And it's goodbye to BCC's health scrutiny committee - and will anyone notice?

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11 February 2020

Last Friday BCC's scrutiny committee on health and adult social services (HASC) met for the last time.

One of the items HASC considered was the "temporary" closure of 22 beds on Chartridge ward at Amersham Community Hospital (see blog of 12 October 2019 below).

A similar closure occurred in Oxfordshire last year. Oxfordshire County Council's health scrutiny committee asked the Oxfordshire NHS Heathcare Trust a lot of very pertinent questions about the closure and then passed a vote of no confidence in the Trust. The beds were re-opened.

I just wondered if there was any chance HASC could do the same.

The answer, as expected, was no.

This was no great surprise as we already knew what the Chairman of HASC, Councillor Mike Appleyard, thought about the bed closures in Amersham. He was asked by a constituent for the impact assessment and responded:

“These are NOT hospital beds, they are Care beds that happen to be in a hospital. The impact assessments will be that people moving out are likely to be happier than stuck in a hospital bed until they die.”

Let's consider this for a moment.

Amersham Hospital's wards are for rehabilitation.  Patients in these wards, for example amputees, do not need acute medical care but need more medical care than they can get at home. Bucks NHS Healthcare Trust has said that the lack of such beds is causing bed blocking and delays in A&E. So these are hospital beds.

Councillor Appleyard then suggests that two things could have happened to patients who were moved out of Chartridge ward (or no longer have the opportunity to go there). They could be stuck in a hospital bed until they died. Or they could have been moved out to - well, wherever. Councillor Appleyard believes patients would be happier with a move to wherever.

Perhaps it's not dawned on Councillor Appleyard that patients who are in hospital for rehabilitation do not expect to die. Neither do they expect to be moved out to wherever. They expect to stay in hospital until they don't need to be there and then they expect to have the home care they need to go home.

To say that patients would be happy for the beds to close whatever the alternative beggars belief. Not to mention showing a distinct lack of compassion.

I listened to the HASC discussion about the bed closures on BCC's webcast. If you want to listen for yourself, it's at item 10 at https://buckscc.public-i.tv/core/portal/webcast_interactive/462220 .

Here's my highlights: -

1. Jane McBean (who I think is a Conservative councillor on Chiltern District Council), asked if the "temporary" closure of the ward was now permanent.

Answer from the CEO of the Trust - was "not absolutely".. "we will keep as it is for now" ... we are continuing to look at recruitment" ... "we want to maintain the conversation" and "we need to consider in the broader context". So now you know.

Councillor McBean said the 6 month pilot to assess the impact of closing community beds had now taken 2 years; residents needed to know what was going to happen to Chartridge ward with clear timelines and a clear vision.

Answer - the Trust would keep in touch, perhaps next summer?

2. A representative from BCC's Adult Social Care (I think) pointed out in a rather oblique way that moving patients from hospital to residential accomodation moved the costs from the NHS (free to patients) to BCC (means tested for the patient).

So perhaps that's what it's all about.

3. Councillor Wassell passed on the concerns of residents about the closure of Chartridge ward, saying residents were suspicious of the Trust's intentions based on past experience. She asked if patients didn't need more beds and more home care?

Councillor Appleyard started to answer the question until Councillor Wassell pointed out it was not for the Chairman of HSAC to answer for the NHS; the purpose of HASC was to get answers direct from NHS managers.

Answer to Councillor Wassell's question from the Trust - who knows. Something about a continuing conversation, keeping options open and broader considerations.

HASC's final conclusion? Who knows?

So there you have it. The Trust congratulated HASC for its rigorous scrutiny over the years and for keeping it on its toes (yes really). And that was the end of HASC.

Will the new Bucks Council do any better? You must be joking. Although Councillors will of course be paid a lot more money.

I just wonder if we could have Oxfordshire's scrutiny committee instead - it seems to know how to do the job.

P.S. BCC says it "welcomes the public’s involvement in scrutiny to help strengthen transparency and accountability". So I put down a question for this last meeting of HASC about the closure of the 22 beds in Chartridge ward. I pointed out that the closure was incomprehensible when the Trust has a bed occupancy rate of 98% which was dangerously high. I asked whether it might have had something to do with the Trust not having enough money.

However, Councillor Appleyard decided not to have public questions at this last meeting. Other residents' concerns were similarly dismissed. No surprise - it is par for the course. I had the added distinction of Councillor Apppleyard making disparaging comments about me in an e-mail to his colleagues.

BCC really welcomes the public's involvement - not!

Steve Baker and Matt Hancock should discuss the future of Wycombe hospital with residents – not pose for an election photo- opportunity

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16 November 2019

This is a letter I wrote to the Bucks Free Press today.

Dear Editor

A few weeks ago, the Bucks Free Press ran an article in which Steve Baker, the Conservative candidate for Wycombe, said he had invited Matt Hancock, the Secretary of State for Health to High Wycombe to discuss the future of Wycombe hospital. Steve Baker called Wycombe hospital an “increasingly tired 1960s tower block”.

The CEO of the Bucks Healthcare NHS Trust admitted the Trust is having to rely on "ageing" technology and had to put off maintenance to their buildings.

Mr Baker added that we “can be incredibly proud of how NHS staff have improved local services since 2010. We now need to look for investment in technology and ageing buildings, which is why the government is spending an additional £33.9 billion by 2023/24 and bringing forward the Health Infrastructure Plan.

“I know from my regular meetings with Buckinghamshire NHS managers that our tower block is increasingly tired, so my top local priority in the next parliament is to obtain the necessary investment for Wycombe”.

What the article didn’t say was when Matt Hancock would be coming – and whether there would be a public meeting so that residents could join in the discussion about the future of their hospital. And whether there would be any opportunity for the electorate to ask both politicians some questions about the NHS before the election.

Here’s the questions I would ask:

1. Why has “getting the necessary investment for Wycombe hospital” suddenly become Steve Baker’s top priority? Why hasn’t it been his top priority for the last nine years when he has been Wycombe’s MP and has voted for every single cut made by the Conservative government to the NHS?

2. Does Steve Baker still believe Wycombe hospital should be privatised?

3. Exactly how much money is the Government now committed to spend on hospital infrastructure and equipment? By when? Exactly how much of that money is coming to Wycombe hospital? (I think the answer is zero but I would be delighted if I am wrong.)

4. What are the Trust’s long term plans for Wycombe hospital? The majority of elective plastic surgery is planned to move to Wycombe hospital from Stoke Mandeville. But A&E went, maternity services went, vascular services went and now the cervical screening laboratory service will go. Is the Trust going to close other services at Wycombe?

5. While we are at it, why are waiting times for A& E so abysmal in Bucks? In October 2019, the latest figures, 25% of patients in England waited more than 4 hours – the worst ever recorded.

But in Bucks 35% - over a third - of patients waited more than 4 hours. Why is Bucks so much worse?

(Some of us remember that back in 2010 only 4% of patients waited more than 4 hours in A&E departments.)

6. Why are waiting times for treatment getting longer?

In 2010, I had a hip replacement. I went to my GP (same day appointment), was referred to a consultant and had the operation, on the NHS, all within 9 weeks.

This year my husband went to his GP about arthritis in his knee. It took him 7 weeks to get an X-ray. He opted for a pain- killing injection but after 12 weeks he hasn’t even got an appointment for the injection.

7. Why are some treatments no longer available on the NHS and how does the public get to know?

Five years ago, a friend of mine had a hernia operation on the NHS. This year he had another hernia but this time was told he wasn’t allowed a hernia operation on the NHS unless it was life threatening. He went private. It cost him over £4000. What do people do if they haven’t got £4000 to spare?

8. Why is the Bucks NHS Healthcare Trust closing down non-acute hospital beds when it hasn’t got enough beds to operate safely?

So far it has closed down 42 beds at Marlow, Thame and Amersham community hospitals and replaced them with “community hubs” as part of a so- called pilot. The hubs aren’t working all that well but there are no plans to bring back the much needed beds. Why not?

9. Why is the ambulance service struggling? Why are mental health services failing?

10. Why is the NHS service falling way behind the quality of service provided in other countries? In 2010, the NHS was one of the most cost- effective healthcare services in the world. Why are patients now waiting to be seen, on trolleys, in corridors?

11. What will be the effect on the NHS of a hard Brexit which Steve Baker advocates? What effect is Brexit having in Bucks on NHS staff recruitment and retention and what happens if we leave without no deal?

12. Is Steve Baker absolutely sure that the NHS will not be for sale as part of a trade deal with the US and other countries if we leave the EU? What guarantee have we got – apart from the word of Boris Johnson? Because the majority of voters don’t believe Boris Johnson when he said the NHS was off the table in any trade deal.

 

Steve Baker needs to answer to his electorate for the performance of the NHS in his time as Wycombe’s Conservative MP. What is not needed is a cosy chat with Matt Hancock, one of his colleagues, as a publicity stunt for the election.

Yours sincerely

Linda Derrick

Closure of Chartridge ward at Amersham Community Hospital – my challenge to Bucks Healthcare NHS Trust

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12 October 2019

A few days ago, I was invited to a workshop organised by Bucks Healthcare NHS Trust to discuss the future of Chartridge ward at Amersham hospital. The majority of participants were health professionals.

Chartridge ward was “temporarily” closed by the Trust about 4 months ago. I thought the Chief Executive of the Trust had given a firm commitment to re-open the ward in November and the workshop was about how this could best be done.

Instead, the workshop was about alternative scenarios for the ward, including its permanent closure. I said I thought I was there on false pretenses and prepared to leave.

In the end, I was persuaded to stay because the organisers of the workshop said they needed challenge from the public and from health campaigners.

So here’s my explanation of what is happening – my challenge is at the end.

The Trust needs to provide the right number of hospital beds with the right number of properly qualified staff, providing the right sort of care, and in the right places.

The Trust is finding it difficult to do this; in fact it is failing dismally.

The recommended occupancy rate for hospital beds in the NHS is 85%. That means only 85 beds out of a hundred should be occupied at any one time. The current national occupancy rate is 88%.

The occupancy rate for Bucks is 98%. This level of occupancy is regarded as unsafe. It means there simply aren’t enough beds to meet demand and non-critical operations like knee replacements often have to be cancelled to allow critical patients to be admitted.

Some beds are occupied by patients who don’t need a bed in an acute ward, or even a bed at all.

Many patients don’t want to be in hospital and it is safer, and cheaper, for them to be at home.

But many patients don’t have the necessary support at home so can’t leave.

Moreover, you can’t use a hospital bed without nurses. And the Trust finds it difficult to recruit nurses to Amersham hospital; Amersham is one of the more prosperous parts of Bucks where nurses find it difficult to live on their salaries and where they don’t get London weighting. The Government also closed the bursary scheme for nurses so the supply of newly qualified nurses has been drying up. And Brexit means nurses who are EU citizens are leaving and the recruitment of EU nurses is also drying up. 16% of nursing posts in the Trust aren’t filled.

Now it doesn’t take a genius to suggest some solutions to this problem. First, it needs a massive investment in providing support to patients coming out of hospital – and quickly. This should relieve pressure on the existing beds.

Second, and perhaps on a temporary basis, it needs an increase in the number of beds while the investment in home support is rolled out. That means extra beds being provided where nurses could be better recruited or an increase in nurses’ pay and conditions.

Unfortunately, this would need more money – lots of it. And the reality is that the Trust has had nearly a decade of swingeing cuts. It is, to say the least, strapped for cash. There are more cuts coming down the line and no sign of much, if any, extra money for Bucks.

So there’s no happy outcome to this problem. There really isn’t. The Trust is boxed in a corner and there is no way out unless it gets lots more money.

I heard participants at the workshop saying it wasn’t about money – it was about smart working. I don’t agree. The NHS can work as smart as it can, but no organization can meet increasing demands on its services and make massive organizational changes while its budget is slashed for years.

At the end of the day, if we want a good national health service (and I do), then we have to pay for it with our taxes.

So given that the Trust is boxed in a corner and there is no happy outcome, where’s the challenge?

My challenge to the Trust is for it to explain what is happening simply and honestly to residents.

Cutting 22 beds on Chartridge ward, on top of previous cuts at Marlow and Thame Community Hospitals, is simply bad news.

