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    FEEDBACK AND TOUGH QUESTIONS 17 5 2020

    TOUGH QUESTIONS

     

    QUESTIONS ON TEST, TRACE AND ISOLATE

    We must continue to press for testing and contact tracing locally and expose contracts going to private sector


    http://edition.pagesuite.com/html5/reader/production/default.aspx?pubname=&edid=a708f69f-8beb-4220-b47c-fb76a4892194

    What stopped the Govt engaging with Local Resilience Forums set up to coordinate local planning in the event of a pandemic?


    The absolutely key issue is testing and contact tracing and why on earth are we easing the lockdown in England when we have not got this system up and running? The R number is far less relevant here. Only 1500 volunteers out of 18000 needed in place? Many volunteers meanwhile twiddling their thumbs (we have a WhatsApp group of former medics many of whom have volunteered but not been called upon.) I am genuinely shocked about the lack of contact tracing still after 4 months


    If the country is now undertaking more than 100,000 tests per day, why is it that the NHS’s own labs are not receiving sufficient reagent supplies? This is resulting in patient samples being transported much longer distances, with longer turnaround times, and increased risks in hospital due to more patients that are pending their test result as a consequence.


    We’ve been working in City and Hackney to persuade Local Government members and officers establish a community based case detection and contact tracing Vanguard demonstrator (proposal attached) – but they are struggling in face of centralised approach. Local politicians have written to Matt Hancock but, I understand, have received no reply.

    There is a news article:

    See https://www.hackneycitizen.co.uk/2020/05/07/coronavirus-local-politicians-challenge-government-trial-contact-tracing-testing-hackney/

    Our approach was informed by the Sheffield Community Tracers project: https://www.communitycontacttracers.com/

    So, my question would be two fold and asking when Secretary of State will:

    1. a) empower local authority staff, under DPH, to establish a local identification and tracing service and
    2. b) ensure data from test centres is fed to local teams to support the process.

     

    DATA SHARING WITH PRIVATE SECTOR

    Has anyone yet asked about the implications of data sharing with the Private Sector?  We had a really big issue in the NW with data being shared with private companies, with disastrous results. Work with the CCG at that time gained some positive changes.


    MENTAL HEALTH

    https://uk.reuters.com/article/us-health-coronavirus-mentalhealth/u-n-warns-of-global-mental-health-crisis-due-to-covid-19-pandemic-idUKKBN22Q0AO

    Has the PM taken notice of this article and will he not only “protect NHS Hospital care” but ensure support and capacity in respect of the emotional/psychological/ psychiatric impact as outlined in this report?


    Where I work, we are heading towards a situation where there are a few remaining COVID-19 wards and many of us back to BAU.

    I think the most important questions to ask now are:

    1. whether the government will renationalise the NHS
    2. will they commit to keep services publicly provided from here onwards, not to give contracts to private providers without full, transparent consultation and justification
    3. will they allow an independent enquiry into the handling of COVID-19 so that we can learn from mistakes and from anything that might have gone well?

    HOSPITALS

    With the NHS recommencing elective surgical activity, including more cancer operations, what assurance can be given on the supply of sterile surgical gowns, which are essential PPE for operating theatre teams?

    Can it be confirmed what equipment (such as ventilators, blood gas analysers and haemofiltration machines) hospitals have requested to support the safe management of Covid-19 patients, and what equipment has been provided to them?

     

    FRONTLINE FEEDBACK

    TESTING

    I was given permission to leave work early, in order to have the test. Although you read stories about the tests being privatised to private companies, this test centre appeared to be run by the army.

    After I had done the test and dropped my sample into the appropriate bag, I was told that I would have to register my card when I got home. I was also told that I should get the result within two days, but not to chase it up unless I did not get it within seven days.

    Later that day, I tried to register my test. The registration card stated that I needed to register my test on https://www.test-for-coronavirus.service.gov.uk. However, this website only took me to the site for booking a test, not for registering a card. I rang the helpline and was directed to a website where I could register my card. When I tried to enter the barcode, I got a message stating that this number was already registered and inviting me to try again. I tried again and got he same result. I rang the helpline again and was eventually told that the site must have registered me anyway.

    Since then, my wife and I have waited, but have not been sent any result for the tests. And we have continued to attend work. This morning (Thursday 14 May 2020), my wife rang the number on the registration card and asked if we could have our results as it had now been 8 days since the test. We both gave our details, including name, barcode number and car registration at the test site. The person who took our details stated that they could not look anything up themselves, but they would pass on our details so that they could be chased up. Since then, we have still heard nothing, either by phone, text or email.

    An eight day (and counting) wait for a test result defeats the object of having a test. My best guess is that the government are more interested in the headline figure of the number of tests carried out, rather than actually getting any useful data from them. I could be wrong. But our tests are entirely separate from each other, but neither of us has had the result.

    DISCHARGE TO CARE HOME

    My friend (female, 50) works at one of the care homes run by a Charitable Trust that were spun off from the Council.

    She says that one of her residents was sent last month to a local hospital for a Covid test, tested positive, then was sent back to the Home.  Whether or not this was the cause, the virus later spread through an entire floor at the Home.

    I find it shocking that this discharge back to the home happened.  Who takes responsibility for this? A consultant, hospital management, or the Government? Or all of them? This is as shocking as the railway worker dying after someone spat in their face!

    SICK PAY

    Secondly, it turns out that if my friend goes off sick with a (non-Covid) sick note, the employer doesn’t pay any sick pay, and she has to apply for sickness benefit through the benefits system, even though she works 5 days a week and was appointed with an interview and references!

    Comments Off on FEEDBACK AND TOUGH QUESTIONS 17 5 2020

    From Vivien Walsh in Manchester

    Right at the beginning of the lockdown, several of my friends said how concerned they were about the likely impact of enforced social isolation on those who are suffering from domestic abuse. On Monday, the (cross party) Home Affairs Committee of MPs, chaired by Yvette Cooper, reported on this, demanding “that the Government makes domestic violence and abuse a central pillar of the broader strategy to combat the Covid-19 epidemic.”

    Calls to domestic violence helplines, such as Refuge and Women’s Aid, were nearly 50% higher in the week 6-12 April than the average before the pandemic began. Visits to the website of Refuge were three times as high in March 2020 as they were in March 2019. The Home Affairs Committee called for this domestic violence strategy to combine “awareness, prevention, victim support, housing and a criminal justice response, backed by dedicated funding and ministerial leadership”.

    It also made a point of the need for specialist services for different ethnic communities, and for legal aid as an automatic right for women applying for Domestic Violence Protection Orders (DVPOs). An extension of the current time limit for reporting offences is also necessary, since many abused women will be unable to report the abuse they have suffered until after lockdown ends.

    Between March 23 and April 12 there were at least 16 killings of women and children in domestic situations, said the report on Monday. The average number of deaths from domestic violence during lockdown has gone up from 5 per week from a figure of two before. In a year that would be over 250 women killed by the person who is supposed to love them. The Parliamentary Committee had also received evidence that incidents reported were not only more frequent but involved higher levels of violence and coercive control.

    Unless the government takes action to deal effectively with domestic abuse and to properly support the victims of it, we will be facing “devastating consequences for a generation.” Funding is urgently needed to enable a growth in provision of housing for women and children escaping from violence, and to support refuges as temporary accommodation and support. Even before current emergency, England had 30% fewer than the recommended number of beds, and 64% of referrals were turned down in 2018-19.

    There is a National Domestic Violence Helpline (0808 200 247). This is the number to call for  emergency referrals as they are open 24/7. In addition there a variety of services based locally. For example Manchester Women’s Aid (call 0161 660 7999  9:30am-4:30pm Mon-Fri) provides confidential advice and information, safe temporary housing, one to one support for those living in their own homes, access to legal advice and civil orders, specialist workshops for young women 15-25, language workers and access to interpreters, specialist support for women with poor mental health and drug and alcohol misuse. The full list of services in England and Wales is at the end of the article.

    The lockdown is in place to keep people safe from the virus: but it is also providing cover for abusers. Escape from being locked in with an abuser is a matter of life and death. A decade of austerity has not only undermined our NHS, on which we are now so dependent, but has also decimated support for survivors of domestic violence. The Government must increase funding as a matter of urgency – and there will be just as much need for services as abused women and children try to return to “normal” life when the lockdown is over. And Children’s services also need a big increase in funding to make sure children as risk, not only from the mental and physical impact of domestic violence, have access to help and support.

    Amna Abdullatif (whose day job is Women’s Aid lead for Children and Young People, and who is also a Manchester City Councillor) added the following information for the SHA in this blog: “78% of survivors experiencing domestic abuse told us that Covid-19 has made it harder for them to leave their abuser. If you’re feeling trapped, we’re here for you.”

    “Our Live Chat is now open from 10am – 2pm with expert support workers just one click away. You can be reassured that our Live Chat is completely confidential. To access support and advice go to: https://bit.ly/2y7ab0Q

    “If you, or someone you know, is experiencing abuse please read our Covid-19 safety advice for survivors, family, friends and community members https://bit.ly/2yNzqoW

    There are also local services for ethnic groups, such as Saheli Asian Women’s Project in Manchester, which provides advice, information and support services to Asian women and their children fleeing domestic abuse and/or forced marriages.

