Health Services

By Nick Triggle Health reporter, BBC News

The NHS is failing to treat elderly patients in England with care, dignity and respect, an official report says.

The Health Service Ombudsman came to the conclusion after carrying out an in-depth review of 10 cases.

The ombudsman, which deals with serious complaints against the NHS, said the patients – aged over 65 – suffered unnecessary pain, neglect and distress.

Charities said the findings were “sickening”, while the government admitted improvement was needed.

While the ombudsman’s Care and Compassion report is only based on 10 cases, the ombudsman said they were far from isolated examples.

Of nearly 9,000 complaints made to the ombudsman last year, 18% were about the care of older people. In total, it accepted 226 cases for investigation – twice as many as for all the other age groups combined.

Ageing population

The report concluded there was a gulf between the principles and values of the NHS and the reality being experienced by older patients.

NHS: What are my rights?

• Under the NHS constitution, you have the right to have your complaint dealt with efficiently and properly investigated
• You should be told the outcome of any investigation into your complaint
• You can complain either to the service you are unhappy with or the PCT that commissioned it
• Complaints should be made as soon as possible – normally within 12 months
• If you are not satisfied with the response, you can complain to the independent Parliamentary and Health Service Ombudsman

And the ombudsman, which is called in once a complaint cannot be resolved by individual NHS trusts, said the fact there was an ageing population made it even more essential that the concerns were dealt with.

Several themes became clear from the ombudsman’s analysis. Half the people featured did not consume adequate food or water during their time in hospital.

Some were left in soiled or dirty clothes. One woman told the ombudsman how her aunt was taken on a long journey to a care home by ambulance.

She arrived strapped to a stretcher and soaked with urine, dressed in unfamiliar clothing held up by paper clips, accompanied by bags of dirty laundry, much of which was not her own.

Communication was also highlighted as a problem with one 82-year-old woman recalling how, on being discharged from hospital after minor surgery, she was frightened and unsure of how to get home.

She asked the nurse to phone her daughter, but was told “this is not my job”.

In another case, a cancer patient wanted to be discharged to die at home. When his daughter arrived to collect him, she found him sitting behind a closed curtain in distress.

He had been left for several hours in pain and desperate to go to the toilet. He was unable to ask for help because he was so dehydrated that he could not speak or swallow.

Case study

After being admitted to hospital with severe abdominal and back pains, Mr D was diagnosed with advanced stomach cancer.

He asked to be discharged so he could die at home. But when his daughter arrived to collect him, she found him sitting behind a closed curtain in distress.

He had been left for several hours, was in pain, desperate to go to the toilet and unable to ask for help because he was so dehydrated that he could not speak or swallow.

The emergency button had been placed out of his reach, his drip had been removed, fallen and had leaked all over the floor.

At home, his family discovered Mr D had not been given the right pain relief.

His daughter said later: “It was as if he didn’t exist.” After investigating the case, the ombudsman found the trust had failed on a number of grounds.

But he added: “It is of course important to put these 10 examples in perspective. The NHS sees over a million people every 36 hours and the overwhelming majority say they receive good care.”

Steve Jamieson, the head of nursing at the Royal College of Nursing, said the “shocking report” indicated the need for a “complete overhaul” of the way care is offered to some NHS patients.

He told the BBC Radio 4 Today programme: “The RCN would never condone poor care and people need to be held to account for the examples we have read in this report.

“We need to understand why this is happening and why dignity is not being promoted.”

Care services minister Paul Burstow acknowledged standards still needed to improve.

“We need a culture where poor practice is challenged and quality is the watchword. The dignity of frail older people should never be sidelined.”

He said the government’s reforms of the NHS would strengthen the voice of patients.

The PCT released the following on Friday 11/2 describing the start of outpatient services at the expanded Bridge Lane Health Centre in Battersea as part of the strategy for shifting care from hospital into the community and making it more accessible to local residents.  Ophthalmology is the first service to be offered, to be followed in April by dermatology and then orthopaedics and sexual health, with more services to come on stream after that.