It is going to mean that beds are going to be in even greater demand.

What is that going to mean in practice? What will it mean to waiting times for operations? Or for A&E?

Such an explanation is known as an impact assessment. Campaigners have asked for impact assessments many times with no success. The Trust really should do one for the closure of Chartridge ward. And the Trust should do it in terms the public can understand.

The beginning of the end for Amersham community hospital? 

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10 July 2019

The Bucks Healthcare NHS Trust closed a ward in Amersham community hospital at the beginning of the month. This, the Trust said, was due to “staff shortages” which had been identified by the Quality Care Commission during an inspection. This means the Trust has closed down 22 community beds. It says the closure is temporary; it will review the situation in November.

So that seems all very reasonable, doesn’t it? 

Well it might do if you didn’t know the background.

You see back in 2017 (see blog below of 3 March 2017), the Trust decided to close down 20 community beds in Marlow and Thame community hospitals. These beds were used for terminally ill patients and those requiring rehabilitation. The Trust didn’t consult on the closures; they referred to it as “re-providing” beds.

The Trust then said these were temporary closures while it ran a 6 month pilot “to assess how health providers can work more closely with social care and voluntary services”.

Bucks County Council’s Select Committee on Health and Adult Social Care is meant to scrutinise NHS services in Bucks. However, it totally failed to provide any scrutiny of this “temporary” closure (see blog of 1 April 2017 below). The Committee’s members couldn’t even agree a definition of “re-providing”. Nevertheless, it thought the pilot was a great idea.

Three thousand residents disagreed and signed a petition to say so.

A year later, a report of the pilot was produced by the Trust (see blog of 20 April 2018) It was made available too late for the public to ask questions at BCC’s Select Committee. The report contained no evaluation of the pilot; success criteria were made up during the pilot and made no sense; no costs were included; and there was no options appraisal nor impact assessment.

Despite this, the Trust said the pilot was a great success and it intended to continue the closures at Marlow and Thame. 

The Trust also said it would roll out similar closures at Amersham, Chalfont and Buckingham community hospitals.

This time round, the Select Committee had got its act together somewhat and asked the right questions. As it got few coherent answers, the Trust was asked to return a month later (see blog of 25 April 2018 below). Unfortunately, when the Trust returned, the Select Committee nodded the report through.

The community beds at Marlow and Thame community hospitals have gone. 

So I don’t think it’s a coincidence that when the Trust was inspected by the Care Quality Commission apparently the only ward that was understaffed was at Amersham community hospital. And no coincidence that the solution to the understaffing was to close the ward down. This is what the Trust said it wanted to do over a year ago.

What’s the betting the review in November will decide the closure should be permanent? What’s the betting the Select Committee will agree?

And what’s the betting that more community beds will go in Bucks? 

 

If you want a long and healthy life, don’t live in the centre of Aylesbury, Wycombe or Chesham

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1 March 2019

There is so much to blog about on healthcare in Bucks – but very little of it is good news. I’ve just picked three things to highlight today.

First, here’s a chart provided by the Bucks Healthcare NHS Trust showing who in Bucks can expect to have a long and healthy life.

If you are a man living in the countryside west of Marlow, there is good news – you can expect to have a healthy life until you are between 75 and 77 years old.

On the other hand, if you are a man living in the centre of Aylesbury, Wycombe or Chesham in an area of deprivation, you can only expect to have a healthy life until you are 56-64 years old.

It all goes to show that poverty isn’t good for your health.

Second, here’s a chart showing the vacancy rate for nurses in the Trust over the past 18 months.

Despite every effort by the Trust to recruit more nurses, the vacancy rate has hovered around 16-18%. That means about 1 in 6 nursing posts are vacant.

Staff turnover is high – as fast as the Trust recruits, nurses resign.

Vacant posts and high turnover puts the health of patients at risk. Moreover, perpetually recruiting and training a high inflow of nurses is expensive; so too is filling the gaps with agency nurses.

Now Germany is trying to recruit Polish nurses in the UK. The German adverts suggest Polish nurses might like to come home to the EU. So the current nursing shortage in the Trust can only get worse.

Third, and speaking of the EU, I asked the Trust in January if it could provide me with any information about its plans to mitigate the impact of Brexit on its operations.

No reply – not even an acknowledgement. Nothing surprising there.

But I wonder if the Trust’s Board knows it has a freedom of Information address on its website that doesn’t even acknowledge requests. I wonder if it cares?

It doesn’t give me much confidence if we have a no deal Brexit.

Conflicts of interest by members of Bucks Clinical Commissioning Group

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17 December 2018

Last Thursday, the Minor Injuries and Illness Unit at Wycombe hospital was renamed the Urgent Treatment Centre. The UTC was opened by the Mayor of Wycombe accompanied by a collection of councillors and healthcare practitioners.  The only difference between the two units seems to be that you can get GP appointments at the UTC.

So I thought what’s the fuss? We still haven’t got an A&E back. Why the relaunch?

Then I noticed that the Unit is to be run by a new company called FedBucks. 

According to Companies House, FedBucks is a private sector company run for profit. It was set up in June this year and issued about 466,000 shares at 25p each which raised about £116,000 of capital.

Those shares were bought by 43 surgeries and medical centres throughout Bucks in varying amounts. Marlow Medical Group for example has about 27, 000 shares at a cost of about £7000 while Oakfield Surgery has only 5000 shares at a cost of £1250.

Any dividends paid out by FedBucks would be paid, in proportion, to the Medical Centres and GP surgeries.

Bucks Clinical Commissioning Group (CCG) awarded a contract for the UTC worth £5.7 million a year for 5 years, extendable for another 5 years. The contract was awarded to a consortium called Bucks Provider Collaborative of which FedBucks is a member. It looks as though FedBucks will receive that £5.7 million a year to run the UTC.

Four members of the Governing Body of Bucks CCG are GPs in surgeries which have FedBucks shares. They therefore have declared a direct interest in any decision awarding a contract to FedBucks. Seven member of the Executive Board of the CCG have similarly declared a direct interests in FedBucks.

So these members were faced with an award of a contract to a private sector company in which they had a direct financial interest – not unusual nowadays, as more and more services are privatised.

In this case, the decision on awarding the contract was delegated to lay members of the Governing Body in line with the CCG’s policy on conflicts of interest.

However, it leaves me wondering how many of the CCG’s many contracts involve private sector companies in which members of the Governing Body or the Executive have financial or other interests?

How many of the decisions have to be delegated to lay members? If the expertise of medical practitioners is so vital to the CCGs, how can key decisions be delegated to lay members?

And of course, conflicts of interest don’t just arise in awarding contracts. They arise in drawing up contracts or specifying services which can be biased towards certain providers. They also arise in monitoring contracts and deciding whether to terminate, change or extend contracts. This sort of influence is not transparent nor open to scrutiny.

Am I the only one to be left with an uncomfortable feeling? CCGs, which are intended to be run by GPs, are awarding very large contracts to private sector companies in which GPs have a direct financial interest. This contract is only one example.

But perhaps this is the reason for the big opening – advertising the UTC would bring more business and therefore more profits to FedBucks and more money to the companies which own the GP surgeries.

Dr Rebecca Mallard –Smith, who extolled the virtues of the UTC in the Bucks Free Press, is a member of the CCG’s Governing Board with a declared and direct interest in FedBucks. She should have declared that direct interest when touting for business for the new Unit.

Steve Baker – ducking and diving again

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20 October 2018

In my blog below, 8 October 2018, I criticised Steve Baker for making a personal attack on a health campaigner rather than dealing with her concerns. Here’s Steve Baker’s response as reported in the Bucks Free Press (link below):

“The town’s healthcare debate has been blighted by political partisanship and an unwillingness to engage with the facts for years.

Sadly, this is worsening as Corbyn supporters from outside the constituency pile in. Their words should be discounted heavily.

At a time when our local health professionals are striving so hard to improve general practice, hospital care and integration with social care, it’s time to take the politics out of the NHS.

Our local NHS leaders will continue to have my support, encouragement and, yes, scrutiny on behalf of local people as they strive to do more for Wycombe. I wish them every success.”

This response is misleading in a number of ways.

To begin with, there has been little contribution by the opposition political parties to any healthcare debate in Wycombe for years, probably since the 2015 general election.

I challenge Steve Baker to find any substantial recent comment from any of the opposition parties about healthcare in Wycombe, including from Wycombe Labour’s Parliamentary candidate.

On the contrary, the healthcare debate in Wycombe (and generally elsewhere in Bucks) has been taken forward by campaigners on a non-party political basis.

So what on earth is Steve Baker talking about? Where is this political partisanship (except for his own of course)?

For my part, I wish there was a political debate on healthcare in Bucks. The NHS is in crisis and virtually all the politicians in Bucks – MPs, councillors, political parties – just don’t want to know.

The crisis has been caused by Conservative ideology that believes state provision of healthcare should be cut to the bone with as much as possible outsourced to the private sector. An ideology that believes in austerity for its own sake.

As an extreme right wing Conservative, Steve Baker believes Wycombe hospital should be privatised and he used taxpayers’ money to draw up plans to do this.

It’s no good Steve Baker saying we should take the politics out of healthcare; politics determine how the NHS is funded, who makes the decisions and who provides the services. Politics determines how long we have to wait for an operation and where we have it. Politics determines the funding for mental healthcare and where and how we give birth.

It’s amazing. The Conservatives bring the NHS to its knees and, when you criticise, their response is to say we should support the staff as they are working so hard and suggest everyone else is playing party politics.

Martin Tett, the Conservative Leader of Bucks County Council, said the same thing about BCC’s failing Children’s Services.

Both Steve Baker and Martin Tett are using dishonest tactics attempting to put the blame on campaigners and refusing to take responsibility for the consequences of their own actions.

In 2010 after 13 years of a Labour Government, the NHS was the best health service in the world in terms of efficiency, equity and quality of care. Not just my view but the view of independent, well –respected researchers in America and elsewhere. It had the lowest waiting lists and the highest levels of satisfaction from the public in its history.

The blogs below set out the facts of what is happening now. And it will get worse if Steve Baker gets the Brexit he is obsessed with. These are the facts he should be engaging with.

This is the political debate we should be having on healthcare in Wycombe. However, contrary to what Steve Baker says, it just isn’t happening because, sadly, politicians don’t seem to care.

P.S. I did wonder how I had missed all these “Corbyn supporters from outside the constituency”. Does anyone know where they are?

 

https://www.bucksfreepress.co.uk/news/16973610.wycombe-mp-steve-baker-slammed-for-verbally-attacking-campaigner-over-new-medical-super-hub-plans/

Concerned about healthcare? Tell Steve Baker, your MP - and get attacked

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8 October 2018

Last Friday the Bucks Free Press had an article on its front page about a proposal for a medical “super hub” on the site of Wycombe hospital.

Buckinghamshire’s Clinical Commissioning Group (CCG) has been allocated £8.8 million for three hubs in Bucks, including one in Wycombe which could serve up to 50,000 patients. It would offer GP, out-of-hospital and voluntary sector services. The link is below.

The article also reported the concerns of Ozma Hafiz, a Wycombe resident, about this proposal. She campaigns for better healthcare in Bucks. She was concerned that:

- Some patients would be forced to travel further for treatment if some surgeries are moved to the new site;

- Not enough GPs could be found to work at the hub as the NHS continues to battle huge shortages in healthcare staff across the country; and

- The CCG needs to fully consult the public about the proposals.

The BFP also reported the concerns of Councillor Tony Green, who is a Conservative councillor for Terriers and Amersham Hill on Wycombe District Council. He was concerned that:

- WDC had concluded that existing GP provision was too concentrated in the town centre rather than outlying areas; and

- Putting a super GP hub on the site of Wycombe hospital would concentrate even more provision in the town centre.

I went on BBC 3 counties the same day and expressed similar concerns; a GP super hub on the hospital site would mean more car or bus journeys, increasing costs and inconvenience for patients, and increasing traffic congestion and parking problems.

I couldn’t see how this super hub would meet the objectives of the proposal i.e. to “bring care closer to home” and “reduce unnecessary trips” to hospitals. In fact the proposal would do the reverse.

I thought many elderly and ill patients would put off making visits to their GPs which meant that major problems would not be caught early. And research indicates that patients do better if they have a long term, personal relationship with their doctor.

