Category Archives: NHS Hospitals

Jeremy Corbyn wrote a long letter to Boris Johnson on 31st March.
As well as wishing him a speedy recovery, Jeremy made some strong points about aspects of the current crisis, and asked for immediate action on:

  • Full PPE now for Health and social Care workers
  • Test Test Test
  • Expand Social Care
  • Enforce Social-distancing and Protection
  • Bolster Support for Workers
  • Lead a Global Reponse

(the 4  pages of the letter are attached)

Posted by Jean Smith on behalf of SHA member Diane Jones.

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COVID-19 and the NHS – “a national scandal”, comments the Lancet.

“The gravity of that scandal has yet to be understood.” Reports Richard Horton in the Lancet 28 March 2020 :

“When this is all over, the NHS England board should resign in their entirety.” So wrote one National Health Service (NHS) health worker last weekend. The scale of anger and frustration is unprecedented, and coronavirus disease 2019 (COVID-19) is the cause. The UK Government’s Contain–Delay–Mitigate–Research strategy failed. It failed, in part, because ministers didn’t follow WHO’s advice to “test, test, test” every suspected case. They didn’t isolate and quarantine. They didn’t contact trace. These basic principles of public health and infectious disease control were ignored, for reasons that remain opaque. The UK now has a new plan—Suppress–Shield–Treat–Palliate. But this plan, agreed far too late in the course of the outbreak, has left the NHS wholly unprepared for the surge of severely and critically ill patients that will soon come.”

Please read the full article here. You can download the pdf at this link.
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The Socialist Health Association (SHA) published its first Blog on the COVID-19 pandemic last week (Blog 1 – 17th March 2020). A lot has happened over the past week and we will address some of these developments using the lens of socialism and health.

  1. Global crisis

This is a pandemic, which first showed its potential in Wuhan in China in early December 2019. The Chinese government were reluctant to disclose the SARS- like virus to the WHO and wider world to start with and we heard about the courageous whistle blower Dr Li Wenliang, an ophthalmologist in Wuhan, who was denounced and subsequently died from the virus. The Chinese government recognised the risk of a new SARS like virus and called in the WHO and announced the situation to the wider world on the 31st December 2019.

The starter pistols went off in China and their neighbouring countries and the risk of a global pandemic was communicated worldwide. The WHO embedded expert staff in China to train staff, guide the control measures and validate findings. Dr Li Wenliang who had contracted the virus, sadly died in early February and has now been exonerated by the State. Thanks to the Chinese authorities and their clinical and public health staff we have been able to learn about their control measures and the clinical findings and outcomes in scientific publications. This is a major achievement for science and evidence for public health control measures but….

Countries in the Far East had been sensitised by the original SARS-CoV outbreak, which originated in China in November 2002. The Chinese government at that time had been defensive and had not involved the WHO early enough or with sufficient openness. The virus spread to Hong Kong and then to many countries showing the ease of transmission particularly via air travel. The SARS pandemic was thankfully relatively limited leading to global spread but ‘only’ 8,000 confirmed cases and 774 deaths. This new Coronavirus COVID-19 has been met by robust public health control measures in South Korea, Taiwan, Hong Kong, Japan and Singapore. They have all shown that with early and extensive controls on travel, testing, isolating and quarantining that you can limit the spread and the subsequent toll on health services and fatalities. You will notice the widespread use of checkpoints where people are asked about contact with cases, any symptoms eg dry cough and then testing their temperature at arms length. All this is undertaken by non healthcare staff. Likely cases are referred on to diagnostic pods. In the West we do not seem to have put much focus on this at a population level – identifying possible cases, testing them and isolating positives.

To look at the global data the WHO and the John Hopkins University websites are good. For a coherent analysis globally the Tomas Peoyu’s review  ‘Coronavirus: The Hammer and the dance’ is a good independent source as is the game changing Imperial College groups review paper for the UK Scientific Advisory Group for Emergencies (SAGE). This was published in full by the Observer newspaper on the 23rd March. That China, with a population of 1.4bn people, have controlled the epidemic with 81,000 cases and 3,260 deaths is an extraordinary achievement. Deaths from COVID-19 in Italy now exceed this total.

The take away message is that we should have acted sooner following the New Year’s Eve news from Wuhan and learned and acted on the lessons of the successful public health control measures undertaken in China and the Far East countries, who are not all authoritarian Communist countries! Public Health is global and instead of Trump referring to the ‘Chinese’ virus he and our government should have acted earlier and more systematically than we have seen.

Europe is the new epicentre of the spread and Italy, Spain and France particularly badly affected at this point in time. The health services in Italy have been better staffed than the NHS in terms of doctors/1000 population (Italy 4 v UK 2.8) as well as ITU hospital beds/100,000 (Italy 12.5 v UK 6.6). As we said in Blog 1 governments cannot conjure up medical specialists and nurses at whim so we will suffer from historically low medical staffing. The limited investment in ITU capacity, despite the 2009 H1N1 pandemic which showed the weakness in our system, is going to harm us. It was great to see NHS Wales stopping elective surgical admissions early on and getting on with training staff and creating new high dependency beds in their hospitals. In England elective surgery is due to cease in mid April! We need to ramp up our surge capacity as we have maybe 2 weeks at best before the big wave hits us. The UK government must lift their heads from the computer model and take note of best practice from other countries and implement lockdown and ramp up HDU/ITU capacity.

In Blog 1 we mentioned that global health inequalities will continue to manifest themselves as the pandemic plays out and spare a thought for the Syrian refugee camps, people in Gaza, war torn Yemen and Sub Saharan Africa as the virus spreads down the African continent. Use gloves, wash your hands and self isolate in a shanty town? So let us not forget the Low Middle Income Countries (LMICs) with their weak health systems, low economic level, weak infrastructure and poor governance. International banking organisations, UNHCR, UNICEF, WHO and national government aid organisations such as DFID need to be resourced and activated to reach out to these countries and their people.

  1. The public health system

We are lucky to have an established public health system in the UK and it is responding well to this crisis. However we can detect the impact of the last 10 years of Tory Party austerity which has underfunded the public health specialist services such as Public Health England (PHE) and the equivalents in the devolved nations, public health in local government and public health embedded in laboratories and the NHS. PHE has been a world leader in developing the PCR test on nasal and throat samples as well as developing/testing the novel antibody blood test to demonstrate an immune response to the virus. The jury is out as to what has led to the lack of capacity for testing for C-19 as the UK, while undertaking a moderate number of tests, has not been able to sustain community based testing to help guide decisions about quarantining key workers and get intelligence about the level of community spread. Compare our rates of testing with South Korea!

We are lucky to have an infectious disease public health trained CMO leading the UK wide response who has had experience working in Africa. Decisions made at COBRA and announced by the Prime Minister are not simply based ‘on the science’ and no doubt there have been arguments on both sides. The CSO reports that SAGE has been subject to heated debate as you would expect but the message about herd immunity and stating to the Select Committee that 20,000 excess deaths was at this stage thought to be a good result was misjudged. The hand of Dominic Cummings is also emerging as an influencer on how Downing Street responds. Remember at present China with its 1.4bn population has reported 3,260 deaths. They used classic public health methods of identifying cases and isolating them and stopping community transmission as much as possible. Herd immunity and precision timing of control measures has not been used.

The public must remain focused on basic hygiene measures – self isolating, washing of hands, social distancing and not be misled about how fast a vaccine can be developed, clinically tested and manufactured at scale. Similarly hopes/expectations should not be placed on novel treatments although research and trials do need supporting. The CSO, who comes from a background in Big Pharma research, must be seen to reflect the advice of SAGE in an objective way and resist the many difficult political and business pressures that surround the process. His experience with GSK should mean that he knows about the timescales for bringing a novel vaccine or new drugs safely to market.

  1. Local government and social care

Local government (LAs) has been subject to year on year cuts and cost constraints since 2010, which have undermined their capability for the role now expected of them. The budget did not address this fundamental issue and we fully expect that in the crisis, central government will pass on the majority of local actions agreed at COBRA to them. During the national and international crisis LAs must be provided with the financial resources they need to build community hubs to support care in the community during this difficult time. The government need to support social care.

