.

In total, the 37 county authorities receive £2bn less funding for health and social care than other parts of the country, according to the network.

The CCN argues that there is no quick fix to the issue of delayed discharges and only one third of them nationally are attributable to social care.

Noble called on the government to develop long-lasting reform to social care that makes the system work better. He said counties, which spend 47% of the nation’s total expenditure on social care, want to work with the government to better integrate services.

However, the network argues the social care funding crisis will only be solved if funding discrepancies between rural and urban councils are resolved in tandem with a long-term sustainable funding settlement for all councils.

A Department for Communities and Local Government spokesman said: “No one should stay in hospital longer than necessary. It puts unneeded pressure on our hospitals and wastes taxpayers’ money.”

http://www.publicfinance.co.uk/news/2017/08/counties-urge-hunt-rethink-bed-blocking-targets

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22 Aug 2017

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

Care homes – a dying industry

“Care homes are teetering “on the edge” and a chronic shortage of funding risks “catastrophic failure” within the National Health Service, the businessman expected to be the biggest operator of residential homes has warned.

Chai Patel, chairman of HC-One, which could take over more than 120 homes from Bupa, predicted that six national chains would emerge to dominate the market by benefiting from economies of scale. The acquisition would enable his company to expand to about 350 homes with 22,000 care beds and become the biggest in the sector.

There is immense pressure on care homes amid government funding cuts and an increase in costs since all adults over 25 became eligible for the national living wage. Some small operators are quitting, with 144 care homes closing last year and a loss of about 2,000 beds a year. Many more are “zombie” homes, feared to be close to bankruptcy as struggling councils force down the rates they pay.

A shortage of capacity means that the number of people in residential homes has not increased in line with rising longevity, forcing many frail and elderly people to rely on specialist care in their own homes.

In an interview with The Times, Dr Patel admitted: “There is no question the sector itself is on the edge.” He added: “The impact of chronic under-funding of social care will result in catastrophic failure in the NHS.”

and underneath this article:

“An investment group that is set to be the biggest care homes owner in Britain has vowed that it will not become the next Southern Cross.

HC-One is poised to acquire about 120 homes from Bupa, possibly through a debt and equity deal amid unease about the implications for the group’s debt levels and with memories of Southern Cross’s collapse fresh in the memory.

Southern Cross, which once ran more than 750 care homes and had 37,000 beds and some 41,000 staff, failed in 2011 when all its homes were taken over by their landlords.

The equity for the Bupa purchase, which is close to completion, is understood to be being provided by Stepstone Real Estate and Safanad, an investment firm, and the debt arranged through Deutsche Bank and Apollo Global Management.

The acquisition of more than 9,000 beds from Bupa would take HC-One’s total to almost 22,000 and catapult it above Barchester Healthcare and Four Seasons Health Care. HC-One rose from the ashes of Southern Cross when it acquired about a third of the homes and has expanded through two other acquisitions since 2015. The purchase of Helen McArdle Care, which had 20 homes, was funded through debt.”

Source: Times (pay wall)

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21 Aug 2017

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Accountability, Austerity cuts, Health and Social Care (local), Honiton/ Gittisham, NHS (local), Seaton/ Colyford / Colyton

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Coverage of Seaton hospital bed closures

Owl still thinks THIS is the real reason for the hurried closure:
https://eastdevonwatch.org/2017/08/20/is-this-why-there-is-a-dangerous-rush-to-close-community-hospital-beds/

“Protesters waved banners and shouted ‘shame’ outside Seaton Hospital today (Monday, August 21) as health chiefs began implementing their in-patient bed closure plans.

A similar vigil will take place outside Honiton Hospital next Monday when the cuts are due to begin there.

Yesterday’s gathering was addressed by Seaton’s county councillor Martin Shaw who said the town had been badly let down, and town mayor Jack Rowland, who said that while they may have lost the fight to save the beds the battle would now begin to save the actual hospital.

The dates for the closure of in-patient beds in East Devon was announced by health officials last week.

In a statement the Royal Devon and Exeter NHS Foundation Trust said: “The NHS has given details of how it intends to implement its ‘Your Future Care’ plans to improve patient care across Eastern Devon, including creating new nursing, therapist and support roles.

“Your Future Care” set out proposals to move away from the existing bed-based model of care. Instead it proposed a model of care focused on proactively averting health crises and promoting independence and wellbeing.