The CCG has said new facilities will cost more to run. It wants local planning authorities to increase developer contributions towards health infrastructure costs.

About 1000 new homes are going up in Councillor Green’s ward in Terriers - and the NHS hasn’t asked for contributions for any new GP practices there; it says there is no need. It seems it wants developers to pay for a new super GP hub but not a local GP surgery.

So what was the response of Steve Baker, Wycombe’s MP to these concerns? He tweeted:

“I was deeply disappointed yesterday when our local paper used a notoriously ill-informed campaigner to seek to provoke unnecessary worries about improvements to our NHS.

In a statement, Bucks CCG, who organise the delivery of local health services in Wycombe, said, ‘Across the CCG we have high quality GP services delivered from small, medium and large practices; we see the benefits of supporting all such styles and sizes because it enables patients to choose their preferred service’.

I look forward to full details of how the CCG will be improving local services through the new hub, especially following advice from patients and doctors that positive change is needed here.”

So he ignores the concerns and attacks the person making them.  This is a despicable tactic generally used by someone who knows concerns are real but has no answers.

I’d like to ask Steve Baker some questions:

1. The CCG put in a bid for £8.8 million for the super hubs 18 months ago. It didn’t announce this publicly and has declined for over a year to say what plans it had for the Wycombe hospital site.

How can a health campaigner become well – informed if the NHS refuses to provide information?

2. The CCG finally announced its plans in a paper to a Bucks County Council Select Committee last week. The plans for all three hubs are covered in half a page at item 8 on the agenda. The information provided is minimal.

Isn’t it amazing that a campaigner actually managed to find out what was going on and express some concerns?

3. Why did you attack Ozma Hafiz, a campaigner, as notoriously ill-informed, and not attack Councillor Green when he was expressing similar concerns in the same article?

4. Why did you assume Ozma Hafiz was trying to provoke unnecessary worries but not Councillor Green?

5. Is it because Ozma Hafiz is an ordinary constituent and Councillor Green a fellow Conservative?

6. How many staff do you employ, paid for by the taxpayer, to support you in your work as an MP? How many staff do you think Ozma Hafiz employs to support her in her work as a campaigner? Which do you think should be better informed and better able to address residents’ concerns?

7. Ozma has done such a lot to raise the concerns of residents. And you have done so little, not even trying to fight for Wycombe’s A&E.

Don’t you think you should take a bit of a break from Brexit and address your constituents’ concerns? Rather than leaving it to Ozma?

 

https://www.bucksfreepress.co.uk/news/16962952.fears-gp-surgeries-could-be-lost-as-medical-super-hub-plans-revealed/

Mr Tett sees no crisis on health and adult social care - or does he?

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25 September 2018

I’m really starting to get worried about Martin Tett, the Leader of Bucks County Council. 

Last week he said he didn’t see any evidence that health and social care in Bucks would be in crisis if and when we leave the EU.    

 

 

This week he said rising budget pressures on adult social care was an existential threat to BCC.  He urged the Government to publish its proposals for adult social care and to give Councils more money.

So which is it?  Are we OK and won’t even face a crisis when Brexit comes?   Or are we in crisis now and desperately need more money?

It seems Martin Tett can’t decide which way to face.   

So I’ll be helpful and tell him the answer. 

1.      Health and social care are in crisis now.  

2.     The Government has no time or money to give to things like social care because they are completely absorbed in Brexit and fear we will go into recession next year.

3.     Health and social care are going to be in a bigger crisis when EU citizens leave in even greater numbers. 

There, that was easy wasn’t it? 

If Mr. Tett wants the evidence that health and social care are in crisis, he might look no further than the latest scorecard for Bucks Healthcare NHS Trust below.   The Trust is missing a third of its targets and is at risk of missing another third.     

 

For example, the latest figures for A&E waiting time in August means that over a quarter of patients have to wait for over 4 hours.    (Incidentally I use the figures for real A&Es and don’t include minor injuries and illness units as the Trust does.   I want to know how long I would have to wait if I had something really serious and not just a cut or sprain).  

Mr Tett could also note the 18% vacancy rate for nurses and the turnover of staff of 15%. 

Or Mr. Tett could look at the latest report of the Bucks Clinical Commissioning Group – much of which is also coloured red and includes pages of explanation for what is going wrong.

For example, the report mentions that the Trust continues to struggle to provide timely health assessments for children who are looked after by BCC because it doesn’t get the necessary information from BCC.  So the NHS and BCC are failing children in care.

Or Mr. Tett could look at the last quarterly report of BCC’s performance.  It too has quite a lot of red and amber alerts for its health and adult social care responsibilities.   He could even talk to his staff on his own front line.   

If Mr Tett can’t see the evidence for a crisis – he’s not looking very hard.

 

 

Well done to Ozma and the Save Wycombe Hospital Campaign

Follow me@LindaDerrick1

6 September 2018

I suggested in my blog below that Aylesbury Labour Party might like to campaign on any one of 15 local healthcare issues but, apart from joining a couple of demos, there doesn’t seem to have been any action.   Nothing changes. 

Campaigning on healthcare is not being done by the opposition parties; it’s being done by committed individuals.   It makes you wonder what the opposition parties are doing.   

But let’s have a look at one particular issue - no. 12 in my list below.   

A paragraph in Wycombe District Council’s local plan suggests that the site of Wycombe Hospital could form part of a major office and retail redevelopment. 

The paragraph implies that part of the hospital site could be sold off to developers for commercial redevelopment.   This suggests major changes to the services at Wycombe Hospital and possibly further closures of vital hospital services.  

The estates plan of Bucks Hospital NHS Trust was due to be published last September.  This was meant to provide the Trust’s vision of the future of Wycombe Hospital.   Apparently it’s still not available a year later.  

So there are no grounds for the local plan suggesting the redevelopment of the hospital site. 

You have to ask what does Wycombe District Council know that we, the public, don’t?

Moreover, a paragraph suggesting redevelopment of the hospital site encourages the interest of developers in the site which is a prime piece of land in central Wycombe.    

So this paragraph matters and should be deleted. 

The local plan is currently the subject of a Public Examination, and I asked if anyone was going to raise the issue of Wycombe Hospital in the Examination.   

The answer is that the Save Wycombe Hospital Campaign challenged the local plan and did so very successfully.  The Inspector decided that the disputed paragraph should be deleted or modified in consultation with the Campaign. 

It was an individual from the Campaign, with no help from any of the political parties, who organised a petition beforehand and spoke at the Examination.  It is a daunting task for any individual to speak at a formal examination without any experience.  It has to be done with hard evidence and determination.  

So well done Ozma and the Save Wycombe Hospital Campaign. 

 

If the Labour Party in Bucks is still looking for suggestions for campaigns, here’s 15 healthcare issues it might consider

Follow me@LindaDerrick1

29 July 2018

Aylesbury Labour Party asked a month or so ago for suggestions for campaign issues.   I like to be helpful to ex-colleagues so I suggested a campaign opposing the expansion of the grammar schools (see Education page).  However, no-one has responded to that yet.  

Judging from the website of Aylesbury Labour, it still hasn’t found any issues to campaign about so I’ll suggest some more.  

 

Here’s a round-up of healthcare issues, with many thanks to the Bucks Free Press (BFP).  Links to press articles are below.

Aylesbury Labour might like to help challenge those responsible and hold them to account.   I’ve included some questions the Labour Party might ask.  These are questions that I and others will certainly be asking in the months to come.

1.     Two weeks ago, the BFP reported the closure of two GP surgeries in Wycombe.  There seems to be a shortage of GPs in Bucks and long waiting times for appointments in some places.  Is this right and how does the public find out? 

 

2.     The Buckinghamshire Healthcare NHS Trust (BHT), which runs the hospitals, had the worst waiting times for A&E over the winter since records began.   How is A&E at Stoke Mandeville coping in the heatwave? 

 

3.     Waiting times for operations with BHT are getting longer.  How is BHT doing now?

 

4.     For over a year, BHT has failed to meet its targets for patients with cancer.   How is BHT doing now?

5.     The NHS is rationing more operations.  The BFP reported that hundreds of people in Bucks are being refused life- changing hip and knee operations.  Meanwhile the Telegraph reported that seven Clinical Commissioning Groups (CCGs) are planning restrictions which are so severe that surgeons have warned patients could be left at risk of painkiller addiction.  Senior officials in those CCGs are being paid rates of more than £300,000 a year. 

What restrictions is Bucks CCG imposing and what are its senior officials paid?

6.     BHT has had high turnover of its medical staff and high numbers of vacancies.  What are the latest numbers and how will Brexit affect this?

7.     Last week, the BFP reported that more than 1,000 days a month are lost to bed blocking in Bucks hospitals.  On an average day at BHT, 37 beds are occupied by patients who no longer need to stay in hospital.  99 per cent of these delays were caused by problems with the NHS and one per cent by problems with social care. 

Really?  Only 1% of bed blocking caused by problems with social care?  And what were those problems in the NHS?  

8.     Meanwhile BHT has closed Marlow and Thame Community Hospitals with their 20 beds. Why did Bucks County Council’s Select Committee let BHT get away with this?  Isn’t this closure the most unprofessional organisational change by BHT since it closed Wycombe’s A&E?  Is BHT now going to close Buckingham and Amersham Community Hospitals?

9.     The Observer reported today that growing numbers of critically ill patients are coming to harm as a result of inadequate care provided by NHS staff.  The number of “serious incidents” involving “sub-optimal care of deteriorating patients” is going up in hospitals, ambulance services and mental health settings.

Unfortunately this information is in a report leaked to a MP.  But what’s the position in Bucks?

10.  Is the Trust still in financial trouble?

11.  For over a year, the ambulance service has failed to meet its deadlines to get to seriously ill or injured patients.  Is it meeting its deadlines now?

12.  My blog of 17 November 2017 explains that Wycombe’s local plan mentions the redevelopment of land in Wycombe which includes Wycombe hospital.  The local plan is currently the subject of a Public Examination. 

Is anyone going to raise the issue of Wycombe hospital in the Examination?  And where is BHT’s estates plan (due to be finished last September) which I requested over a year ago?

13.  About a year ago, the Government announced Buckinghamshire would be part of the first wave of Accountable Care Systems in England.  What does this mean for Bucks?   How much of the Bucks CCG budget currently goes to the private sector?

14.  Care UK were awarded the contract for the 111 service in Bucks and the GP’s out-of- hours service?   Is this multinational company, which has a poor reputation for paying its taxes, delivering a cost effective service?

15.  Last, but definitely not least, the front page headlines in the BFP yesterday was “17,000 abused children in Bucks 'not receiving adequate mental health care', charity NSPCC warns”. 

An NSPCC investigation said Bucks CCG failed to produce “adequate” mental health plans in 2017/18 for vulnerable children.   The NSPCC gave Bucks CCG a traffic light rating of red - suggesting they "failed to recognise" that abused children are more vulnerable to mental health problems.

Bucks CCG refutes this.

The question here is simply who do you believe?  The NSPCC or the Bucks CCG?  

 

http://www.bucksfreepress.co.uk/news/16357629.future-of-two-gp-surgeries-chiltern-house-medical-centre-and-dragon-cottage-plunged-into-doubt-after-partnership-that-delivered-services-is-dissolved/

http://www.bucksfreepress.co.uk/news/16379607.hundreds-of-bucks-patients-being-refused-life-changing-knee-and-hip-surgery/

https://www.telegraph.co.uk/news/2018/07/27/nhs-rations-hip-operations-paying-bosses-300000-salaries/

http://www.bucksfreepress.co.uk/news/16369391.more-than-1000-days-lost-to-bed-blocking-in-bucks-hospitals/

https://www.theguardian.com/society/2018/jul/28/nhs-safety-alert-critical-patients

http://www.bucksfreepress.co.uk/news/16379491.17000-abused-children-in-bucks-not-receiving-adequate-mental-health-care-charity-nspcc-warns/

 

Councillor Tony Green is right; the report on the closure of Marlow, Thame, Buckingham, Chalfont and Amersham Hospitals is a “marketing” exercise

25 April 2018

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I blogged below about the pilot which replaced the Marlow and Thame Community Hospitals with part-time clinics.  Bucks Healthcare NHS Trust prepared a report on the pilot for Bucks County Council’s Select Committee.  The report failed to evaluate the pilot or assess the cost and benefits of the hospitals against the costs and benefits of the replacement clinics. 

