What the NHS 10 year plan means for Leeds – Dr John Puntis

Stephen Hammond MP (Minister of State for Health) writing recently from his Wimbledon constituency to the good people of Leeds

https://www.pressreader.com/uk/yorkshire-post/20190112/282041918287291)

claimed: ‘The NHS Long Term Plan’ “will preserve the nation’s most prized asset”.

The ‘plan’ aims to keep people well and identify illness earlier, and is an amazing uncosted wish list of wonderful things that could be done if only the government could be persuaded to give the NHS enough money and staff:

  • community health crisis response services to swing into action within two hours of referral? – no problem sir;
  • home-based and wearable monitoring equipment to predict and prevent events that would otherwise have led to a hospital admission? – of course madam;
  • assessment and treatment of frail elderly patients by multidisciplinary teams delivering comprehensive geriatric assessment in A&E and acute receiving units? – definitely, every hospital medical and surgical department will have them.
  • One in three women experience urinary incontinence after childbirth – fine, we will have multidisciplinary pelvic health clinics across England, etc., etc.

The current reality, however, is that/ two thirds of acute Trusts are in the red, compared with 5% in 2010. Cancer waiting times are the worst on record, huge problems exist in A&E, and the average wait for a GP appointment is up 30% to two weeks.

This is all because of chronic underfunding. Until eight years ago, the NHS budget annual increase was 4% to meet rising demand, before being savagely cut to 1%. The Office for Public Responsibility estimates a 4.3% increase in spending is needed. The amount of extra funding which is supposed to pay for implementation of the ‘plan’ is a meagre £20.5 bn. It does not make up for the accumulated financial deficit, and increases the overall budget by only 3.4% – and not until 2023/4!

The ‘plan’ also sets out intentions to implement a top down reorganisation, with 44 ‘Integrated Care Systems’, lacking in public accountability (i.e. everything about you decided without you) and unprotected from takeover by the private sector.

Forced mergers of GP practices will cover populations of 30-50,000, causing accessibility problems for many. Whereas most of the 60+ uncosted commitments in the ‘plan’ to improve services would be very welcome, they are completely unrealistic given the funding offered.

An obsession with non-evidence based digital solutions, lack of a workforce plan to tackle the current 100,000 vacancies, absence of information on how much capital will be available for new projects, and ignoring the crisis in social care (“when agreeing the NHS funding settlement the government therefore committed to ensure that adult social care funding is such that it does not impose an additional pressure on the NHS over the coming five years” – so that’s alright then!) all spell further misery for patients. £20.5 bn may help keep the lights on, but this ‘plan’ is in reality a recipe not for the preservation but for the destruction of our most prized asset.

The lack of detail on manpower despite many trumpeted innovations that clearly would need more staff is astonishing. Perhaps they see unpaid volunteers as the solution, since £2.3 million is being committed to the Helpforce programme?

Helpforce is a charity that aims to boost the 74 000 volunteers in the NHS to “millions”. It was set up by Sir Thomas Hughes-Hallett, educated at Eton and Oxford before becoming a barrister and investment banker (giving him his soubriquet – ‘Thomas Huge-Wallet ‘). Apparently Sir Tom can often be seen waiting for a GP appointment or queuing in A&E. Billed by the Daly Mail as “one of the UK’s top health experts” (surely some mishtake? – Ed.), his insightful pronouncements on the NHS include: “to keep it on the road it should – like a garage – charge for extras”.

‘Leeds Keep Our NHS Public’ invites the people of Yorkshire to join a demonstration demanding proper NHS funding at 11.30 on March 30th 2019, outside the art gallery in Leeds.

Find the NHS Plan at: http://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/, write to NHS England, PO Box 16738 | Redditch | B97 9PT, or email at
england.contactus@nhs.net to request a paper copy.

Briefing for Rachel Reeves MP

pdf version

Young people’s mental health is a ‘worsening crisis’. 

Action is needed writes Mary O’Hara in The Guardian 31/7/2018 ‘Whatever the language deployed to describe the scale of mental health challenges facing Britain’s young people, it has to be addressed immediately.’

NHS figures published last month revealed that almost 400,000 children and young people aged 18 and under are in contact with the health service for mental health problems. According to the figures, the number of “active referrals” by GPs in April was a third higher than the same period two years prior. Those seeking help for conditions such as depression and anxiety showed a sharp increase….