COVID-19 is particularly dangerous to our older population and those with underlying health conditions. This means that the government needs to work energetically with the social care sector to ensure that the public health control measures are applied effectively but sensitively to this vulnerable population. The health protection measures which have been announced is an understandable attempt to protect vulnerable people but it will require community mobilisation to support these folk.

Contingency plans need to be in place to support care and nursing homes when cases are identified and to ensure that they can call on medical and specialist nursing advice to manage cases who are judged not to require hospitalisation. They will also need to be prepared to take back people able to be discharged from acute hospital care to maintain capacity in the acute sector.

Apart from older people in need there are also many people with long term conditions needing home based support services, which will become stressed during this crisis. There will be nursing and care staff sickness and already fragile support systems are at risk. As the retail sector starts to shut down and there is competition for scarce resources we need to be building in supply pathways for community based people with health and social care needs. Primary health care will need to find smart ways of providing medical and nursing support.

  1. The NHS

In January and February when the gravity of the COVID pandemic was manifesting itself many of us were struck by the confident assertion that the NHS was well prepared. We know that the emergency plans will have been dusted down and the stockpile warehouses checked out. However, it now seems that there have not been the stress tests that you might have expected such as the supply and distribution of PPE equipment to both hospitals and community settings. The planning for COVID-19 testing also seems to have badly underestimated the need and we have been denied more accurate measures of community spread as well as the confirmation or otherwise of a definite case of COVID-19. This deficiency risks scarce NHS staff being quarantined at home for non COVID-19 symptoms.

The 2009 H1N1 flu pandemic highlighted the need for critical care networks and more capacity in ITU provision with clear plans for surge capacity creating High Dependency Units (HDUs) including ability to use ventilators. The step-up and step-down facilities need bed capacity and adequate staffing. In addition, there is a need for clarity on referral pathways and ambulance transfer capability for those requiring even more specialised care such as Extracorporeal Membrane Oxygenation (ECMO). The short window we now have needs to be used to sort some of these systems out and sadly the supply of critical equipment such as ventilators has not been addressed over the past 2 months. The Prime Minister at this point calls on F1 manufacturers to step in – we wasted 2 months.

News of the private sector being drawn into the whole system is obviously good for adding beds, staff and equipment. The contracts need to be scrutinised in a more competent way than the Brexit cross channel ferries due diligence was, to ensure that the State and financially starved NHS is not disadvantaged. We prefer to see these changes as requisitioning private hospitals and contractors into the NHS. 

  1. Maintaining people’s standard of living

We consider that the Chancellor has made some major steps toward ensuring that workers have some guarantees of sufficient income to maintain their health and wellbeing during this crisis. Clearly more work needs to be done to demonstrate that the self-employed and those on zero hours contracts are not more disadvantaged. The spotlight has shown that the levels of universal credit are quite inadequate to meet needs so now is the time to either introduce universal basic income or beef up the social security packages to provide a living wage. We also need to ensure that the homeless and rootless, those on the streets with chronic mental illness or substance misuse are catered for and we welcome the news that Sadiq Khan has requisitioned some hotels to provide hostel space. It has been good to see that the Trade Unions and TUC have been drawn into negotiations rather than ignored.

In political terms we saw in 2008 that the State could nationalise high street banks. Now we see that the State can go much further and take over the commanding heights of the economy! Imagine if these announcements had been made, not by Rishi Sunak, but by John McDonnell! The media would have been in meltdown about the socialist take over!

  1. Conclusion

At this stage of the pandemic we note with regret that the UK government did not act sooner to prepare for what is coming both in terms of public health measures as well as preparing the NHS and Local Government. It seems to the SHA that the government is playing catch up rather than being on the front foot. Many of the decisions have been rather late but we welcome the commitment to support the public health system, listen to independent voices in the scientific world through SAGE and to invest in the NHS. The country as a whole recognises the serious danger we are in and will help orchestrate the support and solidarity in the NHS and wider community. Perhaps a government of national unity should be created as we hear much of the WW2 experience. We need to have trust in the government to ensure that the people themselves benefit from these huge investment decisions.

24th March 2020

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20/03/2020

 

OPEN LETTER TO THE PRIME MINISTER FROM THE SOCIALIST HEALTH ASSOCIATION

Dear Mr Johnson,

The pandemic has exposed the steady destruction of our public services and welfare state which has happened over the last 10 years.

This is the most unprecedented health challenge in 100 years which is complex and difficult – but as voiced by many experts in the field, we have significant concerns about the way the UK government has hitherto been approaching this national emergency. We hope from now on this will be better co-ordinated. We support frontline staff at this worrying time.

However the public is finally waking up to the fact that, as a result of government austerity and privatisation policies, we are ill-prepared – with too few ICU facilities, NHS beds, healthcare staff and equipment – to offer a safe and effective response to the virus. Those most at risk also have to use a threadbare social care system which is already bending under the strain.

The UK should be in a relatively strong position on public health with a comprehensive service, considered one of the best in the world. However, Tory reforms in England destroyed the health authority structure below national level and has slashed budgets but at least Public Health England has a regional organisation and Local Government have Directors of Public Health. We wish to make some key points:

  1. You are placing staff at risk

There is not enough personal protective equipment (PPE) for clinicians/frontline staff who are now personally at risk every time they go to into work.

There is insufficient testing of staff who, having been put off work with minor illness and then return to the front line, do not know whether they have had the virus or not.

  1. You are placing patients at risk

There are too few beds and too few trained intensive care staff and equipment such as respirators. The government appears to have acted too late. We should be requisitioning beds from the private sector, not paying them £2.4 million a day.

Covid-19 testing has been wholly inadequate. It appears that a combination of inadequate preparation and misguided policy is responsible.

  1. You are placing communities at risk

Undocumented people, for instance migrants and refugees, have long felt unable to use the NHS for fear of being referred to the police or the Home Office. This will increase risk. Legislate on charging and reporting undocumented migrants must at least be suspended.

Those precariously employed, particularly gig economy workers, are still not financially protected and may be compelled to continue working inadvertently spreading infection.

Thousands of excess deaths have occurred in the last few years as a result of the slowdown and reversal in life expectancy. Austerity policies have been a significant cause. It confirms international evidence that cutting the welfare state while at the same time introducing austerity, kills people.

This pandemic is likely to add to that grotesque toll.

  1. You are placing the NHS at risk

Government policy has split hospitals from general practices and from each other. It has created an industrial approach to care where staff and patients are increasingly seen as economic units. The newest redisorganisation has opened up the English NHS planning process to the private sector and to the US, especially if we have a trade deal. In addition, it has the potential to split the English NHS into 44 independent units – exactly what we do not want as we fight a global pandemic. If your government’s Long-Term Plan had already been fully implemented doing exactly that, we would not have been capable of a well-coordinated national response to the Covid-19 crisis.

  1. You are placing Social Care at risk

Too little funding for Local Authorities has put social care on life support. Those most at risk receiving personal or residential care appear to receive the least advice and the least support to combat the virus. Those with Direct Payments, organising their own care with Local Authority funding, appear to be entirely on their own if their carers get ill.

  1. You are placing democracy at risk

The most recent reorganisation of the NHS has made both formal and informal democracy more difficult. Just when we need all communities to collaborate and contribute to responding to this global challenge, NHS organisations have become more distant and poorly responsive.

It has been frustrating and confusing to have changing government advice without any formal presentation of the data and evidence behind it. It was patronising and did not inspire confidence.

 

WE EXPECT YOUR GOVERNMENT TO:

  • Treat us like adults – show us the evidence on which you base your decisions
  • Protect frontline staff right now with clinically appropriate protective gear and systematic testing. Bring testing in line with the WHO recommendations.
  • Protect the population of the UK by permanently increasing NHS staff in hospitals and primary care, increasing hospital beds, increasing respirators.
  • Roll back privatisation and austerity across public services.
  • Seize the opportunity of this pandemic to invest for the long-term in the welfare state, recognising that a thriving society requires a thriving state.
  • Suspend now legislation on the charging and reporting of undocumented migrants.
  • Invest permanently in social care, making it free at the point of use, fully funded through progressive taxation, promoting independence for all and delivered by a workforce with appropriate training, career structure, pay and conditions.
  • Protect those in precarious employment from financial meltdown from the pandemic. All those who should not be at work should have an living income.
  • Ensure that people across the UK have equitable access to the help they need, through their Devolved Administrations
  • Review the Long Term Plan

 

Faced with this international emergency, we need to combine medical expertise – including support from abroad, with technical investment with practical solutions and community engagement along with emergency economic measures to fight this together.