    The full list of services from the Womens Aid web site is below:

    National Domestic Abuse Helpline

    The National Domestic Abuse Helpline is run by Refuge and offers free, confidential support 24 hours a day to victims and those who are worried about friends and loved ones.

    Telephone and TypeTalk: 0808 2000 247

    Wales Live Fear Free Helpline

    The Wales Live Fear Free Helpline offers help and advice about violence against women, domestic abuse and sexual violence.

    Telephone: 0808 8010 800

    TypeTalk: 18001 080 8801

    Text: 078600 77 333

    The Men’s Advice Line

    The Men’s Advice Line is a confidential helpline for male victims of domestic abuse and those supporting them.

    Telephone: 0808 801 0327

    Email: info@mensadviceline.org.uk

    Galop – for members of the LGBT+ community

    Galop runs the National LGBT+ domestic abuse helpline.

    Telephone: 0800 999 5428

    TypeTalk: 18001 020 7704 2040

    Email: help@galop.org.uk

    Women’s Aid

    Women’s Aid has a live chat service available Mondays to Fridays between 10am and 12pm as well as an online survivor’s forum. You can also find your local domestic abuse service on their website.

    The Survivor’s Handbook, created by Women’s Aid, provides information on housing, money, helping your children and your legal rights.

    Karma Nirvana

    Karma Nirvana runs a national honour-based abuse and forced marriage helpline. If you are unable to call or email, you can send a message securely on the website.

    Telephone: 0800 5999 247

    Email: support@karmanirvana.org.uk

    Hestia

    Hestia provides a free mobile app, Bright Sky, which provides support and information to anyone who may be in an abusive relationship or those concerned about someone they know.

    Chayn

    Chayn provides online help and resources in a number of languages about identifying manipulative situations and how friends can support those being abused.

    Imkaan

    Imkaan are a women’s organisation addressing violence against black and minority women and girls.

    Southall Black Sisters

    Southall Black Sisters offer advocacy and information to Asian and Afro-Caribbean women suffering abuse.

    Stay Safe East

    Stay Safe East provides advocacy and support services to disabled victims and survivors of abuse.

    Telephone: 020 8519 7241

    Text: 07587 134 122

    Email: enquiries@staysafe-east.org.uk

    SignHealth

    SignHealth provides domestic abuse service support for deaf people in British Sign Language (BSL).

    Telephone: 020 3947 2601

    Text/WhatsApp/Facetime: 07970 350366

    Email: da@signhealth.org.uk

    Shelter

    Shelter provide free confidential information, support and legal advice on all housing and homelessness issues including a webchat service.

    Sexual Assault Referral Centres

    Sexual Assault Referral Centres provide advice and support services to victims and survivors of sexual assault or abuse.

    Get help if you think you may be an abuser

    If you are concerned that you or someone you know may be an abuser, there is support available.

    Respect is an anonymous and confidential helpline for men and women who are harming their partners and families. The helpline also takes calls from partners or ex-partners, friends and relatives who are concerned about perpetrators. A webchat service is available Wednesdays, Thursdays and Fridays from 10am to 11am and from 3pm to 4pm.

    Telephone: 0808 802 4040

    Get help for children and young people

    NSPCC

    The NSPCC helpline is available for advice and support for anyone with concerns about a child.

    The NSPCC has issued guidance for spotting and reporting the signs of abuse.

    Telephone: 0808 800 5000

    Email: help@nspcc.org.uk

    If you are deaf or hard of hearing, you can contact the NSPCC via SignVideo using your webcam. SignVideo, using British Sign Language, is available on PC, Mac, iOS (iPhone/iPad) and Android smartphones (4.2 or above). This service is available Monday to Friday from 8am to 8pm and Saturdays from 8am to 1pm.

    Childline

    Childline provides help and support to children and young people.

    Telephone: 0800 1111

    Barnardo’s

    Barnardo’s provide support to families affected by domestic abuse.

    Family Lives

    Family Lives provide support through online forums.

    Support for employers

    Employers’ Initiative on Domestic Abuse

    The Employers’ Initiative on Domestic Abuse website provides resources to support employers including an employers’ toolkit.

    Support for professionals

    SafeLives provides guidance and support to professionals and those working in the domestic abuse sector, as well as additional advice for those at risk.

    Support a friend if they’re being abused

    If you’re worried a friend is being abused, let them know you’ve noticed something is wrong. Neighbours and community members can be a life-line for those living with domestic abuse. Look out for your neighbours, if someone reaches out to you there is advice on this page about how to respond. They might not be ready to talk, but try to find quiet times when they can talk if they choose to. If someone confides in you that they’re suffering domestic abuse:

    • listen, and take care not to blame them
    • acknowledge it takes strength to talk to someone about experiencing abuse
    • give them time to talk, but don’t push them to talk if they don’t want to
    • acknowledge they’re in a frightening and difficult situation
    • tell them nobody deserves to be threatened or beaten, despite what the abuser has said
    • support them as a friend – encourage them to express their feelings, and allow them to make their own decisions
    • don’t tell them to leave the relationship if they’re not ready – that’s their decision
    • ask if they have suffered physical harm – if so, offer to go with them to a hospital or GP
    • help them report the assault to the police if they choose to
    • be ready to provide information on organisations that offer help for people experiencing domestic abuse

    If you are worried that a friend, neighbour or loved one is a victim of domestic abuse then you can call the National Domestic Abuse Helpline for free and confidential advice, 24 hours a day on 0808 2000 247.

    Comments Off on News from the Frontline 01.05.20

    The SHA started to publish its Covid-19 Blogs on the 17th March and since then have issued weekly blogs. It is extraordinary to reflect on this being our sixth commentary on the socialist health view of the unfolding global pandemic.

    In earlier Blogs we have covered many different topics and each Blog reflects on particular issues that have sprung up over the past week and identified as emerging issues. In this week’s Blog we will look at social care, testing, and possible steps out of lockdown.

    1. Social Care

    This has rightly hit the headlines over the past week as the plight of our care services and their residents have been under the media spotlight. We knew from the early data from China mid January that the C-19 virus seemed to particularly harm older people and particularly adults with underlying conditions such as obesity, diabetes, heart and lung disease. Mortality rates in these at risk groups is comparatively high and 90% of deaths in the UK have been in the over 60 year olds with half of these deaths being in people over 80 years old. This has led the UK government to define vulnerable groups and also those ‘very vulnerable’ people who need to be ‘shielded’ from exposure to the virus. The very vulnerable shielded groups are estimated to a number 1.5m and are self isolating indoors for 12 weeks. Many but not all of these very vulnerable people will be in residential or nursing homes.

    Having identified these at risk populations, attention needed to be directed towards those sub populations of older or vulnerable people who were living in residential or nursing homes. These institutions are high risk as ‘closed communities’ accommodating a group of high-risk individuals who would be at risk of an outbreak of C-19 within that setting.  Decisions have had to be made by the management of these residential and nursing homes to, in many cases,  exclude relatives from visiting.  Some brave and extremely committed care staff have decided to move themselves into the nursing or residential homes to reduce the risk of them bringing C-19 in from their own homes and local community. It cannot be a surprise to hear now about outbreaks in these establishments causing disease and death to workers and their residents. Again like other aspects of this pandemic response – we had early warnings from Italy and Spain about the isolation and risks that this sector faced. Did we do enough quick enough?

    SHA President Prof Allyson Pollock published an Editorial in the BMJ on the 14th April, which identified that social services in the UK are amongst the most privatised and fragmented in the world, and have been underfunded for decades. Between 2010 and 2018 local authority spending on social care in England fell by 49% in real terms. The UK has 5500 providers operating 11,300 care homes for older people and 83% of these care home beds are provided by the for-profit sector, it is more privatised than the US.

    She also reports that care services employ 1.6m care staff (1.1m full time equivalent) of which 78% are employed by the independent sector. Pay is low; 24% of people working in adult social care are on zero hours contracts, and in March 2019 around a quarter were being paid the national living wage of £7.83 an hour or less. The sector is 120,000 workers short, and agency staff, are commonly employed and move from care home to care home. Social care has been a low priority for PPE supplies despite the high risks for residents and staff.

    Valiant efforts have been made by the sector with heroism shown by these low paid workers as well as stoicism by residents, many of whom may well be bemused and depressed as to why they no longer have visitors as well as the unusual PPE equipment being used by staff. It will have been difficult to plan for the various contingencies when cases emerged in homes, to access testing of staff and residents, to successfully isolate cases and discuss whether residents should be moved to hospital to obtain extra levels of care. Such admissions to more resourced NHS facilities should be an option even if cases would not meet eligibility for ITU care or wishing to be subject to that level of intrusive care. There should be options available, rather than simply assuming appropriate care will be delivered in that setting by stretched staff with relatively few registered nurses, no medical presence on site and few resources of PPE and other equipment such as oxygen supplies, oxygen delivery equipment and monitors such as oximeters.

