NHS Services

report by Roger Appleton

The financial challenges facing St George’s Hospital were set out clearly in a report considered by the Council’s Adult Care and health Overview and Scrutiny Committee recently.  Although the trust achieved financial balance in 2010/11, it did not achieve its savings target and this failure has contributed to its decisions to delay its application for Foundation trust status.  In the current year, the trust faces a double problem of anticipated reduced demand for its services amounting to some £15 million pounds in income, alongside the challenge of achieving its own savings target of a further £38 million.

Under questioning from the LINk representative, the Trust confirmed that it had faced some self-inflicted problems during the past year with reduced clinical activity because of Consultant unavailability but promised that this problem would not recur during the current year.

Much of the anticipated reduced demand in the current year relates to treatment for non-Wandsworth patients but the Trust still could face a problem of having to re-expand its services in an unplanned way during the year if the planned demand reductions do not take place and more patients are admitted than were expected.

As well as these financial challenges, it appears that the pressure on the A&E services at St George’s remain and it is not clear that the alternative walk-in arrangements put in place by NHS Wandsworth have had a significant impact of attendances at A&E.  The LINk will take this up with NHS Wandsworth at its next meeting.

Wandsworth  Council has now approved a full response to the Wandsworth LINk Hospital Discharge Report.  The response is a joint one on behalf of all the local health and social care agencies.  Almost all of the LINK’s proposals in the original report have been agreed and plans put in place to ensure the changes take place.  The exception is the issue of who should coordinate discharges which take place at weekends.  The LINk will continue to encourage local hospitals to discharge patients in a planned way at weekends if the patient is ready to go home and any community service needed is in place.  The full Council response is attached.

Council Response to LINk Hospital Discharge Report

Wandsworth LINk has been hearing reports about long waiting times at St George’s, one lady arrived at 9.30 and was number 80 in the queue and by lunchtime she was  number 47.

Have you recently attended a St George’s clinic? And if so did you have a similar experience?  How long did you have to wait? what was the waiting are a like and how did you find the staff attitude?

Please let LINk know so we can get your experiences heard by the people at St George’s who make the decisions. The LINk Executive is meeting with David Astley St George’s CEO and Peter Jenkinson Trust Secretary on Thursday 24 th March

Roughly two thirds of England’s population is now covered by ‘pathfinder’ GP consortia following the acceptance of a further 31 groups onto the scheme.

Health minister Andrew Lansley said the varying shapes and sizes of the groups piloting GP commissioning showed there had been a ‘truly bottom-up response’ to his reforms.   A number of consortia from the second wave have now merged, meaning the total number of pathfinder consortia is now 177, according to the DoH.

But  Dr James Kingsland, the DoH’s national clinical network lead, admitted little information had been fed back about the programme so far.

Pathfinders by region

Pathfinders by wave

East of England

Cam Health Integrated Care       

Geographical area:  Cambridge

Number of practices: 8
Population size: 72,564

East and North Herts GPCC

Geographical area:  East and North Hertfordshire

Number of practices: 50

Population size: 463,692

Luton GPCC

Geographical area:  Luton

Number of practices: 32

Population size: 210,447

West Norfolk PBC Consortium 

Geographical area:  West Norfolk

Number of practices: 22

Population size: 156,021

South West Essex Federation of GPs

Geographical area:  Thurrock and Basildon

Number of practices:  34

Population size: 179,170

South Essex Managed Care Consortium LLP

Geographical area:  Wickford and Basildon

Number of practices: 10

Population size: 51,268   

East Midlands

North Derbyshire

Geographical area:  North Derbyshire

Number of practices: 31
Population size: 230,000

Crescent

Geographical area:  South East Leicestershire & Rutland

Number of practices: 33
Population size: 311,000

North and West Leicestershire

Geographical area:  North and West Leicestershire   

Number of practices: 49
Population size: 360,000

Nottingham West Consortium

Geographical area:  12

Number of practices: Broxtowe locality, which encompasses Beeston, Chilwell, Bramcote, Stapleford, Kimberley and Eastwood
Population size: 93,000

Newark and Sherwood Health

Geographical area:  Market town of Newark and surrounding villages extending to Sherwood and A1 border with Lincolnshire

