Deja Vu - Moving care closer to the patient

Our local hospital, Buckinghamshire Healthcare NHS Trust (also the community health provider for the county) is holding a series of public meetings about developing care closer to the patient. I guess the need for this event comes from the publication last year of the ‘Five Year Forward View’ that describes the strategy for the NHS over the next five or more years.

 It is called ‘Your Community, Your Care – developing community hubs’.

The first meeting was held on Thursday evening in Thame. Thame is a lovely market town on the Oxfordshire/Buckinghamshire border. There were quite a few people there and the groups were buzzing with ideas on what services should be provided in their community. 

A few common themes emerged.

• The services should be truly multi-disciplinary and joined up.
• There should be rapid access.
• It could support the promotion of good health & signposting for solutions.
• The ‘hub’ could act as a true community facility. 

At the end of the meeting I was chatting to one of the facilitators about the results of the meeting.  I said that the things that people said were not a surprise. Indeed I said that we have known that this is what people want for many years and went on to add that what we should be doing is getting on with developing these community based services instead of having more public engagement meetings.

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Now I am a sad person and I keep lots of documents and stuff about health care, usually filed in heaps on the floor of the spare room. I knew we had had similar meetings in the past so I went through the piles of papers and found the feedback from a previous meeting (August 2010) on: wait for it!

‘Developing community healthcare services’

The views of the public then are the same as the views expressed at the meeting on Thursday. In fact the hospital could save itself the trouble of writing a report on the meeting and just recycle the old one from 6 years ago.

Amazing!

Not!

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They are holding another five of these meeting in the next few weeks.  What a waste of time.

The question is why have they not developed these community hubs?

Now I am guessing here but perhaps the reason that they failed to do this six years ago and a distinct risk to doing it now, is the fact that the various providers of services cannot agree to share the scarce resources i.e. staff and budgets.

They talk about joined up working and integrated care but still won’t take the risk with the money.

All the talk at the meeting was about care.  Not ‘health’ care or ‘social’ care but ‘care’.  As we get older, and I am a pensioner now so in the next few years that will be me, we need care and support. It becomes harder to distinguish between health care and social care as we become frailer and less able to cope on our own.

So until we get the Directors of Finance and the CEOs to come to these meetings and tell us that they will share the resources we need to have our community hubs I cannot see these ideas being implemented.

I wonder how many more times I have had these Deja Vu moments?

Don't just talk - do something.

Have you ever talked about your GP surgery over dinner, sitting in a café, standing in the checkout at the supermarket….?

Well you are not alone!

A Million people a day use their GP surgery and most of those will have something to say about the experience.

Most of those experiences are good.

However sometimes us patients have ideas about how to make the experience of talking with a GP or practice nurse better.

There can be problems with the phone service, making appointments isn’t always easy, seeing your own GP can mean waiting weeks, no privacy at the reception desk, access can be difficult for those with disabilities and as for car parking…!

So instead of talking about things on your own – join your Practice Patient Participation Group (PPG) and do something about them.

A patient participation group is a bunch of volunteers who want to make a difference.  They work with the practice to gather information from patients and to make suggestions about improvements.

They look at the surgery and ask:

What works well?

What works less well?

Are there services that are not provided but would benefit patients?

They also run an annual patient survey, hopefully the questions are set by the patients not the surgery.

Sadly General Practice is going to have to change. Being part of your PPG is one way you can help to make sure we keep the best bits of General Practice

Your voice on its own is very quiet.

But the voice of the many people in the PPG is much louder and will be listened to.

Please join your Practice Patient Participation Group.

Ask at reception or look on the practice website.  Maybe there is a social media page?

Better Care Fund - Mission Impossible?

The government having just made the biggest re-organisation of the NHS is now insisting that local health and social care economies now embark on another! 

Health and Wellbeing Board which only came into existence 12 months ago are now developing plans to use the Better Care Fund.   This fund is drawn from existing funds from health and social care commissioners. The total could be around £4 billion for England and in Buckinghamshire the fund will be nearly £100 million. This is three times the size of the fund that other areas are implementing!  Are they being too ambitious?

What will this fund do?

The Better Care Fund is to be used to integrate health and social care services, especially for older people.  It is hoped that this integration will reduce costs and improve the quality of care (in that order).

Many of us have asked for a closer integration of health and social care and so we should be welcoming this new work.  But should the timer scale for developing the project be longer than 12 months?  Can these new organisations, barely out of nappies, successfully implement such a big change in the way services are commissioned?

 Patients, especially those with long term conditions  & the elderly need care and support and they get that support from many different agencies – the NHS, Social services, the voluntary sector, the private sector, families and friends to name a few. Currently some care is called health care and some is called social care. But patients don’t really care what it is called. Or who commissions & funds it.  What they want is for it to be provided without any gaps, when and where they need it.  

They don’t want to have to go to one lot of people for one sort of care and then go through another assessment for more support! They just want to go to one point to ask for help.

So this Better Care Fund sounds as if it a good idea. But some say it will not save money and will not improve services.  They say there is no evidence that it will achieve these objectives.

I am also concerned that locally the public and patients have not been involved in the design of this new service.   As usual we will be involved and consulted with in the middle of the process rather than at the beginning.   Who is to carry out that involvement?  It is Healthwatch Buckinghamshire who are virtually unknown to the population of Buckinghamshire.   Will they be able to carry out a meaningful engagement with the public, let alone real involvement in the design of the new service?

Finally who is going to manage this fund, who will monitor the quality (and quantity) of the care? Who will be accountable?

It’s a mystery!