    The SHA has been concerned about the social care sector for years and has developed policies to transform the sector under the banner ‘rescuing social care’. At the 2019 Labour Party Conference the SHA called on a future Labour Government to legislate for a duty to provide a universal system of social care and support based on a universal right to independent living. This should be based on need and offering choice; be free at the point of use, universally provided and fully funded through progressive taxation. This new National Care Service (NCS) should ensure that there are nationally agreed qualifications for staff, a career structure and enhanced pay and conditions of service. Recognition of informal carers is needed too with clarity about rights and support. The policy proposal has many other facets and stops short of integrating the NCS with the NHS. However close working would be built in and integrating data and information into a common system would be expected.

    As for many of the issues that have arisen so far with the pandemic the social care sector has not been in a strong position to push back C-19. The underpaid staff, the high vacancies and the often unsuitable, adapted accommodation is rarely fit for modern care needs. The fragmentation of the sector with ‘for profit operators’ finding it hard with constrained funding has led to vulnerability in the sector as well as the residents. Maybe this will be the time that showed how, rather than a shiny green badge, the social care service should be taken into a publicly funded national care service.

    1. Tracking, Tracing, Testing, and Treating (isolating)

    One of the criticisms we have made of the Government’s pandemic response has been the decision on the 12th March to pull back from testing for cases in the community and contact tracing. It may turn out that this was a policy decision driven by the lack of availability of tests rather than a decision made not to control community spread. On the 24th February there had been 9 confirmed cases of C-19 in the UK and the WHO had announced that countries should ‘ prioritize active, exhaustive case finding and immediate testing and isolation, painstaking contact tracing and rigorous quarantining of close contacts

    By the 22nd March there were 5683 confirmed cases and yet even then the WHO advice was ‘ find those who are sick, those who have the virus and isolate them. Find their contacts and isolate them’.  In outbreaks you do not always have confirmatory tests available but can make public health decisions based on the history and observation in the context of the unfolding epidemic. We seem to have forgotten the cardinal symptoms of continuous cough and fever.

    We have pointed out in earlier Blogs that countries that have been successful so far in controlling C-19 such as South Korea and Taiwan have been ones that have used widespread testing, tracing contacts and quarantining them. Germany has also been an example of a Western European country that has used this traditional communicable disease control methodology to save lives and protect their health service. Such a public health approach is most important in epidemics like this where there is no vaccine and no effective therapeutics other than sophisticated intensive supportive care.

    It is symbolic that the data that is presented at the daily press briefings has in the main used hospital testing data, hospital admissions and until recently exclusively hospital deaths. TV crews have been crawling over ITUs to get extraordinary footage of these wonderful NHS teams doing outstanding and stressful work. The incredible success of building Nightingale Hospitals in record time has been a reminder of the extraordinary efforts made in Wuhan to meet urgent need.

    However outside hospitals we have had the social care sector relatively unprepared, people self isolating in their homes and having to gauge the seriousness of their symptoms with intermittent telephone calls to NHS111. The disease has been spreading across the country from London to other metropolitan centres and then into smaller towns and rural areas. We could and should have shutdown London earlier as this has been our Wuhan. Local surveillance is limited and active contact tracing thought to be irrelevant even when many areas across England, Wales and Scotland had few cases. Environmental Health Officers in Local Government have not been mobilised. An opportunity missed.

    We have also seemed content to keep our airports and seaports open with little if no border health security. Again other countries who have managed to control this pandemic stopped and controlled air traffic, quarantining arrivals from high risk areas and making basic investigation on history (?cough) and taking travellers temperatures. Not difficult to do and look at Australia and New Zealand for actions on this source of new infections of a virus with high levels of transmissibility. In the UK it is estimated that over 190,000 people flew into the UK from China between January and March with no testing/quarantining.

    1. Evidence of unpreparedness

    The UK seems set to be one of the countries in Western Europe with the worst outcome in regards to mortality rates from C-19 despite the effectiveness of the NHS, which has withstood the pressure. We are often said to have an exemplar emergency planning system, the government had a pandemic as No. 1 risk on the national risk register, kept stockpiles and has computer modellers of world class.

    Yet we do not seem to have acted on the emergency planning exercises such as the 2016 Operation Cygnus (‘swan’ flu). We are now aware that in Sept 2017 the National Risk Register of Civil Emergencies reported that “There is a high probability of a flu pandemic occurring with up to 50% of the UK population experiencing symptoms, potentially leading to between 20,000 and 750,000 fatalities and high levels of absence from work’.

    There have been disclosures recently that are worth referring to that set out the timelines which showed the Prime Minister distracted and absent from COBRA meetings in January/February (A comprehensive countdown to how Britain came to have one of the highest COVID-19 per capita death rates – http://www.bylines.com). Also there has been an Insight team report for the Sunday Times on the 19th April 2020 (Coronavirus: 38 days when Britain sleepwalked into disaster). The current Secretary of State is an actor in this drama and the former Secretary of State for Health Jeremy Hunt who has been a critic of some aspects of the Governments response was of course in power during this time. We are told that ‘pandemic planning became a casualty of the austerity years when there were more pressing needs’ and ‘preparations for a no-deal Brexit sucked all the blood out of pandemic planning’

    1. Getting out of lockdown

    There are various scenarios that are being set out about how to get out of lockdown once the number of new cases decline and the first wave is thought to be ‘over’. This is likely to take time as the curve is flat and the proportion of the population with resistance is thought to be quite low. The government are hesitating about setting out the scenario and talking too much about the delivery of an effective, safe and tested vaccine. This usually takes 12-18 months and can never be guaranteed. They also are talking up the possibility of an effective drug therapy but we all know that viral illness do not lend themselves to highly effective drug treatments as we know with the Tamiflu debate after the 2009 H1N1 pandemic. So really we should again consider more immediate and classic public health control measures that have been shown to work in this pandemic.

    This will need health scrutiny and effective border controls that New Zealand and Australia have used successfully. There will within the country need to be effective systems of testing, contact tracing and quarantining with every day life respecting physical distancing and the use of facemasks. South Korea has shown the way that this can be enhanced and made more bearable by using mobile phones loaded with new technologies. These will warn people if at risk and disclose red, amber or green status. This will allow the economy to restart and people begin to get out and about again. The very vulnerable will in the early phases of this need to be protected.

    Prof Pollock in a recent BMJ editorial (Covid-19: why is the UK government ignoring WHO’s advice) states that ‘this means instituting a massive, centrally co-ordinated, locally based programme of case finding, tracing, clinical observation, and testing. It requires large teams of people, including volunteers, using tried and tested methods updated with social media and mobile phones and adapting the guidance published from China’ and other countries who are implementing such systems.

    This will require a change of mindset in government and from their medical and scientific advisers but as J.M.Keynes said:

    When the facts change, I change my mind. What do you do?”

    20th April 2020

    Published by Jean Smith on behalf of the SHA Officers and Vice Chair’s

    2 Comments

    BUYING BEDS FROM PRIVATE HEALTHCARE PROVIDERS

    Can the minister explain why the Government has chosen to buy beds from private healthcare providers rather than requisitioning private hospitals and staff as the Spanish Government has done?

    The Centre for Health and Public Information (CHPI) has demonstrated that the government’s deal to purchase their entire capacity in return for covering their “operating costs, overheads, use of assets, rent and interest” is in effect a bailout for private hospitals. https://chpi.org.uk/blog/who-benefits-from-the-nhss-bailout-of-private-hospitals/

    Based on the accounts (2017 or 2018) of their operating companies, four of the largest private hospital providers (Spire, BMI, Nuffield, Ramsay) have an average gearing (total debt / equity) of over 300%. This means that they are heavily reliant on debt to finance their businesses, and are therefore potentially vulnerable to a prolonged period of low or non-existent demand.

    Without the deal, private healthcare providers would face the same fate as other industries who are experiencing a significant drop off in demand due to the virus. Crucially it also represents a bailout for the landlords and lenders of the private hospitals whose investments would also be at risk if the hospitals were unable to honour their payments.

    Why is the Government acting to protect private healthcare providers, and the profits of their investors, rather than taking the alternative approach of requisitioning private hospitals and their staff to support the NHS?


    What payments will the government have to make for requisitioned private health care capacity?


    Can the government provide assurances that the contracts signed for ventilators from known Tory backers like Dysons and JHB are of the required standard to enable gradual re-establishment of breathing?

    CARE AND NURSING HOME RESIDENTS

    Are you confident that all care and nursing home residents who are symptomatic are being tested for COVID-19?


    Why there is a difference in priority for the NHS and Care sector?

    Please supply any figures of death rates and infection rates as incidence and prevalence.  It should surely be easy for every care home retirement village and other institutions to collect daily stats and report regionally.

    How can you ensure that Trusts, NHS charities and local authorities work together to provide a system coordinated response?


    PUBLIC HEALTH ADVICE

    Why does the Government advise 7 days isolation for those who are symptomatic for COVID-19 while the WHO advice, followed in most of Europe is to isolate for 14 days?

    CONTACT TESTING, TRACING AND NUMBERS

    • What is the best estimate of the proportion of the population who have had Covid-19?
    • What is this estimate based on?
    • Is there any community surveillance for Covid-19 taking place? If so what are the details? What are the results?
    • How much contact tracing is done for patients who have been diagnosed as having Covid-19?
    • What role will contact tracing play in managing the easing of the current public health measures?
    •  What steps is the government taking to have a robust tracing capacity in place as we emerge from the current public health measures?
    • What criteria will be government use in terms of R0, new cases, patient deaths, herd immunity, contact tracing capacity etc to inform any decision to ease current public health measures?
    • How many of the NHS and care staff who have died in this epidemic are from overseas?

