Category Archives: NHS (local)
Now home care is in crisis
Owl says: if you believe that final paragraph you will believe anything and, if you are old or otherwise vulnerable should not complain when you get no help! Though some, of course, will be rich enough to buy their way out of trouble – but it was ever thus.
“Home care contracts are being ripped up across half the country as companies say they are no longer paid enough by councils to look after the elderly.
Dozens of care providers are going bust and a quarter are at risk of insolvency as local authorities force down what they pay for carers to go into the homes of the elderly and provide essential help, research has found.
Hundreds of thousands of older people are already going without help with everyday tasks such as washing and dressing as councils cut back and there are fears that the problem will worsen if companies collapse.
The elderly care system was promised an emergency injection of £2 billion over three years in the budget, but councils say a long-term solution to keep pace with an ageing population is needed if the money is not simply to delay disaster.
Freedom of information requests by the BBC Panorama programme found that 95 of 197 councils which replied had seen home care contracts cancelled.
Mears, one of the largest home care companies, handed back a contract with Liverpool city council in the summer, saying they could not cover costs at the £13.10 an hour they were being paid. “That was a terrible thing to do for both service users and for care staff. We absolutely did not take that [decision] lightly, but frankly what choice did we have?” Alan Long, from the company, told the programme.
Colin Angel, of the United Kingdom Homecare Association, an industry body, said: “We have some really desperate providers who really do not know whether they’re going to be able to continue in business beyond the next year. That means they’re really having to make some hard commercial decisions, whether they might need to cease trading or indeed just hand back work to local councils.”
Analysis for Panorama by the consultancy Opus Restructuring found that a quarter of Britain’s 2,500 home care companies were at risk of insolvency, and 69 had shut down in the past three months.
A Department of Health spokeswoman said: “Older and vulnerable people must get compassionate care, which is why we have provided councils with £9.25 billion of dedicated funding, including an extra £1 billion in 2017-18 to provide immediate relief. We will bring forward proposals later this year to ensure a more financially sustainable social care system.”
Source: The Times (paywall)
GPs tell the truth to other GPs but don’t let on to us
One of Owl’s owlets picked up a copy of a GP’s magazine (Pulse) recently and was astounded at some of the articles it contained. Here is a summary:
Front cover: Austerity for GPs must end
Page 6 – GP practices in Northern Ireland threaten to leave the NHS en-mass “unless the Government substantially increases investment”. If they do this then “many patients [will need to] pay for GP services”.
Page 6 – Practices lose six-figure sum after federation fails – 54 practices lost £284,700 after investing in a federation that failed. See also Page 18.
Page 6/7 – Chief Inspector of Care Quality Commission has his own practice rated “requires improvement” after failing to review patients on high-risk medications.
Page 7 – Capita is planning to replace staff with robots to boost profits by “taking away some of the decision-making”.
Page 7 – GPs in Somerset have been banned from prescribing a raft of medicines for minor illnesses.
Page 7 – Virgin Care wins £67m contract in W Lancs.
Page 16 – “Closing the gate before our role has bolted” – moaning that GPs are now a gatekeeper service to refer people to other treatment points, making them “deskilled and lazy” and “nodding off at the gate, drowsily waving people through”. See also page 34 for a similar story by a different doctor.
Page 18 – “Is federating putting GP practices at risk?” See also page 6. Government is still promoting these as a way of improving productivity – spending “£205m” (of our money) on promoting it. “My concern is that federations are a stepping stone towards finishing off the independent contractor status of the self-employed GP [and] large healthcare companies [see Page 7] could step in and start running them.” So Virgin Healthcare will make more profits and GPs will be paid less, leading to a shortage of GPs in the UK (like nurses and soon junior doctors).
Page 22 – “GPC bids to save ‘last man standing’ GPs” – talking to Welsh government about bailing out an increasing number of small GP practices where doctors are leaving due, with 20 practices in Wales having quit the NHS in 2016 cf. a total of 33 between 2011-2015.
Page 22 – “13 practices to close in single county [Fermanagh, NI]” “Patients will be travelling 30 to 40 miles to see a GP.” “The situation in [NI] has worsened significantly [!!!!] since reports that a third of practices will close due to retirement of a third of the 66 GPs”.
Page 22 – “Just 7% of [Scottish] GPs say 10-minute consultations are adequate”
Page 24 – Full page article on how “GPs [have to] drive patients to hospital [themselves] amid ‘scary’ ambulance delays” “Very young and elderly patients are dying because of worsening delays to 999 calls, say GP who, in some cases, have had to drive patients to hospital when an ambulance has failed to arrive.” “Underfunding of ambulance services is putting patients at risk.”
Page 24 – Government wants GPs to provide “urgent home visits”. Government wants CCGs, emergency 111 providers and local councils to set up A&E Delivery Boards to consider this alongside asking GPs to spend time in A&E departments. GPs say they haven’t got enough resources. See page 26 and 30.
Page 26 – Commissioners want to save £22bn in primary care i.e. GP services by “investing” £1.2bn. See page 24 and 30.
Page 30 – “Austerity for GPs … can’t continue” – “The primary care minister” (David Mowat) says “the Government can’t attract 5,000 extra GPs if it continues to suppress funding. See page 24 and page 26 and page ….
Page 34 “Do you want to be a musician [i.e. treating people] or a conductor [i.e. referring people]?” See page 16.
In summary, this looks to me to be a GP crisis in its infancy but growing up fast.
You have to be either especially stupid and incompetent or especially evil to create this breadth and depth of crisis so quickly.