Hospital Outpatient Services now at Bridge Lane

Friday 11 February 2011

Lengthy trips to the hospital for outpatient appointments could soon be a thing of the past for Battersea residents, now that the Bridge Lane Health Centre has an extra seven new consulting rooms. Completed in December 2010, this additional 800 sqm provides a light airy welcoming space for patients and will not only mean the practice makes much better use of its environment following a refurbishment of their area, but also allows the Bridge Lane Health Centre to contribute to NHS Wandsworth’s shift of care agenda. This will see a range of the outpatient services currently provided in hospitals, relocated into local community settings, such as health centres and GP practices, making them much easier for people to get to and use.
 

Later this month, patients will be able to opt to visit the Bridge Lane Health Centre for their ophthalmology outpatient appointments. From April 2011, NHS Wandsworth will begin to commission dermatology clinics at the Centre, closely followed by orthopaedics, sexual health clinics and other outpatient based services, which are all scheduled to be available from this site later in the year.  The extra capacity will also provide clinical space for services aimed at supporting patients living with long-term conditions and healthcare promotional events.
 Dr Snape, GP at Bridge Lane Group Practice said: “We’re very impressed with what has been achieved with this refurbishment and new build in such a short space of time and the potential increase in services it provides for Battersea residents. The building’s improvements will not just benefit our patients, but also patients registered at other practices, as well as those living or working in different parts of the borough. In fact, anyone in Wandsworth needing an outpatient appointment for any of the services on offer at this site, that would find Bridge Lane a much more convenient location, can chose to have it at this site by just asking their GP to refer them here.”

SWLondon & St. George’s MH Trust are aiming to become a Foundation Trust By 2012.

The Trust will be implementing a new approach known as the triangle of care whereby  the carer is more integrated as part of a three point approach with the service user and the professional.

The Trust has commissioned Canerows and Plaits to provide peer support and befriending to patients within the hospital.

The first recovery College has opened on the Springfield site offering training and support to users, carers and mental health professionals who are all treated equally in their roles at the college.

Dear colleague,

We wanted to update you on progress we are making in south west London towards implementing transitional arrangements as we move towards the plans described in the Health and Social Care Bill, following consultation on the White Paper “Liberating the NHS; Equity and Excellence” last year.

In November 2010, the PCTs in south west London agreed to work together more closely to manage the transition from PCT-led commissioning to GP and Local Authority Commissioning, and also make significant management cost savings.  Although individual PCTs will remain as statutory organisations, we will now operate as one management team across south west London to share resources, roles and functions. We will continue with a strong borough focus and work closely with GPs and Local Authorities. This will take effect from 28 February 2011.

As you know, Ann Radmore was appointed as Sector Chief Executive in January and will become the accountable officer for all five PCTs in the cluster, subject to the approval of the five Boards: Croydon, Kingston, Richmond, Sutton & Merton and Wandsworth.  The appointment process for a single chair for all five PCTs is also underway. 

We are also now able to announce the new South West London management team. 

South West London Team

• Bill Gillespie, Director of Strategy and Performance
• Jonathan Hildebrand, Director of Public Health
• Jill Robinson, Director of Finance
• Dominic Conlin, Managing Director of the Acute Commissioning Unit
• Amanda Philpott, Managing Director for Croydon
• Penny Taylor, Managing Director for Merton
• Dominic Wright, Managing Director for Richmond 
• Graham Mackenzie, Managing Director for Wandsworth
• David Smith, Director of Health and Adult Services for Kingston

(Joint appointment with the Royal Borough of Kingston-upon-Thames)

• Simon Currie, Interim Managing Director for Sutton, for four weeks whilst a substantive post holder is selected. 
• Charlotte Gawne, Director of Communications and Corporate Affairs
• Jocelyn Fisher, Director of HR, OD and Workforce

The remaining director posts to be appointed are Medical Director and Director of Transition. 