    The figures now emerging for the deaths of those working in the NHS cover the very substantial numbers of outsourced workers, a cohort that the public just don’t know about. Aside from being cheaper and allowing corporates to cream off a profit, these workers are treated as second class employees, with worse conditions, oppressive supervision, abysmal support and non-existent occupational health. Aside from low pay and the insecurity of zero hours contracts there are countless ways in which they are coerced to “just get on with it”, risking serious harm.

    The DHSC is undercounting numbers of health workers infected, can the government give assurances that they will provide accurate figures and include out sourced agency and locum staff?

    Hospitals have been asset-stripped for years by outsourcers, PFI partners and management and IT consultants, and Lansley’s Health and Social Care Act has undermined the structural coherence of the NHS. The malign results of this we now see with hospitals struggling against collapse with the untold sacrifices of heroic staff. And even here, the government (Matt Hancock) has consistently under stated the numbers of deaths of NHS staff: on Friday he said the number was 19 when it was 31 and he repeated the 19 figure on Saturday when it was in the 40s and in the public domain. Can we be assured that Mr Hancock will provide accurate figures and strive to remain on top of his brief?

    We know the numbers of front line workers losing their lives to Covid is now in excess of 40  – why has the government not acknowledged this nor yet apologised for their gross mishandling of PPE supplies.


    The finger-prick antibody tests that Hancock has ordered are widely regarded as unreliable with low sensitivity and specificity. Can we be assured that this is not the case?


    With respect to testing – why has the government wasted millions on a test which quickly proved not to be reliable. Who sanctioned this?


    What are the step changes to increase current testing capacity to 100,000 by the end of the month?  When will each new site come on stream and how much capacity will be added – and then say what actually happened – on a weekly basis?

    What really is the approach to testing front line staff? Pretending to test all front line staff is pointless as someone who is negative today could be positive tomorrow – so this would mean testing everyone everyday which would need significantly more capacity than planned. Are they testing staff who are currently self isolating and not at work and those who become symptomatic?

    What is their approach to testing care home residences and staff? Initially this should focus on those home with assumed cases and needs to be done in a consistent way

    FUTURE FUNDING

    We are pleased to hear of the Prime Minister’s recovery, and noting his praise for the dedication and commitment of NHS staff, will he now reinstate the NHS as the preferred provider when work is commissioned?

    Given the inability of local Public Health teams to provide an adequate local response to the epidemic given recent cuts and reorganisation, will be now ensure the reinstatement of Public Health powers and budgets?


    Public support for the NHS has never been higher, arguably because the population understands better than this and the previous Tory government how vital it is to national life. Will the government undertake to reinstate the NHS on its former footing as a National health service, and undertake to spend the same proportion of GDP on it as comparable countries?

    COMMUNITY SERVICES

    There is likely to be a wave of people being discharged from hospitals who remain very ill. Given the shortfall in GP and District Nurse numbers, how does the SoS expect that these patients will be adequately supported?

    Is now the time to commit to a significant increase in District Nurse numbers with upskilling to enable more people to remain at home post-Covid with GP support?

    PPE

    PHE has continually prevaricated about the spec – and in comparison to other countries still falls short, yet even that is still proving impossible to obtain for too main frontline workers, both in hospitals and in the community. We know the supply chain in England in particular is flawed because the Cabinet Office brought in an a ‘middle man’ without any experience of handling PPE or the manufacturing industry. Cabinet Office must be told they should be stood down with immediate effect from their role in England and allow industry to liaise directly with hospital Trusts, primary care bodies and care organisations for fast track targeted purchasing to unblock this ASAP.

    Why has the government persisted in shipping PPE/ventilators equipment from abroad  –  some of it substandard or out of date  – when we have received skilled offers from such as GTech in Worcester offering 30k ventilators ( not CPAPs) and the British textiles manufacturing industry being continually blocked from their significant capacity to provide PPE  – some of which is now going abroad in frustration?

    Tough Questions

    1 Comment
    1. On PPE. From a Greater Manchester doctor working on a respiratory ward, unofficially renamed by staff the “Coronavirus Ward”, about protective equipment:

    “It’s not so much whether there’s enough, it’s what’s being brought in is really poor quality and advice about what constitutes PPE  is changing daily. Loads of my colleagues have already tested positive…… that’s one good thing my hospital is really on it with testing staff.”

    1. From a Unison rep in NHS Greater Manchester:

    “I am worried about members with diabetes, especially type 1. First of all they were listed in the ‘at risk’ group, not quite as at risk as the ‘vulnerable’ group, but who should still not be asked to work. Now they are being asked to go in. The responsibility has been put on them to observe the recommendations. They are sent on to wards where it is impossible to keep a 2m distance from patients, and PPE is still a problem.”

    And “there are not enough tests for the virus. But it would be possible to identify people with symptoms, and teams could be recruited to monitor symptoms and track contacts. However this is not happening.”

    1. Care workers are also on the Frontline. From a care worker in Scotland who visits patients in their homes. She was very upset because she was not allowed to shop at the time reserved for NHS staff “because she had the wrong uniform”. She has been working double shifts for a month, and will be doing so until July, and at the same time doing shopping for some of her patients, elderly people unable to get out of the house and whose adult children live too far away to help. This has been made more difficult by not being treated as a frontline worker, especially as there are limited occasions when she can do shopping, given her extra workload. She points out she is risking her life and those of her family members, but not being treated as “frontline”.

     

    1. Terror of the Unknown. From another Greater Manchester doctor, a retired consultant: “I have been retraining, but will be back at work full time on Monday. The main thing I noticed last week was the atmosphere of fear amongst the staff. Our hospital are pretty organised, it seems to me, with training and equipment, but not unexpectedly, there is terror of the unknown.”

     

    1. Ventilators and Tory Donors. Andrew Raynor of MEC Medical submitted an application to help the government on 16th March, but “nothing” happened. They are a worldwide supplier of oxygen therapy, suction, flow meters, electric suction, regulators and more. Raynor said the government had, instead, “ploughed loads of money into big consortiums to try and make a cheap, makeshift ventilator”. He did not have a problem with the government wanting to make a cheaper ventilator, but pointed out that his firm was already a ventilator manufacturer, and could “upscale quicker”.

    Instead, on 26 March, the BBC reported that the government had ordered 10,000 ventilators from the vacuum cleaner firm Dyson, which has no experience making the ventilators required. Dyson, working with medical technology firm, The Technology Partnership, has “hundreds of engineers working round the clock to design the ventilators from scratch.” The BBC commented that even if a suitable prototype was produced as a result, it still had to get regulatory approval, and move to production on a significant scale.

    As an anaesthetist commented to us: “simple ventilators allow you to dial in the tidal volume (the amount of air moved into or out of the lungs during each ventilation cycle), the respiratory rate” and the concentration of oxygen being breathed in. The ventilators deliver all the breaths and can be used during surgery or for transferring patients.” That is, for short term ventilation.

    But after several days on these ventilators, usually necessary for Covid-19 patients, “people develop wasting and loss of condition in the muscles responsible for breathing in. This means that patients need to be supported during this time, but support can be gradually reduced as they begin to recover muscle strength and can take progressively larger breaths. “They usually also need a temporary tracheostomy to reduce the amount of dead space, enabling lighter sedation and more effective breathing.”

    However, the Dyson ventilators are very basic and do not allow for weaning of the ventilator. “But he’ll make a lot of money, get a peerage, and make it look like Matt Hancock is doing something.”

    In contrast, “modern Intensive Care Unit ventilators are expensive and take ages to produce. Hancock just wanted a soundbite and a photo-opportunity. He passed over offers from established manufacturers to award contracts to big name companies like JCB and Dyson, with no experience of ventilator production, but owned by Tory donors.”

    Our informant compares the finger-prick antibody tests that Hancock has ordered. “They are totally unreliable, with low sensitivity and specificity, but home testing makes for a good, eye-catching headline, even if it’s a waste of time and money. Hancock is a joke; he is surrounded by sycophants and yes-men at the DHSC.”

    Obviously the production of much-needed ventilators is welcome. But the Government’s choice of manufacturers raises major questions about whether it has prioritised its friends and donors, rather than the specification of the ventilators needed.

    Blog from Vivien Walsh

    Comments Off on News From the Frontline

    Patients still make enquiries at busiest hours, despite 24/7 online access

    · University of Warwick publishes first independent evaluation of one of the main providers of online consultation platforms

    · Targeting services at younger patients and those with general administrative enquiries could be most effective

    · “In reality, patients were seeking access to health care at the same times and for the same sort of problems than they did using traditional routes.” Says supervising author.

    Patients are using online consultations in the same way they would arrange a consultation via traditional means, a new independent evaluation by the University of Warwick reveals.

    Despite this, the study identifies several opportunities to tailor online platforms to specific patient requirements and improve their experience.

    Primary care researchers from Warwick Medical School have today (26 March) published the first independent evaluation of one of the main providers of online consultation platforms in NHS general practice. Published in the British Journal of General Practice, it provides independently analysed information on the types of patients that are using online triage systems, how and when patients are using this platform, and what they think of it.

