Sunday, 28 January 2018

A healthy nation yields a healthy economy

If STPs for Lancashire want folk to adopt preventive medicine then they can ruddy well pay for it!  TORIES scrapped free swimming at Chorley leisure centre and Brinscall in 2010 reducing the activity levels of those using the free facilities. T

Technically it wasn't free, it was government subsidised by New Labour in 2009 but the Tories scrapped the funding in 2010 as soon as they got to power.

Austerity is an excuse to kill 

The announcement to remove the funding in 2010 formed part of the Conservative government’s future spending plans, which aimed to reduce the national deficit. What they actually did was to add to the increase in hospital and GP attendances.

Now, in 2018 the same Tory government are pushing for people to 'self care' and use 'prevention' to avoid future illnesses and reduce hospital admissions and  attendances at the doctors.

But they can't have it both ways; removing free access to healthy leisure facilities increases chances of more GP and hospital attendances.
So if they are serious about preventative medicine they'll need to fund it. Historically, there's little chance of a Conservative government funding free access or vastly reduced concessions to leisure for the unemployed, disabled or unwaged.

This year, in 2018, I'm going too push for free/concessionary access to leisure for EVERYONE who can't afford the ridiculous fees currently charged at local leisure centres.

Councils that subsidise local leisure centres could save the health service money in the longer term by helping people stay fit.

At present, Chorley council claim to be partnered with local leisure centres yet concessionary admission fees at these centres for the disabled or unemployed are still expensive and unaffordable to many.

In a recent news article, the Health & Wellbeing commissioner for Wales Sophie Howe said public bodies, such as councils and the NHS, were now required by law to think in an "integrated way" about the impact of their decisions.

She also said a "national conversation" was needed on whether tax increases were needed for health and social care.

Prevention is better than cure. "For too long we've put health in the category of the health service [and] hospital spending and that's at the acute end, that's where things have actually already gone wrong."

Wales has the 'Future Generations Act' which requires all those public bodies coming together under something called a public services board - to be having exactly those sorts of conversations. So if, because of budget pressures, the local authority is thinking about closing leisure centres they should be having that discussion with other partners [and saying] 'who can help us?

The health of a community depends largely on keeping people fit thus preventing further problems down the line. In England the issue has been overlooked for too long and many people are excluded from physiotherapy and physical activity at their local leisure centres due to high admission costs or annual membership fees. If we are to take preventive medicine seriously this needs to change.

In July 2010 free swimming at Chorley leisure centre and Brinscall was axed.
At the time the Leader of Chorley Council Councillor Peter Goldsworthy said: “Although free swimming was popular in Chorley, all the evidence suggests it had been taken up by people who were already swimming and it wasn’t attracting lots of people to take up the sport".

Ironically, Cllr Goldsworthy then went on to say to encourage these people to continue swimming and keeping themselves fit and healthy at our leisure centres they'll now have to pay.
Surely if people aren't using the free swimming scheme it won't cost anything so why not keep free access open in the event people do? The answer of course is leisure centres need money as a business so they axed the free swimming and introduced charges - and the charges didn't stop at swimming fees either...
Free swimming, which was launched nationally in 2009 and funded by the Government, was aimed at getting more people taking part in exercise. Yet as soon as the Tories came to government in 2010 the funding was axed. As mentioned above the announcement to remove the funding formed part of the Tory government’s future spending plans, which aimed to reduce the national deficit.

So on the one hand the Tories in 2010 scrapped a scheme that was helping towards keeping the nation fit and healthy. In 2015 the Tories set out reforms that heavily involve keeping the nation fit using preventative medicines.
They can't have it both ways. 
The unwaged, disabled, unemployed are all too often forgotten about when it comes to social care and preventive medicine. A healthy nation yields a healthy economy. But the funding must be released to enable this to happen.

Let's all press for the funding - and at the same time kick STP NHS privatisation plans into the long grass where they belong...

Free swimming at Chorley axed [July 2010]

Wednesday, 24 January 2018

Lancashire Hospital Chief exec to self-certify delays

Poor results of Delayed Transfers of Care (DToC) at the hospitals in Lancashire is causing backlogs, long A&E waits, and even Ambulances being redirected to other hospitals.

So when a local Health & Wellbeing board identified Lancashire Teaching hospital NHS Trust as having the worst patient transfer delays in England you'd think an independent body would monitor and report back on the issue?

Bizarrely, Lancashire County Council's health & wellbeing board have asked the hospitals chief executive and commissioning group to self-certify that all is well or otherwise. 

Lancashire Health and Wellbeing Board
Minutes of the Meeting held on Tuesday, 14th November, 2017
Hospital Delayed Transfers of Care (DToC) from hospital to home/care

This area has been recognised as the top priority for joint working by NHS and Social Care. There is significant national scrutiny that has placed Lancashire in the worse performing quartile resulting in an impending review of the use of the iBCF monies in improving DToC performance.