“The plans were subject to a 13-week public consultation that closed earlier this year, following which the NHS NEW Devon CCG approved a way forward which enhanced community services to support more home-based care by redirecting and reinvesting some existing bed-based resources. The net result would mean an increase of over 50 community-based staff to support out of hospital care and a reduction in community inpatient beds across the Eastern locality of Devon.

“Detailed operational work began in this area with the introduction of the Community Connect out-of-hospital service in March which has already led to a reduction in demand for community inpatient beds.

“In order to achieve this transition safely, implementation will take a phased approach to redeploy and recruit staff to the additional nursing, therapy, care workers and pharmacist roles which will enhance community services in Exeter, East Devon and Mid Devon.

This will enable the reduction in inpatient beds – moving from seven community inpatient units to three.

The timetable for implementation is:

• Seaton Community Hospital week commencing 21 August 2017

• Okehampton Community Hospital week commencing 21 August 2017

• Honiton Community Hospital week commencing 28 August 2017

• Exeter Community Hospital week commencing 4 September 2017.

“The provision of inpatient services at these locations will cease from these dates. All other services at these hospitals will continue as normal. Patients in these areas in medical need of a community inpatient bed will be accommodated at either Tiverton, Sidmouth or Exmouth hospitals, depending on where they live.

“Over the past couple of weeks it has become apparent that the schedule for the closure of the in-patient units needs to be brought forward. This is due to the increasing pressures on safely staffing the current configuration of seven community inpatient units. Furthermore, now that the workforce HR consultation has been completed, 170 staff can be redeployed into the enhanced community teams and our hospitals to provide extra capacity and resilience to meet the demand for care for the people of Eastern Devon.”

Adel Jones, Integration Director at the Royal Devon and Exeter NHS Foundation Trust said: “It is acknowledged that getting to this point in the process has not been without its challenges and I would like to thank all who have contributed to the development of the implementation plans.”

Dr Anthony Hemsley, Associate Medical Director at the Royal Devon and Exeter Hospital said: “Although the decision to reduce inpatient beds will only affect a small number of patients per week, we, with the support of the clinical assurance panel, are confident that our plans to provide more care at home are safe and ultimately will help more people to be independent.

“At the point of implementation, we will be able to redirect some of the existing bed-based resource into local community teams. Additional staff including community nurses, therapists and personal support workers will be there to provide greater provision and access to care and support. However, we know that there is still much more work to be done, particularly around prevention, wellbeing, recruitment of staff and availability of domiciliary care. This can only be done in partnership with communities and we at the RD&E look forward to continuing this work.”

Rob Sainsbury, chief operating officer for NEW Devon CCG, said: “Reallocating resources away from hospital bed-based care into more home-based and community care will really make a positive difference to people’s lives.

“It will ensure that everyone who needs the service in our community has the best access to good quality and sustainable health services and help people to stay independent for longer, with the benefit of being cared for closer to family and friends.”

http://www.midweekherald.co.uk/news/protest-over-seaton-hospital-bed-closures-1-5157377

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East Devon Watch

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21 Aug 2017

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Accountability, Austerity cuts, Health and Social Care (local), Neil Parish, NHS (local), Paul Diviani, Sarah Randall Johnson, Scrutiny, Seaton/ Colyford / Colyton

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RIP Seaton Community Hospital beds – vigil, noon today

The town with the largest catchment area for elderly people – its community hospital closes the doors on its beds today.

Built by public subscription, funded by a hard-working League of Friends, only its outpatient services will remain – for now.

The heart of a community stops beating today.

Thanks to the vote of East Devon District Leader (Paul Diviani – who voted at EDDC against his own district recommendation) and former Leader and Chair of DCC Health and Social Care Committee Sarah Randall-Johnson, who voted along with all other Conservatives on that committee not to refer the closures of Seaton and Honiton (next Monday) to the Secretary of State.

This will leave the whole of the eastern side of the district with no community beds at all – the few remaining beds to be (for the time being) in Sidmouth and Exmouth, closer to Exeter and Cranbrook.

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East Devon Watch

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20 Aug 2017

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Austerity cuts, NHS (local)

Hunt v Hawking

Guardian:

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East Devon Watch

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20 Aug 2017

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Accountability, Austerity cuts, Health and Social Care (local), Honiton/ Gittisham, NHS (local), Seaton/ Colyford / Colyton

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Is this why there is a dangerous rush to close community hospital beds?