Demand for help is up, but services are diminishing…. The revelation in November 2017 that two-thirds of children referred for specialist mental healthcare are not receiving treatment ………………………………………………………………………………………………………….

Current situation in Leeds:  Children and Adolescent Mental Health (CAMHS) are provided by the Leeds Community Healthcare NHS Trust says the CAMHS website. CAMHS is a specialist mental health service for children and young people. Staff are highly trained in a range of different assessment techniques and evidence-based therapies. Staff work closely in teams so that they can offer services tailored to the needs of children, young people and families.

For a very small number of young people, highly intensive assessment and treatment packages are needed. Leeds CAMHS has both intensive outreach and inpatient services. Little Woodhouse Hall is the adolescent inpatient unit in Leeds. It is for young people up to the age of 18. There are 8 residential places there but there is are no Psychiatric Intensive Care Unit (PICU) in Leeds. Some years ago, 16 and 17-year-olds even 15-year-olds with challenging behaviours used to be put on adult mental health in-patient wards but we campaigned against that.

More recently young people are sent to Out of Area Treatments (OATs), mainly to the Cheadle Royal Priory, a private hospital in Cheadle, Greater Manchester or to an NHS adolescent unit at Middlesbrough if they need to be in a PICU, both of which are about 50 miles away from Leeds. This distance must put great strain and cost on families, as well as create difficulties in continuity of treatment and care planning.

Plans for new £13m CAMHS unit to be shared with public

Leeds Community Healthcare NHS Trust is inviting the public to a drop-in information session where proposals for a new inpatient Child and Adolescent Mental Health Service (CAMHS) unit will be unveiled.

The proposed new unit will provide crucial specialist support to young people with mental health problems on the St Mary’s Hospital site in Armley.

The drop-in event is to be held between 3.30pm and 7pm on Thursday 13 September in the Class Room, Holly House, St Mary’s Hospital, Green Hill Rd, Leeds, LS12 3QE. Free parking, including disabled parking, is available directly outside the Holly House building.

It is an opportunity for people to view and comment on plans prior to submission of a planning application. Service, construction and design representatives will be on hand to answer any questions.

Earlier this month it was confirmed that Interserve Construction Limited had been appointed as the Trust’s construction partner for development of the prospective £13m unit – which got the go ahead following a successful bid for NHS funding led by Leeds Community Healthcare.

Thea Stein, Leeds Community Healthcare NHS Trust Chief Executive, said: “It is very important to the Trust that the voice of young people, families, staff and the local community has a strong presence in the development of the new unit and we will continue to work together to make sure we get it right.”

If you can’t attend the event but would like further information, or if you have any special requirements, please contact Samantha Hirst, Communications and Engagement Manager on 0113 843 1204 or email Samantha.Hirst2@nhs.net

You can also keep up-to-date with the latest on the project by visiting: https://www.leedscommunityhealthcare.nhs.uk/

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What is proposed. This is fantastic news for the development of children’s and young people’s mental health services in West Yorkshire, at last. The new residential unit, proposed for the Leeds and York Partnership Trust’s site, but run by the Leeds Community Healthcare Trust and funded by £13 million from NHS England, will have 18 residential places and 4 in a PICU, totaling 22 for West Yorkshire. It is to be built on part of the St Mary’s Hospital site on Greenhill Road in Armley which has mainly been cleared of services in recent years. It is likely that the old hospital in the centre of the site which is a listed building will be sold for apartments, perhaps for hospital staff. Unfortunately, although space has been provided there is no funding for a crisis assessment unit for children and young people.

I attended the public drop-in for the new in-patient CAMHS unit and met the architects and various professionals and was impressed by the building, but I had some concerns about it being institutional, overlooking the cemetery, and isolated from the local community. Young patients had been actively involved with planning the interior and facilities of the building.

Opportunities for the local community

  1. This must be a good opportunity for employment in the development of jobs in both building and running the new unit. How can we promote this to ensure local people are trained to take up work?
  2. Young people and their families, and workers, are likely to travel to the unit from across the north of England, with consequent opportunities for the improvement of transport to St Mary’s Hospital. What financial support will be available to carers for traveling?
  3. The multinational out-sourcing company, Interserve, has been chosen to both build the unit and provide the staff to run it. I am concerned that Interserve appears to have financial difficulties, reminiscent of Carillion.