The key role for the Managing Directors will be to lead the local work for the borough and a small team of commissioners focusing on the needs of the borough’s population, working closely with their local authority and GP clinical leaders.  They will also form part of the management team for south west London. 

We would like to take this opportunity to thank the Chief Executives from each PCT for their hard work and dedication over the past years to improve the health and health services of local people in South West London.

Arrangements for the governance of how these arrangements will work will go to our public PCT Board meetings in February. Please contact Ann’s office or your PCT if you would like a copy of the Governance Proposals.

These director level appointments are an important step towards making this transition. The coming period in the NHS in south west London will be challenging – all parts of the NHS system are changing.  We are confident that this new team can successfully lead us through this process.

This is the first phase in these changes and unfortunately the overall management cost reduction will mean redundancies for a number of our managerial and administrative staff.  Staff consultation for the majority of our staff ended in January 2011 and an appointments process will follow.

We have been briefing staff frequently throughout this process and working closely with our union representatives to ensure staff are supported throughout this process.  The new structure will be in place by April 2011, and I know all our staff would appreciate your patience and support as we continue through this difficult time.

Kind regards,

Ann Radmore, Chief Executive, and Sian Bates, Chair, of the NHS in South West London

8 February 2011  BBC article

NHS shake-up ‘risks diluting patient power’By Nick Triggle Health reporter, BBC News GP consortia should be up and running by 2013

Patients risk having less of a say in the running of the NHS in England under the proposed shake-up, eight leading health charities say.

GPs are being given control of much of the NHS budget under the changes laid before Parliament last month.

Part of the reasoning was that it would help empower patients, but the groups, including the British Heart Foundation, said it could weaken their involvement.

 The government insisted the changes would give patients “real clout”.

The intervention by the health charities – in a letter published in the Times – follows widespread criticism of the reforms by health unions and MPs last month when the bill paving the way for the changes was published.

Accountability

Managers working for primary care trusts (PCTs) are currently responsible for planning and buying local services, but GPs working together in consortia would take on responsibility for this from 2013 under the reforms.

Pilots are already starting and once the process is complete, two tiers of management – PCTs and the 10 regional health authorities – will be scrapped.

The letter, which was also signed by the Alzheimer’s Society and mental health charity Rethink, questioned the powers and resources being given to the local Health Watch bodies, which will be set up across the country to represent patient interests in the new NHS structure.

“If we don’t do this well and thoroughly we could end up with patient and public involvement weaker than it is and no-one really wants that” 

End Quote Andrew Chidgey Alzheimer’s Society

It states: “If the new NHS is to properly serve patients and the public, this democratic deficit must be addressed and the voices of patients heard by those making crucial decisions affecting their lives.”

The letter also said the proposed scrutiny arrangements – local authorities are being put in charge of monitoring GP consortia – meant the lines of accountability were “too weak”.

Andrew Chidgey, of the Alzheimer’s Society, told the BBC the issues needed addressing now that the bill was working its way through Parliament.

“If we don’t do this well and thoroughly we could end up with patient and public involvement weaker than it is and no-one really wants that.”

The eight signatories to the letter are the Alzheimer’s Society, Asthma UK, Breakthrough Breast Cancer, Diabetes UK, National Voices, Rethink, the British Hearth Foundation and the Stroke Association.

Their criticisms represent a new area of concern about the changes.

A Department of Health spokeswoman said the letter raised “constructive” points, adding: “We will work together to ensure the bill, which is in its early stages, delivers the reality of improved patient involvement.”

However, she disputed the suggestion that patient power could be diluted, citing the ability of Health Watch to trigger official NHS inspections.

Last month, the House of Commons’ health committee said the plans had taken the NHS by surprise and could threaten its ability to make savings.