East Devon Alliance NHS cuts meeting – Colyford hall filled
“COLYFORD Memorial Hall was packed for East Devon Alliance’s (EDA) public meeting today (Saturday) to fight the decision to close hospital beds in Seaton and elsewhere in East Devon.
Independent county councillor Claire Wright was the invited guest speaker, the stage also featuring EDA leader Dr Cathy Gardner and EDA county council candidates Paul Arnott, Martin Shaw and Paul Hayward.
In short, it was decided to put pressure on town and parish councils, and East Devon District Council to oppose the decision by NEW Devon Clinical Commissioning Group.
The possibility of seeking judicial review/s was discussed.
An action plan will be finalised in about two weeks’ time when it is known where town and parish councils, and other interested parties stand.”
https://www.viewnews.co.uk/colyford-hall-packed-seaton-hospital-bed-closure-protest-meeting/
More NHS crisis evidence from front-line staff
As reported by health campaigner and Independent DCC councillor Claire Wright:
“Patients are being left stranded on trolleys without access to vital medical supplies and sent home too soon amid widespread hospital crowding, doctors say.
More than half of medics polled by the Royal College of Physicians (RCP) said patient safety has deteriorated over the past year and three quarters fear dangers to patients within 12 months.
The survey of more than 2,100 RCP members from across the UK found that 84 per cent had experienced staffing shortages. And less than half thought doctors at their trust would speak up if they were concerned about risks to patients.
In the survey, doctors said they were “firefighting”, “papering over the cracks” and “hanging on by their claws”. One said: “The hospital is operating at full capacity all of the time, We are asked (almost daily) to ‘lower our thresholds’ for what we consider to be a safe discharge.”
Medics said they were working in circumstances which were “completely unsafe” for patients, with one describing 55 emergency beds being opened, without extra staff.
“Currently the hospital is overfull, with patients on trolleys in corridors and in the middle of the bay (with no curtains, access to electricity, oxygen etc) .. elective surgery has been cancelled (including cancer surgery)” said one. “I feel like I’m on the Titanic” said another.
Research by the royal college found 43 per cent of doctors were working in departments with shortages of medics.
Prof Jane Dacre, RCP President, will today tell the college’s annual conference that doctors were being “pushed to their limits”. “We worry that there are inherent safety risks in a hospital running at full or over capacity – from an increase in hospital acquired infections to the impact of burnout from overworked staff,” she said.
Janet Davies, chief executive and general secretary of the Royal College of Nursing, said: “Hospital doctors are blowing the whistle on sliding standards in patient care – wards are full and without the staff to cope.
“Nursing staff share their fear that things will get even worse in the next year.”
Philip Dunne, health minister, said: “We want to make the NHS the safest healthcare system in the world supported by world-class doctors and nurses – that’s why there are already 34,800 extra clinical staff, including over 11,600 additional doctors and over 13,400 additional nurses on our wards since May 2010. “
Tory voter or NHS supporter? You can’t be both
Up to 100 Tory MPs believed to have been ready to revolt over National Insurance hike for self-employed. Result: abandoned after Budget within a week.
Absolutely no Tory MPs ready to revolt about cuts, privatisation and contraction of NHS. Result: it goes forward – with budget funding to speed it up.
Tory voter or NHS supporter? No middle ground.
Devon MPs: powerless to stop cuts try to talk their way out of trouble
“The Royal Devon and Exeter hospital is facing a £20million deficit, city MP Ben Bradshaw warned a debate on health and social care in Parliament.
Meg Hillier, Labour chair of the Public Accounts Committee, called the debate, which was dominated by Devon MPs.
Ms Hillier warned: “We are in the grip of a crisis in social care.”
Mr Bradshaw said the clinical commissioning group which provides health services in North, East and West Devon is facing a £40 million deficit.
And the Royal Devon and Exeter Hospital – “one of the best run hospitals in the country” – is facing a £20 million deficit.
Mr Bradshaw urged the government to “end the uncertainty” over EU nationals working in the health and social care system.
“We face a workforce crisis exacerbated by uncertainty over Brexit.
“People are already leaving and they are not able to recruit. The workforce crisis is going to do more damage in the short term than anything else.”
Mr Bradshaw added: “We need to have an honest conversation with the British pubic about how we fund this.”
He called on Health Minister Philip Dunne to say whether the government had ruled out a “posthumous levy” on people’s estates.
Devon MPs urged the government to ensure fairer funding for rural areas.
Councils have been given the right to raise an extra 3% from April to pay soaring adult social care costs.
In his Budget last week the Chancellor allocated an extra £2 billion for social care.
Sarah Wollaston, MP for Totnes and chair of the Commons Health select committee, said: “While £2 billion over three years is welcome, I would like the minister to address how this gets to the front line and is distributed according to need.”
She warned that £1.2 billion had been transferred from capital to revenue budgets, hampering the ability to put in place effective plans.
The Chancellor also announced that GPs would be “co-located” in A&E departments.
Dr Wollaston said that GP practices would struggle to provide that service while they also have to offer out-of-hours and Sunday services, and alongside a “retirement bulge”.
She said spending had been squeezed just as Britain was experiencing an “extraordinary demographic change”, and called on the government to stop and take stock.
Most of the MPs joined Dr Wollaston in calling on the government to widen its proposed green paper review of adult social care to include the NHS.
Anne Marie Morris, Conservative MP for Newton Abbot, said: “The NHS is the envy of the world. The social care system, frankly, is not.