Number of practices: 14
Population size: 115,231

Erewash

Geographical area:  13

Number of practices: The towns of Ilkeston and Long Eaton including surrounding villages
Population size: 102,000

Corby           

Geographical area:  Corby

Number of practices: 6
Population size: 67,124   

Skegness and Coastal    

Geographical area:  Skegness and Coastal

Number of practices: 7
Population size: 72,000

London    

The Federation      

Geographical area:  Sutton & Merton

Number of practices: 32

Population size: 262,557

Wandsworth           

Geographical area: Wandsworth

Number of practices: 46

Population size: 370,366

Lambeth Commissioning Collaborative         

Geographical area:  Lambeth     

Number of practices: 52

Population size: 377,624

Richmond & Twickenham GP Consortium

Geographical area: Richmond & Twickenham

Number of practices: 32

Population size: 197,524

United Medical Consortium (UMC)

Geographical area:  Barking & Dagenham (part of)

Number of practices: 15

Population size: 71,098   

Havering First Consortium         

Geographical area:  Havering (part of)

Number of practices: 27  

Population size: 108,994 

Havering Premier

Geographical area:  Havering (part of)

Number of practices: 22

Population size: 143,416

Camden Commissioning Consortium

Geographical area:  Camden

Number of practices: 39  

Population size: 224,450

Hillingdon

Geographical area:  Hillingdon

Number of practices: 49

Population size: 273,256

Barking & Dagenham Quality Healthcare Commissioning Consortia (BDQHCCC)   

Geographical area:  Barking & Dagenham (part of)

Number of practices: 26

Population size: 123,000 

Newham Commissioning Group (NCG)

Geographical area:  Newham (part of)

Number of practices: 11

Population size: 68,199

North West

Lancaster Morecambe Carnforth Garstang Practice Based Commissioning Consortium   

Geographical area:  North Lancashire

Number of practices: 13  

Population size: 160,000

Wylde Commissioning Consortia

Geographical area:  North Lancashire

Number of practices: 21  

Population size: 157,000

South Cheshire Commissioning Consortia (SCCC)           

Geographical area:  South Cheshire

Number of practices: 16  

Population size: 164,000

Warrington  

Geographical area:  Warrington

Number of practices: 28  

Population size: 208,000

Ashton Wigan and Leigh with 5 consortia: (62 Practices)

ALPF Health Commissioning Consortium     

Geographical area:  Ashton Leigh and Wigan

Number of practices:

Population size: 90,832   

TABA Consortium

Geographical area:  Ashton Leigh and Wigan

Number of practices:

Population size: 45,127   

North Wigan Consortium                        

Geographical area:  Ashton Leigh and Wigan

Number of practices:

Population size: 54,946   

Wigan Commissioning Consortium

Geographical area:  Ashton Leigh and Wigan

Number of practices:

Population size: 75,998

United League Commissioning                        

Geographical area:  Ashton Leigh and Wigan

Number of practices:

Population size: 106,837 

South West

Swindon NHS Consortium: The Transitional Leadership Group

Geographical area:  Swindon

Number of practices: 30

Population size:  250,000

West Cornwall Commissioning Consortium

Geographical area:  West Cornwall

Number of practices:  23

Population size: 160,457 

Newquay Commissioning Consortium

Geographical area: Newquay, Cornwall

Number of practices: 3    

Population size: 28,000   

West Midlands

Nuneaton & Bedworth     

Geographical area: Nuneaton and Bedworth

Number of practices: 11

Population size: 40,000   

South Warwickshire Consortium

Geographical area:  South Warwickshire including Leamington Spa, Warwick and Stratford-upon-Avon

Number of practices: 36

Population size: 270,000

HealthWorks Commissioning Consortium

Geographical area: Birmingham and Sandwell

Number of practices: 13

Population size: 124,340

Intelligent Commissioning Federation

Geographical area: Heart of Birmingham (Ladywood, Aston and Sparkbrook areas of

inner city Birmingham)      

Number of practices: 29

Population size: 134,000

Yorkshire and the Humber

North Kirklees Health Alliance (NKHA)

Geographical area:  Kirklees

Number of practices: 31  

Population size: 183,000

Greater Huddersfield Commissioning Consortium (GHCC)

Geographical area:  Huddersfield

Number of practices: 41  

Population size: 237,000 

Rotherham Commissioning Executive                                               

Geographical area:  Rotherham

Number of practices: 41  

Population size: 255,500 

Closure of wards and loss of staff for a hospital already struggling to meet patient needs.