Yesterday the Select Committee met to scrutinise the pilot and hold the decision-makers in the NHS to account. 

So how did they do? 

Well the Committee got a presentation from Trust officials which explained what was in the paper - just in case Committee members hadn’t read it.  That took some time. 

Then members asked questions and got lots of answers from the Trust officials.   No-one could complain about the volume of the response. 

The Trust officials also raised all sorts of interesting issues and went down all sorts of fascinating avenues.

Yet somehow none of the voluminous responses seemed to answer the questions directly.   It got to the point where the Chairman had to suggest the Committee was drifting off all over the place and should focus on the pilot.

So I am going to do a summary (my comments in brackets). 

The Trust officials were asked repeatedly by Committee members and indirectly by the public about the impact of closing 20 hospital beds at Marlow and Thame.  

The Trust said they had not done an impact assessment.  (Is this negligent, disgraceful or both?) 

The Trust confirmed the occupancy of beds in Bucks is as high as the national rate.  The national occupancy rate of beds is dangerously high.   A lack of beds is one of the reasons waiting times for A&E and elective surgery are too long.  (So tell me again, why is the Trust closing beds?). 

The Trust did not know how much beds cost (really?), although they could guess.   However, whatever it cost, the Trust could not afford to retain beds and, even if they had the money, the Trust did not have the nurses to staff them.  (So it all comes down to lack of funding but no-one will admit it).   

Trust officials did not know where the patients had gone who would have occupied the beds if they hadn’t been closed.  The Trust assumed they were cared for in the community.   

(No-one mentioned that these patients would have fallen to BCC’s adult social care services nor mention that this service is under severe pressure.  Nor did anyone ask if patients would have to pay for that care in the community or point out, if they couldn’t afford it, that these patients would be back in A&E before long). 

The Trust was asked about the impact of patients coming out of hospital early because there were too few beds.  The Trust was asked about the stress this put on carers, many of whom were not well themselves.  The NHS said it had not done an impact assessment on that either. (They really don’t seem to have done much homework, do they?)

The people who had been offered the new healthcare facilities at the clinics at Marlow and Thame thought the service was wonderful.  (Well they would do, won’t they? But no- one could consult the patients who failed to get beds because the bed weren’t there; they had no voice.)

In brief, the NHS is going full steam ahead on closing Buckingham, Chalfont and Amersham hospitals as well as Marlow and Thame without assessing the impact of the closures, particularly on vulnerable patients, and without assessing the long term costs. 

Councillor Tony Green got it in one at the beginning of the meeting.  He congratulated the Trust on its presentation calling it a “marketing video”.  That is what the Trust is engaged in – a marketing exercise.   

The Committee asked the Trust to return for questioning on 22 May.  Let’s hope they refer the Trust’s plans to the Secretary of State as providing poor health outcomes for the residents of Bucks.

 

The case of the disappearing report on Thame and Marlow NHS community hubs

14 April 2018

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A year ago Bucks Healthcare NHS Trust turned Thame and Marlow Community Hospitals into part-time “community hubs” and closed 20 in-patient beds.  The six- month pilot of the hubs was extended to a year.  The Trust intended to do the same thing to other community hospitals in Bucks if the pilot was successful.  (For more information, see the blogs below with the picture of the parrot).  

At that time, the Head of NHS England said he was going to make it much harder for hospitals to cut beds.  He said the dramatic loss of beds since 2010 was widely blamed for exacerbating the winter crisis. 

The situation has got worse since then.  It is now estimated the NHS is short of 5000 beds and has nearly 1500 beds unused because of lack of resources.

When Bucks County Council’s Select Committee looked at the proposals a year ago, its scrutiny was hopeless.  It clearly didn’t understand that in-patient beds were being taken out of use.  It thought the pilot was a great idea.     

Three thousands residents disagreed and signed a petition opposing the closure of the hospitals.  There were protests at the hospitals, including by local Councillors.

So you would think the Trust and BCC would make sure there was proper scrutiny of its decision-making now the pilot has finished. 

But you have to be joking.       

I knew BCC’s Select Committee was due to consider the pilot again this month.  So in mid- March I asked the Trust for:-  

a) the evaluation of the pilot i.e. how successful had the pilot been against its objectives; and

b) the options appraisal i.e. the costs and benefits of the community hubs compared with the costs and benefits of the community hospitals they replaced (or any other options the Trust was considering).

The Trust refused to give me the information on the grounds that it would be “published later”.

I asked the Trust to reconsider.  I said I would like to have the information well before BCC's Select Committee so I had time to prepare questions to ask at the Select Committee.

The Trust said the papers for the Select Committee would be published in advance of the meetings and “hopefully this would give me enough time to view the information prior to the meeting”.

Well the Trust might hope this but it didn’t happen.   

Select Committee papers are statutorily required to be published 5 working days in advance of a meeting.  However, members of the public are required to submit questions 7 working days in advance. 

I’ll leave you to spot the flaw in the system.

 

The report on the community hubs for the Select Committee meeting on 24 April was put on line by BCC sometime last Thursday.  The deadline for questions from the public was 5pm the same day.  The paper is over 50 pages long.  I had no time to read the paper let alone make any sense of it.  I had no time to consult colleagues or put down the questions I would have liked answered.  

The question I asked instead was whether BCC or the Trust believe this is a transparent, open or democratic way of making and scrutinising decisions on what is an important healthcare issue for residents in Bucks.      

I also pointed out to the Secretary and Chairman of the Select Committee the problem members of the public have in asking questions if the papers are not available.  I suggested the meeting be delayed or the deadline for questions from the public be extended.   

I received no response but the papers for the meeting have disappeared from BCC’s website with no explanation.   

I have to keep reminding public bodies in Bucks that they are required to act and take decisions in an open and transparent manner.  Information should not be withheld from the public unless there are clear and lawful reasons for doing this.

They are also accountable to the public for their decisions and actions and required to submit themselves to the scrutiny necessary to ensure this.

It is not a matter of the Trust leaving it to BCC to publish the Trust’s report and hoping the public would have enough time to read it.  The Trust is required to provide the information and submit itself to scrutiny.

Openness and accountability of public bodies is our right.

 

P.S. All I’ve got to do now is read the report which I prudently printed before BCC took it down.  

The Healthcare Trust is not just closing Marlow and Thame hospitals – it intends to do the same at Buckingham, Amersham and Chalfont.

 

20 April 2018

 

Follow me @LindaDerrick1

 

I’ve now had time to read the report on the closure of Thame and Marlow Community Hospitals.  However, the deadline is way past for asking questions at BCC’s Health and Adult Social Care Select Committee (see blog below).  So I wrote instead to the local press.  The letter is below.     

 

You might note that it is not just about Marlow and Thame Community Hospitals – the report says the same thing is going to happen at Buckingham, Amersham and Chalfont.

 

The Bucks Free Press has done an article on the issue today (link below) with a nice picture of an small impromptu protest meeting.   

 

I have also written to the Bucks Healthcare NHS Trust asking a host of questions because, as I say in my letter, the report raises more questions than it answers.  And I would like those questions answered, even if I have to ask them under freedom of information legislation. 

 

 

 

Dear Editor

A year ago Bucks Healthcare NHS Trust turned Thame and Marlow Community Hospitals into part-time “community hubs” and closed 20 in-patient beds.  The hubs were to be piloted for six-months, later extended to a year. 

 

At the end of the pilot, the Trust had to make two decisions.  First, whether the pilot achieved what it set out to do and within the resources allocated.  Second, whether the resources would be best spent on continuing the pilot or returning to the services previously provided at the Community Hospitals.      

 

I therefore asked the Trust for the evaluation of the pilot and the options appraisal so I could see how it made these two decisions. 

 

Bucks County Council’s Select Committee is due to look at the pilot on 24 April and I asked if I could have the evaluation and options appraisal well in advance so I could ask questions at the Committee.

 

The Trust declined to give me the information and told me I would have to wait for BCC to put it on-line.   BCC put a report on-line on Thursday.  It is 51 pages long and full of incomprehensible jargon.  Anyone wanting to put questions to the Committee had just hours before the Committee’s deadline.       

All I had time to ask was whether BCC or the Trust believe this is a transparent, open or democratic way of making and scrutinising decisions on what is an important healthcare issue for residents in Bucks.   The answer can only be no. 

 

I have no idea who wrote the report or who is responsible for it as there is no author and no NHS or BCC logo on it.  The only logo is “Developing Buckinghamshire together”.   Who is this? 

 

The report does not contain an evaluation of the pilot.  The aim of the pilot is said to be “to develop and test our vision of providing more care closer to home”.  Success criteria were not set at the beginning of the pilot.  They were agreed during the pilot and do not measure whether care provided by the hubs is actually closer to patients’ homes than care provided by other providers, including by GPs in their surgeries.      

 

The measures used merely count the number of patients seen or are inexplicable e.g. “Adult Community Healthcare Team and Rapid Response and Intermediate Care Team Patient related experience measures”.    One of the “top-line results” is that only 1% of the 1000 people using one of the services at the hubs were referred to A&E.  However, to make sense of this performance you would have to compare this to a control group – but there wasn’t one. 

 

 Nor does the report set out the costs of the pilot.  All it says is that £1million was invested in “community services” (which community services?) and staff were deployed from the Community Hospitals.   What was the total cost?  Who is being paid from what budget to provide what services?  And who is responsible for the spend?

 

 Nor does the report contain an options appraisal looking at the costs and benefits of the community hubs as compared to the costs and benefits of the Community Hospitals. 

 

 There is no mention of the loss of 20 in-patient beds and the impact and costs of this on bed-blocking elsewhere.   No mention of any shortage of beds in Bucks or whether, like the rest of the country, bed occupancy in Bucks is running at an unsafe level.    The NHS has a shortage of 5000 beds with about 1500 unused due to lack of funds.  Why is Bucks taking beds out of use?

 

 The Trust intend to continue with the community hubs at Marlow and Thame and roll them out across Bucks including at Buckingham, Chalfont and Amersham.   And yet the report raises more questions than it answers.  

 

 It’s almost as though the decision was made to go with hubs before the pilot began and no-one wanted the facts to get in the way.  

 

 BCC will probably nod this through next week.   That’s scrutiny in Bucks.

 

 Linda Derrick

 

 http://www.bucksfreepress.co.uk/news/16157936.Campaigner_hits_out_at__absurd__claims_there_is__overwhelming_support__for_controversial_health_hub_scheme/#comments-anchor

 

I never thought I would say this – but well done BCC’s Select Committee on Health and Social Care

6 April 2018  

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A rare event took place on 20 March 2018 - a Select Committee of Bucks County Council did some scrutiny.  

The Select Committee was the Health and Adult Social Care Committee and the subject of the scrutiny was the mental health services provided by Oxford Health NHS Foundation Trust for Bucks.  

The Trust had provided an “update” for the Select Committee beforehand.  I read this a few weeks ago and groaned.  All the update did was describe the services the Trust provided.  There was very little about the Trust’s performance on providing mental health services in Bucks and nothing about the funding, the effectiveness of the services or the problems the Trust faced.    

I have to admit I expected the Select Committee, on past performance, to ask a few easy questions, say how difficult things were and congratulate the Trust on its hard work. 

But no.  

To begin with, the Chairman, Councillor Brian Roberts, had asked Councillor Julia Wassell, one of the members of the Committee who had some experience in the area, to take the lead on this item. 

Second, the Committee had obviously done its homework and agreed beforehand which questions needed to be asked, who should ask them and in which order. 

Third, the questions covered the ground:

-        how did the Trust assess whether there was parity between physical and mental health provision?

-        how much of the recent extra Government funding had gone to mental health provision in Bucks and where?

-        where were the financial and performance data?

-        what were the demographic challenges?

-        what was the strategic direction for the services and how did the Trust know it was getting there?

-        how was the Trust tackling the problems of children with mental health problems making the transition to adult services?

-        what was happening to the Valley Centre, currently closed?

-        what was the scale of the Trust’s problems on recruitment and retention, and what was the Trust doing about it?

