Showing posts with label health. Show all posts
Showing posts with label health. Show all posts

11 July 2019

Consultation on local NHS Services - 16th July

 A local GP writes:

The NHS Long Term Plan was published last January 2019. One of many suggested changes was that each Sustianability and Transformation Partnership(STP) should become an Integrated Care System (ICS). To help achieve this, NHS England (NHSE) would like there to be one Clinical Commissioing Group (CCG) for each STP area. It is not explained, but the reason is to give the STP/ICS legal footing.  The CCGs are set up in law by the Health and Social Care Act 2012. The STP/ICS are a later idea, and currently only have legitimacy insofar as it is shared by their constituent CCGs. 


The changes would mean moving from the current 191 CCGs to just 44, one per STP "footprint".  The Plan suggests that should be achieved by April 2021, but in SE London they want achieve it by 2020.  


CCGs are important because they commission most of your local services. A few are commissioned by the local council. NHSE and Public Health England commission services nationally. The commissioners  decide what work they want to be done, and contract with providers to provide these services. The providers are GPs, hospitals, community health services, mental health trusts etc. The providers have some choices about how they provide the services, but little choice over what services they provide.


In Lewisham, the opposition of Lewisham CCG was a significant factor in throwing out the plans to close the A&E and maternity services at Lewisham hospital. If we had a CCG covering the whole of SE London would we have had such support?


The consultation period is now!  There is one consultation event for each of the 6 boroughs/CCGs (Currently boroughs and CCGs are co-terminus). It does not give you the date until you click on the Eventbrite link, but the Lewisham one is on Tuesday 16th July, 16.30-19.30 St Laurence Centre, Bromley Road SE6 2YS

https://www.ourhealthiersel.nhs.uk/get-involved/help-us-to-shape-the-future-of-the-nhs-in-south-east-london.htm

Some of the issues you may wish to consider:

  • Will mergers on this scale cause a loss of accountability?  
    • Local accountability was a big feature of the 2012 Health and Social Care Act.  They may say that there will be sub-committees at borough level, but will these have decision-making powers?
  • Will meetings still be held in public? 
    • The Act says that CCG Governing Body and certain other meetings must be held in public. If the CCG is at SE London level, you may have to travel a long way to attend meetings, and much may be about other parts of SE London in which you have little interest/knowledge.  They may say local meetings could still be held in public, but there will be no statutory responsibility to do this.
  • Will clinicians still have the same influence? 
    • This was another big feature of the 2012 Act - more clinical involvement, less managerial.
  • Has it really been made clear what is proposed? 
    • The website does not say anything about mergers!
  • What will happen if local GPs vote against merger?

31 July 2013

High Court quashes decision by Jeremy Hunt to close Services at Lewisham Hospital

The High Court today (31 July 2013) found that the Secretary of State for Health, Jeremy Hunt MP, had acted outside his powers and therefore unlawfully, in deciding to substantially cut services and close departments at Lewisham Hospital.

In today’s judgment Mr Justice Silber said that the decision of the Secretary of State must be “quashed” as he had acted outside his powers as Secretary of State, and in breach of the National Health Service Act 2006, when he announced to Parliament that services at Lewisham Hospital would be downgraded and closed.

Law firm Leigh Day, representing the Save Lewisham Campaign Group, successfully argued that the decision of the Secretary of State was unlawful. They also successfully argued that the decision of Trust Special Administrator, the first to be appointed under new health service guidance, was also unlawful.

The High Court today found that “The TSA did not have vires [the power] to make his recommendations relating to LH [Lewisham Hospital]; The Secretary of State did not have vires to make his Decision relating to LH.” (Para 208) ‘Therefore the Decision of the Secretary of State insofar as it relates to LH must be quashed as must the recommendations of the TSA also insofar as they relate to LH.’ (Para 210)


Details above taken from http://www.savelewishamhospital.com/ where you can find the full press release from the campaign team.

The Forest Hill Society has consistently supported the campaign to protect services in Lewisham Hospital and welcome today's judgement. We hope that this is an end to the matter and that the Department of Health do not choose to appeal against this judgement.