Nothing to do with care at home”, everything to do with austerity cuts. AND much more opportunity for private companies to make big profits from home care instead of NHS costs in hospitals.

“Councils have been told to reduce hospital bed-blocking by up to 70% by next month or face funding cuts.

The warning came in a letter, seen by The Sunday Times, sent to council and NHS chief executives by the Department for Communities and Local Government (DCLG) and the Department of Health last month.

The letter sets out the “expectations” it has for local authorities to reduce delays in discharging people from hospital, with some councils facing demands to cut bed-blocking by up to 70%.

Councils that do not do enough to help NHS patients go home could have their share of a £2bn social care fund withheld.

Of the 152 councils with social care responsibility, 42 are required to reduce bed-blocking by 60% or more, based on their performance in February. Reading borough council has been given the highest target of a 70% reduction.

More than two-thirds are expected to reduce bed-blocking attributable to social care by 50% or more.

The letter accompanying the targets said progress would be assessed in November and 2018-19 allocations of the £2bn fund could be reviewed.

This could see poorly performing councils lose out on anticipated funding.

Last night, Izzi Seccombe, a Tory council leader who speaks on community wellbeing for the Local Government Association, said setting “unrealistic and unachievable targets” for councils to cut bed-blocking was “counterproductive.”

“The threat of reviewing councils’ funding allocations for social care . . . could leave many councils facing the absurd situation of failing to meet an unattainable target, losing their funding and, on top of this, potentially being fined by hospitals.”

Last month The Sunday Times revealed that the NHS had fined at least 22 councils for causing delays in discharging patients and threatened 11 others with charges.

A DCLG spokesman said: “No one should stay in hospital longer than necessary. It puts unneeded pressure on our hospitals and wastes taxpayers’ money.”

Source: Sunday Times (pay wall)

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East Devon Watch

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20 Aug 2017

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

Does our councils promote social value when funding public services via charities?

This is i portant be ause, more and more, councils are sub-contracting their responsibilities for health and social care to charities.

“Small charities that deliver public services have a problem.

The government grants that once helped to fund this work are drying up fast – their total value halved in the decade between 2004 and 2014, according to the NCVO, and has continued to drop ever since. This leaves organisations dependent on income from local council contracts, where the complex tendering process is stacked against smaller providers. At risk of being squeezed out completely, they face what the Lloyds Bank Foundation earlier this year called a “broken commissioning landscape”.

The government knows this is a problem. The House of Lords select committee on charities expressed concerns back in 2016, recommending that the government takes steps to promote commissioning based on impact and social value rather than simply on the lowest cost.

The Social Value Act, introduced in 2012, is one of very few ways in which central government can influence who is commissioned to deliver local services. It requires councils to think about the social, economic and environmental benefits of their decisions when they commission contracts above a certain value (around £170,000).

This means officials are encouraged to do more than simply favour the lowest bidders; they are invited to consider what else a provider could contribute to the area. One organisation might be committed to employing local people, for example. Another might offer to work with small community groups, or bring together existing networks of GPs, schools and others to coordinate services more effectively. The aim is to level the playing field, and enable non-profit providers – such as charities, social enterprises and community businesses – to compete with big private companies.

The government promised a review of the act back in February, something tantamount to an acknowledgement that it is not having the desired impact. Those plans have since been derailed by the snap election and the review is now promised “in due course”.

With the review still pending, we at Power to Change spoke to (pdf) community businesses across England, to find out what changes could be made to improve the situation.

The organisations we spoke to were positive about the aims of the act, and confessed that the commissioning landscape would be “much bleaker” without it. Some councils even welcomed the fact that the act gave them, as they saw it, “permission to explicitly consider social value”.

But many community businesses dismissed the act as “tokenistic”, complaining that it made little practical difference to how councils commissioned or from whom. We found limited evidence that the act actually affected their decisions about whether to tender for contracts: organisations who wanted to work with their council said they would have gone ahead regardless.

If the government wants to improve the impact of the act, our research has some simple recommendations.

Lower the financial threshold

Fairer UK charity contracts will demand long-term government support
The act only applies to local authority contracts worth more than £170,000. Very few community businesses operate at that kind of scale, particularly those committed to working only in their local area. A lower threshold would bring more small organisations into play, either as providers or, more likely, as partners.