 

Chair SHA

Dr Brian Fisher, London

Vice-chairs SHA

Dr Tony Jewell

Tony Beddow, Swansea

Norma Dudley, London

Mark Ladbrooke, Oxford

Secretary

Jean Hardiman Smith, Ellesmere Port

Treasurer

Irene Leonard, Liverpool

Co-Chair KONP

Dr Tony O’Sullivan, London

 

Co-signatories

Dr John Carlisle, Sheffield.

Terry Day, London

Carol Ackroyd, London

Corrie Louise Lowry, Wirral

Caroline Bedale, Oldham

Hazel Brodie, Dumfries

David Taylor-Gooby, Newcastle

Peter Mayer, Birmingham

Dr Alex Scott-Samuel, Liverpool

Dr Jane Roberts, London

Dr Judith Varley, Birkenhead

Vivien Giladi, London

John Lipetz, London

Jane Jones, Abergavenny

Dr Kathrin Thomas, Llandudno

Dr Louise Irvine, London

Dr Jacky Davis, London

Dr Coral Jones, London

Dr Nick Mann, London

Dr John Puntis, Leeds

Brian Gibbons, Swansea

Anya Cook, Newcastle,

Alison E. Scouller, Cardiff

Punita Goodfellow, Newcastle upon Tyne

Parbinder Kaur, Smethwick

Gurinder Singh Josan CBE,  Sandwell

Jos Bell, London.

Steve Fairfax Chair SHA NE, Newcastle upon Tyne

 

The Socialist Health Association is a policy and campaigning campaigning membership organisation. We promote health and well-being and the eradication of inequalities through the application of socialist principles to society and government. We believe that these objectives can best be achieved through collective rather than individual action.

4 Comments

 

Make the UK the safest place world to have a baby!

Why is the UK still not in the top ten countries for infant mortality and for maternal deaths? Why? We are a rich country. We have an established high-quality health service. Healthcare is supposed to be accessible to all. How come babies and mothers die or are badly hurt at birth? How come Black and Ethnic minority babies suffer most? Why do poor areas have worse outcomes than wealthy areas? Why is infant mortality rising? (The infant mortality rate is the number of children that die under one year of age in a given year, per 1,000 live births. The neonatal mortality rate is the number of children that die under 28 days of age in a given year, per 1,000 live births. These are both common measures of health care quality, but they are also influenced by social, economic and environmental factors). Are there fundamental problems with core policy documents like the maternity review “Better births”? These are painful questions.

Our campaign wants real improvements for mothers and babies. This posting is not intended as a clinical paper, it is a discussion amongst activists and concerned citizens about where the problems lie. A key set of participants in this discussion are mothers who have given birth, including those who have lost babies, grandmothers and other birth partners, and women who could not conceive.

Our campaign published our Maternity Manifesto during the election but though well shared on Facebook, it did not get into any parties’ manifesto.

We also called a national meeting on issues in maternity care.

What then are the factors that result in UK outcomes at birth worse than other advanced countries?

The answers include shortage of NHS funding, staffing shortages, poor management in some hospitals, staff in fear of speaking out, some policies and procedures, disrespect towards the women carrying the baby, and, as cited in the East Kent enquiry, a lack of practical understanding by staff and by mums of the need to “count the kicks” in the latter part of pregnancy. The introduction of charges for migrant women has also caused deaths. NHS material seems to centre the cause on mothers who smoke, or who are overweight. (Now smoking in pregnancy is plain stupid, it really is, and most mums would not do so if they were not addicted. Don’t do it!). However, other countries, Greece for example, who smoke more, have better outcomes in pregnancy than does the UK. Wider problems like obesity and diabetes, and even women giving birth older, are mentioned in the literature about this. Again, the age of the mother as a factor, but this is only partly true. Giving birth older is often safer than giving birth too young. Globally it is most often young girls who die in childbirth.

Answers may lie in the financially and emotionally vulnerable place that pregnant women occupy in our society, including poverty, violence and stress. Poverty and inequality are factors in infant mortality; “The sustained and unprecedented rise in infant mortality in England from 2014 to 2017 was not experienced evenly across the population. In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100 000 live births per year (95% CI 6 to 42), relative to the previous trend. There was no significant change from the pre-existing trend in the most affluent local authorities. As a result, inequalities in infant mortality increased, with the gap between the most and the least deprived local authority areas widening by 52 deaths per 100 000 births (95% CI 36 to 68). Overall from 2014 to 2017, there were a total of 572 excess infant deaths (95% CI 200 to 944) compared with what would have been expected based on historical trends. We estimated that each 1% increase in child poverty was significantly associated with an extra 5.8 infant deaths per 100 000 live births (95% CI 2.4 to 9.2). The findings suggest that about a third of the increases in infant mortality between 2014 and 2017 can be attributed to rising child poverty (172 deaths, 95% CI 74 to 266).” (Our bold for emphasis).

The UK is a rich advanced country, with a long history of universal healthcare but we have rising infant mortality. “Rising infant mortality is unusual in high-income countries, and international data show that infant mortality has continued to decline in most rich countries in recent years” and “In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100,000 live births per year, relative to the previous trend“.

Poverty is not the sole cause of high Infant Mortality though, Cuba has good outcomes equal to the UK for infant mortality. Cuba is very poor indeed and the UK is one of the wealthiest economies (sadly Cuba does less well on maternal deaths).  

Research shows out of 700,000 births a year in England and Wales, around 5,000 babies are stillborn or die before they are a month old”. 5,000 babies each year. There have been major news stories about baby deaths in many hospitals, notably in ShropshireEast Kent and Morecombe Bay.

Maternal deaths. The UK is not in the top ten countries with the lowest infant mortality rate, neither is it the safest place to give birth. In 2015-17“209 women died during or up to six weeks after pregnancy, from causes associated with their pregnancy, among 2,280,451 women giving birth in the UK. 9.2 women per 100,000 died during pregnancy or up to six weeks after childbirth or the end of pregnancy.” In 2016 The UK ranked 24th in the world in Save the Children’s Mothers’ Index and Country Ranking Norway, Finland, Iceland, Denmark, Sweden, Netherlands, Spain, Germany, Australia, Belgium, Austria, Italy, Switzerland, Singapore, Slovenia, Portugal, New Zealand, Israel, Greece, Canada, Luxembourg, Ireland, and France, all did better than the UK. The situation in some other countries is massively worse than here but that is no excuse. But these baby and mothers’ deaths must stop. We cannot sit back and let these deaths continue.

Let’s be clear, the situation for women in pregnancy and childbirth is massively better than before the NHS, and is head and shoulders better than in the USA today. But maternal mortality is an issue here in the UK, and a huge issue in poorer countries, especially where women give birth without a trained professional being in attendance. Quite rightly professionals and campaigners in the UK participate in international endeavours to improve this situation. The NHS should be training and sending midwives to those countries, instead, it is recruiting midwives from poorer countries. In Europe we have cuts in healthcare through Austerity; in the global south, the same concept of cutting public services to the bone is called Restructuring.

Why is the UK, a rich country with (almost) universal health care not doing better by its mothers and babies? Look at just this case and see the problems in the provision of maternity care;

Archie Batten

Archie Batten died on 1 September 2019, shortly after birth.

When his mother called the hospital to say she was in labour, she was told the QEQM maternity unit was closed and she should drive herself to the trust’s other hospital, the William Harvey in Ashford, about 38 miles away.

This was not feasible and midwives were sent to her home but struggled to deliver the baby and she was transferred by ambulance to QEQM where her son died. Archie’s inquest is scheduled for March. (BBC).

