Leeds Hospital Alert minutes March 2019

Care Homes warning in the Guardian if Interserve go into administration on Friday

Outsourcing: – full discussion postponed until next time but the report from the New Economic Foundation has been e -mailed to everyone. Also, Jenny Shepherd and 999 NHS are keeping up the pressure.  The sheer volume of contracts with Interserve as, it was with Carillion; highlights the dangers of current policy. (update cf. the Guardian Saturday March 16)

NHS 10 Year Plan: – many good things in the plan but a glaring omission is services for children. The plan has scant regard for how it will relate to schools.  Mental health support teams will work in schools but will be managed by clinical commissioning staff.  The conclusion of the first Children’s Commissioner for England is that we cannot continue to fail so many children.  Beatrice to contact Lisa Mulherin.

No deal Brexit:  letter sent to Theresa May signed by the great and the good of the NHS.

Alex Sobel is continuing to ask questions in Parliament about insulin supplies.

Digital services in the NHS: – patients will have the right to online and video consultations by April 2021. For further information see Specific Improvements – primary care on line. 8 specific improvements in total. An app a day will keep the doctor away. 25 % of doctor’s appointments will be via app by July 2019.  The accent is to be on DIY healthcare.

Already experimenting with robot doctors!!

IN addition, by 2023 – 2024 an army of social prescribers will be handling approximately 900,000 patient appointments a year.

NHS agreement to extending the Babylon service outside of London to Birmingham is cause for concern.  Believed that Leeds will be its next target.  Richard Vautrey chair of the BMA’s GP committee said ‘ We are incredibly disappointed with this decision, which is not only premature but flies in the face of place based care delivered by practices embedded in local communities, which the recent changes in the GP contract are committed to deliver’   Are patients going to be warned that by signing up to Babylon they will automatically lose their local GP service.  Who is going to monitor Babylon?

N.B. it is estimated 90,000 people in Leeds have no internet service

Questions are being asked about the role of OPTUM which is a subsidiary of United Health (another big American Company) Leeds CCG doesn’t have any contracts with them but NHS England has a contract with them for 4 sites across England to develop staff capability in the use of data to better support front line teams and planners.

Yet another new name.  This time Accountable integrated Care Partnership. WE must monitor developments.

GP At Hand complaint

Babylon GP at hand – please be aware of Dr John Puntis and many other doctors’ complaints:

The leaflet from ‘GP at Hand’ is being distributed through letterboxes in parts of London. As you see, it promises an instant recovery (“Get well now”) for patients with symptoms. GP at Hand has been destabilising practices by taking out young, well individuals from GP lists, and reducing practice income needed to look after complex and chronically ill patients. Despite an ongoing independent evaluation of the service not yet being completed, Babylon Health has recently had the go ahead to expand from London into Birmingham. GPs have expressed concern over fragmentation of care and patient safety and have pointed out that the service flies in the face of the place-based care delivered by a practice embedded in the local community that is the focus of the new GP contract.

I have lodged the following complaint with the Advertising Standards Authority:

‘Babylon GP at Hand’ have produced a flyer being hand delivered to residential addresses in Islington. I was given a copy of this flyer yesterday. It implies that symptoms will resolve instantly (“Get well now”) with a telephone consultation. It does mention that to register with the ‘GP at Hand’ service patients will need to de-register from their current GP, but does not explain that this will cause considerable problems if the need for urgent care arises.

The flyer also states: “prescriptions delivered to the pharmacy of your choice within an hour” which disguises the fact that prescribing without seeing and examining a patient is extremely poor medical practice and fraught with risk for both doctor and patient. My complaint is that this flyer gives a mistaken impression of the benefits of using ‘GP at Hand’ and fails to point out inherent risk. There are also wider risks to the NHS from young, well and tech savvy patients being registered with ‘GP at Hand’ and removed from GP lists thus reducing the practice income that is required to look after older and more complex patients with chronic conditions.

Babylon GP At Hand leaflet

Leeds Hospital Alert Minutes

pdf version LHA Feb 19

We have received a fun thank you card from Nicola.

Bronwen received a reply from Simon Stevens in response to the letter expressing our concerns concerning further privatisation of the NHS and expressing our support for changes to the Lansley Act.

Alex Sobel asked at PM Question Time about the supply of insulin post Brexit.  It is all in hand he was told but we must keep a sharp eye on what happens next.

Concerns about the lack of staff in the NHS causing real problems in all services.

Must keep track of NHS England’s demand for increased use of electronic consultations and services.  We especially need to know what happens for those who do not have internet access.  Many GPs unhappy about recent developments. They could be dangerous.

Social Care Report:  Bronwen, Sylvia, Jeremy, Gilda attended the Social Care meeting at the Central Library. Time was spent looking at the Preston Model, the Foundation Economy Unit at Manchester University, the Sheffield Civic Society model.  All concerned about the cost of outsourcing, its effect on budgets and on patient services.  Good contact was made with Charles Dannreuther at Leeds University.  He would like to know more about LHA.  Sylvia to contact him. We need to know how to move the Council on from their current entrenched position.  Ought we to contact the Centre for Disability Studies at the University?  There will probably be a Northern Conference as follow up to the Birmingham Conference.  Gilda will keep us up to date.

Community Mental Health Services.  Sylvia gave a brief report. The Service is returning to working in teams with the aim of keeping patients out of hospital and in their own homes.  All day units have been closed including Malham House. Intensive home care treatments go live March25. There will be a transition period with re-design of homecare teams.  There will be an on line questionnaire for service users but not for their carers. Further report at our next meeting.

Leeds CCG would like your views on the proposal for urgent treatment centres in Leeds.  Closing date for feedback 15 April 2019.  Contact the CCG on 011 3 843 5470 on leedsccg.comms@nhs.net

KONP: Urgent Care- 111 Service- to be provided by Yorkshire Ambulance Service.  New targets from April.  Could be put through straight to a GP.

Vascular services.  Lack of trained staff means either Huddersfield or Bradford will lose their department.  Leeds working to full capacity.

Combating loneliness.  Aim to rekindle community spirit.  See the e-mail forwarded   from John.  Jan’s cautionary tale about   the threat to her tai chi class not very encouraging. To discuss at the next Yorkshire meeting the possibility of a Northern Conference probably in June.

There will be a workshop at SUMMAT March 9 in Notre Dame Sixth Form College

NHS March 30th March.  Please help with distributing postcards as widely as possible. Cards available from Gilda.

Next meeting Tuesday March 12 Muir Court 7.30

April 9 come to say thank you to Phil Corrigan before she retires in July.  Would be good to have as many members as possible at this meeting.

NHS Vision from Doctors in Unite

Their vision for the NHS

Full working document

Their principles:

We believe in

  • A society that promotes good health.
  • NHS and social care which is publicly funded through general taxation, publicly provided, publicly accountable, free at the point of delivery and comprehensive in its scope.
  • Addressing the social determinants that lead to poor and unequal health experiences.
  • Healthy ageing as essential to contain health and social care demand.
  • Welcoming migrants.
  • Democratic control of the NHS by neighbourhood health committees,
  • Parity of esteem and funding between mental and physical health.

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/

………………………………………………………………………………………………………………………………………………………………….

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.