She said social care took £14.4 billion – a third of local authority spending. “Those of us in rural areas are clearly having to pay more because we pay more council tax overall,” she said. “We have a disproportionate number of over-85s, we have rural sparsity not properly dealt with.”
“The government must face up to the problem, but the public must also play its part. We must accept change.”
North Devon MP Peter Heaton-Jones said the number of Devon MPs speaking in the debate reflected concern that rural areas of the South West are not getting their fair share of funding.
He said the NHS “sustainability and transformation plan” reforms were causing concern in North Devon, particularly about the future of some acute services at the district hospital.
Any cuts at the hospital would be “absolutely unacceptable” because of the “three Ds” – distance, demographics and deprivation.
Kevin Foster, the Torbay MP, said the problems had been caused by the success of the NHS, which meant that people were living longer.”
http://www.devonlive.com/exeter-hospital-faces-20million-deficit/story-30202550-detail/story.html
Health trusts and impossible performance targets
“The QC who carried out a review of failures at the Mid Staffs Hospital five years ago says that a similar collapse is ‘inevitable’ under current circumstances where some health trusts are accepting impossible performance targets.
In an interview with Shaun Lintern for the Health Service Journal, Robert Francis QC warned of a “a real danger of a relapse” unless the present NHS leadership continue to focus on the lessons learned in Staffordshire.
The QC described a repetition of the same problems as “inevitable” in cases where financial stress is combined with unrealistic targets. He said: “If you look at the number of trusts who are not only in deficit but won’t agree their control targets, the fact some are not agreeing their control targets is good because it means they are saying we can’t actually do that and carry on the service you want us to provide.
But there will be those that have said ‘yes’ when they actually can’t do it. Absolutely yes, that is a danger. …”
“LET’S MAKE BRITAIN GREAT AGAIN. East Devon Alliance joins Devon’s NHS campaigners in Central London.”
“This was one message East Devon Alliance (EDA) representatives took to what the national press called “one of the biggest NHS rallies in history”, in Central London just one week ago ( Saturday 4th March). An estimated crowd of 250,000 from all over the country, included coachloads from Devon’s ‘Save Our Hospital Services’ (SOHS) network of campaigners, strongly supported by EDA. Prominent amongst the East Devon Alliance group were District Councillors Cathy Gardner (Ward Member for Sidmouth Town) and Val Ranger (Newton Poppleford & Harpford), along with Mayor of Axminster,Paul Hayward. Their call to the government is to reinstate the NHS, now being systematically dismantled, and to repeal the 2012 Health & Social Care Act NOW!
In bright sunshine, the marchers gathered in a densely-packed Tavistock Square at midday, to hear speeches. One was on behalf of hard-pressed Junior Doctors (“We have to take this fight to the streets”). Another example, from Devon’s SOHS , “ now a mass movement in the whole of Devon”, told of “cuts of 93 beds in 5 community hospitals, in Seaton, Okehampton, Honiton, Whipton and in Holsworthy” , and of “six-figure salaries of consultants parachuted in to Devon” who say that there will be “no red lines: any service could go”. Hence the SOHS events based on ‘protective red lines’ drawn by the public..in red clothes, hats, ribbons,etc,…around hospital services.
Due to the huge numbers, there was some delay until the procession to Parliament Square could begin, and for the same reason, it took a full 3 hours’ walk to arrive at Big Ben. On the way, SOHS led the chants outside Downing Street, enthusiastically echoed by the crowds, “Hey, Hey, Theresa May, How many beds have you cut today?” Throughout the event, a pervading mood of sincerity, calm determination, and decency, left the police on duty notably friendly and relaxed.
The policy of dismembering the NHS may not be good for the government’s long-term health, nor for ours!
Come and join the ‘Red Line’ actions in East Devon on Saturday, April 1st. Details coming soon.”
“Surrey council received boost in budget after ‘sweetheart deal’ claims”
“Analysis by Labour shows that out of the £2bn of new money for social care in England announced in Wednesday’s budget, Surrey will see the biggest increase in the share of funding by the 2019/20 financial year.
The analysis says that Surrey will get 1.66% of the money, rising from 0.75% in 2017/18, an increase of 0.91 percentage points in the three-year period – more than double the increase of the second council, Hertfordshire.
Theresa May has repeatedly denied Surrey will receive any form of funding not available to other local authorities, after the council last month called off a planned referendum on increasing council tax by 15% to pay for what it said was a crisis in social care funding.
But soon after the postponement, leaked text messages about a supposed “memorandum of understanding” between the council and government prompted Jeremy Corbyn to accuse May of buying off Surrey with a special deal, which she denied.
The Labour leader reiterated the accusation this week after the release of an audio recording in which the council leader, David Hodge, told fellow Surrey Conservatives about a “gentleman’s agreement” with ministers.
Hodge revealed in the recording that there had been a “series of conversations” with the communities secretary, Sajid Javid, in a car outside Downing Street. That was followed by a second meeting with the chancellor, Philip Hammond, he said.
Later that day, documents released by Surrey under freedom of information rules showed Hammond was among a series of Surrey Conservative MPs who lobbied Javid over the issue.
A new set of correspondence released by Javid’s department shows that on the morning of 7 February, the day Hodge announced he was backing down from the referendum, frantic negotiations were still going on.
At 8.23am Surrey’s director of finance, Sheila Little, messaged Matthew Style, head of local government finance at the Department for Communities and Local Government (DCLG), one document showed.
“The leader [Hodge] has just shown me a note from a Surrey MP about a conversation late last night with SJ,” she wrote. SJ refers to Javid.