We know that temporarily “closing” maternity units because they are full is a common occurrence. Women then have to go to a different hospital. Induction of labour can be halted because the unit is full. It is not a pleasant situation for mothers. Some maternity units have closed permanently, meaning mothers have to travel further for treatment, at a time when the ambulance service is under great strain (though being in labour is not considered an emergency for the ambulance service!).

Shortage of Midwives and consequent overwork for the existing staff. The UK has a shortage of three thousand five hundred midwives. The midwife workforce is skewed towards older midwives who will retire soon.

Gill Walton, general secretary and chief executive of the Royal College of Midwives said “We know trusts are facing huge pressures to save money demanded by the government, but this cannot be at the expense of safety. We remain 3,500 midwives short in England and if some maternity units regularly have to close their doors it suggests there is an underlying problem around capacity staffing levels.

Training midwives is not just about recruiting new starters to university courses. There need to be sufficient training places in the Hospitals who are already working flat out, leaving little time for mentoring of students, as well as places in the Universities. Alison Edwards, senior lecturer in midwifery at Birmingham City University, who says: ‘It isn’t as simple as recruiting thousands more students as this requires the infrastructure to support it.

‘You need more tutors, more on-site resources and, perhaps more importantly, more mentors and capacity in placement areas – which is currently under immense strain.’ 

One student midwife wrote about her experiences in this letter, where she described very hard work without either pay or good quality mentoring.

The government and the NHS call for Continuity Care from Midwives. This means the same midwife or small team of midwives cares for the mother through her pregnancy, birth and postnatal period. We too believe this would be wonderful if it were possible. It is however impossible with the existing ratio of midwives to mothers. Providing continuity of care to the most vulnerable mothers is a good step. NICE have reduced this to the idea of each woman having a named midwife. One to One a private midwife company claimed to provide this but was unable to continue trading, and went bust leaving the NHS to pick up the pieces.

Nationally the NHS is underfunded and looks set to continue so. Much of the problem comes from a long period of underfunding. We spend less than 9.8 per cent of GDP on health. Switzerland, Germany, France, Sweden, Japan, Canada, Denmark. Belgium Austria Norway and the Netherlands all spend more. That places the UK 13th in the list of high spenders on health care. The US spends 16.9 %. (although a lot of that money is diverted from patient care to the big corporations and insurance companies). The NHS was the most cost-efficient health care service in the world.

Underfunding causes staff shortages. Some errors at birth come from staff being overworked and making mistakes.

Some, our campaign believes, flow from fundamental flaws in government policy such as in the Maternity Review, where the pressure is on staff not to intervene in labour.

 Listen to the Mother. Some of the deaths are from women not being heeded in pregnancy and childbirth. This is backed up in reports from mothers, including some quoted in the big reviews mentioned above. However, overworked and tired staff who know labour like the back of their hand can easily stop heeding an inexperienced mother.

Poverty kills mothers and babies. As we said above, some deaths, poor baby health, and injuries come from growing maternal poverty and ill-health. Low-income families find it hard to afford good food. Food poverty affects a staggering number of children. The charity UNICEF estimates that “2.5m British children, or 19%, now live in food-insecure households. This means that there are times when their family doesn’t have enough money to acquire enough food, or they cannot buy the full variety of foods needed for a healthy diet. In addition, 10% of these children are also classified as living in severe food insecurity (the European average is 4%) and as a result, are set to experience adverse health.”

Studies show that;

The Independent inquiry into inequalities in health (Acheson 1998) found that a child’s long term health was related to the nutrition and physique of his/her mother. Infants whose mothers were obese had a greater risk of subsequent coronary heart disease. Low birth weight (under 2500 g) was associated with increased risk of death in infancy and with increased risk of coronary heart disease, diabetes and hypertension in later life. Accordingly, the Inquiry recommended, ‘improving the health and nutrition of women of childbearing age and their children, with priority given to the elimination of food poverty and the reduction of obesity’. (NICE )

A significant number of deaths of new mothers come from mental health issues that spiral out of control. Some of these will be newly developed conditions and some existing conditions made worse by pregnancy and childbirth. Mothers family and professionals must all be on the alert and intervene early. There are good ways to treat mental health in pregnancy.

Reducing the social and economic stresses around pregnancy would also help reduce the deaths and suffering

When Birth goes wrong it can be a dreadful experience for everyone involved. In most cases, the panic button brings in a well-drilled team of experts who can solve nearly every problem and do it calmly. At other times, it is dreadful, as described in the coverage of the birth and death of baby Harry Richford. Harry Richford was born at the Queen Elizabeth the Queen Mother Hospital in Margate in 2017 but died a week later. https://www.bbc.co.uk/news/uk-england-kent-51097200

Sands, the baby death charity explains that there are many causes of babies dying before birth. Crucially important is that mothers are heeded when they are concerned and that everyone Counts the Kicks

 

Maternity is not the only area of the NHS that suffers. There have been serious mistakes in NHS planning including closing far too many beds. The NHS closed 17,000 beds and now is working beyond safe bed occupancy. There are 100,000 staff vacancies. Waiting times in A and E are dreadful, as are waiting times for cancer treatment. NHS managers and the Government have taken the NHS far from the Bevan model of healthcare (for history read this).

Press coverage. How does the press cover the NHS, and baby deaths? There are very real problems in the NHS and maternity care but the coverage in the press of these problems seems to switch on and off in strange ways, often to suit Conservative Party political requirements. The NHS and the Government are masters of propaganda and news manipulation. The public needs to learn to judge the news and to look both for actual problems and look out for bullshit and manipulation. Why was news of the arrest of the nurse from the Countess of Chester hospital headlines on the 70th Anniversary of the NHS? Why was the news of the understaffing there not given similar nationwide publicity? Why have we heard little or nothing since?

If the government can switch the blame to the professionals in the NHS (but not their mates the high admin of the NHS), then they seem to be happy to publicise the problems. In other cases, problems are swept under the carpet.

Professionals expect to (and do) take responsibility for their own actions. Mistakes will be made. It is impossible to go through life without some mistakes. When we are dealing with life and death mistakes can be catastrophic, even where there is no ill intent.

Malicious action is rare.   There are the terrible cases of serial murderer Harold Shipman, and the convicted surgeon Ian Paterson who falsely told women, they had breast cancer and operated on them unnecessarily. The hierarchical system in the NHS and the lack of regulation in private hospital, which was described as “dysfunctional at almost every level” allowed that harmWe have not found such a case in maternity.

Unintentional bad practice, however, has also harmed babies. No one went to work intending to harm in the events publicised in the Morecombe Bay Enquiry into the deaths of 11 babies and one mother. It was said that “The prime responsibility for ensuring the safety of clinical services rests with the clinicians who provide them, and those associated with the unit failed to discharge this duty over a prolonged period. The prime responsibility for ensuring that they provide safe services and that the warning signs of departure from standards are picked up and acted upon lies with the Trust, the body statutorily responsible for those services.”

The Enquiry described what happens like this “In the maternity services at Furness General Hospital, this ‘drift’ involved a particularly dangerous combination of declining clinical skills and knowledge, a drive to achieve normal childbirth ‘whatever the cost’ and a reckless approach to detecting and managing mothers and babies at higher risk.”

The Furness General Hospital was pushing for Foundation Trust status at the time and was not exercising the necessary supervision.

“Maternity care is almost unique amongst NHS services: the majority of those using it are not ill but going through a sequence of normal physiological changes that usually culminate in two healthy individuals. In consequence, the safety of maternity care depends crucially on maintaining vigilance for early warning of any departure from normality and on taking the right, timely action when it is detected. The corollary is that, if those standards are not met, it may be some time before one or more adverse events occur; given their relative scarcity in maternity care, it is vital that every such occurrence is examined to see why it happened.

So, many factors come into play in such incidents of harm to mother and baby. Professionals too can be emotionally wrecked by tragedy.

Huge personal and professional lessons can be learned from a detailed review of cases where mistakes are made. There is a whole literature about learning from mistakes. The worst such incidents are referred to as Never Events. This is just one article about such errors but there is a whole field of research devoted to it. Serious Mistake Reviews often happen at the end of shifts, and in the worst cases, may lead to long public enquiries.

