Policy to Reality

On Monday I blogged about my Mum’s passing and how ‘far too close to home’, I saw the system of health and social care, policy, commissioning and providers work, in our case, rather well. But as the various systems kicked in I thought to myself you know what, this is precisely why we must get the policies, funding and the way we set up the system, right. This stuff does actually matter for those vital moments in our lives when we need the system to take good care of us.

Last Wednesday I attended the Local Government Association’s Community Wellbeing Board meeting in London and in amongst a packed agenda was a discussion on Better Health and Social Care integration. One of those think tank pieces put together before the next parliament to give the Westminster politicians food for thought as the return after the general election, about the policies they need to enact to hopefully improve the system rather than hinder it.

Geoff Alltimes and Richard Humphries from the King’s fund were in attendance to discuss with us the Barker Report, as it will be known after Kate Barker who is heading it up, as they go about the evidence gathering stage. Here is a link to a short video explaining the commission and its remit http://www.kingsfund.org.uk/audio-video/kate-barker-commission-future-health-and-social-care-England

The report certainly pitches a wide variety of ideas about the future funding of the NHS and what is the role of social care in amongst its mix. Amongst them is such headline grabbers as charging to see your GP or attend A&E alongside the less sensational but more fundamental about the notion of a free NHS and how it sits so uncomfortably with the financial assessment and charging for Social Care. It was quite bizarre as the NHS element of Mums’ care was delivered and you could ‘watch before your very eyes’ the money being spent and yet when it came time for a small element of social care to be planned, out came the forms for this assessment and who is going to pay and the charging mechanism. This is not a criticism of those who very involved as they handled it very well but for such a small element of Mum’s care suddenly the system changed and it was jarring.

At the Board meeting we also discussed the governance and accountability of the NHS and I made the point hat there are so many, many structures in the NHS with vast armies of friends, governors and structures to delivery such things that in reality does it really work or it just a maze where no one, including those who designed it, quite knows who is responsible for what and when it goes wrong across an array of services, well!!. Because in my experience whenever you ask a question of any aspect of the NHS someone seems to point at someone else, just look at the Francis report on ‘Mid Staffs’ Hospital.

In an earlier blog I explored this with new Directors of Adult Social Services, how in local government, Councillors are the first point of call for residents because they elect them. The line to Directors to respond, is one email not a vast system of accountability. In making my point I was stressing to both Geoff Alltimes and Richard Humphries how I saw the future of an NHS delivering services but local government being far more involved with elected representatives being the key local way in which the NHS is provided with accountability and governance. It will be interesting to see their final report and I’ll blog it when it’s published in the autumn.

The CQC and the NHS

Poor Standards, cover-ups and scandal seem to be swirling around that most beloved institution, the NHS.

One of the most fascinating thing I have been involved in over the past few years is learning about this thing called the NHS, for it is not one thing but a vast collection of organisations often competing with itself and local government, it is extremely complex and ‘eats’, after welfare, more of our nation’s money than anything else and more than the entire cost of Defence, Local government, Home office costs and overseas aid put together.

The latest scandal is of course the Care Quality Commission (CQC) cover-up and its interesting watching David Behan, it’s new Chief Executive, a former local Government Director of Adult Social Services and latterly chief civil servant to successive Care Ministers deal with the political and public fall out. Somewhat less visible has been the organisation’s new chairman David Prior, which is a surprise given his political background, it’s interesting and such a small world that he lost his North Norfolk seat to one Norman Lamb in 2001 by just 483 votes, who of course is now the Care Minister.

I recall a few years back the reformed CHC coming to a meeting in Endeavour House, Ipswich and telling us of the scope and scale of the organisation going forward and how the new regime was about simple registration of Care Homes and Health organisations and how this process would ensure standards. I and officers left that meeting ‘gob-smacked’ at what was being proposed and perhaps what we are seeing today is a direct result of those decision taken then, in essence I think we have seen an organisation trying to step up but with extremely limited resources. I have met with David Behan on a number of occasions, particularly around the challenge of the Dilnot reforms and if anyone can move that organisation forward it is him, provided he is given the resources with which to do so.

Indeed if, and I have, you have ever read one of their reports it is clear that the process is far from robust and often anecdotal at best. There are some commentators who are saying that one regulator going forward who covers social care, primary care, dentistry and hospitals is ridiculous. I don’t agree with that but do say that what is ridiculous is the level of funding provided to carry out their function. To say they are thin on the ground would be something of an understatement, in Suffolk they have two part timers covering the whole system, a system that employs tens of thousands of people and spends a collective £1.5Billion. How do two part timers hope to meaningfully report.

So what we have is a swirling bubbling pot, add to the truly shocking Francis report about hospitals and the clear blueprint he proposes for change both in our hospitals, their accountability to patients and indeed the role of Local Government Scrutiny; next add in the new Healthwatch organisations and Health and Wellbeing boards and it is difficult to see what we will get, how do we create a robust system of monitoring and checking not only to make sure our hospital and health system is safe but actually drive forward improvements.

Sometime ago at the creation of Police Commissioners I blogged about the notion of Health Commissioners, the care and health system is vastly more complex than the police service, vastly more important to most people’s daily lives, collectively it spends, in Suffolk alone, about 1000% more than the police service and yet is for the main part at the local system level is essentially democratically unaccountable. I think to improve and move forward an important element must be meaningful local democratic accountability. I continue to pounder that a Health Commissioner would have the democratic mandate and accountability to pull all of this vast complex system together at a local level for the better. Mind you what a job!

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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