Interserve shares dive on rising concerns over future

Simon Jack, Business editor @BBCSimonJack 13/11/2018

“A former big shareholder in construction and facilities management company Interserve has told the BBC he is doubtful the firm can survive. Shares hit a 30-year low on Monday and are down a further 15% on Tuesday. “We could be looking at another Carillion. I don’t see how they can raise the £500m or so needed,” he said. However, two different sources close to the company denied the firm was close to bankruptcy and said it was set to ask new investors for more capital. Interserve, a major UK government contractor, sells services, including probation, cleaning and healthcare, and is involved in construction projects. The company is making more than £100m in cash and although the construction business has got a few problems, the core facilities management business is doing well, according to people who attended a recent management meeting. One source added that the sharp falls in Interserve’s share price reflected the growing realisation that existing investors will get a worse deal than those prepared to commit fresh cash.”

  1. The young people who are admitted to the unit will be some of the most distressed; experiencing for example, initial onset of schizophrenia, severe eating disorders and be at great risk of suicide and self-harm. I propose a local community centre, preferably on the hospital site which does not have a workers’ café anymore.  HMP Leeds has the Jigsaw voluntary organization on-site to welcome families at a distressing time, with activities for adults and children and food and drink. This might be a useful model.

14/11/2018

Recent Leeds Hospital report: outsourcing home care services in Leeds

Report: https://leedshospitalalert.files.wordpress.com/2018/12/HAoutsourcingcasestudy

Summary:

Outsourcing of public services has become an increasingly controversial issue, with the collapse and potential collapse of key outsourced services, and more services being taken back in-house in response to the failures of outsourcing.

This Report, by the campaigning group Leeds Hospital Alert, looks at the outsourcing of the home care service by Leeds City Council over the period 2014 – 2018.

Key points are:

The problems identified with the outsourced service in 2014, leading to Leeds City Council’s decision to adopt the Unison Ethical Care Charter in 2015, committing to higher standards of service by the outsourced providers.

The flaws in Leeds City Council’s 2015 – 2016 Review and closure of the remaining in-house service, including failure to consider different service options, unexplained costings, and ignoring the views of service users, carers, and staff.

The disadvantages of the new outsourced service, including potential financial collapse of service providers, great service complexity, problems with service quality, breaches of the Ethical Care Charter, and lack of strategic knowledge of the service.

Based on all the above information, the clear case for taking the service back in-house. This would be in line with current national trends and the decision by the Labour Party to support the taking back of services in-house.

Leeds Hospital Alert responds to LGI Consultation

New Leeds Hospital

Several members of Leeds Hospital Alert attended the drop-in sessions to see the plans for the new hospital on the LGI site. These are our concerns: –
The cost —- there is still a huge gap between the money promised/secured and the amount needed.

Wonder if there is sufficient expertise available to ensure that LTHT doesn’t suffer the same costs/penalties of PFI.

Will there be sufficient safeguards to ensure that obtaining money from private sources doesn’t mean further privatisation within the Trust? Far too much NHS money is going into private hands instead of patient and staff care.

The size of the buildings and the site itself presents problems for many patients especially those arriving by public transport or have problems walking or are simply not well. Are you negotiating with the transport authority or considering the use of a hopper bus?

There can be serious problems too for wheelchair users especially when they are not allowed to bring their carer with them in the ambulance. Will there be an efficient porter service with wheelchairs at the point of access.

Can we assume that everywhere will have wheelchair and disabled access plus help for those hard of hearing?
Assume you will negotiate with and accept advice from the Department of Disabled Studies at the University

Members with nursing experience question the use of a day ward for children needing blood transfusions or chemo. There can be 7 or 8 at any one time on the ward. To be told they could be transferred to another ward isn’t considered to be satisfactory. Certainly not the best treatment of young people.

We were assured that there would be no reduction in beds but this fails to take into account a rising population, referrals from another hospital and whether these have been taken into account in modelling bed numbers. Rising demand must necessitate more beds not just maintaining the current number.

Bringing together all maternity services on to one site creates a very large unit. Is this best practice? We would recommend a public consultation a.s.a.p.

Very concerned about the proposed use of apps. Have you considered just how many people will not have an app? Not everyone has an i-phone or indeed a computer. Has any assessment been undertaken to discover just how many mistakes already happen with the computer services at LTHT? How many patients are blamed for faults in the system?