-        how many beds were there in Bucks for in-patients and what was the occupancy rate?

-        how many people in Bucks were on Community Treatment Orders?

Finally, Councillor Wassell made it clear, politely but firmly, that the Committee expected to get the answers to its questions, even if the Trust needed time to respond and get back after the meeting. 

I was delighted – really delighted - to see this scrutiny.  The fact that the Committee was led on the issue by an opposition Councillor was, in my view, irrelevant.   What was important was that mental health provision, which has been the poor relation in the NHS, got the scrutiny it needed. 

Well done the Select Committee on Health and Social Care.

 

The worst performance in A&E since records began

9 March 2018

While the Government has been consumed with Brexit, the NHS recorded the worst ever performance for waiting times in A&E since records began.   

You may not remember what it was like before the Conservative Government started to cut public services and told us we needed austerity.  

In 2010, 96% of patients going to an A&E waited less than 4 hours.    Yes, 96%

In comparison, in February 2018, only 77% of patients waited less than 4 hours.  In Bucks, 74 % of patients waited less than 4 hours.

To put it another way, last month more than a quarter of the patients turning up at an A&E in Bucks faced a wait of over 4 hours.   

Waiting times at A&E are of course only one indicator of the performance of the NHS in Bucks.   However, A&E is meant to be the safety net for the NHS.   When we are involved in an accident, or have a heart attack, we think A&E will be there to look after us.  When we can’t get an appointment with the GP, or the after-hours service doesn’t deliver, we think we can go to A&E and we will be looked after.

Well not any more.      

Because there are too many patients going to A&E to be looked after by too few staff with too few beds to put the patients in.    

There are too many patients like the thousands of children now living in poverty who need more emergency treatments.   Too many patients like elderly people who aren’t getting the social care they need and end up having to be rushed to hospital.  Too many patients with mental health problems who can’t get treatment and end up in A&E. 

And still not a bleat from Conservative politicians in Bucks. 

 

Theresa May says there is no crisis in the NHS - but the red lights are flashing in Bucks

16 February 2018   

The table opposite is taken directly from the January Board papers for the Bucks Healthcare NHS Trust.  

It is a traffic light system for the Trust’s targets.    Overall the Trust is assessed as “requires improvement” which is the second worst rating a Trust can have.

Very roughly, the Trust is failing on about a third of its targets, is at risk of failing on another third and is meeting the last third of its targets.

I’m not going to comment.  All you have to do is stand back and look at the colours – because this is what a struggling organisation looks like.  This is the NHS in crisis.  

And none of our politicians, Councillors or MPs, have said a word.  They just don’t seem to care.  

Follow me @LindaDerrick1

 

Councillor Whyte’s twitter attack on Labour Party woman is unwarranted, offensive and unacceptable.

 30 December 2017        

Warren Whyte is a councilor on Bucks County Council and Aylesbury Vale District Council. 

 He has a twitter account - @CllrWarrenWhyte.

 A week ago the following twitter exchange took place between Councillor Whyte (in blue) and one of our female Labour Party members (in red):-

 “Great service at @LandD hospital today – in and out in super prompt time and all staff friendly and efficient.  Thank you #NHS”

  “Indeed.   No thanks to Tory policy is it????”

  “When a Labour troll can’t help herself being bitter and twisted when the #NHS actually delivers good service.  Thanks for asking who the patient was by the way!”

 “Troll??  Of course….how dare anyone question Tory policy without being called bitter and twisted.”

“Sorry, which it of being seen on time, being provided high tech equipment to help diagnose, friendly and efficient staff, warm and bright ward……all despite 7 years of conservative Government is a problem?”

You can make up your own mind about this exchange but I think Councillor Whyte’s attack on the Labour Party member was unwarranted, offensive and unacceptable.

The Labour Party member agreed with Councillor Whyte that thanks were due to NHS staff for their prompt, friendly and efficient service.   She then questioned whether this service was delivered despite the policy of the Conservatives.   A perfectly reasonable question and one asked by millions of people in this country (myself included). 

In return, Councillor Whyte made a personal attack on the woman making some very unpleasant personal insults.    This is precisely the sort of attack that makes life so difficult for women in public life who dare to question the status quo.   Such an attack reflects very poorly on Councillor Whyte. 

Moreover, Councillor Whyte is Bucks County Council’s cabinet member for Children’s Services.  He is responsible for BCC’s policies for the safeguarding of children. 

You have to ask whether someone who makes such a vicious and unwarranted attack on a woman in public is really fit to be responsible for the safeguarding of children. 

Councillor Whyte is also responsible for proposals to close down 35 children’s centres in Bucks.  Again, you have to ask whether someone who makes such a vicious and unwarranted attack on a woman in public is really fit to carry through such a vital change to services which will significantly affect children and their parents, particularly their mothers.

Is this his normal response to criticism from women?  

Councillor Whyte has to comply with the Codes of Conduct for Councillors made under the Localism Act 2011.  These require Councillors to “respect others and not bully any person”.    Perhaps Councillor Whyte needs to understand that he is required to show respect to everyone – and that includes female Labour Party members who might question his views.  Nor is he allowed to bully them.

 

The reality of A&E at Stoke Mandeville

5 December 2017

On Sunday evening my husband wasn’t well.    He was in pain and extreme discomfort.  

He didn’t want to go to A&E so he thought he would phone the out-of- hours GP service.

The website for our GP surgery says

 Out of Hours.  For problems that cannot wait until the surgery is next open please call 111.”

So he phoned 111.  

The 111 call handler took the details of my husband’s condition, said she needed to get a medical assessment and told him someone would call him back at some time.  He waited about 45 minutes and had no call back.  By this time, the pain was worse and he was cold and clammy.  So I drove my husband to the A&E at Stoke Mandeville hospital.  It took about 30 minutes along rural roads and the A413.   I had some difficulty finding A&E as the signposting is not good in the dark. 

I could not drop my husband off at the entrance.  The nearest I could get was about 30 yards away.   So he walked, rather unsteadily, to the entrance while I found somewhere to park.  The minimum parking charge (up to 3 hours) was £3.50.  

My husband checked in about 9.50 pm.  A board by reception said the expected waiting time to see a doctor for major cases was 5 hours.  It gave no indication of waiting times for minor cases. 

My husband was seen by a triage nurse about 11.30pm.  He then had blood and urine samples taken and sat down to wait to see a doctor.   He was told this would probably take hours.   He was faint and at times near collapse.    After a while, he suggested I go home and get some sleep (which I did).

About 4.30 am he phoned me and asked me to collect him.  When I arrived, he had still not been seen by a doctor and the receptionist did not know when a doctor might be available.   My husband had decided to discharge himself.  It took some time to find a nurse to take the cannula out of his arm.   

We left about 6am.  Someone had amended the board by reception.  The expected waiting time to see a doctor for a major case was now 6 hours.

My husband had waited over 8 hours in A&E, had not seen a doctor and had no indication of when a doctor might be available.  

My husband was not the only one in this position.  About half a dozen patients who came in about the same time as he did were still there when he left.   

This is A&E at Stoke Mandeville hospital in December 2017, before the winter sets in and ahead of any flu outbreak.  We were told by staff that this is normal.   The Trust management had been repeatedly told about the situation but nothing happened.

A few questions.

When the Government says there are other options rather than going to A&E, exactly what options are available to someone in pain and uncertain whether their condition is life-threatening or not?

Has the 4 hour waiting time target at A&E now been completely abandoned in Bucks?

What will it be like in A&E at Stoke Mandeville this winter?

How did we go from having the best, most cost-effective healthcare system in the world in 2010 to this? 

 

Wycombe hospital site to be redeveloped?

14 November 2017

Last December I went to a public meeting of the NHS Clinical Commissioning Groups in Bucks.  The Bucks Free Press published my letter about this somewhat surreal experience (see blog below of December 2016). 

During the meeting Dr Dardis, the Chief Executive of the Bucks NHS Healthcare Trust, assured us that “no further services would be moved from Wycombe Hospital; Wycombe Hospital was vital to the future of the NHS hospital service in Bucks”.  He said the services offered at Wycombe Hospital would expand.   

This was really good news.  

Trouble is Wycombe Hospital sits on a prime site for development near to the town centre and with good transport connections.   And the Trust, like most Trusts in the NHS, is very short of money.  So there must be an enormous temptation to sell off part of the site for development.

If the Trust sold off some of the site, it would of course not be available for the proposed expansion of hospital services in Wycombe or for existing services. 

So I have been asking for the estate plan for Bucks Healthcare NHS Trust since June when it was said to be in preparation.  This would hopefully reassure residents that Wycombe Hospital was not up for grabs by developers.

The plan was scheduled to go to the Trust’s September Board meeting but it didn’t emerge.   It seems to be still in preparation. 

So no reassurance there.

Meanwhile the Wycombe District Local Plan was published.    

Page 147 sets out the policy for the development of an “Office Outlet Site” on Queen Alexandra Road (formerly Staples) which is right next to Wycombe Hospital.  The site is allocated to be a mixed office and retail development.  One of the conditions for its development is that it should not prejudice any future redevelopment of Wycombe General Hospital.  

The Plan goes on to say “The NHS are considering the long-term vision for the future of Wycombe General Hospital, and dependent on that vision, this [site] may come forward as a part of a larger redevelopment scheme. Development proposals should be sensitively designed to accommodate future proposals for the hospital site”. 

No reassurance there either – in fact it’s a bit worrying.

Surely it’s about time the Trust informed residents what it proposes to do with the site and gives residents a genuine opportunity to comment?   

 

Wouldn’t it be nice if we were given the facts about healthcare in Bucks?

10 September 2017

I haven’t blogged about health issues for some time mainly due to the fact that nothing much has changed; the NHS continues to struggle, the situation will get worse and none of our local politicians seems to care.    

On the one hand, we get relentlessly optimistic public statements from the Chiltern and Aylesbury Clinical Commissioning Groups, the Bucks Healthcare NHS Trust and Bucks County Council.    

On the other hand, there is the depressing reality of what is happening buried in Board papers or on the Government’s statistical websites.  

We also have the depressing reality of our own experience.  For example, a friend of mine couldn’t get a same day appointment with his GP or get to A&E.  After a few hours, one of the doctors at the GP surgery diagnosed his condition over the phone and gave a prescription for a course of antibiotics.   Raises so many questions.

Here’s a selective update.   

Let’s start with some latest performance indicators.  The target for the 4 hour waiting time for A&E in Bucks was not met.  The 18 week target for referring patients for treatment was not met.   The 31 day waiting time for radiotherapy treatment for cancer patients was not met.   Ambulance response time targets were not met. 

It is also useful to keep a check on the vacancy rate for nurses at Bucks hospitals.  It was 17% last quarter.  It’s now 18%.    So roughly 1 in 5 nursing posts are unfilled in Bucks hospitals.

Let’s turn to the pilot at Thame and Marlow where 20 community beds were closed down and replaced with community hubs with no consultation with residents.   The pilot is being evaluated and a decision on the future provision will be taken in September. 

The homepage of the Healthcare Trust says “New services, voluntary organisations and outpatient clinics are coming on board each month and the number of patients being seen continues to grow.”  In July, the Marlow community hub had an open day.  The Trust’s Chief Executive said it was “part of our ongoing programme of engagement with the local community”.   

Meanwhile an update on the pilot went to the Board of the Trust.  Unfortunately, there seemed to be no success measures for the pilot so there was no way of evaluating its success.  What is more important, there was no way to compare value for money of the community hubs as against the provision of community beds.   

Let’s not forget that Bucks County Council is responsible for public health including obesity, smoking, and sexual health.  I’ll give you a challenge.  Try finding out how much money BCC spends on public health; what outcomes the spend is intended to achieve and how far the outcomes are achieved; and whether the spend provides value for money.  As far as I can tell, the budget for public health is contracted out and BCC hasn’t got a clue about outcomes or value for money.

 Finally, a look at progress on the Accountable Care System in Bucks.   Well apparently it is all going hunky dory.  We are going to have fast and tangible progress, a leadership cohort, collective enthusiasm, learning sessions, and ambitions to be outstanding.  In fact, we are all holding hands and skipping towards a beautiful sunset. 