Apply it to goods and works, not just services

The principles behind the act are very popular with government, councils and community business alike, so extending it to contracts for goods and works would be another way to introduce social value into commissioning. In his report into the act in 2015, for example, Lord Young celebrated parliament’s decision to commission bottled water for two years from a social enterprise whose profits were shared with the charity Water Aid. There is no reason this sort of innovation shouldn’t be more widespread.

Offer more support for potential providers

Providing more support and guidance, especially some highlighting successful practice, could boost take-up of the act. For commissioners, this could mean giving examples of where they have made savings or improved outcomes through commissioning with social value in mind. For small voluntary or community-led organisations, this could be examples of similar organisations that successfully engaged with the process.

Access to data on the progress and effects of the act is also limited. We recommend the introduction of an open-source, central dataset on the use of the act across local authorities in England, including monitoring data on social value outcomes.

Promote the act more

Our research found an alarming number of social enterprises and community businesses either weren’t sure how the act worked or hadn’t heard of it. The government should give the act greater publicity, targeting community groups who might want to take up the opportunity it offers. For the same reason, the guidance surrounding the act needs to be much clearer and more accessible.

Explain how social value is measured

It can be fiendishly difficult to measure social value, but it can be done – and local groups told us that councils could do more to explain how they will be assessed. This could start with commissioners consulting interested parties locally on what sort of measurements they will be using and how they will be collected, not least so that local groups can decide whether or not to apply for a contract in the first place.

Encourage councils to take risks

New charities minister, but government isn’t interested | Asheem Singh
Local authorities like to praise the not-for-profit sector for bringing more innovation and greater flexibility to social problems. But this does not always extend to commissioning decisions, which can favour large, well-known private firms over smaller groups. This may be understandable, but councils will need to overcome this risk-aversion in the future.

Make the act part of wider social change

The act requires councils only to consider social value in commissioning. But not every local authority limits itself to this: Oxfordshire county council and Somerset district council were celebrated last year by Social Enterprise UK for incorporating the act into a wider agenda for social change. This meant using the act to focus on a whole strategy to strengthen the local area, something commissioners all over the country could learn from.

Russell Hargrave works for Power to Change”

https://www.theguardian.com/voluntary-sector-network/2017/aug/15/seven-ways-improve-social-value-act

Posted by

East Devon Watch

Posted on

19 Aug 2017

Posted under

Accountability, Austerity cuts, Health and Social Care (local), Honiton/ Gittisham, Neil Parish, NHS (local), Seaton/ Colyford / Colyton

Comments

2 Comments

“Neil Parish MP snubs Seaton Mayor’s request for urgent meeting with Health Secretary”

And Parish sends a circular letter as his reply – one exactly like others he sent to people also asking him to save their hospitals:

“Councillor Jack Rowland, Mayor of Seaton, has posted on Facebook:

As many of you know I wanted to arrange a face to face meeting with Neil Parish and Jeremy Hunt regarding the CCG decision to close the hospital beds at Seaton Hospital.

I’ve now received a reply from Neil Parish and the email I sent to him and the reply is reproduced below.

Dear Jack,

Thank you for your email on beds at Honiton and Seaton.

I am deeply saddened by the decisions to close beds at Honiton and Seaton Hospitals. I wanted beds to be retained at Seaton and Honiton, as part of a wider upgrade to health services in Devon. This closure is not the outcome I wanted. I would like to pay tribute to all the staff who have worked so hard to maintain fantastic inpatient beds at the hospitals over the past years.

We now have to make the best of the current situation. The CCG have stated they believe there is sufficient at-home care to replace the current beds. Hospital staff will now be redeployed into community care. Every patient who previously required care in the hospitals must now have the same level of care delivered to them at home or in a residential care home. This promise must be kept and I will be monitoring the situation carefully.

Regarding the future of Honiton and Seaton Hospitals, I want the buildings to continue to host vital health and social care services. Particularly, I want the sites to be used as health and social care hubs, with a positive future for each of the locations. I believe the hospitals still have an important role to play in community healthcare services. Any suggestions you could provide in this area, which would help maintain viable services at Seaton, would be appreciated.

I know this might be a disappointing response, but I hope we can continue to maintain excellent care in our community.

Thank you again for your email.