    Online triage is a system in which patients describe their problems via an online form and subsequently are telephoned by a GP to conduct a telephone consultation or arrange a face-to-face consultation. Practices aim to respond within one hour of receiving the request.

    The researchers examined routine information from 5140 patients at nine general practices using the askmyGP platform over a 10 week period. Highest levels of use were between 8 am and 10 am on weekdays (at their highest on Mondays and Tuesdays) and 8 pm and 10 pm at weekends, mirroring the busiest time for patients contacting their practice via telephone.

    Supervising author Dr Helen Atherton, from Warwick Medical School, said: “With online platforms there is an assumption that having a 24/7 ability to make contact with a general practice will cater to those who wish to deal with their health problem at a convenient time, often when the practice is shut, and that being online means they will perhaps share different problems than they would over the telephone or face-to-face.

    “In reality, patients were seeking access to health care at the same times and for the same sort of problems than they did using traditional routes. This suggests that patients’ consulting behaviour will not be easily changed by introducing online platforms. Therefore practices should be clear as to exactly why they are introducing these online platforms, and what they want to achieve for themselves and their patients in doing so – the expectation may well not meet reality.”

    The NHS Long term plan sets out that over the next five years all patients will have the right to online ‘digital’ GP consultations. The main way these are being delivered is via online consultation platforms. The online platforms claim to offer patients greater convenience and better access and to save time and workload for GPs, however there is currently a lack of independent evidence about their impact on patient care and care delivery.

    Patient feedback analysed as part of the study showed that many found the askmyGP system convenient and said that it gave them the opportunity to describe their symptoms fully, whilst others were less satisfied, with their views often depending on how easily they can normally get access to their practice, and on the specific problem they are reporting.

    The study found that two thirds of users were female and almost a quarter were aged between 25 and 34, corroborating existing evidence. The commonest reason for using the service was to enquire about medication, followed by administrative requests and reporting specific symptoms, with skin conditions, ear nose and throat queries and musculoskeletal problems leading the list.

    The researchers argue that practices should avoid a ‘one size fits all’ approach to implementing online consultations and should tailor them to suit their practice populations and model of access, considering whether it is likely to add value for their patient population.

    Dr Atherton adds: “Individual online consultation platforms are uniform in their approach, patients are not. We found that patient satisfaction is context specific – online consultation is not going to be suitable for all patients and with all conditions and that one approach is unlikely to work for everyone.

    “Practices could focus on encouraging people to deal with administrative issues using the platform to free up phone lines for other patients. It could be promoted specifically to younger patients, or those who prefer to write about their problems and not to use the telephone. Clear information for patients and a better understanding of their needs is required to capture the potential benefits of this technology.”

    · ‘Patient use of an online triage platform; a mixed-methods retrospective exploration in UK primary care’ published in the British Journal of General Practice, DOI: 10.3399/bjgp19X702197

    1 Comment

    Responding to the Health Secretary’s pledge to overhaul mental health and wellbeing services for NHS staff following the launch of a Health Education England review, BMA mental health policy lead, Dr Andrew Molodynski, said:

    “Staff are fundamental to the delivery of patient care in the NHS and without a healthy workforce our health service can barely function, let alone thrive.

    “Given the current pressures that the NHS workforce is under, the Secretary of State for Health and Social Care’s commitment to improving mental health and wellbeing support for staff is both timely and necessary.

    “We know that doctors’ mental health and wellbeing has been adversely affected by the increasing demands of their work and this is true also for medical students who are dealing with stress, fatigue and exposure to traumatic clinical situations, very often without adequate support on hand.

    “The BMA recently for greater provision of mental health support for NHS staff as their report¹ found that only about half of doctors were aware of any services that help them with physical and mental health problems at their workplace – while one in five respondents said that no support services are provided.

    “While these measures will go a long way to providing much-needed support for NHS workers who are struggling with their mental health and overall wellbeing, more must be done to address the wider pressures on the system, such as underfunding, workforce shortages and rising patient demand, so we can reduce the number needing to seek help in the first place.”

    1 Comment
    1. Response to the concerns we have expressed on the Mental Capacity (Amendment) Bill. As my colleague stated (6 and 7), we cannot take our eyes off the ball on this. The Chair of the Relatives and Residents is an SHA member and some of you may have heard her speak at meetings/conferences our organisation either ran or was part of:

     

    1. I reproduce here the Noble Baroness Thornton’s Speech on the above resolution:-

     

    1. VOLUME 7904 – COLUMN 596 “My Lords, I feel sorry for the Minister that after so much agreement we are now criticising the Bill. However, the reason we have reached a happier state than the one we started off in in July is due to the work of a great many people, including the Minister and the Bill team.

    I have put my name to several amendments in this group—I support my noble friend Lord Hunt and the noble Baroness, Lady Tyler, in what they have said—and I shall speak to Amendments 143A and 147A.

    In a way, the amendments are part of what should have happened before the Bill reached us; that is exactly right. It is important to note that a coalition of organisations is concerned about what is and is not in the Bill and how it will be implemented. For the record, we have discussed the Bill with at least 44 organisations in the very short time we have had to consider it. They include Mind, the Alzheimer’s Society, Liberty, Learning Disability England, Disability Rights UK, the Relatives & Residents Association, the Care Provider Alliance, VODG—the voluntary sector’s disability group—and many others. We must pay credit to both them and the noble Lords who have worked so hard on this for the fact that we have to come to a point where the Bill has significantly changed and been improved.

    Echoing what my noble friend said, the amendments ask that the revised codes of practice for the Mental Capacity Act take account of Schedule 1 to the Bill and, prior to the provisions in the Act coming into force, that the code be revised by statutory instrument using the “made affirmative” procedure. Amendment 143A states:

    “Before any provisions of this Act other than those which come into force on its passing come into force … the Secretary of State must publish a report detailing which of the provisions of the Act will be consulted on, by whom and by when … publish his or her consideration of the conclusions of the Independent Review of the Mental Health Act … conduct further consultation with vulnerable people, families, charities, providers … publish an equality impact assessment on the impact of the provisions of this Act”.

    I would like the Minister to say that the Government have done the equality impact assessment but I have missed it somehow. However, it seems that the Government are duty-bound to consider the impact on people with protected characteristics under the Equality Act. An equality impact assessment is the established way of the Government showing that they have considered the impact on vulnerable groups. That Act begs that this process should have been gone through in preparation for the Bill. I hope that a full equality impact assessment will be conducted and made available to the Commons when it considers the Bill.”

    1. The Following is part of the Response of the Noble Lord, Lord O’Shaughnessy, The Parliamentary Under-Secretary of State, Department of Health and Social Care, relating specifically to Amendment 143A standing in the name of the Noble Baroness Thornton previously circulated.

     

    1. VOLUME 794 – COLUMN 599. “Amendments 143A and 147A, tabled by the noble Baroness, Lady Thornton, would require the Government, before the new system could come into force, to conduct public consultation on the Act with vulnerable people and other stakeholders and publish a report on its findings, as well as to publish their response to the Mental Health Act review and an equality impact assessment. I hope that I have dealt with the issue of public consultation, as well as consultation on the code and, equally, on the Mental Health Act review. The noble Baroness is quite right to bring the equality impact assessment to the House’s attention. It was prepared prior to introduction and required amendment following input from the Welsh Government. It will now need to be amended further to reflect the changes made in the Bill. I can commit to publishing the equality impact assessment before the Bill makes it to the Commons so that there will be ample time for consideration before it is debated there.”
    2. Following the Noble Lords response Amendment 143A was not moved, but not withdrawn as other motions had been.

     

    1. I respectfully suggest that we and our counterparts/cosignatories cannot not take our eye off the ball. It is my experience that information can be changed or lost in the plethora of legalise wording of legislation.

     

     

     

    Comments Off on Mental Capacity (Amendment) Bill update

    SHA Wales

     

    ‘LEGISLATION WATCH WALES’ – October 2018

    Health and Social Care Briefing

    Acts

    Additional Learning Needs and Education Tribunal (Wales) Act 2018

    http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=16496

    The Act makes provision for a new statutory framework for supporting children and young people with additional learning needs. This is to replace existing legislation surrounding special educational needs and the assessment of children and young people with learning difficulties and / or disabilities in post-16 education and training.

    The Act also continues the existence of the Special Educational Needs Tribunal for Wales and provides for children, their parents and young people to appeal to it against decisions made in relation to their or their child’s additional learning needs, but renames it the Education Tribunal for Wales

    The Bill was introduced on 12 December 2016. Royal Assent was given on 24 January 2018.

    Abolition of the Right to Buy and Associated Rights (Wales) Act

    http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=17260

    According to the Explanatory Memorandum accompanying the Act, the purpose and intended effect of the Act is to end all variations of the Right to Buy and the Right to Acquire.