No mention of the £500 million of cuts Beds, Bucks and Oxon have to make by 2020.   In fact no financial figures at all and no mention of the massive reorganisation this System will require.  Nor any concerns that this System will take us towards an insurance healthcare system. 

Trouble is residents won’t know how bad it’s going to get until it hits them.

 

Government gives £3.5 million to Bucks for the Better Care Fund and just tells them to spend it.

13 July 2017

It’s not often I feel sorry for a Tory Councillor.  However, I did feel a small twinge today for Councillor Hazell, the Cabinet member for Health and Wellbeing when I read a Cabinet report on the Government’s Better Care Fund. 

The Fund underpins one of the Government’s most chaotic, dysfunctional, and incoherent policy initiatives – and that’s saying a lot.  And it’s Councillor Hazell’s responsibility to take decisions on the Fund for Bucks County Council.

But never mind, that’s what she’s paid to do. 

The Better Care Fund was set up in 2014.  It is intended to integrate health and social care, for example to support people in their homes so they don’t need to go into hospital, and to support patients discharged from hospital.  It affects millions of people.   

So you would think the Government had a plan – you know, a bit of paper with objectives, something that says who does what, money allocated to do what is necessary, and monitoring and review arrangements.  

You would think that – but you would be wrong. 

To begin with, this massive organisational change was kicked off with no new money.  The Fund simply consists of money brought together from existing budgets.   

For example in Bucks, the Fund this year is £30 million.  It includes

-          £3 million from Government for the Disabled Facility Grant (which is transferred immediately to district councils who have always managed the Grant);

-          £3.6 million from BCC (for work on “Care Act – Information Advice and Guidance, Advocacy, Carers, Social Care Pressures”); and

-          £18 million from the NHS (for “Locality Integrated Teams, Rapid Response Intermediate Care and Community Care Co-ordinators” and for piloting Community Hubs/Frailty assessment clinics in what used to be the Marlow and Thame community hospitals.)

Then, in the Spring Budget, extra funding was announced - £3.5 million this year for Bucks – and now the Government says the money should be spent as quickly as possible. 

Trouble is the Government hasn’t published any guidance on how to spend it.  Moreover, the amount of funding for 2018/9 is uncertain and there may be no funding beyond 2019-20. 

And who knows what the Government is planning for future social care?  (I’ve forgotten which of the many U-turns the Government finally decided on.)     

It looks like the Government is just letting local groups do what they want with the money.   So the good news for Councillor Hazell is that the Government is not going to scrutinise her decisions. 

The report’s proposes to spend the £3.5 million to

-          “stabilise the market place”,

-          “protect VCS preventative capacity”, and

-          “influence the self-funder market”.

No – the report doesn’t explain what any of this gobbledygook means.    And I bet you no-one on BCC’s Select Committee will ask.    

 

Can it get any worse for the NHS in Bucks? Well, yes it can

19 June 2017

If you read the blogs below you get a pretty depressing picture of the NHS in Bucks.  I’ve summarised the facts about waiting times, about vacancies for clinical staff (getting worse with Brexit) and about lack of money.  I’ve also had a go at understanding the Sustainability and Transformation Plan for Bucks, Beds and Oxon where £500 million of cuts have to be made by 2020.

You would think that would be enough.  You would think that with such a slim majority and increasing anger about public cuts, Teresa May might change tack a bit.  But no, Jeremy Hunt is still Secretary of State for Health.  (At least I think he is – his appearances seem to get fewer and fewer with the passing years.)  And there are at least another two major changes about to hit the NHS.

One is the Naylor report and the other is the “Accountable Care System”.

When I tell you that the Accountable Care System is an American model of healthcare management, you might start to fear the worst.  When I add that one of the most extreme right wing Conservative MPs in Parliament welcomes Buckinghamshire being part of the first wave of Accountable Care Systems in England, you just know more privatisation is going to happen.  And yes, I am referring to Steve Baker, Wycombe’s MP, one of the keenest advocates for the free market.

When Steve Baker is joined in that welcome by Martin Tett, Bucks County Council’s Conservative Leader, you just know things are going to go from bad to worse.   This is the Martin Tett who was so keen on cutting public spending that the Government cut his grant to minus £10 million (yes I do mean minus £10 million).  This is the Martin Tett who was then amazed when residents complained about poor services and said BCC needed more money.   

I’m sure we will hear more about Accountable Care Systems in the future.

Meanwhile, few people will have noticed that Teresa May emphasised her support for something called the Naylor report during her interview with Andrew Neil before the election.    It is one of those boring reports which no-one reads until too late.  It proposes to force (or bribe) NHS Trusts to sell off as much as possible of their estate.

I highly recommend the youtube video explaining the report below.  It is 11 minutes long, amusing and clear as a bell about a complex subject.    

Bucks Healthcare Trust said in December:

'Our clinical strategy will determine our overall estates requirements. Our estates plans are currently still under development'. 

So we don’t know, for example, if parts of Wycombe hospital are to be sold – which is something many of us have feared for some time. 

I’ll ask the Trust if the estate plans are any clearer yet.

 

the Naylor Report explained

The risk of cyber-attacks on Bucks NHS Healthcare Trust

15 May 2017

In view of the recent collapse of parts of the NHS due to cyberattacks, I thought I would see what is happening with Bucks Healthcare Trust. 

The good news is that it is running as normal – no mention on their website of cyberattacks.

The even better news is that the Trust assesses the likelihood of a cyber-attack in its Corporate Risk Register for March (the latest), as low (a score of 2 out of 5).  The consequence of such an attack is assessed as high (a score of 4 out of 5).  This puts the risk of a cyberattack on amber. 

Alternatively perhaps the Trust’s assessment is too optimistic.

I can’t find anything else on the risk.

There are many other risks on the Risk Register with 15 risks assessed as red.  So it is understandable that the Board of the Trust would focus on these higher risks and indeed put its resources into these higher risks.

I will ask the Trust if it has re-assessed the risk of a cyber-attack in the light of recent events.

 

A remarkable silence from the Tories in Bucks on the crisis in the NHS

15 April 2017 (updated 9 May)

This is by way of a round-up and up-date of healthcare in Bucks. Then you can decide whether the NHS is safe in the Tories’ hands or whether the Tories need to account for what is going on in Bucks.

The last Labour Government turned the NHS around.  By 2010, the UK had the best healthcare system in the world (as assessed by the Commonwealth Fund, a well-respected US foundation amongst others). That’s what the Tories inherited.

So what has happened in Bucks since then?

Ø  Waiting times at A&E departments in Bucks were the worst ever this winter.  In December and January, over 20% of patients had to wait more than 4 hours.

Ø  The Bucks Healthcare NHS Trust is missing its targets for waiting times for cancer treatment and elective surgery.

Ø  The Trust is closing down 20 beds at Marlow and Thame Community Hospitals as a pilot without proper consultation with residents.

Ø  11% of the Trust’s posts are vacant.  17% of the Trust’s nursing posts are vacant.  The Trust has 54 clinical vacancies.

Ø  Last year, there were a series of all- out strikes by junior doctors in protest at the imposition of a contract that put patients at risk.

Ø  10% of NHS staff in the Thames Valley region come from EU countries other than the UK, 11% of doctors in the NHS in Thames Valley are from other EU countries and 18% of nurses.  Brexit means that these staff feel unsure about their future in the NHS and many are starting to leave.

Ø  As at the end of February, the Trust had a £1.5m deficit as compared to a planned £2.4m surplus.  It is failing to deliver its required efficiency savings of £20 million.  It will not be repaying a loan of £5.3m in March but will instead be taking out a further loan of 2.4million.   It faces massive cuts under the Sustainability and Transformation Plans.

Ø  This is not to mention the huge problems faced by GPs, the ambulance service and mental health services in Bucks.

And what have our local Tory politicians said about this crisis in the NHS?  Well not a word as far as I can tell.   Nothing from our MPs and nothing from Bucks County Council which is statutorily responsible for holding the NHS to account.    Not a word of concern, or anxiety about funding, staffing, morale, the effect of Brexit, or about the standard of healthcare we are getting.   Nothing on their websites or in their speeches.

I sent this blog to all the MPs in Bucks and asked them if I have got it right.  None of them responded so I think it is safe to assume they don’t want to know or are happy to see the NHS collapse.

Posted by Linda Derrick.  Promoted by Martin Abel on behalf of Linda Derrick at 5 Spencer Road, Aylesbury HP21 7LR     

 

BCC – couldn’t scrutinise a dead parrot

1 April 2017

NHS Bucks Healthcare Trust are “re-providing” 20 community beds today at Marlow and Thame Community Hospitals (see blog below) during a 6 month pilot.  No, this is not a joke.

Up to now, Thame and Marlow hospitals provided rehabilitation and terminal in-patient care. 

The NHS says “during the pilot our clinicians will not admit patients overnight to the inpatient wards at Marlow and Thame hospitals.  Instead the space will be used to run the new frailty assessment clinics.” 

Bucks County Council is responsible for holding the NHS to account in Bucks so I wondered what it had made of the changes.   

Councillor Roberts, the Chair of BCC’s Health and Adult Social Care Select Committee, said it scrutinised the pilot at its meeting on 21 February so I looked at the webcast.    

I was delighted to see that, despite interruptions, Councillor Wassell managed to ask the NHS where the patients would be cared for overnight if not at the Marlow and Thame hospitals.  She was told either at the patients’ homes or in “transitional beds” in care homes – or perhaps in Stoke Mandeville.

And that was about it.   No questions about the effect the closure of the beds would have on bed blocking.  No questions about consultation with residents (there hasn’t been any).  No questions about how the pilot would be evaluated.

The Select Committee’s conclusion?  Well, Councillor Roberts said the pilot was a “wonderful idea” and, as no-one disagreed, I assume this was the Committee’s conclusion. 

But then, at its meeting in March, the Select Committee didn’t seem to know what this pilot to “re-provide” beds was all about.    Councillors didn’t want to use the words “bed closures”.  They maintained the beds are not being closed - simply that there would be no “overnight admissions” – although no-one seemed to know whether the beds were available during the day.  And if so, who for?   Surely rehabilitation and terminally-ill patients would not be expected to spend their days at Marlow or Thame hospitals and their nights somewhere else?  

Councillor Roberts even suggested that it meant patients would stay in the beds overnight but won’t be admitted after 9pm.   So if patients wanted a bed, they needed to come during the day.  Is this what “re-providing” means? 

Finally the Select Committee decided the minutes of the February meeting would need to be checked with the NHS to find out what the NHS really means to do. 

Perhaps I can help.  These beds, as far as rehabilitation and terminally-ill patients are concerned, have ceased to be (albeit on a temporary basis).  The beds are closed.  They have moved on.   They are no more.   They have expired and gone to meet their makers. They have kicked the bucket.  They have shuffled off their mortal coil.  THEY ARE EX-BEDS.      

I know BCC are poor at scrutiny and this is end of term but, even so, is this the best it can do in holding the NHS to account? 

Posted by Linda Derrick.  Promoted by Martin Abel on behalf of Linda Derrick at 5 Spencer Road, Aylesbury HP21 7LR      

 

Bucks County Council – doesn’t know what’s happening to patients (and can’t be bothered to ask)

9 March 2017

In February, residents found out from the press that Ward 5b in Wycombe hospital would no longer care for elderly, frail patients who are assessed as fit to go home (see blog below). 

BCC carried out no scrutiny of these changes so Labour’s County Councillor, Robin Stuchbury obtained a copy of the report and asked some questions.  

It has taken nearly a month to get the answers (and the use of freedom of information legislation) but here they are.  

Speaks for itself really – major changes that affect elderly, frail patients and BCC doesn’t know what is happening and doesn’t seem to care.

1.      Are community home- based services in place to enable the report’s recommendations to be fully implemented?

Answer

Don’t know.  Ask Buckinghamshire Healthcare Trust.*

2.      Is there an effective interface between BCC services and NHS staff to meet all the intentions of the report as the proposed links between for example district nurses and GPs seem ambitious?

Answer

Don’t know.  Ask Buckinghamshire Healthcare Trust*

3.      Is there funding in place within BCC to meet the NHS ambition for joint working and wrap round care?

Answer

Don’t know.  Ask Buckinghamshire Healthcare Trust*

4.      Is there to be joint NHS/social care teams who will follow the patient through recovery and to independent living?