“Seems to indicate government are willing to get us some extra funding from 2018. V interested in whether this is sincere. As it stands isn’t enough to call the ref [referendum] off? But could it be?”
May’s official spokesman was adamant when asked whether the exchange indicated the prime minister might have misled the Commons over the issue. “No,” he said. “There is absolutely no change in our position.”
A DCLG note released with the freedom of information documents made the same point.
“Whilst the final settlement has yet to be approved, the government is not proposing extra funding to Surrey county council that is not otherwise provided or offered to other councils generally,” it read.
“There is no ‘memorandum of understanding’ between government and Surrey county council.”
However, Labour’s Teresa Pearce, the shadow communities secretary, said the analysis of the extra social care money showed ministers “are busy playing political games with funding allocations in a desperate attempt to hide their sweetheart deal”.
She said: “This week’s budget won’t fix the issues facing social care. What we need from the Tories is a long-term sustainable plan, rather than cosy deals for Tory councils.
“Theresa May has failed to come clean about the terms of the deal offered to Surrey, failed to apologise for her government’s misleading suggestion that there had been no such deal and would not give the assurance that other local councils will get the same treatment.”
Late on Friday night, Labour MP Andy Burnham tweeted that he would raise the question of whether the ministerial code had been broken.
A DCLG spokesman said: “To suggest that any local authority is being given preferential treatment is simply not true.
“The majority of the £2bn of additional funding for adult social care announced at the budget will be allocated in the same way as the Better Care Fund, ensuring those who can raise less through the social care precept benefit most. The remainder will be allocated according to relative need in recognition of the additional challenges which social care places on certain councils.
“This is entirely fair, transparent and consistent with how we already fund adult social care.”
The ‘Alice in Wonderland’ fight at DCC for local hospital beds – winner and losers
The observations of a member of the public (Chris Wakefield) at the meeting. Note: whoever voted for Councillors Brook (Chudleigh) and Diviani (Honiton St Pauls) at the last election – hang your heads in shame.
Brook tried to stop Claire Wright’s tough motion (which was carried) because she wrote it down!!!!! Diviani, also Leader of East Devon District Council) said and did NOTHING to help Honiton hospital to stay open. Others who voted against are named below.
The vote (which should have been unanimous) went 7-5 in Claire Wright’s favour. Those voting against were: Jerry Brook (Chudleigh), Paul Diviani (Honiton St Pauls) Chris Clarance (Teign Estuary), Debo Sellis (Tavistock)and Rufus Gilbert ( Salcombe).
“Having watched the Health & Wellbeing Scrutiny Committee webcast it is easy to see why we are where we are with this. Here’s a selective personal account for anyone who missed the live action.
CCG’s team was out in force, with a front bench of four, bolstered by some invisible ‘friends’ mentioned by the chairman but never seen by us, to urge them on.
They kicked off with a slightly nervy CCG presentation mainly to tell us why the consultation was such a remarkable achievement – an award-winning consultation – endorsed by all sorts of benchmarks, quality marks, kite marks, hall marks and all; and it is hard to fault it against the measures offered to us. The only down side is that everyone else thought it was a ready-made decision seeking a post-facto endorsement. Neil Parish MP called it a ‘sham’ and few would disagree with him.
The councillors on the committee, in the main, then laid into them, and voiced what the feeling was among their constituents, which was justifiably murderous, and which prompted CCG’s Rob Sainsbury to launch into vigorous technicalities, emphasising his case with staccato hand movements, and showing the clear strain of casting his carefully modeled pearls before such porcine auditors.
There were questions, to which most answers were inadequate, and others not given. There was talk, (threats possibly) of FOI demands, which is alarming given that all these people are in public employment, and I have never worked out why any information is not forthcoming simply for the asking.
Anyway, a few highlight will cheer us up – first the pleasure of watching old hands in action – Cllrs Westlake and Greenslade in particular, the latter quite chirpy considering the doleful nature of the business at hand, leaping on Simon Kerr’s foot-in-mouth remark about the complete absence of responsive social care in Axminster, and brazenly cutting to the chase, asking how much the Success Regime was costing us. (An interim cost was £2.6m I thought I heard, but I could be wrong – that seems like an awful lot of cutter for a man-and-a-dog outfit like Carnell Farrer).
No one in fact was inclined to give wholehearted support to the CCG in their plans; there were a few limp equivocations – cllr Diviani told us (once he could get his voice going – the key is turned but the engine always takes ages to actually start) that he’d been in hospital and it was brilliant, and one or two others wrung their hands over the clear lack of social care provision, while not condemning the process that brought us the crisis.
Claire was invited to make her proposal for the committee to vote on, whereupon the snappily dressed cllr. Brook, clearly confused that Claire has prepared for the meeting by writing down her proposal, suggested that people who wrote things down were clearly trying to subvert the democratic process. (Tories have traditionally held that teaching the working classes to read and write had been a mistake – and that tendency has played into our education system ever since 1872, which is why legislation has studiously avoided any education in matters of politics, in order to forestall indiscipline in the ranks. There is a cracking story on that topic, but I’ll skip it for the moment).
Cllr Westlake, from the chair, reminding cllr Brook that writing was OK, proposed that Claire’s proposal was put to the vote. Result 7 – 5 in favour. That’s OK, good even – but what is there to vote against one wonders, the proposal is merely to make sure we do the utmost to get things right before trashing the existing local health infrastructure. And when you hear ‘We are very cautiously optimistic that the new model of care can be implemented’ from the CCG, then caution seems eminently sensible.