NHS as a research organisation One of the great virtues of the NHS is the research base it offers professionals. What happens in the NHS which covers 62 million people is studied, evaluated, and researched. This is invaluable to staff and above all to patients. Sadly this research is also of interest to big business especially to those who sell health insurance and to the big corporations who have their ‘snouts’ in the NHS ‘trough’. Research for the common good is clearly different from research to make money. We see that regularly in big pharma. Cheap effective medicines do not make money for the companies. Yet the government is giving away our medical data to companies to make a profit.

There are also “errors” that happen when everyone is following accepted procedures and protocols; “untoward events, complications, and mishaps that resulted from acceptable diagnostic or therapeutic practice”. Procedures within the NHS can be robust and well researched, and problems still occur.

https://www.mamaacademy.org.uk/news/mbrrace-saving-lives-improving-mothers-care-2019/

Research matters. Only by studying outcomes can these errors be revealed. A classic example is the once customary practice of episiotomy, cutting a woman to prevent tears to the perineal skin in childbirth, which is now no longer used except in an emergency. Research both formal and informal changed that practice. As another example of such research, Liverpool Women’s hospital has been involved in research about the benefits of leaving the baby attached by the cord if they are born unwell. NHS staff and other health professionals, academics and pressure groups are working hard to improve outcomes for mothers and babies. Each mothers death is reviewed in the MBRRACE-UK report

https://mamadoc.co.uk/the-maternal-mortality-report-we-should-all-learn-from/

Never again. The tragedy of the death of a mother and or baby is felt by that whole extended family. Most families want to know it will never happen again. Cover-ups and lies mean it will happen again, so brutal honesty is needed.

 

The aftermath of medical treatment or neglect which causes real harm is complex. Whether the outcome is death, life long impairment, or long term physical and mental health issues, these are very significant events for all concerned.

Campaigners in Liverpool campaign for SEN funding to be returned. 2019

If a baby is born with life-changing impairments, the baby is left facing catastrophic difficulties and the mother and family can face major heartbreak and hardship. The huge love we have for our kids (may it long continue), whatever their issues, does not prevent the financial, housing and employment issues families with disabled children face. Nor does it guarantee the best educational opportunities, SEN is being battered by cuts. but parents and teachers are fighting back.

 

The cost of financial “compensation” from an injury to a newborn is huge because it is life long. The cost of this “compensation” used to be carried by the government but the system changed to make hospitals “buy” insurance from a government body which is set up like an insurance company. The cost to the hospital is charged on the basis or earlier claims, like car insurance. Obstetrics make the highest claims of any section of the NHS.

Liverpool Women’s Hospital had a huge case (not about babies) some years ago, arising from a surgeon who left many women damaged after incontinence operations. Their total bill, over 5 years, according to the Echo, was £58.8 million. “The NHS trust has been forced to pay out £58.8m in the last five years for both recent and historic negligence cases.

The limited work we do, as a campaign, in holding the hospital to account, leads us to believe lessons have been learned by the hospital. However, in every hospital, there are pressures which could lead to problems. These pressures include financial and organisational, problems of management ethos, and the potential for bullying, the distrust by the staff of their management, and disrespect for whistleblowers.

The NHS has gone through years of reorganisation after reorganisation. In that time the financial and government pressure has been to complete the re-organisation, or face catastrophic consequences so very many hours of admin and senior doctor time has been wasted on this process. That time could have been focussing on saving babies.

At STP and national level, there are other problems. The NHS is intensely political. There are deep structural problems. (We believe the NHS should return to the Bevan Model of health care)

The NHS is not only deprived of adequate funding, but it has also been forced to implement many market-based changes, including the internal market, outsourcing and commissions of services to for-profit companies. These market-based structures are expensive.

The NHS has also seen dire staff shortages resulting from stupid decisions like removing bursaries, not training enough doctors and the hostile environment to migrant staff.

There are moral and financial issues in all cases of such errors. The hurt to the babies is our priority.

Baby deaths and severe injury at birth have complex roots. Though what happens in the hospital is crucial, it is not just what happens in the hospitals that matter. The stress, poverty and anxiety many mothers endure during pregnancy do sometimes affect the outcomes for the child. Many women are still sacked for being pregnant but families can rarely cope with just one wage (do fight back against sacking pregnant women!). See Maternity Action for details. Both mums and midwives can call Maternity Action for advice.

Low pay or the dreaded universal credit can make food heating and rent all too expensive. This can lead to food poverty. Women do not yet have real equal pay but mothers have the worst pay of all  Benefits are no longer allowed for a third child. even though most claimants are working. Whether parents are working or not, every child has a right to food and shelter, be they first or 10th child. The child gets no choice!

Not every pregnant woman is in a stable caring relationship. Housing, especially private renting, becomes more difficult when women are pregnant. Who can forget the story of the homeless woman giving birth to twins in the street? Pregnancy is often the time when domestic violence is inflicted on a woman but it is the time when women are least able to walk away. Poverty kills babies too.

Please join us in campaigning for better outcomes for all mothers and babies in the NHS and across the globe. We want this to start a discussion, so please send us your views. and information

 

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Staff at Frimley Health NHS Foundation Trust, who face being transferred to a wholly owned subsidiary (WOS) designed to avoid paying tax, will strike in protest for a further three days this month.

Unite, Britain and Ireland’s largest union, said today (Thursday 5 December ) that its estates’ management, equipment maintenance, catering, portering, procurement and security staff, numbering about 90, will strike from 07.00 on Wednesday 18 December for 72 hours.

This latest wave of industrial action follows two days of strike action last month.

Unite will be coordinating  the strike action with the GMB union – altogether about 1,000 staff at Frimley Park Hospital, Camberley; Wexham Park Hospital, Slough; and Heatherwood Hospital, Ascot are affected by the trust’s plans.

Unite said that it had evidence that the trust is intent on pushing ahead with its flawed business model, as it is issuing new uniforms without the distinctive NHS logo on the clothing, which previously had been the case.

Unite regional officer Jesika Parmar said: “The latest bout of strike action this month demonstrates the continuing depth of anger at what we believe is biggest proposed wholly owned subsidiary in England so far, which could adversely affect up to a 1,000 employees at the trust.

“Our members have voted overwhelmingly that they have no wish to be employed by a WOS designed to avoid paying tax. They are concerned that their pay and employment conditions will be seriously eroded by such a plan.

“Already the trust is issuing new uniforms without the NHS logo on the clothing, which previously had been the case – it is clear that the trust bosses don’t see this new venture as being part of the NHS, which is disgraceful.

“The trust is also attempting to undermine the strike by employing expensive agency staff.

“We are calling on the trust’s board to ditch these misguided and flawed plans. We are seeking an undertaking from the trust that it will agree to continue to employ all our members and not transfer them to a WOS.

“We remain strongly against the formation of these entities which, we believe, could lead to a Pandora’s box of Carillion-type meltdowns – with knock-on effects for patient services and jobs.”

The Frimley trust provides NHS hospital services for about 900,000 people across Berkshire, Hampshire, Surrey and south Buckinghamshire. Unite has 220 members at the trust and only balloted those directly affected by the WOS.

Unite members voted by 92 per cent to strike.

Notes.

Unite has waged an extensive campaign against these wholly owned subsidiaries as they could lead to job losses and salami slicing of service provision.

Unite is concerned that trusts are forming these wholly owned subsidiary companies in England so that they can register for VAT exemption and compete on a level playing field with commercial competitors who register for VAT exemption for their work in the NHS, when NHS trusts can’t.

There were more than 30 such subsidiaries in England in 2018.

The Department of Health and Social Care announced last year that it was consulting on this issue. The consultation ended in November 2018 and the requirements that trusts and foundations have to meet to create wholly owned subsidiaries were tightened up.

This also included a condition to consult stakeholders, such as staff and the wider community. A number of trusts have already decided to abandon plans to set up such a subsidiary.

