Category Archives: NHS

The interim report on the Parliamentary Review on the Welsh Health and Social Care Service was published in July 2017 just before the National Assembly’s summer recess. Its main message was that both services needed to innovate and modernise at a much faster rate if they are to continue to provide quality care over the next five to ten years.

This is a well rehearsed and often repeated message. However, unlike previously, instead of encouraging “a thousand flowers to bloom”, the Review urges more limited and strategic approaches with a particular emphasis on the needs of the older population. These limited innovations should be properly and thoroughly evaluated before a wider general application across the two services….in summary a call to “innovate, evaluate and disseminate”.

But while this central message is clear the report itself throws up a range of issues which do not sit easily within the confines of this central recommendation.

The initial Welsh Government response welcomed the Review but highlighted this ambiguity when it  summarised the conclusions as

“Frontline staff, the public, and other public and voluntary organisations will be asked to work together to develop new models of care, to help hospital, primary care, community health and social care providers to work more effectively together. The models will be developed to work in different settings such as urban and rural, and take account of Welsh language needs. The Parliamentary Review interim report recognises that new models will need to be underpinned by action in a number of areas and makes further recommendations including the need for a step change in the way the health and social care systems adapts to the changing needs of the population the people of Wales, staff, service users and carers to have greater influence on new models of care with clearer, shared roles and responsibilities new skills and career paths for the health and social care workforce with a focus on continuous improvement better use of technology and infrastructure to support quality and efficiency streamlined governance, finance and accountability arrangements aligned for health and social care.”

This is in effect is calling for a total, rather than limited, system and culture transformation across the combined health and care service. The final report plans to provide a range of specific recommendations which will both inform and provide benchmarks for what the new service will look like. However the sheer scale of the change agenda will test the Review Panel’s ability to deliver its own objectives.

In undertaking such a broad ranging review, the interim report covers and comments on many areas which are central to the future sustainability of services but often they are just noted or merely mentioned in passing. While it might be argued that some of these findings are beyond the formal remit of the review they could provide an importance context in evaluating the prospects for success of the final detailed recommendations.

It reports that NHS spending in Wales will need an annual increase of 3.2% to 2030/31 with adult social care requiring 4.1% to maintain pace. In an era of continuing austerity this level of financial growth is a forlorn hope and consequently increasing service effectiveness and efficiency “is essential for future sustainability”. However the interim report does not quantify the possible impact of its recommendations on achieving the reduction in funding pressures which a sustainable service needs. This is a major gap which, hopefully, will be addressed in the final report.

But even if there were sufficient resources there are crucial bottlenecks and imbalances across the system. Staff recruitment and retention at all levels is vital but there is a growing problem with conditions of pay and conditions. The chaotic Brexit negotiations is only aggravating the uncertainty. In addition infrastructural investment needs to have a clear vision and sense of purpose. IT will be particularly important in providing the communication network though which new integrated, partnership working will take place.

The need to have a unified health and social care vision is reiterated on many occasions. It is acknowledged that looking at the barriers between a “means-tested” care system and “free at the point of use” health care system is beyond the remit of the review but there are areas where meaningful progress can be made. In responding to the report, the Welsh Health Cabinet Secretary pointed out that pooled budgets, facilitated by the Social Services and Well-being Act (Wales) 2014, will be rolled-out across more service areas from April 2017.

The imbalance between primary care and the rest of the health service is also highlighted. While innovation has taken place it still remains the case that despite a relatively older GP workforce, the number of GPs in Wales have effectively been static over the last half decade. This is in contrast to the hospital sector where consultant numbers continue to increase. This lack of growth inevitably means that community based health services are not achieving the type of outcomes which will make a difference to patients’ experience and well-being as well as the optimal smooth running of the overall system.

Addressing and reducing health inequalities in Wales was also part of the Parliamentary Review remit. It acknowledges the importance of the social determinants of health and the importance of other parts of public policy such as welfare benefits, housing and early years. However it is remarkably light in scrutinising the continuation of “the Inverse Care Law” in health and social care. This omission is glaring and addressing it must be a major priority for the Review in its final phase of work.

The review spends a lot of time considering how to make things happen and looks at the role of the Welsh Government in facilitating change without outlining specifics. A separate recent report on health and care services stressed the need for the Welsh Government to give a stronger lead. This is a bit challenge for them.

On the one hand Welsh Government is keen to promote more locally sensitive and delivered services. But clearly this approach has only had limited success in delivering the the scale of change that is required. In practice “localism” can be a barrier to much needed change when “parochialism” tends to dominate the debate and decision making. And with many of crucial “facilitators” of change in the hands of the Welsh Government, this will be a critical area for the final report’s recommendations.

The overall success of this Parliamentary Review will be judged on how useful its final report will be. In producing the final report the Review Panel is aware that other similar work has failed to make a comprehensive transition from the page to the clinical setting. It states its determination to make recommendations which will be meaningful, focused on outcomes, manageable and implementable over a reasonable timescale. Based on the interim review this will be a very tall order faced with continuing austerity in our public finances.

https://beta.gov.wales/review-health-and-social-care?lang=en

http://www.assembly.wales/en/bus-home/pages/rop.aspx?meetingid=4304&language=en&assembly=5&c=Record%20of%20Proceedings&startDt=10/07/2017&endDt=21/10/2017#C489167

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Conference notes:

  • The NHS Accountable Care System contracts announced on 7 August impose a basis for 44+ local health services to replace England’s NHS, bypassing Parliamentary debate and legislative process.
  • On 9 August, the House of Commons Library revealed a doubling of the number of NHS sites proposed for sale. 117 of these currently provide clinical services.