Wandsworth LINk was horrified to hear  that St. George’s hospital is due to close 3 wards and lose 500 staff, in a bid to make £55 million of savings in the next financial year. This decision was made without any prior consultation with the community or patients’ groups and at a time when the hospital’s services are already stretched to breaking point.

St. George’s has been failing to meet its targets to admit patients within 18 weeks of referral during the first months of 2010/11. They have also failed to meet their target of a waiting time of no more than 62 days for urgent cancer referrals. At LINk’s last meeting with the Trust, held on 12^th January, we were informed that the `Winter pressures` – increased numbers of very unwell patients – meant that A&E waiting time targets could not be met and there was overcrowding on the Wards and problems with maintaining single sex accommodation.

The government made a commitment that the current financial restraints would not apply to front line NHS services. Wandsworth LINk, is concerned that the loss of so many jobs will have “serious consequences” not only for the local community and London, but for patients across the south-east. LINk will be writing to St. George’s NHS Trust to seek the reasons for these drastic cuts and to challenge them on their failure to consult.

Note to editors:  The failure to meet targets was reported to Wandsworth Council’s Overview and Scrutiny Committee which met on Tuesday 15^th February Paper No 11-163

The Wandsworth LINk is a statutory body, funded by government, to monitor and bring about improvements in health and social care locally by involving local residents, patients and service users.  The LINk meets regularly with representatives of the Trust in order to ensure an exchange of information between the hospital and the community

Jenny Weinstein Chair Wandsworth LINk

C/o Wandsworth Care Alliance  3^rd Floor

Trident Business Centre

89, Bickersteth Rd

SW17 9SH

Tel: 0208 516  7767

12:11pm Thursday 17th February 2011

• By Ian Mason »

Bosses at St George’s Hospital have refused to confirm how many jobs will be axed as they attempt to cut costs by £55m this year.

Unison members claim 500 posts, including frontline doctors and nurses, are under threat along with wards, the number of beds available and a cap on the number of births in its midwifery unit.

The sweeping changes at the Tooting hospital are being blamed on the Government’s £20bn NHS cuts programme.

A spokeswoman for St George’s Healthcare NHS Trust, said: “St George’s Healthcare is not immune from the financial challenges currently facing the wider NHS and we have been open with staff and Unions about the need to achieve £55m savings during 2011/12.

“The trust is a major trauma centre, hyper-acute stroke unit and centre of excellence for cancer, cardiac and women’s and children’s services and we are committed to providing quality care to our patients.

“We cannot speculate at this stage on the exact number, or nature, of posts that will need to go but we aim to protect frontline staff and hope to avoid the need for compulsory redundancies.

“Our main focus is to reduce our temporary staffing bill, which is currently £30m per year, and we are also reviewing non-clinical services.”

The spokeswoman added no further comment would be made at this time.

Mr Burns was repeatedly questioned on the section of legislation in the Health Bill that aims to protect the NHS from political interference

A lengthy list of amendments was discussed, including changes that would delay the abolition of PCTs and ensure the NHS Board has a role in managing the NHS as a whole.

During a noisy exchange with the Health and Social Care Bill committee, health minister Simon Burns was repeatedly pressed on the section of legislation that aims to protect the NHS from political interference.

Labour MPs warned that in its current form, the Health Bill absolves the secretary of state responsibility for the provision of NHS services. But Mr Burns said accountability was already ‘integral’ to the Bill. He was eventually warned by the committee chairman to ‘stop being so provocative deliberately’ as he fended off criticism.

None of the amendments debated was passed. The committee will continue to consider amendments to the Bill until the end of March. After the report stage, MPs will vote on the Bill at its third reading in Parliament, before moving to the House of Lords.

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.”