You can see the latest update on Buckinghamshire Health and Wellbeing Board's plans here

Here is a review of the evidence recently published by the University of York which suggests that these schemes should be rolled out cautiously and may increase overall costs.

Buckinghamshire Healthcare NHS Trust AGM 2012/13

I realise that I have not written anything for my blog for a long time.  It has been a good summer so I have been otherwise engaged on holiday and working on my allotment.

I have just come back from our local hospital trust AGM.   This is a trust under special measures and heavily involved in the Jimmy Savile inquiry. Yet all is not lost –there is good news as well.

There was not a single case of MRSA during the year 2012/2013.  They recorded their lowest number of C Diff infections ever. – down by 50%.

The Hyper-acute Stroke Unit is the best in the region according to the Royal College of Physicians.

The hospital and the spinal injuries centre were at the centre of the Paralympics opening ceremony. A statue of Sir Ludwig Guttmann has been installed in front of the Spinal Injuries Centre

Three members of staff received national awards during the year.

In the first quarter of 2013/2014 even the HSMR has dropped below 100, it is now 97!

As the Chief Executive, Anne Eden, said “It was the best of times and the worst of time”.

The hospital had over a million contacts with patients and 5770 babies were born.

There have been service development and a £5M capital investment in A&E is being undertaken.

As part of their response to the Keogh report they have started  an “Every Patient Counts” action plan designed to improve services.

But the future is challenging as the health and social care economy has been under stress for many years and will be even tougher in future years. The CCG which is a major contributor to the income of the hospital is looking at a shortfall in its budget next year. There are difficult decision to be made in this year’s commissioning round which starts now.

The cost of the staff in the hospital accounts for 59% of the total expenditure of the trust.

There was a presentation by the emergency surgery team on how they have been redesigning the way in which they manage things.  They admit 3800 patients a year of whom 500 are over 80 years of age.  They see three times that number altogether.

I found it a bit confusing when they talked about emergency surgery that does not need to be done that day and the fact that their patient could be reasonably well.  Some patients can even stay at home.   This is obviously a version of ‘emergency’ that is new to me.

It was amusing to hear surgeons talking about holistic care!

The CE presented some internal awards to staff who had “Gone the extra mile” for patients.   These were people nominated by their colleagues and patients and from the hundreds of nominations a small number were selected.  They were both clinical and non-clinical staff and it was a nice way to end the formal part of the event.  Congratulations to those who received an award.

There was a final event when the statue of ‘Poppa’ Ludwig Guttmann was formally donated to Stoke Mandeville Hospital by the charity that had raised the money for it and other projects. http://www.poppaguttmanncelebration.org/

At the end of the meeting there was time reserved for the audience to ask questions.  I will discuss what happened then in the next blog. 

A brief history of patient involvement in NHS

The new Health and Social care Act 2012 was sold to us as putting the patient at the centre of everything the NHS (in England) does.

I have spent many years collecting information on patient and public involvement and I would like to share some of the things I have filed in boxes and piles of paper.

Way back in 1974 the Community Health Councils (CHC) were created to give the patient a chance to have a say about the way the NHS was run.  Later other groups replaced the CHCs and as part of the HASCA Local Healthwatch will take over that role (in April 2013).

I started to collect quotes when I joined our local CHC in 1992.

Here are a few:

1991
"A consumer responsive NHS will treat its consumers with respect and will enable individuals and communities to influence the health service purchased and provided on their behalf"
A Regional Strategic Framework - Towards 2000.

1991
"The government recognises that...involving people more at both strategic and operational levels in discussions and decisions about options and priorities.... will help them achieve their objectives"
The Health of the Nation June 1991

1993
"Patients and the public must have a say in health service decision making"
Purchasing for Health July 1993

Zooming on a bit

1998
The NHS must be more open and truly accountable to the public.
- involving the public in decision making and monitoring process
- involving patients in service planning, development and implementation
A First Class Service. Quality in the new NHS 1998

2001
"Duty to involve and consult patients and the public in service planning and operation and in the development of proposals for change"
Health and Social Care Act 2001 Section 11.

Its all sounding a bit familiar isn't it?
So moving quickly on....

2012
Section 14U.
"Each Clinical  Commissioning Group (CCG)... promote the involvement of patients and their carers in decisions which relate to;
- prevention or diagnosis of illness in patients
- or their care and treatment."
Section 14Z2
"CCGs must make arrangement to secure that individuals.. are involved in
- the planning of the commissioning arrangements by the group
- the development and consideration of proposals by the group for change in the commissioning arrangements where the implementation of the proposals would have an impact on the manner in which services are delivered or the range of services available."
Health and Social Care Act 2012

So what, you say!

My point is that various governments over the last 20 years have said a lot about the need for patients and the public to be involved in decision making at various levels in the NHS.  The fact that they are still saying it suggest that it has not yet happened across the country in a meaningful way.

Will the embryonic CCGs really involve us patients in commissioning decisions?

Is it all rhetoric?

Do patients really want to be involved at a strategic level in decision making about health services?

What do we mean by 'involvement' and what do the CCGs mean?

Involvement, to me, is an active thing, it means that patients and the public participate in the development of new patient pathways and how services are changed. It is about involving the public in decisions about which services to commission and which services not to commission.  It is about asking us for our opinions on setting priorities. It is not just asking us for our opinions after the changes have been developed or priorities set.

The question remains though,  how many patients want to be involved in such difficult decisions?

Added in Sept 2017

The latest version of patient participation is Co-Production. This is an idea that originated in the States where whole communities got together with the authorities to develop facilities or services.