    The key purposes of the Act are to:

    • abolish the right of eligible secure tenants to buy their home at a discount under Part 5 of the Housing Act 1985 (Right to Buy);
    • abolish the preserved right of eligible former secure tenants to buy their home at a discount under section 171A of the Housing Act 1985 (Preserved Right to Buy);
    • abolish the right of eligible assured or secure tenants of a registered social landlord or private registered provider to acquire their home at a discount under section 16 of the Housing Act 1996 (Right to Acquire);
    • encourage social landlords to build or acquire new homes for rent, the Right to Buy, Preserved Right to Buy and Right to Acquire will not be exercisable by tenants who move into new social housing stock more than two months after the Bill receives Royal Assent, subject to certain exceptions;
    • provide for at least one year after the Bill receives Royal Assent before the abolition of the Right to Buy, Preserved Right to Buy and Right to Acquire for existing social housing stock comes into force.

    Further detail about the Act can be found in its accompanying Explanatory Memorandum.

    The Bill was introduced on 13 March 2017. Royal Assent was given on 24 January 2018.

    Public Health (Minimum Price for Alcohol) Wales Act

    http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=20029

    The Act provides for a minimum price for the sale and supply of alcohol in Wales by certain persons and makes it an offence for alcohol to be sold or supplied below that price.

    The Act includes provision for:

    • the formula for calculating the applicable minimum price for alcohol by multiplying the percentage strength of the alcohol, its volume and the minimum unit price (MUP);
    • powers for Welsh Ministers to make subordinate legislation to specify the MUP;
    • the establishment of a local authority-led enforcement regime with powers to bring prosecutions;
    • powers of entry for authorised officers of a local authority, an offence of obstructing an authorised officer and the power to issue fixed penalty notices (FPNs)

    The Act proposes the MUP would be specified in regulations. However, for the purpose of assessing impacts and the associated costs and benefits, the Explanatory Memorandum uses a 50p MUP as an example.

    The Public Health (Minimum Price for Alcohol) (Wales) Act became law in Wales on the 9th of August 2018.

    Regulation of Registered Social Landlords (Wales) Act

    http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=19962

    The purpose of the Act is to amend or remove those powers which are deemed by the Office for National Statistics (“ONS”) to demonstrate central and local government control over Registered Social Landlords (RSLs).

    These changes will enable the ONS to consider reclassifying RSLs as private sector organisations for the purpose of national accounts and other ONS economic statistics.

    Further detail about the Act can be found in its accompanying Explanatory Memorandum.

    The Regulation of Registered Social Landlords (Wales) Act 2018 became law in Wales on the 13th of June 2018.

    Law Derived from the European Union (Wales) Act 2018

    http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=21280

    A Government Emergency Bill, introduced by Mark Drakeford AM, Cabinet Secretary for Finance. An Emergency Bill is a Government Bill that needs to be enacted more quickly than the Assembly’s usual four stage legislative process allows. A definition of an Emergency Bill is not provided in the Government of Wales Act 2006 (“the 2006 Act”) or in the Assembly’s Standing Orders however Standing Order 26.95 states that:

    “If it appears to a member of the government that an Emergency Bill is required, he or she may by motion propose that a government Bill, to be introduced in the Assembly, be treated as a government Emergency Bill.”

    As with all Assembly Bills, Emergency Bills must relate to one or more of the 21 Subjects contained in Schedule 7 to the 2006 Act in order for it to be within the scope of the Assembly’s legislative powers.

    The Act is intended to preserve EU law covering subjects devolved to Wales on withdrawal of the UK from the EU. Further, it will enable the Welsh Ministers to ensure that legislation covering these subjects works effectively after the UK leaves the EU and the European Communities Act 1972 is repealed by the European Union (Withdrawal) Bill.

    The Act enables the Welsh Ministers to legislate to maintain regulatory alignment with the EU in order to facilitate continued access to the EU market for Welsh Businesses. It also creates a default position in law whereby the consent of the Welsh Ministers will be required before any changes are made by UK Ministers to devolved legislation within the scope of EU law.

    Further detail about the Bill can be found in its accompanying Explanatory Memorandum.

    The Law Derived from the European Union (Wales) Act 2018 became law in Wales on 6 June 2018.

    Legislation in Progress – current Bills

    Public Services Ombudsman (Wales) Bill

    http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=20012

    This is a Committee Bill, introduced by Simon Thomas AM, Chair of the Finance Committee. The Business Committee has remitted the Bill to the Equality, Local Government and Communities Committee. The Bill includes provision which set out the new powers for the Ombudsman to:

    • accept oral complaints
    • undertake own initiative investigations
    • investigate private medical treatment including nursing care in a public/private health pathway
    • undertake a role in relation to complaints handling standards and procedures

     

    Further detail about the Bill can be found in its accompanying Explanatory Memorandum. The Bill is currently at stage 2.

    Autism (Wales) Bill

    http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=19233

    An Assembly Member Bill, introduced by Paul Davies AM was successful in a legislative ballot in March 2017, and given leave to proceed with his Bill by the Assembly in June 2017.

    The Business Committee has remitted the Bill to the Health, Social Care and Sport Committee.

    The overall purpose of the Bill is to ensure the needs of children and adults with Autism Spectrum Disorder in Wales are met, and to protect and promote their rights.  The Bill delivers this purpose by seeking to:

    • Introduce a strategy for meeting the needs of children and adults in Wales with ASD conditions which will:
      • Promote best practice in diagnosing ASD, and assessing and planning for meeting care needs;
      • Ensure a clear and consistent pathway to diagnosis of ASD in local areas;
      • Ensure that local authorities and NHS bodies take necessary action so that children and adults with ASD receive the timely diagnosis and support they need across a range of services;
      • Strengthen support for families and carers and ensure their wishes, and those of people with ASD, are taken into account;
      • Promote research, innovation and improvement in ASD Services;
      • Establish practices to enable the collection of reliable and relevant data on the numbers and needs of children and adults with ASD, so that the Welsh Ministers, and local and NHS bodies can plan accordingly;
      • Ensure key staff working with people with ASD are provided with appropriate ASD training; and
      • Regularly review the strategy and guidance to ensure progress.
    • Require the Welsh Ministers to issue guidance to the relevant bodies on implementing the strategy.
    • Require the Welsh Ministers to collect suitable data to facilitate the implementation of the Bill.
    • Require the Welsh Ministers to undertake a campaign to raise awareness and understanding of ASD.

    Further detail about the Bill can be found in its accompanying Explanatory Memorandum.

    The Bill is currently at stage 1 (consideration of the general principles of the Bill and the agreement of the Assembly to those principles).

    Childcare Funding (Wales) Bill

    http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=21394

    A Welsh Government Bill, introduced by Huw Irranca-Davies AM, Minister for Children, Older People and Social Care. The Business Committee has remitted the Bill to the Children, Young People and Education Committee.

    The Childcare Funding (Wales) Bill (“the Bill”) gives the Welsh Ministers the power to provide funding for childcare for qualifying children of working parents and to make regulations about the arrangements for administering and operating such funding.

    The Bill is intended to facilitate the delivery of a key commitment in the Welsh Labour manifesto ‘Together for Wales 2016’. This is to provide 30 hours per week of government funded early education and childcare to the working parents of three and four year olds in Wales for up to 48 weeks per year (this is referred to in the Explanatory Memorandum accompanying the Bill as ‘the Offer’).

    All eligible 3 and 4-year-old children (from the term after their third birthday) are entitled to a minimum of 10 hours early education per week during term time over 39 weeks of the year. The Offer builds on this universal entitlement and provides up to a total of 30 hours early education and care per week over 48 weeks of the year for the 3 and 4 year olds of working parents.

    The Bill relates to the childcare element of the Offer and is therefore concerned with the funding that will be provided in respect of the eligible children of working parents.

    Further detail about the Bill can be found in its accompanying Explanatory Memorandum.

    The Bill is currently at stage 1 (consideration of the general principles of the Bill and the agreement of the Assembly to those principles).

    Renting Homes (Fees etc…) Wales Bill

    http://www.senedd.assembly.wales/mgIssueHistoryHome.aspx?IId=22120

    A Welsh Government Bill, introduced by Rebecca Evans AM, Minister for Housing and Regeneration. The Business Committee has remitted the Bill to the Equality, Local Government and Communities Committee.

    The Bill includes provision for:

    • prohibiting certain payments made in connection with the granting, renewal or continuance of standard occupation contracts;
    • the treatment of holding deposits.

    Further detail about the Bill can be found in its accompanying Explanatory Memorandum.

    The Bill is currently at stage 1 (consideration of the general principles of the Bill and the agreement of the Assembly to those principles).

    Future and possible Bills (of interest)

    Assembly members have voted to introduce a Welsh Parliament and Elections Bill due to be brought forward in early 2019. The Bill will be designed to change the name of the Assembly to Senedd Cymru/Welsh Parliament; lower the voting age for Assembly elections to 16; amend the law relating to disqualification from being an Assembly Member and make other changes to the Assembly’s electoral and internal arrangements.

    http://www.assembly.wales/en/newhome/pages/newsitem.aspx?itemid=1910&assembly=5

    In the statement on forthcoming legislation 2018/19, the First Minister highlighted:

    • A Bill to remove the defence of reasonable punishment
    • A Bill to improve accessibility of Welsh Law and how it is interpreted
    • A Local Government Bill (lowering the age for elections and a range of other proposals – not ‘wholescale merger’)
    • A Bill to establish an Duty of Quality for the NHS and a Duty of Candour for Health and Social Care, introduce and establish a new independent body to represent the citizen’s voice in health and social care services and will require LHBs to appoint a Vice Chair
    • Ban the use of wild animals in travelling circuses

    Updated October 2018

    Comments Off on ‘LEGISLATION WATCH WALES’ – October 2018

    Tuesday morning was the launch of the Resolution Foundation report, Healthy finances? Options for funding an NHS spending increase – a response to the rumoured government “birthday present” for the NHS as it turns 70 on 5 July 2018.