Meanwhile, in another letter, also published in the Times, six health unions, including the British Medical Association, warned of their “extreme concerns” that greater commercial competition in the NHS would end up undermining care.

The NHS Confederation, which represents managers, has also suggested hospitals may have to close.

Date of issue: Thursday 27^th January 2011

Thursday 27^th January 2011 saw the unveiling of the newly refurbished central health unit at Wandsworth Prison. The unit has been completely overhauled, with what was formerly considered a grey, soulless, drab and depressing environment replaced by a vibrant and comfortable setting which has helped to encourage inmates to access health education, support and treatment. Services at the prison are provided by a St George’s Healthcare NHS Trust multi-disciplinary nurse-led team that also includes GPs, dentists, sexual health specialists and pharmacists.

The overhaul of the health unit is part of the King’s Fund Enhancing the Healing Environment project, a grants and development programme run by the King’s Fund in partnership with Her Majesty’s Prison Service and Offender Health (a partnership between the Ministry of Justice and the Department of Health).

A team of healthcare staff at Wandsworth Prison successfully won a £30,000 grant from the project, with NHS Wandsworth and the National Treatment Agency for Substance Misuse (NTA) contributing a further £10,000 each. The nurse-led team behind the overhaul included service users, estates staff, arts co-ordinators and Julie Thompson, HMP Wandsworth Residential Governor.

The money has been spent on improving the reception area and treatment rooms, converting the healthcare areas of the prison so that they are welcoming and relaxing.

Bernadette McGreevy, Sister at Wandsworth Prison, said:

“There is a wealth of research evidence to show the positive impact that the environment can have on health so we were really keen to take advantage of the King’s Fund expertise in this area, and we are already seeing the benefits of this programme. There has been a really noticeable effect on patients’ self esteem as they feel like they are being treated in an environment that they would be happy to be treated in if they were in the community. We are also starting to see improved health outcomes and more inmates willing to access health education and support as well as treatment”

Jim O’Gorman, Head of Healthcare at Wandsworth Prison, said:

“It is important to recognise that prisoners are normal people like you and I. Their needs are the same and they want to be treated with dignity and respect, the basic things that we would demand, and being treated in areas like, that are comparable to facilities in the community, can be a catalyst for change. It was important that staff worked with the inmates in every aspect of designing the new environment, increasing engagement with our service users and helping but it has helped us to establish new ways of consulting them.”

Emma Leegood, Lead Nurse at Wandsworth Prison, said:

“Prisoners access health services 77 more times a year than an average person in the community, and we have a responsibility to make sure that those services are provided in the best possible environment with the best possible facilities.”

Sarah Waller, King’s Fund programme director for the Enhancing the Healing Environment, said:

“For many prisoners real opportunities exist to access healthcare services, sometimes for the first time in many years, whilst they are in prison. It is therefore very important that healthcare and health promotion activities are delivered in an environment that encourages people to attend clinics and supports therapeutic interventions. The project at Wandsworth has been planned in consultation with prisoners and staff and has greatly improved facilities for the delivery of healthcare in the prison. We hope it will encourage more prisoners to access and benefit from the range of healthcare services available.” 

-Ends-

Notes to editors

Wandsworth Prison is the largest prison in the UK with a capacity of 1,665 and an annual turnover of 5,000 inmates a year.

For more information, please contact the communications team at St George’s Healthcare NHS Trust on 020 8725 5151 or email communications@stgeorges.nhs.uk. Outside working hours, please page the team by calling 0844 822 2888, leaving a short message and contact details for pager SG548. High res photos available on request.

Wandsworth Councillors, at the last meeting of the Adult Care and Health Overview and Scrutiny Committee, agreed to set up a Shadow Health and Wellbeing Board.  This will have representation from local voluntary agencies as well as from the primary care trust and the local GPs and Councillors on a broad partnership body and there will also be a more limited Executive Group which will have representatives from local GPs, the Council and the PCT.  Wandsworth LINk has been given a seat on both the partnership and the Executive Group.  The first meeting will consider the updated Joint Strategic Needs Assessment.