Email: shaun.noble@unitetheunion.org

Twitter: @unitetheunion Facebook: unitetheunion1 Web: unitetheunion.org

Unite is Britain and Ireland’s largest union with members working across all sectors of the economy. The general secretary is Len McCluskey.

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I have often wondered, during all the discussion of whether one’s local hospital should be shut down, whether hospitals are safe places for patients to be in. Let me rephrase that. Are they safer places to be in, rather than your own home?

I tend to think, surely, that clinicians can’t think hospitals are particularly safe places to be in, otherwise they wouldn’t be in such a rush to have them ‘flow’ in and out? But there are of course economic considerations, for example the cost of a hospital bed being more than the cost of a bed at the Ritz, and so on.

The Royal Colleges of Physicians have warned on numerous occasions about the service being understaffed and overstretched, and the Royal College of Nursing and others have for a long time, famously, been campaigning for safe staffing.

Patient safety supposedly is King, but the problems appear not to go away. The issues with patient safety continue to linger like a bad smell. Take, for example, the Mid Staffs scandal and the current issues with the NMC and maternity care deaths.

In recent years, the focus seems to have been on structures, processes and operations, rather than people and needs. Whilst the slogan ‘person-centred integrated care’ is everywhere, it continues to be the case, perhaps, that people have to be built round services rather than services fitting round people.

For many outpatients, a trip to outpatient’s can be an unpleasant experience, especially if you’re travelling a long distance by car and then have to negotiate an astronomic car-parking fee at the end of it. For patients who are literally bed-bound, and who can otherwise travel only with a carer and a wheelchair, a trip to hospital can be a monumental task.

Hospitals can be the very worst places for certain groups of patients, for example patients who are frail, living with dementia and experiencing delirium. A sudden change of environment from home to hospital can be catastrophic for the delirium, and so can a plethora of other issues in hospital (such as bed rails, lack of communication, inappropriate sedation, inappropriate extensive de-prescribing, etc.)

Whilst hashtag campaigns can be somewhat hyperbolic, it is true that the #endPJParalysis campaign has drawn attention to the issue of patients languishing in beds for weeks such that when they are finally discharged they can no longer walk and have lost their ability to perform certain activities of daily living.

And the medical issues resulting from hospitals, including hospital-acquired infection, pressure sores, DVTs, are well known.

An issue with integration and making a case for change is that, particularly following the introduction of the ubiquitously-despised Health and Social Care Act (2012) from Andrew Lansley, the natural reaction has been to assume that everything is essentially a cost-cutting exercise on the road to privatisation.

But the case of artificially dividing health and social care is no longer tenable. Ahead of talk on processes and structures, such as pooled budgets and organisational structure, there is a basic issue that people for example with long term conditions such as frailty and dementia can have substantial care needs, such as personal care or washing and dressing.

It has long been claimed that mortality is unaffected in palliative care, but anecdotal evidence appears to be that certain healthier patients, despite living with life-limiting terminal conditions, can live longer if in better health.

It could be that one’s own home is a safer place to be?

With initiatives such as ‘NHS Ageing Well’, if we are to take seriously living independently and reablement, we do need to make sure physical health, social health and mental health are on the same footing. This has for ages has been known as ‘making parity a reality’.

In a report from the King’s Fund on #socialcareoptions this morning, it’s been argued that we’ve reached a fork in the road between the universal NHS and means-tested social care system.

I believe strongly that the divide between health and social care is utterly unproductive, and that we cannot have a system which unfairly discriminates against service users to their financial detriment according to what a condition is.

It could be that there is a genuine issue with safety in hospitals (a “push” factor). And that people’s quality of life is genuinely enhanced with independence, provided that this does not lead to isolation (a “pull factor”).

But I think, personally, the idea of hospitals being the “ultimate institution” is long dead. I’ve never met a single patient who says he’s really ‘enjoyed’ being in hospital, and further might exacerbate the sense of ‘otherness’ people with certain conditions might feel.

The NHS is a movement, rather than, merely, a collection of buildings (like hospices are a movement). With the growth of ‘hospitals at home’, there is now a tendency for promoting health, not just fixing illness, to need to take place at the right place, right time, and right way.

 

 

@dr_shibley

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Just a few weeks ago, those who like to keep a keen eye on the local press may have seen a very forthright article in the Southport Visiter which in no uncertain terms declared the future of Southport Hospital and its A&E “safe” and “not under threat”.  It followed fears for the hospital after criticism of surgical standards and safety and also the privatisation of its community and urgent care services, which went to Virgin Care in a contract worth £65m.

 The biggest question mark hanging over it though was the proposal to downgrade the A&E, contained in the Conservative Government’s Sustainability and Transformation Plan project for the NHS, known as the STP.
The town’s new Conservative MP, Damien Moore, featured heavily in the Visiter article and he firmly dismissed concerns about the hospital’s future stating “the suggestion that Southport Hospital needs ‘saving’ is nonsensical and misleading”.  Towards the end of his considerable contribution even the keen-eyed might have missed that he did not completely shut the door on the possibility of “considerable change” but as he soothed the readership by claiming that, if so, it would be a decision for “experienced medical professionals – not bureaucrats or politicians – and on the basis of patient safety”, it might not have set alarms bells ringing. It certainly should have. In any event, they might possibly have been drowned out by all the thundering reassurance on offer, given it was then immediately stated in the piece that “the future of the hospital has never been more clear”. With support from Health Minister Phillip Dunne and, apparently, Trust Chairman Richard Fraser, it appeared Southport’s new MP was basically trying out his good beat cop routine for the first time, best paraphrased as, “All’s fine, nothing to see here, move along now folks please.” It was a bold and confident move that deserved a “Bravo” for its bravura, perhaps it even earned him a Charlie, Lima, Alpha, Papa, back in the control room of Conservative HQ.
Contrast this then with the scenes at the hospital for this week’s visit by Secretary of State for Health, Jeremy Hunt.
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Over 100 protestors, the vast majority Mr. Moore’s own constituents, had gathered at the main entrance to voice their concern for the hospital and their disapproval of Mr. Hunt and Conservative cuts. Organised by Southport Labour and Liz Savage, the town’s Parliamentary Candidate in 2015 and ’17, the protest also involved the GMB, Royal College of Nursing, hospital staff and Sefton Central MP, Bill Esterson.
 Attending the hospital as part of the Hunt entourage, the previously bold Mr Moore decided to avoid them all by taking a side entrance. It wasn’t the only apparent change in attitude by him.  When interviewed on site by BBC North West Tonight’s Health Correspondent, Gill Dummigan, he rightly pointed to the hospital’s recent improvement in care standards. He also told her that the future of the hospital was secure. When the doughty Dummigan specifically asked about the future of the A&E, however, his response was described by the reporter as “less certain”. Indeed, it seemed the only thing Mr Moore was more certain of was his determination to give the hospital trust the old “hospital pass” on this one.
At present, there is a local review of service provision in process. This review comes after plans to downgrade the A&E were included in the local version of the STP, the vehicle by which Mrs May’s Government are looking to make over £900m in cuts in Cheshire and Merseyside. Consequently, the review report is also a big part of the uncertainty hanging over the hospital’s future capability. When asked if he was confident that there would be an A&E at Southport Hospital in a couple of years time, the previously confident Mr Moore didn’t seem so, well, confident. He replied:  “What I’m waiting for is to see what that report says and to actually trust medical professionals to make the decisions based on Southport people”. The health correspondent then asked the MP “So you can’t be certain?”  His repetitive response was anything but:   “I’m waiting on to see what the report says but I’m positive about the work that’s happening in Southport hospital at the moment.”
 We are all sure there is a lot of positive work happening in Southport Hospital every day Mr. Moore but the question was, is the future of the A&E safe?