Answer

Don’t know.  Ask Buckinghamshire Healthcare Trust*

5.      When the Select Committee considered the proposals in May 2016 did it make recommendations or seek reassurances on whether there should be a full health impact service assessment to be completed in advance of the changes?

Answer

Don’t know but the Chairman of the Scrutiny Committee may have contacted you.** 

6.      If the impact assessment was done, was the Select Committee happy with the assessment and assured itself that there are no negative impact for constituents?

Answer

Don’t know but the Chairman of the Scrutiny Committee may have contacted you.** 

7.      If no impact assessment was undertaken, why not – and could the Select Committee seek to have oversight in ensuring that an assessment is now undertaken as soon as possible.

Answer

Don’t know but the Chairman of the Scrutiny Committee may have contacted you.** 

·         The formal answer was “I understand that the Council does not hold information that answers these specific questions. We would advise you that you may find it useful to direct these questions to Buckinghamshire Healthcare Trust, as it is their scheme and their service. “

**  The formal answer was “I understand that the Council does not hold information that answers these specific questions, although I believe you have been contacted by Cllr. Roberts under normal HASC/Councillor procedures in relation to these questions.”

 

Cuts to beds at Thame and Marlow Community hospitals

3 March 2017

I was told a couple of days ago that Bucks Healthcare NHS Trust was closing down beds in Thame and Marlow Community Hospitals.   I was surprised. 

I was surprised because I thought Bucks was in desperate need of beds, including those in community hospitals which take the load off the acute hospitals and reduce bed blocking.  I was also surprised because I hadn’t seen any public consultation on the closures.

So I checked on the Trust’s website.  Nothing about any cuts to Thame and Marlow Community hospitals.    

Then I saw some of the Trust’s papers.   They said 20 community beds were to be “re-provided” from April, 12 beds at Marlow Community Hospital and 8 beds at Thame Community Hospital. 

I had no idea what “re-provided” meant.   Perhaps I thought, optimistically, it meant 20 beds were to be brought back into service.  But no chance.  When I read on, it was clear that “re-provided” means “cut”.  

20 community beds are to be cut and staff deployed to other jobs.  The community hospitals will become “community hubs” whatever that means.  

The Trust says these are temporary closures while it runs a pilot to assess how health providers can work more closely with social care and voluntary services. 

But you know, and I know, that once these beds are cut, it will so much more difficult to bring them back into service.  The Trust needs to cut its budget by hundreds of millions of pounds and this is one way of finding money.   

Meanwhile in my newspaper today, Simon Stevens, the Head of NHS England, said he is introducing rules to make it much harder for hospitals to cut beds.  The dramatic loss of beds since 2010 was widely blamed for exacerbating the winter crisis.  He said in future trusts will have to get approval for the cuts.

In the meantime, he said, there are already tests in place for Trusts to pass before they can cut beds.  “Significant bed closures” for example need the backing of their local MP and the public should have had their say.  

I don’t know if the closure of these beds is “significant” or have the backing of MPs but the public doesn’t seem to have had its say. 

This might be the new way of working in the NHS.  Disguise a cut as a “re-providing”; don’t tell the public, let alone consult them; do it all as lots of small cuts; and do it as a “temporary measure” while doing a pilot. 

P.S.  if the NHS are running a pilot working with social care, does it know BCC is broke and there is a crisis in social care?   Has BCC signed up to this pilot?  If so, how are they resourcing it?

 

Steve Baker, MP, just not interested in views of his constituents on Wycombe hospital?

15 February 2017

The Bucks Free Press published a letter from the MP for Wycombe, Steve Baker, last Friday (10 Feb).   His letter explained who had influenced his decisions on the future of Wycombe hospital.    

Apparently it isn’t local health campaigners who influence him.   Steve Baker said he accepted their “noble intent” but criticised them for not participating in meetings with health providers and not listening to the health providers explain their thinking.

Perhaps Steve Baker needs reminding that these health campaigners, many hundreds of them, are his constituents.  They have considerable knowledge of healthcare in Wycombe.  Thousands have signed their petitions.  

Surely he should be listening to them?   Surely he should be encouraging the health providers to listen to his constituents, not the other way round? 

Perhaps Steve Baker could invite these health campaigners to a meeting.  Perhaps he could respond to the letter they sent him and answer their questions.

Perhaps Steve Baker could even represent the views of his constituents to Ministers rather than tell his constituents what they should have.    Isn’t that what democracy is all about?

I thought Steve Baker was very keen to implement “the will of the people”.  But perhaps that only applies for a hard Brexit.

Nor will Steve Baker be influenced by political activists.  These he said “fail to engage with the NHS and the facts of modern medicine and end up misleading Wycombe people”.   

I am a political activist.  So for that matter is Steve Baker and all the Councillors in Bucks. I wonder who he means.  I’ll check with him that it’s not me.  After all, I did go to a meeting with the NHS recently (see “Silence on NHS cuts” below).  

So if Steve Baker isn’t going to act on the views of his constituents, what does influence his views?  What influenced him to reject the return of an A&E to Wycombe?  What influenced him to propose instead an Urgent Care Centre for emergency heart and stroke treatment, support for the elderly and GP-led urgent care?

Well, apparently it is senior clinicians and “well researched and authoritative papers”.   Trouble is I could find no senior clinicians nor papers which support his proposals.  I searched in the British Medical Journal which Steve Baker cites but no luck. (I will ask for the reference).  

On the other hand, I found a report by the Primary Care Foundation which said urgent care centres might increase the total burden on the NHS.   There are also numerous reports that argue for A&E departments in local hospitals as well as regional major trauma units. Quality care and quick journey times matter.   

I will offer these papers to Steve Baker as, alas, it seems the only means of communication.  

Steve Baker asks us to “stop pretending we can return to 1970 and bedrest for heart attacks”.  I don’t want to go back to 1970.  2010 would do me.  This is when the Commonwealth Fund heralded the NHS as the safest, most cost-effective healthcare system in the world.   How times change under a Tory Government.

 

Austerity means delays in getting an ambulance in Bucks

4 February 2017

Southern Central Ambulance Service Trust covers all of Bucks.  It has been assessed as a “good” trust by the Care Quality Commission. 

 

Nevertheless, according to the National Audit Office, it is failing to hit its targets.   Let’s see what this means if you call for an ambulance in Bucks.  

 

First, your call will be answered quickly.   Most calls were answered within a second last year, although 5% of callers had to wait more than a minute.  

However, you may not get an ambulance as quickly as you should.  If you have a life-threatening condition, an ambulance ought to arrive within 8 minutes.  Last year 25% of patients with life-threatening conditions had to wait longer. 

 

Then when you get to hospital, you may have to wait to get admitted.  You ought to be transferred from ambulance to hospital within 15 minutes. Over 30% of patients had to wait longer than 15 minutes last year.      

 

If you are like other patients, you will think well of the ambulance service.  95% of patients felt they were treated with respect, dignity, kindness and understanding.  76% of patients rated their overall experience with the ambulance service as very good at least. 

 

According to the NAO, the main reason for failing to hit the targets is that funding for ambulance trusts has not kept up with demand.    

 

Ambulance trusts cannot recruit and retain enough staff; last year 10% of paramedic posts were unfilled.  Staff leave because of inadequate pay and reward and the stressful nature of the job.   

The NAO says trusts can’t make changes to improve efficiency when they are understaffed and trouble-shooting all the time.

 

Austerity puts lives at risk and is bad economics.

 

The conclusion?  Ambulance staff are doing as good a job as they can but there is simply not enough money.

 

 

Ward 5b in Wycombe hospital

27 January 2017 

The press have just reported that Ward 5b in Wycombe hospital no longer cares for elderly, frail patients who are assessed as fit to go home.  Instead the ward is for stroke patients.   The Bucks Healthcare NHS Trust says that the elderly patients would recover best in their own homes or in a care home.   

 

This, on the face of it, is a move that most people would welcome; the NHS needs beds and most elderly people would prefer being in a home rather than hospital.  

 

But residents are concerned that patients are being transferred from hospital where they are safe and well looked after to the care of Bucks County Council’s Adult Social Care where we know the Council is underfunded (to the tune of £107 million) and they will receive inadequate care – if at all.

 

You would think in the circumstances that this change would be carefully scrutinized by those who have the statutory power to hold the NHS in Bucks to account and to hold BCC’s Adult Social Care to account.

 

Unfortunately that organization is BCC itself.   Experience shows us that BCC is incapable of holding anyone to account and completely incapable of holding itself to account.   What we have in Bucks instead of scrutiny is an old boys’ club. 

 

So there was no scrutiny by BCC’s Health and Social Care Select Committee on Tuesday (25 Jan).  No publication of the NHS report of the pilot examining the change at Ward 5b.  And no proposal by the Chairman of BCC’s Select Committee to scrutinize the changes until September 2017. 

 

Labour’s County Councillor, Robin Stuchbury has obtained a copy of the report and has started the scrutiny for BCC.   Here are his questions for starters:

 

-          Are community home- based services in place to enable the report’s recommendations to be fully implemented?

-          Is there an effective interface between BCC services and NHS staff to meet all the intentions of the report as the proposed links between for example district nurses and GPs seem ambitious?

-          Is there funding in place within BCC to meet the NHS ambition for joint working and wrap round care?

-          Is there to be joint NHS/social care teams who will follow the patient through recovery and to independent living?

-          When the Select Committee considered the proposals in May 2016 did it make recommendations or seek reassurances on whether there should be a full health impact service assessment to be completed in advance of the changes?

-          If the impact assessment was done, was the Select Committee happy with the assessment and assured itself that there are no negative impact for constituents?

-          If no impact assessment was undertaken, why not – and could the Select Committee seek to have oversight in ensuring that an assessment is now undertaken as soon as possible.

 

 

 

 

 

Waiting times for cancer patients in Bucks

18 January 2017

We hear a lot in the news about patients with cancer having their treatment delayed because of a lack of beds or someone else being given priority. 

I wanted to know whether this was happening in Bucks.

The problem is that all the published data is months out of date.  The latest figures for waiting times for patients with cancer is October last year. 

The maximum waiting time laid down nationally for NHS patients from urgent referral by a GP to treatment is 62 days.  In October, only 82% of cancer patients in Bucks were treated within these 62 days.   

Similarly the maximum waiting time from referral from an NHS screening service to treatment is 62 days.  In October, only 85% of patients in Bucks were treated within these 62 days. 

The papers for the January Board meeting of Bucks Clinical Commissioning Groups also reports that there were 9 cases in September where patients had waited over 104 days and 6 cases in October.

The papers also note there has been a “deterioration in the overall cancer performance”.

It seems reasonable to assume therefore that more patients with cancer have been waiting even longer for treatment over the winter.

There is a crisis in the NHS.  The Government refuses to admit there is a crisis and blames whatever it thinks is happening on the patients and the GPs.

However, the fault lies firmly with the Government who have cut resources for the NHS and social care.  The government was warned.  It knew what was going to happen but let it happen nonetheless.

It’s for you to decide whether you think the Government is incompetent, uncaring and/or deeply manipulative in wanting the collapse of the NHS so it can bring in private healthcare paid for by private insurance.   

 

Not anecdotes but facts on Bucks waiting times in A&E

6 January 2017 

The Red Cross warns today that the NHS faces a “humanitarian crisis” as hospitals and ambulance services struggle to keep up with rising demand.

 

I thought it was worth checking the waiting times in major A&E departments in Bucks.   I am no statistician nor expert in this field and am only too happy to be corrected but here is my best attempt.

 

The target set by the Government for A&E waiting times in June 2010 was for 95% of patients to wait no longer than 4 hours.  

 

Nationally, in November 2010 (which was the first month for the new set of data), 96% of patients in A&E departments waited less than 4 hours.

 

Performance deteriorated and the target has not been met since July 2013.

 

In October 2016 (the latest figures), 84% of patients waited less than 4 hours in major A&E departments.   

 

Waiting times generally get worse in winter so we can expect to see that figure drop.

 

In Bucks, we generally see waiting times no better nor no worse than the national average and indeed for October 2016, we see exactly the same percentage as nationally i.e. 84% of patients in Bucks waited less than 4 hours in major A&E departments.