    The audience included party advisers (I spotted a Whatsapp group chat for a party’s comms team), people from various think-tanks, academics (including an Emeritus Professor from Imperial who had a lot to say), and a representative from at least one (non-militant, at least in the room) campaigning group.

    The line up:

    • Sarah Wollaston MP, Chair of the Health Select Committee and medic who worked as a GP up until 2010. (Given her generally sensible views, I keep having to remind myself that she’s a Tory).
    • Jon Ashworth MP, Shadow Secretary of State for Health, who has a long history as a Labour professional, including as Special Adviser in the Treasury for Gordon Brown.
    • Ben Page, Chief Executive of Ipsos MORI and fellow of the Academy of Social Sciences.
    • Matt Whittaker, Deputy Director at the Resolution Foundation, who previously worked for the House of Commons Library where he provided stats and economics advice.

    The event was chaired by Torsten Bell, Director of the Resolution Foundation, former adviser to Ed Miliband (and, incidentally, architect of the Ed Stone).

    Interlude: What is the Resolution Foundation?

    The launch was set at Resolution HQ in a bright, wide room, with cosy luxurious seats which wouldn’t be out of place in an up-market indie cinema, so I was curious who they are and how it’s all funded.

    Resolution Foundation’s website describes it as “a non-partisan and award-winning think-tank that works to improve the living standards of those in Britain on low to middle incomes.” In their most recent annual report, they defined “low to middle” as those in income deciles 2 to 5, whom they say are overlooked in policy debates. Their focus is on working households.

    They receive most of their funding via donations from Resolution Trust, founded by Clive Cowdery with a £50m donation, “believed to be one of the largest endowments for public policy research made in the UK”.

    Cowdery made his wealth from “sponsoring insurance vehicles” (an FT article says more) and is also founder of financial services investment firm called (again) Resolution.

    Resolution Trust backs Prospect Magazine and, intriguingly, WorkerTech, which seems to be about encouraging alternatives to trade unions for the precarious world of Uberified work. (Here are slides from its launch.)

    What did they say on health funding?

    All agreed that the NHS needs more funding, so the question is how much more funding and where the money is coming from. The issue was framed as a tug-of-war between Treasury and Jeremy Hunt (with Hunt wanting more money, in case not clear – it’s not always obvious), constrained by a complex parliament and a wish to keep voters happy.

    Matt Whitaker took us through some headlines from the Resolution report, emphasising that it was a prediction of what the government was likely to announce rather than what it should do. (Though it sounded very much like advice.)

    Borrowing was seen as likely necessary, so long as the total was below 2% of the projected GDP in 2020-21 (to meet a Tory fiscal target). But borrowing alone would not suffice, so some sort of tax raise is almost certainly on the cards – the problem is how to keep keep Tory voters and donors on side, whilst getting it through parliament.

    One possibility is increasing National Insurance contributions (or NICs, pronounced “nicks”), which Gordon Brown did when he was chancellor. This is a progressive tax for workers; however, increased NICs was seen by the report authors as “unfair from a generational perspective” since older people who rely more on healthcare don’t pay national insurance (this generational perspective might need some analysis). A solution proposed was to extend NICs to include those above state pension age who are still working.

    Increasing income tax could be another way to get the money. LibDems and SNP might support this, and Scotland recently introduced a change to its tax bands meaning some pay more and others pay less tax. Labour, the authors argue, would likely oppose increases for anyone earning under £80k and some Tory MPs might oppose too.

    Another approach suggested was to adjust thresholds for (i) when income tax is payable and (ii) the higher rate of payment. Threshold changes were Tory manifesto promises, but the authors suggest a fiddle (p. 24):

    “An alternative approach would be to lift the Income Tax thresholds to those pledged in the manifesto in 2020-21, but to freeze both them and the NICs thresholds in the final two years of the parliament. This would of course cost money in 2020-21, but by 2022-23 it would raise £3.7 billion relative to the default of uprating in line with inflation every year.”

    Another promising source of funding would come from reversing George Osborne’s 2016 pledge to cut corporation tax by 2020. This tax uncut could provide £5.2 billion in 2020-21 and £5.7 billion by 2022-23. Other political parties would likely support the move and the authors argue (p. 27):

    “The Chancellor might also feel emboldened to act given the way in which the estimated costings of the move from 19 per cent to 17 per cent have shifted since George Osborne first announced it.”

    Remarkably little was said about Brexit. Will it torpedo all the projections and render the suggestions (sorry, predictions?) unimplementable? The exception was Sarah Wollaston, who noted that she never believed the infamous £350m bus claim; she expressed reasonable worries about the effects Brexit would have.

    What might more money mean for mental health?

    Although the focus was very much top-level – where’s the money? – speakers did say a little about how it should be spent. For instance, Jon Ashworth quoted numbers on additional doctors and nurses required (it’s thousands), citing a report from IFS – also cited by Sarah Wollaston.

    Reassuringly, mental healthcare was mentioned a few times as being important and in need of improvement (though note the history of “warm words”). Ben Page cited public support for increased spending, with mental health being second on the list in an April Ipsos MORI survey of priorities, after Accident and Emergency. Jon Ashworth mentioned improving support for addictions, in particular.

    Sarah Wollaston cited the Health and Social Care Committee’s report into integrated care, published yesterday, which discusses detailed contractual changes needed to improve how, e.g., mental healthcare integrates with other services, including discussion of accountable care organisations (ACOs). (Perusing this report just now highlights how difficult it is to have public debates on these issues – it’s technical stuff.)

    The coming weeks as we approach July 5th would be a good time to campaign for key specifics on how much money mental healthcare should receive and what it should be spent on. If the NHS received £20 billion more in 2022-23, how much should go to mental health and where?

    First published on Andy Fugard’s blog

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    Mean societies produce mean people

    Babies haven’t changed much for millennia. Give or take a few enzymes this perfectly designed little bundle of desires and interests has not needed to evolve much. Of all primates, the human is the most immature at birth, after which brain growth accelerates and is ‘wired’ according to the kinds of experience the infant has. Provided there are a few familiar and affectionate people there to care continuously for him or her, baby will be fine. If not, evolution has taken care of that too. You live in a cruel world and treat him roughly? He will develop into a compulsively self-reliant and ruthless individual with little concern for others. Mean societies produce mean people. Through attentive care in the early years we may hope to produce thoughtful, curious and confident young people but our social arrangements are essentially hostile and competitive. Having a baby is regarded as an expensive undertaking rather than as a contribution to the future of society.

    Encouraged by successive governments our world is geared to markets. “It’s the economy, stupid” means you can’t do anything without considering the immediate cost. The more this idea takes hold the stupider we become. The current government’s dedication to continuous welfare cuts hits children disproportionately. Neoliberalism is the enemy of children.

    Evolutionary imperatives

    This is not the environment in which humans evolved. An infant in a hunter-gatherer band – the way we all lived for 99% of our time on the planet – would have spent many hours being held, and not only by the mother. “Infants with several attachment figures grow up better able to integrate multiple mental perspectives”. We are programmed from the start to seek out third positions, to acquire the “capacity for seeing ourselves in interaction with others and for entertaining another point of view whilst retaining our own, for reflecting on ourselves whilst being ourselves.”

    Systematic comparisons between sedentary foraging and farming people living now in neighbouring parts of the Congo basin show how much more egalitarian the foragers are. Men and women see themselves as equal. They hold and converse with their tiny children more intensively, they let the baby decide when to wean and teach them to share from an early age. Violence is rare, though teasing is common. Such children are more socialised than in the west and at the same time protected from catastrophe in the event of the mother’s death. Amongst the farmers, in contrast, “corporal punishment is not an uncommon response for young children who do not listen to or respect their parents or older siblings”.

    In the modern world little public money is available for perinatal services, parental leave, for quality child care and universal education, affordable and secure homes, healthy food, subsidised transport and energy, sports fields, swimming pools, libraries, parks and playgrounds that make rearing children and adolescents more manageable and more successful. Tax, like children, is seen as a ‘burden’. So governments of all parties sign up to reducing it, yet still find money for bank bailouts and unsustainable wars. Whether local or national, tax should be a contribution to the common good, an instrument of social justice. It is collected from citizens, for citizens. In the current climate this equation is neither acknowledged nor understood. Yet something has been understood that was not clear before. There is a greater recognition that early intervention is a good idea: “the brain can be sculpted by experience”; the sooner the better.

    Start at the beginning

    When a woman becomes pregnant her physical and mental states impact on her child. From conception onwards the health and resilience of children – and the adults they will become – is compromised by stress, diet, maternal weight, drugs, genes and insecurity in their parents. Besides the impact on the mother herself, anxiety and depression during pregnancy and after it have significant long term effects on the child’s physical and mental health – particularly on boys – generating huge social costs. Pregnancy is a dangerous time for some women. The most socially deprived mothers are more likely to have very premature births or perinatal death. Low birthweight leads to poor outcomes; early intervention can reduce that.