There was discussion about DToC performance and it was agreed that there would be a Check and Challenge Group that would meet in between Board meetings that will feed back into this group. The membership of this group was agreed as follows:

  • Louise Taylor - Corporate Director Operations and Delivery (LCC)
  • Karen Partington  - Chief Executive Lancashire Teaching hospitals foundation Trust
  • Jayne Mellor - Head of Planning and Delivery Chorley & South Ribble CCG and Greater Preston CCG
Louise Taylor agreed to lead this group and convene the meetings.
source LCC Health & Wellbeing board minutes of meeting Nov 2017

The Lancashire Evening Post reported mid-January that hundreds of patients a week were stuck in Lancashire hospitals – even though they are well enough to be discharged – at a time when bosses are having to put on extra beds to cope with huge demand.

The Lancashire trust run two hospitals in Preston and Chorley.
Chorley hospital had its A&E closed in April 2016 causing a larger number of patients to attend the only full-time A&E in Preston adding to the capacity and patient transfer delay problems. 

Although the A&E supporting Chorley & South Ribble was re-opened part-time in January last year the problems at the neighbouring hospital in Preston persist. 

Campaigners are calling for a full-time round the clock A&E at Chorley which would alleviate the problems at Preston Hospital.


The next Lancashire Health & Wellbeing board is Thursday , 25th January, 2018 10.00 am Committee Room 'C' - The Duke of Lancaster Room, County Hall, Preston. The above issue is on the agenda - come along and speak up!


The transformation of NHS hospitals into businesses was accelerated with the introduction in 2003 of a funding mechanism known as ‘payment by results’, whereby hospitals were paid per each individual who completed treatment, rather than with a lump sum for a given number of cases.

Income now became closely tied to performance, which was measured by ‘throughput’, and payments were based on a national tariff of fixed prices, adjusted for the seriousness of each case category, not on how well patients did after they were treated.

‘Payment by results’ was actually a misleading name for the arrangement – it should have been ‘payment by throughput’. It was another piece of policy bought wholesale from the USA.

excerpt above kindly reproduced from NHS SOS: How The Nhs Was Betrayed – And How We Can Save It (by R.Tallis)

And the result of implementing 'Payment by Results'?
Hospitals act like 'conveyor belts' for dying patients

Sunday, 14 January 2018

Jeremy Hunt, Social Care, and means tests

What d'ya mean 'means-tested'?

"No society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means". Aneurin Bevan
Let's expand on the term 'means tests' and how this relates to the health secretary's new responsibility for social care.

Currently social care is 'means tested' , so if you’re looking at getting some social care, such as help at home, home adaptations or a care home place, and you exceed a certain income or have savings above a certain threshold then you must pay for it.

Integrating social care into the NHS runs the risk that eligibility to NHS medicines and treatment, as with social care, would become 'means-tested'. Hunt, knowing this, intends to do just that and pool his NHS budget to cover social care then roll it out under the American style accountable care organisations (after all - he appointed Simon Stevens, ex vice-president of the largest private health insurer in the USA to head NHS England to further the cause).

The proposed STP reforms intend creating a two-tier system to do just that - split the NHS into a private-public partnership as with medicare in the U.S.A. It will look at your income, savings and property (if you need to move into a  permanent care home) to calculate how much you need to contribute towards the cost of your care and support.

Those who can afford certain treatments or procedures on their insurers (CCGs) list* will be seen prompt and jump the queue. Those who can't will have to wait and put up with a very bare healthcare system which will dwindle as years go by.

*It's anticipated commissioning will be done wholly by CSUs (Commissioning Support Units) and CCGs will continue to further ration healthcare under their existing policies (but this depends on how each Accountable Care System evolves).

It's already started - insurers call it 'Denial of Service'

Clinical Commissioning Groups, underfunded by NHS England are resorting to clinical policies that restrict or deny patients certain treatments (as with HMO private insurers in the states). It starts with the small items, then moves onto cateracts, hip replacements, full or partial knee ops etc. Patients who are now referred by their GP for certain procedures in the CCGs expanding restricted list must now go cap-in-hand and apply for an "Individual funding request".

Patients will eventually be encouraged to make 'co-payments' towards their procedure or take out insurance in case something goes wrong with you or your loved ones.

It's all contrary to providing comprehensive healthcare to all, no matter what means to pay. And behind it all is Simon Stevens and Jeremy Hunt (spelling error) who's next step is to force a failed U.S system on us from the country with the worst healthcare rating in the advanced world. Knowledge is key, read on....

The Americanisation of the NHS, happening right here, right now

Saturday, 6 January 2018

NHS crisis - don't blame patients, blame politicians

Ambulances queue outside Preston hospital
THE winter period is the most important time for Chorley and South Ribble NHS campaigners as it highlights the inadequacies in any healthcare system - especially in our hospitals.

What we need at this time is stability, we need expansion, not the contraction of services NHS England offer under their sketchy five year forward view run by Simon Stevens, ex president of Americas global United health private insurers.