 

In Buckinghamshire, the target has not been met since July 2015. 

 

Like most hospitals in England, the Bucks Healthcare NHS Trust urged people today to stay away from A&E unless it is a genuine emergency, due to an exceptionally high surge in attendances in its A&E departments.   

 

It is therefore reasonable to expect performance to get worse in Bucks A&E departments over the winter.  

 

So we can say:

 

-          this is not a Bucks problem – it is a national problem. 

 

-          in 2010 when the Labour Government left office, the NHS was meeting its targets for A&E waiting times; there had been a dramatic improvement during its years in power.

 

-          we are now back to the 1990s when seriously ill or injured people had to wait very long times for treatment or a bed.  We are back to trolleys in the corridor.

 

-          the NHS is not safe in the hands of the Tories.  

 

And where is Jeremy Hunt?  

 

£500 million cuts to the NHS in Bucks explained – last and 5th part

 1 January 2017

I think I have come to the point when we all know the plan of the Bucks Clinical Commissioning Groups is a charade.    

 

When we are told

 

“The requirement to balance these multiple requirements has led to complexity with no single principle governing indicative activity”.

 

 we know we have reached the end of the line.  No-one is intended to understand these plans.      

 

When we are told “the ethos throughout the two plans will be mirrored” or we are referred to “a jointly owned Sustainability and Transformation Plan across the health economy footprint”   we know this plan is not clinically led.  What doctor or nurse understands this stuff - or wants to understand this stuff? 

 

I got to the finance part and I tried, I really tried to understand it. 

 

There were two graphs meant to show (I think) the movement of money which would turn the 2016/7 deficit into a 2017/8 surplus.  Apparently it will be done by, amongst other things, moving £8 million from something called “activity growth” and moving £1 million from something called “net tariff deflator”.   There was no explanation and I found it totally inexplicable.

 

So I am going to end by writing the CCGs operating plan for them.  It goes something like this.

 

“The NHS in Bucks is required to hit all its nationally-imposed targets for treating patients.  If it doesn’t, it is fined.

 

It is also required to stay within budget.  If it doesn’t, it is breaking the law.

 

The NHS is demand led and demand for our services is rising.

 

The Government has not provided the NHS in Bucks with enough money to cope with demand and hit its targets.   This gap in its funding amounts to £500million by 2020 in Bucks, Beds and Oxon.

 

On top of these existing problems, the Government requires the NHS to deliver a 7- day- week  hospital service for non- emergency as well as emergency surgery.   This has no clinical benefit.

 

It is also required to make substantial changes to its organisation including moving substantial resources from hospital services to community care.”

 

The Board of the CCG knows any such plan is undeliverable.     It should say so loudly, clearly and publicly.     It should challenge Jeremy Hunt* because the NHS is being set up to fail.  The Government wants the NHS to fail because it wants to privatise the NHS. 

 

*That is if anyone can find Jeremy Hunt who seems to disappear when asked difficult questions.

 

 

 

 

 

£500 million cuts to the NHS in Bucks explained – Part 4

29 December 2017

For those of you still with me – and according to my blogsite count this is hundreds of people – Part 4 is about the public sector working together in Bucks under something called the Healthy Bucks Leaders Group (membership unexplained).    It too has a plan (to be implemented by the Buckinghamshire Transformation Delivery Group in case you are interested).  And it too has priorities – 5 of them- which are all somewhat different from the previous priorities.   We are blessed indeed in Bucks in having so many healthcare priorities (18 so far) in our CCG plan.  (I’ve given up counting aims, themes, or challenges which seem to have a life of their own)

This part of the plan says that there is going to be a move away from spending on care in hospitals and high dependency in care homes towards prevention and early intervention.    This is a crucial part of the plan and what most of us would support.

However, that’s about all it says.  There are 2 inverted triangles which are meant to illustrate this move but there are no figures to tell us how much is spent on the different elements of care and/or prevention and how these are going to change.   2 inverted triangles don’t do it for me.

Nor is there any indication as to how this is going to take place when there are such huge cuts to be made - about £107 million it says in the NHS in Bucks over the next 4 years.

If you want to cut back on care in hospitals and care homes, you have to invest in preventive care first.    You need money up front to make the changes. 

You can’t cut the money going to the hospitals and let people die in order to divert money to preventive care.    Or at least I hope this is not what is proposed.    

How is the NHS in Bucks going to deliver these important changes when it is already on its knees and faces massive cuts?  I’m going to have to skip to the end of this plan to see if there is a happy ending.

 

£500 million cuts to the NHS in Bucks explained – Part 3

23 December 2016

This is Part 3 of my attempt to translate the CCG’s operating plan.  We are now onto Section 3 of the plan where, in addition to the incomprehensible key deliverables in Section 2, we are given the 3 national aims of the NHS:

-          better health and reduced health inequalities;

-          transformed quality of care delivery; and

-          sustainable finances.

This seems a bit more like it.   We could all do with better health and it would be admirable if health inequalities between rich and poor could be reduced; rich people in Bucks live about 10 years longer than poor people.    I assume that “transformed quality of care delivery” means we should get better diagnosis and treatment from the NHS.   And “sustainable finances” presumably means the aim is to prevent the NHS going broke (which unfortunately many parts of the NHS already are).

We are then told that the Bucks CCGs are part of the Bucks, Oxon and Berks Sustainability and Transformation Plan footprint.   What on earth does this mean?    Is this a footprint of a plan or a plan of a footprint?   Whatever. 

The Sustainability and Transformation Plan is set out in two Appendices for reference.  I had a peep but retreated quickly.  It is not for the faint-hearted.  I managed to gather however that there are 3 challenges, that £500 million of cuts are to be made, everyone is very confident it can be done and work is to be taken forward by Project Charters.    (No, I have no idea what a Project Charter is.)

To finish the section we have a diagram of the overall plan.  The diagram has 5 challenges (confusingly different to the 3 challenges in the Sustainability and Transformation Plan), 8 priorities and 26 initiatives. 

Suffice it to say I understood just one of the initiatives - increase exercise to improve health.   The rest are inexplicable or need a lot of explanation. 

For example one initiative is for “improved 7 day services to reduce variation in patient outcomes”.   I assume this is the famous Tory manifesto pledge which Hunt insists will cut deaths in hospitals but which has been rubbished by research and hotly disputed by the junior doctors.  Whether you believe Hunt or the doctors (and I know where my money goes), it is going to cost money to implement.   

I still don’t know how the £500 million cuts are going to happen.  Perhaps I will find out in Section 4 after Christmas.  

 

£500 million cuts to the NHS in Bucks explained – Part 2

22 December 2016

This is Part 2 of my attempt to translate the CCG’s operating plan (see below).  I am now onto Section 2 of the plan called “Key Themes”.   I am already starting to struggle.  This is what it says

“ ..we have developed a set of key deliverables:

• Delivery of transformation and new models of care, including delivery of integrated community based services around a cornerstone of sustainable Primary Care; 

• Develop a Collaborative Provider model of local primary, mental health and secondary care; 

• Develop Care & Support Planning with the objective to build capability in primary care; 

• Commission the iMSK service and explore a new model of care delivery for the Diabetes pathway; and

• EMIS Clinical Service system becomes the software of choice for all primary and community services by April 2018.

The delivery of our plan will be clinically led through our programme boards and CCG Executive, overseen by a single Governing Body in-common.”

I thought an operating plan set out the budget, and what would be delivered with the money, by when and how.  And it would be clear at the end of the operating plan whether the thing to be delivered had actually been delivered, on time and within budget. 

Am I missing something here?  How would I know if “transformation” had been delivered?  Transformation of what?  From what?  To what?  How would I know if an “integrated community based service around a cornerstone of sustainable primary care” had been delivered?   Or “a collaborative provider model”?   

And, what’s an iMSK service?  I can guess MSK is muscular skeletal but iMSK?

I don’t even understand what these things are, let alone be able to recognise if they have been delivered.  

And in any case, do I care?  These aren’t my key deliverables and I bet they aren’t the key deliverables of the vast majority of residents in Bucks.

My key deliverable would be an A&E within (let’s say) 40 minutes of any serious accident I and my family might have and capable of dealing quickly with our injuries.   

I don’t like to be critical of doctors and nurses but is this what is meant by “clinically led”?   Surely doctors/nurses didn’t write or approve this stuff?  

 

£500 million cuts to the NHS in Bucks explained – or not

19 December 2016 

The draft operating plan for the clinical commissioning groups in Bucks was made public in early December for submitting to NHS England by 23 December.  This is the plan that incorporates the £500 million of NHS cuts to be made across Bucks, Beds and Berks.  You might therefore think the CCGs would make every effort to communicate the plan to the public, including the impact of the cuts.  Not a bit of it.

 

The plan is on page 112 of the Board papers for the 8 December meeting.  It is 143 pages long and has no Executive Summary.   It is written in management speak and is impenetrable. 

 

Bucks County Council is meant to have scrutinised this - our Labour Councillor, Robin Stuchbury is asking what BCC said.

 

Just for the hell of it, I am going to see if I can translate it into plain English bit by bit over the Christmas period.  I am sending the blog to members of the CCG Board as they might find it helpful. 

 

I don’t promise to finish.

 

Right, let’s start with the

 

1.      The Foreward.  

 

Plain English translation

 

This is a two year plan for Chiltern CCG and Aylesbury Vale CCG which have to all intents and purposes merged.

 

What it doesn’t say

 

When the Tories came to power in 2010, they inherited a system where there was one commissioning organisation for healthcare in Bucks - the Primary Care Trust.   The Tories closed the PCTs, making staff redundant and set up two Clinical Commissioning Groups for Bucks because they wanted commissioning to be more local.      This reorganisation cost about £3 billion nationally.

 

Now the two CCGs have merged creating one commissioning organisation for Bucks. 

 

So we are back to where we started at a cost of £3 billion.  Well done Andrew Lansley, ex - Secretary of State for Health, and Jeremy Hunt, current Secretary of State for Health for wasting £3 billion on a useless re-organisation.    

 

 

Silence over NHS cuts

December 2016

Letter published in the Bucks Free Press

 

Dear Editor

I went to a public meeting last week organised by the NHS Clinical Commissioning Groups in Bucks.    

It was a surreal experience.  

I thought the CCGs would tell us how they were tackling the crisis in the NHS – a failing GP service, delays for cancer treatment, ambulances failing to get to 999 calls quickly, A&E waiting times getting longer, the chronic shortages of nurses and doctors, and hospital beds blocked by patients who cannot be transferred to the community because of the lack of social services support.

I thought the CCGs would tell us how they were going to cope with the huge £479 million funding gap which will open up by 2020.  I thought they would tell us about the impact of the cuts set out in the leaked draft Sustainability and Transformation Plan, including cuts of £34 million/year to the workforce budget.

But no.  Instead we were treated to presentations about virtual community hubs, locality integration teams, well-being coaches and exciting projects for patients negotiating their individual healthcare.  Nothing about how much these initiatives would cost, where the money was coming from and how they would contribute to improving health when the NHS was in crisis.

Then we turned to the Sustainability and Transformation Plan.  We had charts about workstreams.  We were told about something called footprints and that people were full of ideas and innovation.  But not one word about money.  No budgets, no costed proposals and absolutely nothing, until I pressed hard, about the massive cuts the NHS will have to make under the STP.  

Then Louise Patten, the Chief Officer for the CCGs said there was money coming into the NHS.  I asked how much money the NHS would get in Bucks and when, and to what extent this would help plug the gap.  Ms Patten had no answer.   

Dr Dardis, Chief Executive of the Trust, assured us that there would be no cuts to the Trust's workforce budget up to 2020, despite the Trust operating at a loss of millions of pounds in the last two years.  I was so surprised and delighted I took his words down carefully and checked them with him after the meeting.  I just wonder then where the cuts of £34 million will fall.

Dr Dardis also assured us that no further services would be moved from Wycombe Hospital; it was vital to the future of the NHS hospital service in Bucks and he saw the services offered there expanding.  Excellent news.

So there you have it.  Christmas is coming to the NHS with virtual community hubs and locality integration teams (or was it integration locality teams?) while stardust will make the cuts go away.   

Linda Derrick