Just watched the budget in the commons. Must pack this in – politics is infuriating enough without hours of watching it on the telly as well. Except that it is primary data, and bypasses the media, so it does help us to see what actually is going on.
It will be interesting to see how much of the £1bn for top performing STP planners comes Devon’s way. Probably in proportion to the extent of fawning the local MPs can summon for Mrs May’s other tricky issues on the government’s agenda. Well done Claire.”
East Devon Alliance Public Meeting on hospital bed cuts
EDA Public Meeting
Saturday, 18th March at 4.30,
Colyford Memorial Hall
Independents’ Way Forward on Hospital Beds
Speakers:
Claire Wright
fresh from her success on the DCC Health Scrutiny Committee,
together with the Independent East Alliance candidates for
Seaton and Colyton (Martin Shaw)
Axminster (Paul Hayward)
Sidmouth (Paul Arnott)
and
Leader of the EDA, Cllr Cathy Gardner,
to discuss the next steps in the fight for our community hospital beds and to save the NHS in Devon from widespread cuts.
All Seaton and Colyton GPs slam bed closures
“Seaton and Colyton GPs condemn hospital bed closures
The GPs at Seaton and Colyton Medical Practice and Townsend House Surgery have expressed their dismay at the decision to axe all inpatient beds at Seaton Hospital.
They say the closure, as part of the latest round of health economies by New Devon CCG, is a cruel blow to the Axe Valley.
In a statement issued this week they told The Herald: “Since the earlier closure of Axminster, Seaton Hospital represents the only inpatient facility for residents of both towns.
“Coupled with the loss of Honiton Hospital, Sidmouth hospital has the only beds to cover the eastern part of Devon.
“Bed shortages this winter have seen The Royal Devon and Exeter Hospital running at crisis levels so this policy seems misplaced as a way of reducing costs.
“The future plans of care in the community, with carers covering the most vulnerable in their own houses, undervalues the level and complexity of care that is offered as an inpatient and ignores the fact that there is a current shortage of qualified staff.
“End of life patients who cannot be supported at home may now end up admitted miles away from family and friends.
“Sadly, quality of care is steadily being eroded, and it is our most vulnerable patients who will be affected most by this closure.
“Challenging the decision seems futile as the alternative will be closure of Sidmouth Hospital and similar arguments will apply.
“It is the decision to focus on bed closures that needs contesting.”
http://www.midweekherald.co.uk/news/seaton_and_colyton_gps_condemn_hospital_bed_closures_1_4921391
This is how fast our community hospitals can close
And, my, is it FAST if this Torbay timetable is anything to go by:
Rural? Depending on rural care? Probably best to forget it
Are Ottery, Honiton, Axminster and Seaton now classed as “rural communities” now they have no hospital beds, along with villages?
http://www.rsnonline.org.uk/press-releases/shortage-of-rural-doctors-puts-patients-health-at-risk
http://www.rsnonline.org.uk/services/rural-social-care-is-underfunded-–-network
http://www.rsnonline.org.uk/services/communities-blighted-by-patchy-rural-services
http://www.rsnonline.org.uk/analysis/are-rural-carers-overwhelmed-by-need
Hospital care at home? Are you sure that’s what is best?
“… In community health nursing, there has been a 12% drop overall in full-time equivalent staffing numbers since September 2009, despite growing demand.
In the East Midlands, district nurse Mary Black says her team and other colleagues are struggling to cope, because of a mixture of unfilled vacancies, maternity leave and long-term sickness absence, which directly affect patient care. “We firefight every single day: moving patient visits, ringing round to see if other teams can help, and we often have to cancel or defer. We have bank and agency nurses to cover vacancies, but not usually sickness or maternity leave, so it means the staff who are left have lots more visits to do each day,” she says. “There is no continuity, as often there’s a different agency nurse each day and there are a lot of duties and patient visits that an agency nurse can’t do, so the complex patients fall to our permanent members of the team. Agency staff often cancel at the last minute and sometimes don’t turn up.”
Black says: “It often feels like we’re not giving our patients a very good service, we cannot spend the time with them that they often need. Incidents and complaints will have risen.”
Last month’s report on the public sector workforce by the Reform thinktank is blunt about the impact of staffing problems. “Public services fail when employees fail,” it concludes. “This is the dramatic lesson from a number of high-profile errors in recent public service delivery. In many instances, quality is compromised, not because of individual incompetence, but the way the workforce is structured and organised. …
… “When you don’t have the right staff levels, we have to see patients on a prioritised basis,” he says. “Patients don’t get the quality and sometimes it means people get sub-optimal outcomes. It’s frustrating and demoralising.” Some of his colleagues have voted with their feet: leaving for private sector jobs with better work-life balance, or moving somewhere with lower house prices. “They are on the same money as it’s nationally done but the property prices are different,” Davies says. In the South-West, the shortages are particularly acute for more junior grades. “It tends to be easier to recruit more senior physios as they are a band up so the pay is better but it still can be an issue getting the right people down to us.”
https://www.theguardian.com/society/2017/mar/08/uk-social-care-crisis-staff-shortages
Independent DCC Councillor Claire Wright does what ALL our local MPs failed to do
IF ONLY SHE HAD BECOME OUR MP! DIVIANI AGAIN VOTED AGAINST REASSESSMENT OF THE PLANS! LET’S MAKE SURE CLAIRE WRIGHT IS RE-ELECTED AS DCC COUNCILLOR IN MAY, ALONG WITH ANY OTHER TRULY INDEPENDENT CANDIDATES – AND FEEL VERY GRATEFUL THAT DIVIANI IS NOT STANDING FOR DCC AGAIN!
