Hospital A&E Winter Pressures & Social Care

A&E sign imageYesterday saw the latest figures for A&E waiting times published and Addenbrookes Hospital at Cambridge, our local major trauma centre declared a ‘major incident’ which are early warning light systems that we have a problem, of course all businesses have peaks and troughs but these figures are particularly worrying is that it’s not a harsh winter rather mild actually and we are out of the ‘perfect storm’ period of closed GP Surgeries over the Christmas period. All of us must use the right services at the right time but interestingly records show that predominately those who present at A&E are right to do so, so what’s the problem? Essentially it is our ageing population, that long talked about issue is now starting to ‘bit’, with unplanned admissions of elderly people at the front end and bed blocking at the far end. With bed blocking perhaps being the first signs that the cuts in local government funding to provide social care and an increasing number of people needing services are making discharge of elderly patients ready to go home increasingly problematical. The figures bring into focus the need for the whole system to work better from GP services, to pharmacists, out of hour’s services, intermediate care beds (that’s what used to be called convalescence) to social care.

The debate rages about Health and Social Care which is the single biggest interface and spend area for Local Government (about 40% of most upper tier authorities budgets) and the NHS spends about £1 in every £6 of national total spend. As Portfolio Holder for Health and Social Care integration at the LGA’s Community Wellbeing Board and LGA CWB Health and Wellbeing Board Ambassador for the East Midlands I firmly believe we have the structures in place to tackle an Ageing population but need Westminster’s continued backing for the Health and Wellbeing Boards to be the place this integration is championed by and driven forward from.

The danger is that as the issue starts to impact hospital’s ability to cope with admissions, Government looks towards the NHS to quick fix the problem and I tend to think reading between the various lines out there, not least Simon Steven’s, the new CE of the NHS, 5 year vision speech, the NHS is quietly lobbying to take control of social care.

This would have two fundamental impacts firstly the cost of social care would rise dramatically, as frankly however well the NHS does things it never does them cheaply. Local Government is the most cost effective part of government for a reason, firstly it’s local, and secondly, and far more importantly, Local Government is articulating a different approach to services built around community capacity and how communities and individuals develop care services in part for themselves. This cannot be done centrally or nor by organisations trying to begin to learn what this thing called ‘community’ and ‘capacity’ is all about. Much of Local Government has for some time been cutting costs and at the same time working differently with communities and developing services in communities and to dismiss it as not clinically valid (in the NHS sense of the word) and start again is a serious mistake. Local Government and the health services in their many forms, through the Health and Wellbeing Boards must be the start and finish point for Health and Social Care integration to solve these problems as our population ages.

A Different Prospective

PHEE PictureYesterday I was invited by the Public Health England, Network for Public Health Registrars to speak at a seminar they were holding in Cambridge entitled ‘Working in Local Authority and Navigating the Political Environment’. In the session I spoke at I was joined on the platform by Cllr. Dr. Tim Moore who was previously a Public Health professional and now Lib Dem City Councillor for the patch that has Addenbrookes in it, and Cllr. Kilian Bourke, Chairman of Cambridgeshire County Councils’ Heath Committee who is also a Liberal Democratic, so no Labour Councillors, but hey never mind!

The event was held at Addenbrookes Hospital and not a stones throw from where I took my mum for the first 6 months of this year as she fought Cancer. I arrived early, as I was that way for another meeting in the morning, and so walked across past where I used to usually park my car and through the halls of the hospital on my way to the food court for lunch. As I did I reflected on two things, bizarrely I recalled an episode of the great American sit com Frazier where they visited hospital and the episode flashed back to all the events in that families lives that had been played out there and it struck me that a sad section of my families’ life was played out in the hotchpotch of buildings that make up this sprawling hospital only a few weeks before, which now seems another time altogether, time does seem to march relentlessly on as each of all our families stories are, in part, played out in such places.

Back to the matter at hand and all three of us spoke for about 15 minutes and then there was a Q & A session. Both Tim as a new Councillor, 3 months in post, and Kilian were really interesting speakers and I did remark at the start of my few words that it was worrying to find myself agreeing with Liberal Democrats and equally, going third, it’s not easy to find something to say when the best words has been said! I did find some words hopefully interesting about the challenges and more importantly if successful the opportunities ahead and I found the Q&A really thought provoking. As is often the case I think I came away challenged in my thinking and learning a great deal about the different prospective Public Health professionals face as they seek to deliver for the communities we serve and how they work effectively in this new political environment they find themselves in.

Mid Staffs Hospital Report

As the Councillor for Row Heath and representing my community; one of my roles is to sit on the Local Government Association’s Community Well Being Board as a substitute member.

The board sort of speaks for local government on all things Health and Social Care and often seems far removed from here in our community but its work is actually rather important to the lives of residents and in addition feeds a local government prospective into the policy making of Westminster.

A couple of weeks ago on a packed agenda the main item was a discussion on The Francis Report to consider local government’s responds to the Robert Francis Inquiry report into Mid Staffordshire NHS Foundation Trust.

The Mid Staffs hospital where, for far too long, patients were dying through lack of basic care. Here in Row Heath we are well served by the West Suffolk Hospital and Addenbrookes but lessons need to be learned so that it cannot happen ever again anywhere.

We discussed the 139 page executive summary which I have read and I made a couple of points in the debate around the one of the key things for me was that it is a significant part of the Staffordshire story that patients and relatives felt excluded from effective participation in the patients care. To my mind the concept of patient and public involvement in health service provision starts and should be at its most effective at the front end.

The report also looks at the role of external organisations such the Local Involvement Networks (LINKs) and other aspects of system failure following removal of the role of the commission for patient and Public involvement in Health (CPPHI) left each local authority to devise it own working arrangements; in Stafford the squabbling that had been such a feature of the previous system continued and no constructive work was achieved at all.

Criticism was also made of the County Council’s Health Scrutiny process the new Healthwatch organisation is also a key element of this championing the patients and their families and carers and we must ensure that the voice is heard and acted upon when there are concerns we must never ever allow Stafford to happen again and local government and Councillors have  a key role to play in this.

Criticism was also made of the County Council’s Health Scrutiny process and that it did not detect or appreciate the significance of any signs suggesting serious deficiencies at the trust. The evidence before the inquiry exposed a number of weaknesses in the concept of scrutiny which may mean that it will be an unreliable detector of concerns, however capable and conscientious committee member may be.

Here in Suffolk we must also reflect on the report and make sure we learn from the report; I have already sat down with Cllr. Dr. Alan Murray, Chairman of Suffolk Health Scrutiny and discussed what we need to take that on board; there are always improvements that can be made and it is important that our own committee is even better trained and robust with the resources needed to be as effective as is possible.

There are a wide range of routes through which patients and the public can feed comments into the health services and hold them to account. However in the case of Stafford, these were largely ineffective and received little support or guidance.

In the board’s debate I also I added that we should consider looking at other models such as the Region of Lower Austria who have the voice of patients and families built to the hospital key performance indicators.

The report is a sobering read but it makes a number of recommendations that we need to address, most within the Hospitals and the NHS, but some 145 to 150 are the ones Local government need to reflect on and make sure we are as robust in our role as we can be.

A caring, safe, hospital is vitally important to the community I represent and so occasionally these work far removed from my community is actually vitally important to it.

The report can be read or downloaded from:

www.midstafffspublicinquiry.com/

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