Yours sincerely,

Neil

Neil Parish MP
Member of Parliament for Tiverton and Honiton
House of Commons | London | SW1A 0AA
Telephone: 020 7219 7172 | Email: neil.parish.mp@parliament.uk
http://www.neilparish.co.uk

In response to this email:

From: cllr.jack.rowland@btinternet.com [mailto:cllr.jack.rowland@btinternet.com]
Sent: 16 August 2017 12:26
To: PARISH, Neil
Cc: townclerk@seaton.gov.uk; Martin Shaw ; Marcus Hartnell
Subject: Seaton Hospital – bed closures

Dear Mr Parish,

I’m writing to you in my capacity as the Chair of Seaton Town Council.

As you are no doubt aware the Health and Adult Care Scrutiny Committee of Devon County Council voted by 7 votes to 6 on 25 July not to refer the CCG decision to the Health Secretary for a review. An investigation has been called for regarding how the Scrutiny Committee Chair managed that meeting.

In the meantime the RDE Trust are accelerating the bed closure timetable from the original timetable and the beds in Seaton Hospital are now being phased out starting on 21 August and those in Honiton the following week.

This is despite no adequate answers being given to date regarding the concerns about the “Your Future Care” changes now being implemented. At the East Devon District Council Annual meeting all the Councillors present voted in favour of requiring more information on this subject and the EDDC Scrutiny Committee met in June to question representatives of the CCG and were not satisfied with the responses and maintained their opposition to Community Hospital bed closures.

At the Seaton Town Council meeting on 7 August I tabled a motion to demonstrate concern at the decision reached by the DCC Scrutiny Committee and to seek an urgent meeting with yourself and Jeremy Hunt to be attended by myself, Marcus Hartnell (Town and EDDC District Councillor) and Martin Shaw (Town and DCC Councillor). All the Town Councillors present voted in favour of my motion.

In view of your stated opposition to the bed closures in Seaton and Honiton I hope you can facilitate the meeting I am requesting in view of the overwhelming opposition from the elected Councillors in East Devon.

I look forward to hearing from you in the near future regarding potential dates, times and venue – we would be willing to travel to London if necessary.

Regards
Jack Rowland
Seaton Town Council Chair / Mayor”

https://seatonmatters.org/2017/08/19/neil-parish-mp-snubs-seaton-mayors-request-for-urgent-meeting-with-health-secretary/amp/

Posted by

East Devon Watch

Posted on

19 Aug 2017

Posted under

Accountability, NHS (local)

Comments

1 Comment

“Older patients’ families struggle to complain about poor hospital care”

Owl says: No worry – soon there won’t be any hospitals to complain to or about!

“The survey of over 600 Gransnet members reveals that:

of those who were concerned about the treatment of their older relative, just over half (58%) complained

two-thirds (67%) of those who complained do not believe complaining makes a difference

over 1 in 3 (35%) respondents said there were occasions where they were concerned about the care or treatment of their older relative in hospital

almost 1 in 3 (31%) felt that the hospital staff did not have an adequate understanding of their older relative’s condition or care needs.

The survey also reveals wider concerns about communication with older patients and their families:

2 in 5 (40%) participants did not feel they were kept informed about their older relative’s condition in hospital and were not given enough opportunities to discuss their care and treatment;

1 in 3 (33%) respondents felt they were not adequately involved in decisions about their older relative’s care and treatment.

Poor communication is a factor in around one third of all complaints the Ombudsman service investigates about the NHS in England. …”

https://www.ombudsman.org.uk/news-and-blog/news/older-patients-families-struggle-complain-about-poor-hospital-care

Posted by

East Devon Watch

Posted on

18 Aug 2017

Posted under

Accountability, Austerity cuts, Inequality, NHS (local)

Cameron’s former council taken to court over austerity cuts

“There were chaotic scenes on Thursday 17 August as Oxfordshire County Council, the borough in which David Cameron’s former constituency sits, appeared in a central London court. It was there to defend itself in a case which is a legal first. And the case the Tory-run authority had to answer? That its austerity-driven cuts to vital services may have broken the law.

A legal first

The Court of Appeal was hearing the case of Luke Davey. In November, a judge granted the 40-year-old from Oxfordshire a judicial review against the council, following a 42% cut to the amount he received to pay for his care and support. This is because Davey has quadriplegic cerebral palsy, is registered blind, and requires assistance with all of his intimate personal care needs.

But Davey’s case is a legal first, because his lawyers are using the Care Act 2014 to argue that the council has broken the law. Specifically, that Oxfordshire County Council has breached its obligations under the “wellbeing” principle of the act.