A decision to halve the remaining hospital beds in Eastern Devon will be referred to the Secretary of State for Health, unless a raft of assurances are provided.
A review of all community hospital bed closures across Devon since 2014, will also take place, including examining the role of social care.
I made the proposal at Devon County Council’s health and wellbeing scrutiny committee this afternoon and it was voted through by seven votes to five.
Last week, Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) made a decision to close 71 beds at Whipton, Okehampton, Honiton and Seaton Hospitals, retaining beds at Exmouth, Tiverton and Sidmouth.
Their proposal had previously been to retain beds at Seaton and close beds at Sidmouth, but the CCG’s governing body decided to shut beds at Seaton instead of Sidmouth for demographic reasons.
Following today’s health and wellbeing scrutiny committee meeting 14 assurances will now need to be provided by the CCG on its decision within 28 days, which the committee will examine in its new form after the elections on 4 May.
If the assurances are insufficient or inadequate, the decision to close 72 beds will be referred to the Secretary of State for Health.
From my own personal perspective it seemed to me that the four members of the CCG – Laura Nicholas – Director of Strategy, Rob Sainsbury – chief operating officer, Janet Fitzgerald – chief officer, and Dr Simon Kerr – GP from Ottery St Mary, who attended today were trying to convince the committee that the care at home system was going to work, but it was clear that they themselves had doubts.
At one point Laura Nicholas said: “We are very cautiously optimistic that the new model of care can be implemented.”
I asked the following questions:
– How much money will be saved? Answer: Between £2 and £5m
– How many more staff will you need? Answer: This will be variable and it depends. We are working these issues through (I had previously been told by the CCG chair, Tim Burke, that there may be around double the number of staff required for the new care at home scheme)
– How many objections were there out of the more than 2000 consultation responses received?
Answer: Cannot say. I then asked about an approximate percentage, but this couldn’t be given either.
– When are you going to implement the bed cuts? Answer: We don’t know yet. When we are confident that the new model of care is ready
– Sir Simon Stevens announcement last week about NHS England ensuring that health trusts must demonstrate that sufficient alternative provision is there before any future bed cuts are made. Are you confident that if this guidance was in place now you would be able to meet it? Answer: We will ensure the new model of care is ready before any bed cuts are made.
But… the decision to close the beds has already been made!
Chairman, Richard Westlake asked about the future of hospitals that would have their beds removed. But was told there was no hospital buildings identified for closure. It was that the beds were being removed.
Yet in the CCG papers I read last autumn it made it very clear that some hospital buildings would be deemed surplus to requirements and be sold.
Of course NHS Property Services now owns all community hospital buildings in the Eastern Devon area and is already charging its hefty commercial rents ……
We heard from three members of the public including Paul Hayward, Mayor of Axminster, who is concerned about the decision to close beds at Seaton, which will affect Axminster residents, who lost their beds at the same time as Ottery’s in 2015.
We also heard from Cllr Jack Rowland from Seaton Town Council who argued similar points to Paul Hayward and Philip Wearne, a north Devon hospital services campaigner.
Cllr Hayward had carried out some research and found that Devon County Council’s own statistics on demographics were at odds with those published by NEW Devon CCG last week to justify keeping Sidmouth’s beds open instead of Seaton’s.
He and Cllr Rowland also expressed concerns about travel distances to the nearest community hospital.
And to complicate matters, Northern Devon Healthcare Trust has just announced temporary closure of all Holsworthy Hospital’s beds due to staffing shortages and apparent low bed occupancy levels.
The difficulty is that during the consultation the CCG had advised that people from the Okehampton area would be referred to Holsworthy Hospital for inpatient care. Something that they cannot now deliver on.
Cllr Barry Parsons made a compelling case for why this decision was quite wrong and how upset the people of Holsworthy are.
Cllr Kevin Ball from Okehampton expressed his dissatisfaction with the consultation process which he viewed as unfair and how the loss of Holsworthy Hospital’s beds will negatively affect any alternative provision in Okehampton.
The CCG said they would do further work in Okehampton on this.
Caroline Chugg proposed that the committee should recommend no bed closures should take place until there was sufficient alternative provision in place.
Finally, the CCG’s own health scrutiny paperwork admitted that this following damning staff response was a theme (p71): – http://democracy.devon.gov.uk/ieListDocuments.aspx?CId=130&MId=1981&Ver=4
“The potential financial savings of the proposed changes have not been clearly established and the actual costs of replacing hospital based care with community based care are not even estimated. The existing hospital nursing staff have not been consulted on their willingness to transfer to a very different pattern of working. Many of them are very concerned about the professional vulnerability that this presents and, at a time when there are many vacancies both in the NHS and through agencies, they are not likely to simply accept a situation that they do not see as professionally or personally secure.
“ Assurance was given that no hospital beds will be closed before the staff are in place for Care at Home. But assurance also needs to be given to local hospitals now, potentially blighted, to stay open, or staff will walk.”
Managers say that bed closures will affect only 20 patients a week, but this is over 1000 patients a year plus their visitors who may need to travel further to visit.
I have to say that I cannot fully blame NEW Devon CCG for this hopelessly rushed and poorly thought out decision. They are under the cosh of the government’s Success Regime as one of three most financially challenged health areas in the country.
The Success Regime exists as a hatchet programme of cuts because of the projected deficit of £384m by 2020/21.
