Sunday, 8 January 2017

Our NHS and Social Care system are both going through a Humanitarian Crisis, Mrs May. Time to sack Jeremy Hunt.

The NHS is a treasured British institution, a blueprint for state subsidised health care and beloved by most UK citizens, regardless of their political or non-political persuasions. That's why it seems a travesty to many to be told that the NHS is currently going through a "humanitarian crisis" by the British Red Cross (BRC). Chief Executive Mike Adamson has recalled stories of "people sent home without clothes", some elderly patients suffering falls at home and not being found "for days whilst others are not washed because there is no carer there to help them". Adamson is correct to point out that because we don't have a fully funded, fully functioning social care system in the UK at the moment, those who have been discharged from hospital to convalesce at home don't always receive the support they need to convalesce and end up having falls, getting chills or become malnourished, which leads to them being re-admitted to already over-stretched A&E departments for emergency care. Cyclical use of the emergency care system should be prevented wherever possible and that means having a social care system that is fit for purpose.

We should be extremely grateful to the BRC for stepping in to help provide discharged (elderly/disabled) patient transport and to make sure they are given the resources and care they need to convalesce at home; the BRC mentions one trust where volunteers use a fleet of Land Rovers to help transport social care patients home. I'm grateful to the BRC for providing services to East Midlands Ambulance Service (EMAS) on New Year's Day so that discharged patients at Lincoln, Nottingham, Leicester, Kettering and Northampton could get home and receive the initial home care they needed. What would we do without the BRC being there at peak time to assist with patient care in the East Midlands? I dread to think.

The BRC are a charity whose remit includes working with hospitals on a daily basis to provide a "support at home service" to allow patients who will be in need of social care when at home to be discharged sooner. Volunteers make home visits to carry out errands such as collecting prescriptions, shopping or just talking to them so they do not become lonely. Yet the BRC has seen the number of patients volunteers have helped go up 10% year-on-year and they are now carrying out tasks usually undertaken by paid carers, such as making sure the patient eats, washing and dressing patients and assisting them with going to the toilet. They do so willing as caring individuals but volunteers only have a few hours to spare in the week and cannot care for discharged patients by going to them 2/3 times a day, especially if they have a full time job to do as well. Also remember that the BRC only has a finite pot of money in which to provide the resources needed to help volunteers help patients when they initially come home. Most of the BRC's budget comes from private fundraising although they currently having contracts with 100 hospitals to provide the transport + discharge "support at home service" (which run for up to 5 years). What is clear is that the BRC cannot become entirely responsible for initial patient aftercare after discharge and subsequent social care regardless of how fantastic they have been, not without a massive grant from Theresa May to do it and making some of the volunteers into full time, permanent, well-paid staff. I can't see that happening any time soon. 

Theresa Maybe May seems to deny any need to act urgently to prevent the NHS + Social Care Crises from getting any worse this year. Using platitudes and longwinded rhetoric to play a semantic game with voters isn't what's needed from May or her Government at the moment. May can't hide behind the current Brexit process and promise that more funding will be available post Brexit that can be pumped into local councils that haven't been able to raise much money from the social care precept to fund services properly.  Not when 42 hospitals had to ask ambulances to take emergency patients to other A&E departments because they were overstretched last week. Not when deaths at Worcestershire Royal Hospital's A&E have to be investigated to see whether they could have been prevented. Not when constituents in Sleaford and North Hykeham and Grantham, supposedly Conservative strongholds in Lincolnshire are angry that their local A&E in Grantham is running on restricted hours because of staff shortages that should have been rectified a year ago and are now worried that Grantham  A&E may end up closing as part of an ideological push for centralisation of emergency services as currently suggested in United Lincolnshire Hospital Trust's very flawed Sustainability and Transformation (STP).

Theresa May's Ridge On Sunday Booboo?

The comments Theresa May made during her first interview this morning with Sophy Ridge on Ridge On Sunday were mixed at best. I'm pleased that May was not so far gone in "post truth politics land" to admit that the UK does have an ageing population which is putting increasing pressure "on the interface between the health service and social care", but she didn't put much meat on the bone by explaining how to relieve that pressure other than vaguely referring to the Government's implementation of the "Five Year Plan" (really the "Five Year Forward View") for the NHS that was published in October 2014. Most voters don't even know what that plan involves let alone whether it will help ensure the NHS uses "best practice" to provide exceptional patient care.

That being said, I appreciated May's comment RE Mental Health (MH) Services in that she recognises that the "stigma" towards MH needs to be tackled. However May didn't quite quantify her statement; she didn't say what could be done by the Government to help tackle the stigma; for example May could have said that the Government would make it mandatory for workplace HR policies in the private and public sectors to be amended so that employers across the UK understand that they need to show more  consideration and tact when dealing with employees who take time off from work to deal with their conditions. No employer should be able to dismiss an employee without working with the employee to help make adjustments to their working patterns whilst they develop coping strategies for their mental illness. Yet there was no such bold strategy from May...just a quick that MH won't be reduced just through funding alone. Many MH practitioners know that already...they just need to see the colour of the Government's money too so that young people can have the access they need to services. We can't keep turning away 7 in 10 young people and expect them to deal with anxiety/stress, depression, bipolar disorders, or eating disorders alone. I'll be listening to the MH speech with much interest to see if her promises go beyond rhetoric and posturing seen this morning.

Theresa Maybe May appears reluctant to increase funding for Social Care beyond the promises her party have already made in their Autumn Statement. The fact remains that we need more care workers, more social workers, more community nurses that are not 100% leashed to a draconian monitoring system where they get docked money for overstaying at a patient's house to make sure that patient has taken their medication or was properly dressed for the day is paramount. Yet May won't criticise such practices, let alone ban them. Instead we have workplace recruitment and retention issues, with existing staff feeling overwhelmed by the number of clients they need to see on a daily basis and constantly worried that they may make a mistake which could cost them their job whilst keeping to the clock to avoid losing pay.