We can certainly give you some examples. What would you do in circumstances such as 02 closing down completely for 36 (?) hours? How would you contact all the patients who use that provider? What fall back procedures will you have in place?

Substantial buildings are to be put up for sale. Is there sufficient expertise in the Trust to organise these sales so that a fair price is paid with water tight safeguards? In the past this has been questionable.

What happens next if you don’t succeed in raising sufficient funding?

Will just part of the plan be implemented?

Leeds Hospital Alert minutes

LEEDS Hospital Alert.

Minutes Tuesday November 13

LGI proposed development: there is a video of the new hospital in the LTHT website. Several members attended the first of two drop-in sessions at the Carriageworks. Pertinent questions were asked with at least one puzzling result. J and P were told there would be no PFI money whilst M and J were told there would be PFI for the building but not for the running of the services in the building. M concerned about the plans for transference of children from the day ward when having blood transfusions or chemo. Concern also about the suggested use of a smart phone app for communication with and tracking of a patient. Also, the issue of lack of public transport to the site. We support J absolutely in his concerns and will help where and when we can.

Beckett Wing: Wards 30 & 31 care staff being run by a private company; medical services by the NHS. A similar set up to Brownberrie Ward at Wharfedale. S concerned that whilst M was in the ward there was insufficient caring attention for patients. A letter to the Chief Nurse would be appropriate.

NHS Computer Access: contact made with the CCG. See the attachment for details.
Agreed we should invite Phil Corrigan to join us one evening before she leaves.

Mental Health: S attended the patient consultation meeting. Changes are being made.

Older people – retain the Care Hoes team
Community Health teams – 24 per team
Memory Support team to be strengthened.
Older People’s Service to operate until 8pm, then the crisis team at Becklin.
Intensive Home Treatment – 80 staff
Community Health teams – 3 teams of 45 for working age patients.
Extensive training plans to be put in place
Monthly meetings with the CCG
Jargon busting sheet is now available.

New Children’s Unit at St Mary’s. Sylvia to meet with Rachel Reeves to express her concerns.

Home Care: still no meaningful response from Councillors though they have said that to take services back in house as they have done in Preston would cost too much. So how do they propose to improve Home Care. Current services are inadequate and failing. Councillor Charlewood will not accept our Home Care Report. Maybe need to contact Care Quality Commission?

Diabetes: now costing 10% of NHS Budget. Patients being blamed rather than there being education and help on how to avoid becoming diabetic.

J will be attending the Health Campaign Together Conference in Birmingham.

Next meetings: Thursday December 6; Tuesday January 15

LGI Consultation notes from Dr John Puntis

Please see this updated document:

BtLW_Project_Up-date_(02.08.18)-XpiawFbxQM7Z1NJst8yDnUPslLdiy_Ib-9aG6GdLybErh1xNJG9a06nr2ymXmdyGFac_tH6Z0Fhc_3tdRPBeBg==

Despite paediatric colleagues being certain there would be fewer beds, at the consultation today I was told by two corporate people from Trust that bed numbers overall were increasing. There may be an issue about how many in patient and how many day case?

They have not yet finished the outline business case to take first to NHSE then the DH, but probably will have done so early next year.

I wonder how they will ensure NHS gets good value for money when they sell off land/buildings when there is little expertise in this area. Interestingly, Brotherton, Old Med School and Gilbert Scott are all in the Naylor inventory of “surplus assets”, although the trust has previously said they had an estates strategy pre-Naylor and have not modified it post Naylor.

Given all the emphasis on community care, should any surplus estate on LGI site be transferred to community?

Does council have any views/leverage here?

999 NHS Judicial Review in London next week 20-21st November

999 now have confirmation that their judicial review will be heard at the Royal Courts of Justice in the Strand, London on 20-21st November.

Please support 2 rallies, one from 8-9.30 am on Tuesday 20th Nov and one around 4.30 on Wed 21st when they expect the Appeal to have finished.

Leeds rally at initial hearing https://bit.ly/2JKoauQ

More: https://www.crowdjustice.com/case/justice4nhs-stage5-courtofappeal/

Hopefully London activists will turn out in good numbers but if you have any reason or excuse to be in London or fancy a trip, they will be delighted to see you.

Good luck, thank you and loads of solidarity to all the feisty 999 crew!