A major item on the agenda of the OSC was the approval of the closure of Hartfield House, a residential respite centre for Adults with a Learning Disability.  Councillor Clare Clay, as the Carers’ Champion gained an agreement from the Committee that Hartfield House would not close until its replacement services were in place, that these services would have sufficient capacity for friendship groups to be able to have their respite stays together and that the total respite resource would be large enough to accommodate emergency placements which had been steady at around five people at any time without impacting on the respite service.

Changes in the arrangements for the mental Health Resource Centres were also approved.  These signalled a move away from building-based services towards a more one-to-one support service to help users who had suffered from mental illness to return to normal life and employment.  The LINk representative made the point that the availability of social outlets for people recovering from metal illness was still an important part of the recovery process for many and that this need should still be addressed.

For the full details of the reports discussed at the meeting go to

http://www.wandsworth.gov.uk/moderngov/ieListDocuments.aspx?CId=498&MId=3506&Ver=4

roger

The National Media is plagued with stories of vital charities having their budgets cut by Local Authorities, and Wandsworth is no different. The Council, in what many will see as a misguided attempt to meet budget cuts, have just slashed ¼ million pounds from the funding for some of the Boroughs most valued Voluntary Sector Organisations.

The cuts, which will come into place in April, will see Age Concern losing £83,000 from their budget, Wandsworth Community Transport standing to lose £20,000 and the Care’s Centre will be without £5,000, if proposals go ahead.

The implications of cutting the vital services these organisations provide has far reaching implications as Jenny Weinstein, the Chair of Wandsworth LINk, which is a voice for care users, carers and patients has pointed out:

‘These are very substantial cuts for the Voluntary Care Sector and they will directly impact on some of the most vulnerable people living in Wandsworth. In LINk’s view cutting voluntary sector budgets that provide vital preventive services is short sighted.  It will not only hurt the most needy people in the Borough, but, in the longer term, it will put more pressure on expensive statutory social care and NHS services which are also seeing their budgets slashed… `

Central Government says it wants charities to start providing more services as part of it’s ‘ new ‘Big Society,’ and its right to believe that local and voluntary organisations are often more effective than the State in tackling social problems. But, if cuts like this continue, they will destroy the very organisations which could and should, form the foundations of this new ‘Big Society’.

Every GP practice in England needs to save £2,500 a day over the next three years to hit NHS efficiency targets, according to a senior DoH adviser.

By Nick Bostock, 26 January 2011

In an exclusive interview with GP, national clinical commissioning network lead for England Dr James Kingsland warned that the government’s NHS reform plans would fail without a ‘cultural shift’ among GPs.

To save £5 billion a year, the NHS needs to save around 40p per patient every working day of the year, Dr Kingsland said.

‘For a practice of 6,000 patients, that’s about £2,500 per day you need to save by doing something remarkable in your prescribing, in urgent care, in long-term condition management,’ he said.

GPs need to apply the management skills they use to run their own practice finances to their use of wider NHS resources, Dr Kingsland said.

‘That’s where it starts – within consultations, recognising that you align your clinical decision-making with the resources that are deployed.

‘If we don’t get that right in every consultation, in every general practice in England, the reforms can’t work.

‘Every GP needs to recognise that when you make a referral that is a commissioning act.’

Pathfinder bid for the GP Commissioning group.

 Wandsworth LINk supports the ‘pathfinder’ bid by local GPs and the Wandsworth PCT. If successful, this would enable the new NHS reforms in the NHS White paper to be trialled in Wandsworth so that GPs can take the lead in Commisioning health services.

 Jeremy Ambache asked, on behalf of Wandsworth LINk, if the concept of patient representation and a strong ‘patient voice’ can be included within the bid. Also, it was suggested that this will include full patient participation in all the Commissioning groups of the new emerging organization.