    Elegant research shows how already by a few months old babies are engaged in triadic relationships; they are affected by tensions between the adults caring for them. When caregivers are uncooperative infants may be “enlisted to serve the parents’ problematic relationship rather than to develop their own social competence”. Children will more likely thrive if caregivers – parents and grandparents, childminders, daycare and children’s centre staff, nursery teachers – get on with one another, like a good team. “Communication between parents and care providers is crucial to the quality of care.”

    The routine availability and presence of health visitors and other staff supporting new parents and of Sure Start centres for children and families create the conditions for reliable care of children. In a context of skilled early years provision, infants whose parents are paid to spend time with them in the early months are less likely to die. “A ten week extension in paid leave is predicted to decrease post neonatal mortality rates by 4.1%”. This remarkable finding represents just the tip of an iceberg of developmental damage and pathology, modifiable by intensive early support for families.

    Better training and pay for early years staff improves outcomes and reduces turnover. UK needs to learn from continental Europe the tradition of pedagogic professions: proper pay, status and training for the job, particularly when the families most in need are hard to engage. Looking after small children is demanding and stressful, requiring continuous professional development such as reflective discussion groups in which colleagues both support and learn from each other. Work with young families is a professional skill.

    Inequality undermines trust

    A collaborative partnership between caregivers does not in itself cost money, but is undermined by social disintegration, the most poisonous source of which is rising inequality. In Britain this has reached levels not seen since the 1920s. The much maligned 1970s was actually the most egalitarian in our history. Consider this: one index of social health is the number of boys born in comparison to girls. Because the male fetus is more vulnerable to maternal stress, women produce fewer boys when times are hard. (For example there is a fall in the ratio of boys to girls a few months after disasters such as massive floods or earthquakes, or the terrorist attack on 9/11). In England and Wales the highest ratio of boys to girls occurred in 1975. In terms of contented mothers it was the best of times.

    Inequality creates stress in parents who can’t keep up, and anxiety in the better off who fear sliding down. No one is comfortable on a steep slope. It makes all of us less trusting and more averse to communal commitments, such as respecting our neighbours and paying tax. Infant mortality, mental illness, drug abuse, dropping out of education, rates of imprisonment, obesity, teenage births and violence are all higher in unequal countries like ours.

    Though often disappointed, our ancient baby is born to expect some kind – a rather conservative kind – of socialism. What will today’s infants be talking about in 2050? If they know any history they will regret lost opportunities; our collective loss of vision that led to wasted generations. The success of the post war consensus was due in part to the fact that it lasted longer than one or two parliamentary terms, so that children could grow up, get educated and housed, find partners, get work and free healthcare without overwhelming instability or despair. The needs of a baby born today are precisely what they were for one born in the 1950s, or 50,000 years ago. New knowledge of infant development is catching up with evolved wisdom, yet we continue to ignore both, and build bigger obstacles to secure attachments.

     

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    ‘U-turn’, ‘Fiasco’, ‘Chaos’ – Personal Independence Payment (PIP) has been back in the news at the start of 2018 and the headlines don’t make good reading for the government. Back in March 2017, the government changed the eligibility criteria for the mobility component of PIP to exclude claimants experiencing ‘psychological distress’ from receiving the enhanced rate of the benefit. However, the High Court found that the government’s amendments ‘were blatantly discriminatory against those with mental health impairments and cannot be objectively justified, and concluded that ‘the wish to save nearly £1 billion a year at the expense of those with mental health impairments is not a reasonable foundation for passing this measure.’

    The government decided not to challenge the High Court’s decision and now need to undertake a review of 1.6 million claims made for PIP over the last four years at an estimated cost of £3.7bn. It is understood that the review could take up to five years and result in 220,000 claimants receiving higher awards. What, then, does this recent development tell us about the adjudication of disability benefits for people with mental health problems? More broadly, what does it tell us about the ideology and administration that underpins PIP?

    Personal Independence Payments and mental health

    PIP was launched by the coalition government in April 2013 and was intended to assist claimants of working age with the costs associated with disability or long-term health conditions. The government argued that by replacing Disability Living Allowance, PIP would provide more targeted support for those in genuine need with decisions based on medical evidence. Initially, it was anticipated that the full roll-out of PIP would result in 600,000 fewer disability benefit claimants and annual savings of £2.5 billion. Analysis shows there are likely to be ‘winners’ and ‘losers’ from the new PIP regime, but this is difficult to accurately assess because the government has changed the timescales for its implementation and the standards for qualification.

    The uncertainties created by the transition to PIP are a real issue for many people with mental health problems. It is not unreasonable for someone with mental health problems to ask, ‘Am I likely to get PIP?’ or ‘When will I have to go for a PIP assessment?’ At the moment, the system is so fraught with uncertainties and inconsistencies that these are very difficult questions to answer. And surely the whole point of a social security system is to provide some security for claimants.

    I am in the early stages of a research project exploring the impact of the rollout of PIP and claimants with mental health problems have repeatedly told me that their mental health has been negatively impacted by the unpredictability of the system. Consider the following timeline of events over the last 12 months:

    • 23 February 2017: Department for Work and Pensions lays regulations before parliament that amend the eligibility criteria for the mobility component of PIP for those unable to undertake journeys due to psychological distress. It is estimated that this change would result in nearly 300,000 people no longer being entitled to the mobility part of PIP and will affect people with a range of conditions including schizophrenia and anxiety conditions. The government state that this amendment is necessary to restore the original aims of PIP.
    • 21 December 2017: The High Court found that the government’s amendments amount to direct discrimination against those with mental health impairments and the policy intention to save money was based on an untestable hypothesis about levels of need.
    • 19 January 2018: New Department for Work and Pensions Secretary Esther McVey states that the government will not challenge the High Court decision and a review of 1.6 million claims for PIP will be undertaken.

    A charitable view of this timeline would be of the government and judiciary applying scrutiny to a new benefit in order to get things right. However, the impact on claimants, particularly those with mental health problems, is often damaging. Not surprisingly, the second independent review of PIP completed by Social Security Advisory Committee chairman Paul Gray and published in March 2017 described an ‘inherent distrust’ in the system by claimants. This means that a benefit system which should provide a safety net is, in fact, exacerbating anxiety for those living with mental health problems.

    Criticism of the UK disability benefits system has also come from the UN Committee on the Rights of Persons with Disabilities, which found in 2016 that ‘there is reliable evidence that the threshold of grave or systematic violations of the rights of persons with disabilities has been met in the State party’. The committee recommended that the UK government should improve the administration of disability benefits and make it more accessible for disabled people.

    Delayed implementation and chaotic administration

    It should be acknowledged that designing and administering a disability benefit is not an easy task and this is underscored by the fact that few other countries have a comparable benefit to PIP. The eligibility criteria for PIP focuses on claimant’s ‘limited ability’ in relation to mobility and a range of daily living activities. This, in itself, seems reasonable, but as with all social security, the devil is in the details. Unfortunately, with PIP, the details seem to have focused on saving money and reducing the number of claimants.

    The government appear to have overlooked the fact that the needs of disabled people don’t vanish because tighter benefit rules are introduced. This is important as the concessions that the government have been pressed into making are largely because claimants and disability campaigners have been able to clearly demonstrate (often through the tribunal and court system) that significant elements of PIP are not fit for purpose. An ill-conceived policy that seeks to save money invariably ends with compromise and additional cost that was not initially intended. It will be interesting to see to what extent the government’s initial forecast in terms of expected savings and number of claimants has changed once its review of PIP claims is complete.

    The government’s intention was that PIP would create a more fair and objective assessment of need. However, from the early stages of the rollout of this benefit, there has been intense criticism of the assessment and adjudication process. Early concerns were voiced by the National Audit Office and the Work and Pensions Committee about unacceptable delays in the decision-making process. While there have been some improvements in this area, the second Gray review of PIP found that administrative processes need to be significantly improved. This should include improvements to the way evidence is obtained and the need ‘to broaden audit and quality assurance in assessment and decision-making.’ For many claimants, the experience of the PIP assessment process can be as damaging as the final decision that is made, with many reporting cancelled appointments, rushed assessments and a lack of understanding of individual conditions and resulting need. As with other areas of policy, the appropriateness of the involvement of private contractors (ATOS and Capita) has been questioned.

    We should also recognise that public and judicial pressure are not the only reasons for the government U-turn on PIP. The challenges that the government face with the Brexit negotiations mean they must choose their domestic battles wisely and it seems that a fight over PIP was a step too far for Theresa May. (Remember, this is a Prime Minister who chose social justice as one of the central themes of her maiden speech.) While campaigners and social policy academics will rightly welcome the government climb-down on PIP, we must not forget that this creates yet more uncertainty for disability benefit claimants. Rather than a system underpinned by a fiscally-driven ideology, shaped by short-term political considerations and delivered in a chaotic manner, what we really need is a ‘real-world assessment’ of disability and a benefit which appropriately meets the needs of claimants.

    First published by the Social Policy Association

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