My understanding is that this deficit is largely caused by a growing elderly population in Devon with complex health needs, combined with a reduction in the annual growth funding from government, which has dropped from around six per cent to around 1 per cent in the past seven years.
My proposal was put to the vote and was immediately objected to by Cllr Jerry Brook, who claimed it was ‘pre-determined’ because I had typed it out and given it to officers beforehand.
He was reminded by the chairman that this was common practice.
The votes were seven votes to five in favour. Voting in favour (I believe) were: Me, Caroline Chugg, Andy Boyd, Emma Morse, Brian Greenslade, Robin Julian and George Gribble.
Voting against (I believe) were: Jerry Brook, Paul Diviani, Chris Clarence, Debo Sellis and Rufus Gilbert.
The issue will be pursued again after the elections on 4 May.
Here is the motion (it was altered in committee so may appear slightly differently in the minutes but this is the essence):
This committee:
1) Objects to the decision by NEW Devon CCG to reduce the number of community hospital beds in Eastern Devon from 143 to 72
2) Resolves to refer the decision to the Secretary of State for Health on the following grounds if adequate assurances are not given on the points below:
a) It is not in the in the interests of the health service in the area
b) The consultation is flawed
3) Agrees to conduct a review of community hospital bed closures made across Devon since 2014 to establish the effectiveness of the replacement home care, including examining the role of social care
Notes relating to 2 above:
– That no beds are closed before there is sufficient alternative provision
– There is no clear explanation of what care at home will look like or work and this model has frequently been mixed up with Hospital at Home which is entirely different
– There may not be adequate care available in people’s homes, given the staffing shortages in the NHS, and the significant difficulties in adult social care
– That Hospiscare reported in its consultation response to the bed closure proposals that during 2015 managers reported 58 incidents to the CCG where the breakdown of social care packages for people at end of life had caused distress. All of these people had wanted to be cared for at home
– There are no clear answers on how many more staff are required to make the new model of care work. And that there are shortages in many health professional disciplines
– Despite a significant budget deficit, there is no clear financial saving to be made. In fact once the new model of care is in place the savings may be extremely small
– That there is no clear plan on the future of hospital buildings that have lost their beds and are now in the ownership of NHS Property Services
– The new government direction that will come into effect next month which mean health trusts will need to prove that there is sufficient alternative provision before any beds close
– Okehampton and Honiton Hospitals were excluded from the consultation process
– The temporary closure of Holsworthy Hospital beds which is where Okehampton patients were to be referred
– The ongoing and significant pressure on the RD&E hospital beds and difficulty with discharge
– Doubt over the soundness of the data relating to the decision retain Sidmouth Hospital’s beds over Seaton’s
– Staff appear to be opposed to the plans
– Closure of many care homes
The link to the webcast is here – https://devoncc.public-i.tv/core/portal/webcast_interactive/268434
East Devon Alliance represents East Devon at national NHS march
“Cllr Val Ranger (Newton Poppleford & Harpford); Mayor of Axminster, Paul Hayward; Cllr Cathy Gardner (Sidmouth Town)
leading the support from East Devon at what the national papers describe as “one of the biggest NHS Rallies in history”.
They joined an estimated 250,000 healthcare workers, and their supporters, including coachloads from Devon, in a march from Tavistock Square to Parliament Square last weekend (Sat 4th March). The aim is to stop the current dismantling of the NHS, which it’s claimed is putting patient care , and lives, at risk; and to rethink policies where huge amounts of government money are going to PFI (Private Finance Initiative) hospital loan repayments, and to tiers of administration such as the much criticised Clinical Commissioning Groups. (CCGs).
Watch for reports in the local press this week.”
“NHS forced to provide 4,500 extra beds a day”
And still they close our beds! Madness”
“Hospitals had to provide 4,500 extra beds a day at the height of the pressures this winter to avoid “a full-blown crisis”, NHS bosses have revealed.
That is the equivalent of creating more than eight extra hospitals to cope with unprecedented demand in recent months when large numbers of patients were stuck on trolleys and in the back of ambulances outside A&E units.
The NHS in England came under such intense pressure that patients found hospitals “distressing and potentially dangerous”, according to a report from NHS Providers.
The organisation, which represents the majority of NHS trusts in England, claims hospitals are close to “breaking point” as they become overcrowded all year round.
Its analysis of NHS England data on how hospitals performed during December, January and February shows they had to add sometimes dozens of “escalation” beds at short notice so they could admit every patient who needed to stay in. Some used rehabilitation gyms and other areas not usually used for patients.
Chris Hopson, the chief executive of NHS Providers, said: “This has been the busiest winter ever for the NHS. Be in no doubt, these figures show a system running hot and – in particular times and places – overwhelmed by the demands placed on it, risking patient safety.”
In the NHS’s busiest week this winter, between 30 January and 5 February, hospitals opened up a total of 32,558 additional beds. They created almost as many overflow beds in the first half of February, when cold weather added to existing pressures.
Patients had to be diverted from one hospital A&E unit to another 476 times over the winter – almost double the 266 of last winter, NHS Providers says.
“As pressure continues to grow, the likelihood of more trusts reaching and moving beyond breaking point increases,” said Deborah Gulliver, a senior research analyst with NHS Providers. “For patients these difficulties are distressing and potentially dangerous. They are also demotivating and demoralising for the clinical workforce. It is thanks to the extraordinary efforts of frontline staff that we have made it through this winter period without a full-blown crisis. However, trusts are telling us that it was a close-run thing.”
The heavy demand on the NHS all year round was leading to worryingly high levels of bed occupancy, she added. Bed occupancy reached 96% this winter, above the 85% considered safe.