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 The problem for Southport Hospital, its NHS trust, and the people of Southport is that instead of actually being a good beat cop, Mr. Moore appears to be playing political “cups and ball” with the A&E issue. “Cups” is the age old game where you have to guess which of the three cups the ball is under. It’s a favourite back alley hustle the world over and a classic of the art of misdirection.  In this case, the “ball” is the decision on the A&E and the cups are the supposed decision makers. Is it a clinical decision? Is it an administrative decision? Is it a joint decision after public consultation?
As he referred to specifically in the Visiter and by implication in his BBC interview, Mr Moore wants you to believe that the ball currently is with a clinical senate of the hospital trust and its “experienced medical professionals” but it is misdirection. The reality is that whichever “cup” it is actually under, what’s important to understand is that it’s the Conservative Government placing the ball and moving the cups.
During his visit to the hospital, we understand that Jeremy Hunt found himself unexpectedly confronted by medical staff who essentially gatecrashed the talk he was there for. A junior doctor challenged him over his previous claims regarding the “Weekend Effect” on mortality rates so recently and publicly derided by Professor Stephen Hawking. Mr Hunt showed he’s no slouch at misdirection himself by appearing to suggest to those assembled that HE was the one defending the NHS from Prof. Hawking! We certainly did not see that one coming. He also said that due to the conflicting evidence on the issue he’d been advised to choose the side he did. It seems an oddly unscientific basis for such controversial claims, for his proposed changes to hospital working practices, and for subsequently getting into an argument with the world’s most famous scientist and was one which led to claims of cherry-picking from the audience.
hunt___moore_resize_7.jpgIn addition to all this, we believe that the hospital chaplain no less asked him for reassurances about A&E. We suspect Mr Hunt did not earn himself any grace by refusing to give any. A senior consultant meanwhile asked if the Secretary of State could reassure them that the STP would address the yawning gaps in recruitment, once more the ball was placed under a cup when Mr Hunt responded that this would be a matter for the local STP.
He did tell the meeting that he was fully committed to the NHS but then also said that as a Conservative he was opposed to publicly owned services. This as he stood talking to public sector workers, on public sector land, in a public sector hospital. It does not bode well but perhaps it’s not so surprising from the man who literally co-wrote the book on how to dismantle the NHS and replace it with a US-style private medical insurance system. The man the Conservatives have put in charge of the NHS.
One can only assume that at this point in proceedings local MP Mr. Moore preferred to smile and shuffle his feet rather than the cups, it would prove much harder to fool the trained eye of the hospital doctors and staff after all. hunt___moore_resize_6.jpg

Birthplace of the NHS

There is a significant and rather sad irony in all of this, as Southport actually has a strong claim to being the birthplace of the NHS. Back in 1934 at the Garrick Theatre on Lord Street, it’s now the town’s bingo hall, the Labour Party held its annual conference. It was at that conference that the creation of a national health service was first adopted as party policy.  It took 14 years, a second world war and the resulting Labour Government for it to come into being. In the meantime, it has become the cornerstone of our welfare system, a point of national pride and an object of international envy.
Since 2010, however, it has also been under assault after austerity measures were introduced by the Coalition government of the Conservatives and Liberal Democrats.
The 2012 Health and Social Care Act they brought in also allowed the once creeping now sweeping privatisation that is currently undermining it. It’s what enabled Virgin Care to take over those services from Southport Hospital this summer.  The Conservative’s ramping up of the austerity programme has further hamstrung NHS funding; their 1% pay cap is further demoralising its staff.
Massively dependent on foreign staff, the huge uncertainty over Brexit has seen an equally massive 96% reduction in EU nationals applying to work in it. Meanwhile, the Tory backed Naylor Report means NHS trusts are being coerced into selling off the very land they stand on.
Against this background, make no mistake, the future of Southport Hospital and its A&E is not certain; it is not safe; nor confident; nor bold.  
Most importantly, despite what Mr. Moore wants you to believe, the current decisions over service provision and the future of our town’s A&E are not at their root actually a clinical matter, it is instead essentially a matter of choice made by a Conservative government hell-bent on further cuts, one that clinicians and administrators are struggling to do their best with. If that ultimately means downgrading our A&E, Southport’s residents will also struggle. In such distressing circumstances, the people of Southport will not forget how their local MP and his party played a game with them and their hospital’s future. That at least will be clear.
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First published on Southport Labour Party blog
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NHS hospitals in England are forecasting a £2.3 billion deficit by the end of the financial year. This is a big increase from £115m in 2013-14 and £822m in 2014-15. Hospitals are calling for debt relief and bailouts.

These deficits threaten plans to transform the NHS. Of the £2.14 billion devoted to implementing these plans in 2016-17, £1.8 billion is being spent on clearing deficits. This leaves just £340m to support the vision for integrated care and the promised “radical upgrade in prevention and public health”. And channelling more money to hospitals means less is available for community and mental health services. So dealing with these deficits is skewing NHS priorities now and into the future.

But what has caused the deficits and what can be done about them?

Grounds for complaint

Hospitals blame the deficits on things outside their control. They have two main grounds for complaint. First, they are not paid enough for the care they provide. Hospitals are paid according to how many and what type of patients they treat. When this payment system was introduced in 2003-4 the price per treatment was based on average costs reported by all hospitals. But since 2005-6 prices have been reduced by an annual “efficiency factor”. From 2011-12 to 2014-15, this was a particularly challenging 4%. Hospitals have been unable to meet this challenge in full each year. These shortfalls have contributed to the deficits.

In January 2015, hospitals rebelled, objecting to a proposed efficiency target of 3.8% for 2015-16. The target was subsequently dropped and, in a reversal of past policy, 2016-17 prices are to include a 1% “cost uplift”. But the deficit damage has already been done.

The second point is that hospitals are treating more patients because other parts of the system aren’t working effectively. For instance, more people are going to A&E because social care support has been cut back and because the new 111 telephone service advises more people to go to A&E than the old NHS Direct.

Similarly, emergency admissions to hospital have been rising by 2.4% a year since 2011-12 and by 3.7% between 2013-14 and 2014-15. If patients turn up needing emergency care, hospitals can’t simply turn them away. While hospitals get paid more, the more patients they treat, since 2010 they have received only 30% of the usual price for emergency patients. Hospitals complain this isn’t enough, and it has now been increased to 70%.

Patients are being ‘sucked into hospital’.
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Running up deficits

But there are counter-arguments that hospital deficits are partly of their own making. Hospitals are indeed treating more patients, but do they all need hospital treatment? While emergency activity has been increasing, elective activity has been increasing even faster, by 3.5% a year since 2011-12, and 5.1% between 2013-14 and 2014-15. The fastest growth has been for people coming to hospital for investigations and day-case treatment. Some of these people might have been treated elsewhere, but there have been long-standing concerns that patients would be “sucked into hospital” by hospitals wanting to increase their income.

This will only get them out of financial trouble, however, if the additional income generated covers the extra costs incurred. That is increasingly unlikely because prices are based on average costs minus the annual efficiency factor. This makes it more difficult to cover the costs of treating more patients.

To make matters worse, most hospitals have little understanding of how much it costs to treat their patients. The best information comes from patient-level costing systems but only 42% of hospitals are using these. If they don’t have accurate cost information, hospitals can’t tell whether treating more patients will relieve financial pressure. If costs are higher than income, treating ever more patients will make deficits worse.

What next?

The original attraction of the English hospital payment system was that it offered equal pay for equal work – hospitals are all paid the same price for a particular treatment. This principle remains sound, but the payment system needs refining, although the recent removal of the efficiency factor and price increases for emergency admissions should improve matters.

When the payment system was first introduced, it was also hoped that money saved by preventing hospital admissions could be invested in alternatives to hospital care. But there has been little success in preventing emergency admissions and even less in reducing elective admissions. The result has been that hospitals have been accounting for an increasing proportion of NHS expenditure over time. That trend won’t change while extra money is being used to bail out hospitals. And it won’t change until hospitals stop focusing solely on income growth. They have to start getting a better grip on their costs.The Conversation

Andrew Street, Professor, Centre for Health Economics, University of York

This article was originally published on The Conversation. Read the original article.

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Tells the story of those who work in one of the most unnoticed and unappreciated sectors of the British National Health Service. This short documentary offers a unique insight into the joint notions of life and death through the men whose job it is to deal with them on a daily basis.