Overcrowding at hospitals is all year round but worse in winter. Remember, over the last two decades successive governments have closed and downgraded dozens of hospitals in England leaving any remaining A&E hospitals to cope with the additional strain.

That is the real reason we are seeing patients waiting hours outside A&E in ambulances. Coupled with massive intentional underfunding of social care, patients in hospital have nowhere to go leading to bed blocking and delayed transfers of care.
With the advent of Clinical Commissioning Groups in 2013 handing out more NHS contracts to the private sector, we've reached a boiling point of mass orchestrated design leading to the deaths of thousands of patients.
Take Burnley general hospital and Chorley district hospital as examples - both in neighbouring trusts. Burnley's A&E served a huge population of over 260,000.

Yet it was closed in 2007 and moved to the Royal Blackburn hospital (RBH) - who already had a huge Private finance initiative (Pfi) debt. The result was total chaos including RBH temporarily closing its doors to ambulances 8 months later, re-directing them to already overstretched hospitals outside the east Lancashire hospital trust's jurisdiction. It's been crisis management ever since.

Chorley & South Ribble hospital has fared no better, closing its doors in April 2016 due to staff shortages and, like Blackburn hospital, resulted in overcrowding at the only remaining A&E at Preston.

Ambulances stuck at Preston once again can't get back on the road to reach emergencies and it emerged this week [5th Jan 2018] a local man died of a suspected heart attack after waiting over 90 minutes for an ambulance to arrive.

After an initial investigation, it was decided to re-open Chorley hospital A&E on a part-time 12 hour basis. The Chorley A&E re-opened part-time in January 2017.

The table below shows ambulance handover times at Preston including just after Chorley A&E closed. Handover breaches went from 21 to 313 and serious breaches shot up from 1 to 141. This week [Jan 5th 2018] it was reported Preston hospital had the WORST  wait time in England of over one hour for patients in ambulances outside its A&E.

So where do we go from here? There's little accountability in the present NHS system. Following the route of Sustainability and Transformation Plans (STPs) only accelerates the NHS as a market and will remove any accountability that's left. 

All the signs were there

In 2015 the Lancashire trust were told not to build a multi-storey car park they had planned because STPs were in place to attempt to reduce hospital attendances.

If they could pull off the plan of selling off hospital services and moving them into communities run by public private ventures they wouldn't need the multi-storey car park; saving the trust £millions in the process. So what's the plan?

It makes one wonder if building the urgent care centre at the side of Chorley hospitals A&E was a ploy for it to eventually replace the A&E?

It follows the same reasoning as the car parking, and it fulfills the criteria for meeting the STP plans readying for corporate take-over of the NHS.

God bless the NHS, it's all we have left, all other public services are gone.
We must fight hard, and never surrender what's rightfully ours.

Politicians are not having this one. This one's ours...

Friday, 5 January 2018

Social care and the Tory protest letter

In September 2015, a letter of protest about proposed ‘cuts to frontline services’ arrived on the desk of Ian Hudspeth, a county Councillor.

It read in part: 'I was disappointed at the long list of suggestions floated in the briefing note to make significant cuts…. from elderly day centres, to libraries, to museums. 

This is in addition to the unwelcome and counter-productive proposals to close children’s centres across the country … work … could be done to generate savings in a more creative manner.’

The reply from the Councillor was clear: the council had no other options, having already fired middle managers (losing around 2,800 jobs), changed contracts, frozen pay or given under-inflation pay rises. Services had been merged and physical assets sold off, even though this was ‘neither legal, nor sustainable in the long term’.

Although the council was dealing with more older people needing more social support, more children in care and hospitals that were unable to discharge 159 people home because of funding gaps in social care, there was nowhere left to go.

While the protester claimed that the council’s spending had ‘increased in recent years’, the fact was, replied Hudspeth: ‘Our Revenue Support Grant has fallen by almost 50% in the first half of this decade from £122 million in 2011/12 to £62 million in 2015/16, and we expect it to approach zero by 2020.

Other funding streams have not kept pace with this, particularly in real terms.’ In addition: ‘… additional functions have been transferred to local authorities since 2009/10. Most notably Public Health as well as new burdens related to the Care Act 2014 and the Health and Social Care Act 2012. …

The Better Care Fund is not new money for the system, there has been £8 million in additional funding for Adult Social Care, but this has been at the expense of funding for NHS Services.’ The council was having to do more, much more, with less, including delivering public health services. Something had to give.

That something was frontline care.
The sender of the above letter was David Cameron, the prime minister who had overseen the financial cuts to local councils he was complaining about. 
Surreally, it seems he simply did not understand that they could not be absorbed without reducing the services available. Local authorities – which commission and pay for social services – have taken hits of 30% of budget in real terms in England and around 24% in Scotland between 2008 and 2015.
Excerpt above kindly reproduced from Margaret McCartney's book titled The State of Medicine: Keeping the Promise of the NHS

What cuts to your local council should David Cameron be aware of?