Disabled people’s organisation Inclusion London and campaign group Disabled People Against Cuts (DPAC) are supporting Davey’s case. The groups had organised representatives to support Davey before and during the hearing. And in another legal first, Inclusion London was granted an intervention in the case by the judge: the first time an organisation led by disabled people has been given this privilege.

But things didn’t go smoothly for the campaigners.

At first, they gathered outside the main entrance to the courts, raising awareness of both the case and the broader issues facing sick and disabled people in society.

One campaigner’s banner referenced an UN report which accused successive Conservative-led governments of committing “grave” and “systematic” violations of disabled people’s human rights.

And campaigners like DPAC Steer Group member Nicola Jeffery were also highlighting the closure of the Independent Living Fund (ILF), which had previously supported disabled people to access their communities and maintain their day-to-day lives. But the Conservative government abolished the ILF in 2015.

But there were angry scenes when disabled campaigners, their solicitors and the media tried to enter the court building. Security at first told them they could not go in, as there were “not enough staff on duty” to cope, and they were not willing to open the disabled entrance.

After the intervention of a reporter and several wheelchair users, the court’s security opened up the supposedly ‘accessible’ entrance to the court. But the entrance was barely accessible, and one disabled campaigner was nearly knocked to the ground by a passing cyclist.

Setting a precedent?

Davey’s case, if successful, could set a precedent, as it’s the first time the Care Act 2014 has been cited in law. The council argues that there were two underlying reasons given for its decision to reduce Davey’s personal budget. Specifically, that:

He could spend more time alone without the benefit of a Personal Assistant being present.
Davey could and should reduce the amount which he pays to his Personal Assistants.
But his solicitors say that, by cutting his support from £1,651 a week in 2015 to £950 a week now, Oxfordshire County Council has breached Davey’s rights under the wellbeing principle of the act. Specifically, that it will cause/pose:

Additional and excessive anxiety to Davey, from having to spend unwanted time alone.

The risk of Davey losing his established care team of 18 years.

The wellbeing principle of the Care Act says that a council has a legal duty to “promote” a person’s wellbeing. Specifically:

Personal dignity.
Physical and mental health and emotional well-being.
Protection from abuse and neglect.
Control by the individual over day-to-day life.
Participation in work, education, training or recreation.
Social and economic well-being.
Domestic, family and personal relationships.
Suitability of living accommodation.
The individual’s contribution to society. …”

https://www.thecanary.co/2017/08/17/chaos-court-david-camerons-former-tory-council-accused-breaking-law-video/

Posted by

East Devon Watch

Posted on

18 Aug 2017

Posted under

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

Care for people without families

In many “care closer to home” scenarios it is assumed that the patient (Owl refuses to call them clients – this isn’t home hairdressing) have some sort of outside support – family, friends or voluntary groups. This is often not the case – especially in rural areas.

So, what should our health services be doing?

“… Firstly, we need to review our care services from the point of older people doing everything entirely without support from family. This includes everything from finding out information to getting their washing things in the event of unplanned hospital admission to creating a lasting power of attorney to arranging hospital discharge to searching for a care home. Only then can we see how much family support is required to make the system work and where we need to change things so it works for those without. Care services that work for people without family support will work far better for people who do have family too.

Secondly, care services must make a greater effort to understand why so many more people are aging without children and the issues that face them. It is not possible to design services that work if you do not understand the people you are designing them for. People ageing without children must be included in all co-production and planning on ageing as a matter of course.

Thirdly services must consider their use of language. Branding services with “grandparent/grans/grannies” unless they specifically mean only grandparents should use them exclude older people who are not and never will be grandparents.

Fourthly, people ageing without children should be supported to form groups both on and off line where they come together to form peer support networks. People ageing without children want to help themselves and each other.

Fifthly, the gap around advocacy must be addressed. People ageing without children have been very clear on their fears of an old age without a child to act as their intermediary and advocate in their dealings with care services particularly if they become incapacitated mentally or physically.

Finally, everyone, both people ageing without children and those who do have family, should be helped to plan for their later life.

People ageing without children must be brought into mainstream thinking on ageing. By working collectively we can as individuals, communities and wider society address the needs of older people without children or any family support. Only by working together so can we do care differently for people ageing without children.”

https://www.independentage.org/policy-and-research/doing-care-differently/designing-care-services-that-dont-rely-family-kirsty-woodard

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