Made in  Royal Bournemouth Hospital

Director: Dan Ridgeon, James Dougan & Max Cutting
Producer: Dan Ridgeon
DOP: Max Cutting
Editors: James Dougan & Max Cutting

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Why fill our hospitals with vending machines and Costa coffee shops when we are fighting a massive obesity epidemic?

Sally Norton is a NHS consultant, specialising in weight loss and upper gastrointestinal surgery, on a crusade to put herself out of work by promoting healthier behaviour.

At last, with health secretary Jeremy Hunt’s announcement of new measures being introduced to improve the standard of food in English hospitals, we may finally see better quality food in our hospitals.

These changes will see hospitals ranked according to the quality and choice of the food they serve. They will hopefully provide some sanity, and not before time, because I was beginning to think I was going mad.

We read every week, in The BMJ and other leading medical journals, of research detailing the perils of sugar and fizzy drinks. We frequently hear laments about the cost to the NHS of the epidemic of obesity and type 2 diabetes, which is threatening to engulf us. And yet, the NHS, which I understood to be an organisation that promotes and supports health (rather than just treating disease), is actually contributing to the problem.

As a weight loss surgeon, I find it frustrating and, frankly, embarrassing to spend time in clinic, explaining to my patients how sugary drinks and snacks are one of the biggest drivers of obesity, when I know that just outside in our hospital foyer are not one, but two Costa coffee shops, as well as vending machines stocked full of coke and chocolate.

Coffee with whipped cream

When I try to grab a quick coffee from Costa, an obedient employee always tries to tempt me into buying one of their huge, sugar-laden and calorific cakes to go with it . . . hard to resist after a stressful morning in theatre or a busy night on-call. If I did need a snack, I would be hard pushed to find much that you could describe as healthy—there is very little fresh, nutrient-rich food and next to nothing that doesn’t involve a load of refined carbs.

I no longer shake the hands of patients as they come in through the clinic door—more often than not, they are clutching their Costa take-outs, which they have been tempted into buying while waiting for their consultation.

I know I can’t be the only one who thinks that a hospital should be setting a good example for its patients, visitors . . . and its staff.

As we recently heard from Simon Stevens, NHS England’s chief executive, many of our NHS staff are hardly role models for our patients. And, from my own experience, I frequently hear the amazed reactions from patients when they see morbidly obese staff members providing advice on healthcare.

Of course, NHS staff are human too and subject to the usual lack of willpower that makes these sugar-laden temptations difficult to resist . . . although we do have the education to know that we should be trying to do better. However, the stressful environment in which we work, coupled with the unsociable hours, means that we need to have access at all times to good, nutritious food—not a vending machine promising us a sugary quick fix.

However, the old chestnut that it is all down to the individual, and that people should be able to control their cravings, just doesn’t wash. With two thirds of the English population classed as being overweight, we would be tarring a lot of people with the same “weak willed” brush. The problem is as much the food environment that we are constantly subjected to, as it is an individual issue.

The food we eat is now much more densely packed with fat and sugar than it used to be, so we are passively consuming far more calories than we may realise. The cheapness of the food, and the increasingly huge portions, available wherever we turn, mean that we are actively consuming far more too. In addition, more and more evidence is accruing that sugar is addictive, and that we are in a downward spiral of poor eating owing to the excess of highly processed carbs that make up the vast bulk of our diets.

The government seems unable to take a significant stand against the insidious pervasiveness of the food industry, but the NHS can and should make a stand. If we can’t be the leading light in promoting healthy eating, then who can? Shame on us, for allowing most of our hospitals to play willing hosts to the fast food outlets that are contributing to our health crisis.

How can we have allowed hospitals to get tied up in contracts with these providers—who give away some of our control of good nutrition, a fundamental tenet of health? We are giving tacit agreement that it is OK to drink a coffee that contains nine teaspoons of sugar, or a muffin that contains a quarter of our day’s recommended calories.
Why do we allow these vending machines to spew out coke and chocolate at the very patients and staff who we may well be treating for diabetes, heart disease, and knee arthritis before long—and at increasingly crippling expense too.

Let’s just go the whole hog and open a pub in the foyer too—why not? Surely our patients are sensible enough to know that we aren’t actually encouraging alcohol, just because we host outlets on the premises?

More seriously though, the NHS has made it clear to our patients and visitors that hospitals don’t condone smoking on or around our premises. When I was a trainee, I remember patients smoking on the vascular ward. Why is that different to my bariatric patients being offered chocolate and crisps from the hospital trolley while waiting for their weight loss surgery?

We can set a similar example to our anti-smoking policy with a focus on healthy eating. Why don’t we adopt an NHS policy to only commission fresh, locally sourced food to sell on our premises? What a message to give our patients: that we support the “real food” producers in our local community, not multi-million pound chains profiting at the expense of our health. Why can’t we show them that it is possible to eat delicious, fresh food, rather than the sugar-laden, heavily processed offerings that are their current choices?

Enough is enough—let’s face up to our responsibilities as a health promotion service and a role model, and actually practice what we preach. We must ensure that these new recommendations are actioned quickly and properly.

Article first published by BMJ  

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This is  Labour Party  NHS Check 9  originally published by Labour’s Shadow Health Team in 2013

Cameron’s NHS: Hospitals ‘full to bursting’

REVEALED: Hospitals across England too full and patient care put at risk

Official NHS figures for winter 2012/13 show that:

  • Every hospital trust in England operated above recommended safe occupancy levels on a least one day last winter.
  • Almost four in five hospitals filled all standard beds at one point over the winter
  • Half of hospitals filled all standard and extra beds on at least one day – not a single bed available to new patients.

Hospitals have standard ‘core’ beds and use additional ‘escalation’ beds according to demand. During the winter months the Department of Health publishes data on 159 hospital trusts, in Weekly Situation Reports, on bed occupancy levels.
All 159 hospital trusts operated above the recommended safe 85% occupancy at least once over winter. The ‘Dr Foster’ NHS performance watchdog, half Government-owned, warned that above this level quality of care can deteriorate.

The Dr Foster Hospital Guide 2012 said:
“When occupancy rates rise above 85% it can start to affect the quality of care provided to patients and the orderly running of the hospital.”2
In addition:

  • More than half of hospital trusts (86) operated at an average rate of over 95% occupancy
  • 78 trusts have experienced at least one day where there were no beds available at all
  • 27 trusts experienced 10 or more days with no standard or core beds available

Crisis in England’s A&Es

The NHS faced the worst winter in nearly a decade. At every stage of a patient’s journey, waiting times are getting longer. Patients have to wait longer for an ambulance to arrive; patients have to wait longer in ambulances, outside A&Es; patients have to wait longer in A&E before being treated; patients have to wait longer on trolleys before being admitted.

The number of patients waiting longer than four hours in A&E is almost three times higher than in Labour’s last year in office and an extra 161,890 patients waited for more than 4 hours in the last 6 months, compared with the same period last year.

Casualty waitsThere are increasing reports of long waits in A&E departments, with some patients waiting more than 12 hours to be admitted.
“Waiting times are routinely reaching 12 hours in parts of the country, while “queue nurses” have been appointed in others to watch over patients brought in by ambulance until doctors become available.
Official figures submitted by NHS trusts to the Department of Health show that 27,247 patients spent longer than four hours in an emergency department in the week ending March 17, compared with 13,200 in the same week last year.
Telegraph, 24 April 2013

Earlier this month the Norfolk and Norwich University Hospital set up a major incident tent outside its A&E as ambulances queued up outside
“A major incident tent had to be set up outside a Norfolk hospital because ambulances were left to queue outside the A&E department for hours. The mobile treatment area was set up at the Norfolk and Norwich University Hospital after 15 ambulances had to queue up on Monday. The East of England Ambulance Service said each vehicle had to wait for up to three hours to hand over patients. The hospital said demand at the A&E department had been high.
BBC News, 2 April 2013

Low staffing levels

According to the Care Quality Commission, more than 1 in 10 hospitals are operating below safe staffing levels:
“CQC also saw some improvement in staffing levels. However, this was from a low base and the providers still have some way to go. Hospital services met the standard in 89% of inspections.
Care Quality Commission, Care Update Issue 2, March 2013, p. 17

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