Like their US templates, Accountable Care Systems will provide limited services on restricted budgets, replacing NHS hospitals with deskilled community units.  This will worsen health indicators like the long term increase in life expectancy, stalled since 2010. The ACSs and asset sell-off result directly from the 5 Year Forward View currently being implemented via ‘Sustainability and Transformation Partnerships’.  The 5 Year Forward View precisely reflects healthcare multinationals’ global policy aims.

Conference reaffirms its manifesto commitment to restore our NHS by reversing its privatisation and halting Sustainability and Transformation Partnerships. We therefore call on the Party to oppose and reverse funding cuts (ideally meeting Western European levels) but also 5 Year Forward View policy:

  • creating Accountable Care Systems;
  • replacing 7500 GP surgeries with 1500 “superhubs”;
  • downskilling clinical staff.
  • reclassifying NHS services as means-tested “social care”;
  • cementing the private sector role as Accountable Care System “partners” and as combined health/social care service providers.

Conference recognises that reversing this process demands more than amending the 2012 Health & Social Care Act and calls for our next manifesto to include existing Party policy to restore our fully-funded, comprehensive, universal, publicly-provided and owned NHS without user charges, as per the NHS Bill (2016-17)

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In my role as a Shadow Health Minister, while it did not grab many headlines; it was extremely disappointing that a House of Lords amendment, which would have seen more patients able to access life-saving innovative medicines without delay was voted down by the Conservatives. I spoke in support of the proposed changes to the Government’s Health Service Medical Supplies (Costs) Bill, which I have been leading on for Labour.

Through both their failure to back this amendment and their recent changes to NICE, which could further delay access to new medicines, the Government is presiding over a system which leaves increasing numbers of patients in the heart-breaking situation of being unable to obtain innovative treatments which could save or extend their lives. It is also worth pointing out that this directly breaks the Conservative party’s 2015 manifesto promise to speed up the introduction of cost-effective medicines into the NHS.

Last week, even more promises were broken, as the new NHS England Plan, “Next Steps on the NHS Five Year Forward View” confirms that the NHS does not expect to meet the A&E target, to see 95% of patients within 4 hours, which Jeremy Hunt described as being “critical for patient safety,” for at least the next year. It also sets out plans for another round of rationing of treatments and the abandoning of the 18 week waiting target for surgery.

Of course all of this leads up back to where I began with the fact that only an adequate financial settlement can deliver the health and social care service that we all want to see.

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On November 1st 2016 the Welsh Government’s Cabinet Secretary (Minister) for Health, Well-being and Sport, Vaughan Gething, announced the establishment of a Parliamentary Review which will look at the key challenges facing the health and social care services in Wales.

He said  “ … (it) will review the best available evidence to identify key issues facing our health and social care services and draw out the challenges that these will present over coming years. For example, there are challenges with NHS finances within a reducing Welsh Government budget, workforce planning, recruitment and retention, and meeting the rising demands of healthcare and rising public expectations. The review will examine options for the way forward and will then make recommendations about what the health and care service of the future could look like.”

The review was initiated as part of the “Moving Wales Forward” agreement between Welsh Labour and Plaid Cymru underpinned by wider cross party consultation and discussion.

The current Welsh health strategy, “Together for Health “ is due for revision and the Cabinet Secretary hopes that the Parliamentary Review will be completed in time to inform its replacement. This seems sensible and should give the Review a sharp operational focus.

However such a relatively short time window may not provide sufficient opportunity for the Review to engage in the innovative thinking needed to come up with the radical proposals that an under-resourced health and social care service is likely to need just to sustain itself and survive.

The Review will be led by the former Chief Medical Officer for Wales, Dr Ruth Hussey, supported by an an independent panel drawn for a wide range  of experienced backgrounds predominantly from outside Wales. It will be supported by a stakeholder reference group made up of representatives of professional bodies and social service organisations within Wales. Faced with such an strong resource, which has attracted cross party political support, the Welsh Government might wish to consider asking the Review for a relatively early report to help with the revision of its overall strategy and then requesting it to give additional thought as to what Welsh health and social care is likely to need for the medium and longer term.

 

http://gov.wales/topics/health/nhswales/review/?lang=en

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The festive period may be a time of celebration and cheer for most of us, yet medical staff across the country are gearing up for their busiest time of the year. Services across the NHS are set to face a strain not just in terms of workload, but everything from the amount of hospital beds taken up to the demand placed on the primary care services.

Whilst the health service is looking to recruit more and more recruits into GP and nurse jobs, demand on the system is the biggest issue along with a lack of trained professionals. Approximately 89% of hospital beds were occupied over winter last year, delaying treatment by more than 18 weeks for a tenth of all patients. £80 million was lost this way and that’s before the impact on primary care.

On the frontlines, nearly 10% of visitors to A&E were found to have waited more than 4 hours to see a staff member. With the level of severe conditions such as major physical injury, respiratory issues and dementia being on the up, resources have to be spent elsewhere and not on issues that can likely be treated at home. Prevention is better than treatment though so remember to think before picking up the phone this Winter.


Winter Pressures on the NHS – An infographic by the team at Primary Care People
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