I believe the least May could do would be to consider Jeremy Hunt's position as Secretary of State for Health. It doesn't seem that I'm the only person calling for his resignation...cue the funny "Missing Person" satirical piece by Matthew Norman in The Independent which asks where the gormless Mr Hunt is hiding himself whilst the good ship "NHS Getty" is close to floundering off the coast of Extinction. Hunt is a very polarising figure for many, many reasons, not least because I believe he tried to blame junior doctors for the lack of 7 day NHS coverage in hospitals, claiming that it had directly led to more patient deaths at the weekend. Whilst Hunt may have had a point with reference to GP surgeries and dental practices not providing appointments over a 7 day period, Hunt didn't accept the fact that we need more senior frontline specialists to be able to increase the number of operations that can be carried out at the weekend. Junior Drs are drafted into hospitals at any time and we should be thankful they are dedicated to their profession enough to make changes to their social lives to do this. Instead, Hunt drove on with his plans to impose contracts changes on Junior Drs, dismissing their concerns as merely poppycock. His words have demoralised and demotivated some Junior Drs to the point where they are considering working abroad to get a better work-life balance. Working in the NHS can be very rewarding but highly pressured too. Demotivating staff won't help resolve a humanitarian crisis. In fact, we need to motivate doctors, nurses and admin staff in the NHS more than ever and empower them to help find solutions to such a crisis. So who could replace Mr "Incompetent" Hunt?

Step in Dr Sarah Wollaston...

Reading Dr Sarah Wollaston's honest article on the NHS Crisis from the 4th January 2016 in the British Medical Journal  (see here: http://www.bmj.com/content/356/bmj.j5)  has given me hope that there can be a Conservative SoS for Health who is competent, well respected and transparent. Dr Wollaston currently chairs the House of Commons Select Committee and has long spoken out over her party's narrow minded approach to funding the NHS and social care whilst the UK population has continued to age. As the Care Quality Commission (CQC) has noted in its 2016 report on the State Of Care in England
(see here: http://www.cqc.org.uk/content/state-of-care) the number of people over the age of 85 has increased by 31% yet the cuts to social care funding and a "serious workforce shortfall" (due to being unable to recruit more young people into the care sector) has led to more than 1 million older people being left "without the personal care they need to live with dignity in their own homes".

Dr Wollaston is right to point out that any joint commissioning of health and social care is at risk if the "financial squeezing" is such that they "retreat to protect their own budgets". It would be better if budgets were created that allow for better interfacing between health and social care, so that systems can be created which allow registrars to discharge patients knowing that they will have adequate care in place when they get home, with the same carer being involved from discharge through to recovery/long term care if possible.

The STPs are an opportunity to move away from competition based approaches that rely on outsourcers to outbid one another by streamlining vital support services that allow the frontline services to function effectively, but as the ULHT STP debacle has proven, they need to be realistic and provide services for the local community, not take them away.

Dr Wollaston wants to see a holistic approach to solving the humanitarian crisis that includes working with other political parties as well as the NHS. I agree with Matthew Norman that Dr Wollaston is the person who can help the NHS to evolve over the long term, by focussing on public health campaigns which stress the importance of personal responsibility for a person's own diet to prevent them from increasing their risk of developing cancer, type 2 diabetes etc. as well as calling for more funding for carers, care workers and community nurses to help relieve the burden on social care. That can be achieved through collaboration efforts with Labour, Lib Dems, Greens and the SNP. The choices that May makes on the NHS may determine May's political future and that of her Government. Dissent over May's dithering approach is growing and voters will not tolerate it much longer.

Labour's response:

Jeremy Corbyn has asked May to address the NHS Crisis head on in Parliament on Monday, pointing out that the top-down reorganisation instituted by David Cameron and Andrew Lansley through the Health and Social Care Act (2012) has led to increased privatisation of services and an unacceptable reduction in funding that needs to be addressed urgently. In her Ridge on Sunday interview May pretty much dismissed any notion of making a Commons Statement on Monday (pretty much expected) but that doesn't mean that Corbyn should take his foot off the pedal on criticising May's approach. Now I'm still not sure what Corbyn would do to reverse privatisation of NHS services other than to prevent renewal of contracts with outsourcing companies as he could do with G4S and policing services or whether he would relieve the managerial burden from Clinical Commissioning Groups (CCGs) or just change back to Primary Care Trusts. What I do know is that Corbyn needs to keep holding May to accept for her lack of inaction and to get her to admit that the Health and Social Care Act was the wrong course of action in the first place. A hard task if Mrs May doesn't accept this.

Corbyn's proactive approach is also being noticed by Labour MPs who are more critical of Corbyn and that can only be a good thing. Personally I'd like Corbyn to go further, by calling for Jeremy Hunt's resignation or dismissal so that a more progressive, passionate Secretary For Health can be brought in who wants to find solutions by working collaboratively with the NHS, social care providers, local councils and other political party leaders and MPs. I've recommended Dr Wollaston in this blogpost, but if Corbyn has an alternative in mind, he should consider recommending them at PMQs on Wednesday afternoon. We need a change in mindset when it comes to addressing the NHS and social care humanitarian crisis, one that isn't focussed on using the NHS for political point scoring and lets health professionals work with patient groups in CCG areas to determine the direction the NHS needs to take to provide positive outcomes for all patients, especially those that rely on the social care system to look after them once discharged. Mr Hunt has failed, so maybe it's time for Dr Wollaston to take the reins. The question is, is May bold enough to appoint Dr Wollaston in the first place? Time will tell.