“So the resilience of trusts to deal with unexpected spikes in pressure, such as flu outbreaks and norovirus, is compromised. We cannot afford to ride our luck indefinitely,” Gulliver said.
Jonathan Ashworth, the shadow health secretary, said: “This stark warning from NHS Providers makes clear this has been an NHS winter like never before.
“Theresa May’s refusal to take seriously the twin threat of NHS underfunding and rising demand has pushed services to the brink. The direct result of the prime minister’s stubbornness has been a collapse in standards of patient care, with the worst performance on record for A&E and most hospitals dangerously overcrowded.”
NHS Providers is urging Jeremy Hunt, the health secretary, to order a review of how the NHS coped this winter in order to learn lessons and prevent hospitals from coming so close to not coping in future. The current situation is “not sustainable” for the NHS or patients, it argues.
Meanwhile, a poll of 96 MPs of all parties by the Royal College of Emergency Medicine, which represents A&E doctors, has found that only 33% of them believe A&E departments have enough money and staff to provide safe care. More than six in 10 MPs believe A&E departments need more money, said the college.”
https://www.theguardian.com/society/2017/mar/07/nhs-forced-to-provide-4500-extra-beds-a-day
North Devon Healthcare Trust CEO seems to be in the dark about its plans!
“What will happen to acute services at North Devon District Hospital? “I don’t know,” says Northern Devon Healthcare NHS Trust’s chief executive.
Alison Diamond gave a presentation at North Devon Council’s executive meeting on Monday, March 6, under special request from the committee.
The meeting took place at Cedars Inn to allow member of the public to attend and more than 100 people turned up to hear the update and ask their questions.
When asked what was going to happen to the Barnstaple hospital and the proposed cuts to its acute services, which includes stroke, A&E, maternity, paediatric and neonatal support, Dr Diamond did not know the answer.
She said: “I am here on behalf of the Sustainability and Transformation Plan (STP), which aims to provide a Five Year Forward View, to give an update. I do not have any answers today and I do not know what the model of care will look like because no decisions have been made yet.
“Our vision is to have people managing their own care and for that we need responsive care services and fair access to services. Our services are under review because the demand is going up, they were designed for the needs of people from a long time ago, we do not have enough staff, and the standards we have to comply with are always changing.
“Urgent and emergency care, stroke, maternity, paediatric, and neonatal are currently under review but others will follow.”
The emergency services review, led by Adrian Harris, medical director at the Royal Devon and Exeter, states there is a national requirement to meet seven day services, particularly with critical need patients.
It states staffing shortages, especially consultants and nurses, are becoming critical in some of our hospitals and people need to be seen in a timely way but we don’t meet the four hour target in some places in Devon.
The maternity service review, led by Rob Dyer, medical director at Torbay and South Devon NHS Foundation Trust, has found staff shortages in all three services, resulting in a high use of agency staff.
It has said it is more difficult to provide a service 24/7 and there are not enough choice for births, for example, if someone would like to give birth at home. It was noted to have a home birth the mother must live a maximum of 20 minutes from a hospital.
Dozens of members of the public, who were not required to give their names, stood up to put their questions to Dr Diamond and voiced many concerns about the proposed cuts.
The main points were:
Travelling times from the rural North Devon areas to hospitals in Exeter and Plymouth
Social care and appointments needed looking at to improve care
New housing developments would lead to an increase in the population needing care
Staff would not want to come to work at a hospital about to be downgraded
Rob Sainsbury, the trust’s director of operations, said Okehampton patients would be accommodated at Holsworthy hospital, just a day before their cuts were announced
What would the impact be on the hospitals in Exeter and Plymouth and the ambulance service?
Why can planned operations not be moved to more distant hospitals, rather than emergency care?
Is this a move towards privatisation?
One man stated: “The STP is butchering the NHS. Stop these cuts and give the taxpayers back their service.”
A woman added: “Everyone here has reason to be grateful to NDDH, we want it to stay and be improved if anything. We are asking you to help us. We want a hospital that is fit for purpose.”
said
And finally, a man said: “If someone dies on the road to the hospital, that will be on your conscience.”
Councillor Des Brailey, leader of the council, proposed the following statement of principles: “The council will not support any proposals to change preventative services, clinical care or social care, which it considers would disadvantaged the wellbeing of individuals or communities in North Devon.
“People should have ease and timely access to health services to achieve the best outcomes. The structural and service characteristics of any newly commissioned service must have regard to the population characteristics and the local geography of North Devon.”
The proposal was passed by the committee unanimously after it was amended to include equity, aspirational and affordability, as Councillor Frank Biederman stated: “I don’t want to see people having to choose between feeding their children and taking them to hospital.”
The next step is for the STP team to get feedback and create a model of care. Throughout March, clinical workshops and public engagement will continue. In spring, this feedback will be incorporated and in the summer, the options for change will be published, followed by public consultation on these options, led by the Northern Eastern and Western Devon Clinical Commissioning Group.
Challenges were raised in the Case for Change document created by the Success Regime:
One in three people live with one or more long term conditions
Two in three people would prefer to die at home and only one in four are able to
15 years life expectancy difference in some areas
Deficit of more than £550 million by 2020/21 if nothing changes
600 people in hospital do not need to be there
Care home sector is struggling
Stroke, maternity, A&E and children’s services are unsustainable in patches across Devon.
Less money is spent on health and social care in most deprived areas
95,000 people with a long term condition have a mental illness
One in 4 GPs to leave NHS in next few years.”
East Devon Watch 