18 January 2013

Lewisham PCT - Patient Event

Lewisham PCT contacted us to inform us that they are planning a patient event at the Civic Suite on the afternoon of Thursday 31st January 2013.  Lunch from 1 o’clock, with a 1:30pm start.

Last summer they ran a survey with patients across Lewisham and were impressed by the feedback. The information was used to feed into their plans for 2013 – 2015

The afternoon will

  • Feedback what was heard from patients
  • Share how Lewisham PCT used the information and fed them into plans
  • Share the plans they have developed
  • Hear patients views and opinions on them plans
  • Give opportunity for people to make suggestions
  • Discuss the role of the patient in our local health service.

They would like it to be as reflective of the population as possible. If you are interested please contact Grainne Bellenie at gbellenie@nhs.net. There is a limit of 60 places for this event.

18 November 2012

Lewisham Hospital Public Consultation Meeting

The Sydenham Assembly Coordinator's Group and the Sydenham Society have arranged a Lewisham Hospital Public Consultation meeting at Sydenham School, Dartmouth Road starting at 7.30pm on Thursday 6 December. Dr Jane Fryer, Chief Medical Advisor to the Trust Special Administrator, will present the draft recommendations set out in the TSA report.

Please come along to this public consultation meeting - the TSA will be bringing along the short video and consultation packs - so please make your views known through the feedback forms as well as asking questions, giving comments and offering any alternatives.

03 November 2012

Save Lewisham Hospital A&E

The Forest Hill Society supports the campaign to keep a fully functional A&E at Lewisham Hospital. To find out more about the campaign please visit http://www.savelewishamhospital.com/

You can support the campaign by signing the petition at http://www.ipetitions.com/petition/lewisham-hospital/




06 April 2011

NHS Reforms - The Health and Social Care Bill explained

In light of the recent media coverage of the NHS reforms, we thought it would be useful to hear the views of someone impacted by the changes. Penelope Jarrett, Forest Hill Society Member and a GP in Lewisham, is worried about the proposed NHS reforms and summarises her main arguments here. If you want to know where or how information was derived, please contact her via penelope@foresthillsociety.com.

The views expressed here are those of Dr Jarrett and not necessarily those of the Society.

Introduction: Some History


The National Health Service was born in 1948, in the aftermath of the Second World War. A patchwork provision of charitable and private healthcare was nationalised so that healthcare would be free, available to all and of uniform quality no matter where people lived nor what their background. The service was run as a single system, administered by regional and district health authorities. The first big change came with the introduction of the internal market by the Conservative government in the 1990s. The service was split into “purchasers” of care and “providers” of care: the NHS was made to buy services from itself. At this time there was also an experiment with “GP fundholding”, where instead of the health authority purchasing services, GP practices could buy services for their patients.

The Labour Government after 2001 entrenched and extended the internal market. The Department of Health (DH) is not open about the figures, but the Health Select Committee has recently estimated that the transaction costs of the NHS have gone up from 5% of total NHS expenditure to 14% over the last 20 years in which this market has been operating. There is some evidence that fundholding allowed GPs to make some savings by lowering the demand for clinical services, but this was at the cost of higher managerial and transaction costs, and a substantial drop in patient satisfaction.

In 2000, the UK was spending just 6% of GDP on health. The Labour Government pledged to increase this up to the EU average of 8%, and spending went up from £35bn in 1997/98 to around £98bn in 2009/10 and will be £102bn in 2010/11. However, we still lag behind the Organisation of Economic Co-operation and Development (OECD) average, because expenditure has risen in other countries too.

This increased expenditure coincided with a number of other policies such as targets on waiting times, and evidence based policies such as the National Institute for Clinical Excellence (NICE, popular with clinicians) which saw patient satisfaction levels soar from a low of 35 % (quite or very satisfied) in 1997 to an all time high of 64% in 2009 (the latest reported survey). Politicians have commented how the NHS was not an issue during the election campaign of 2010, because people were generally happy.

Despite this, and despite the Conservative pre-election promise of “no top down reorganisation of the NHS”, Andrew Lansley is proposing reforms in the NHS which will be so big that they will be “visible from space” (according to David Nicholson, NHS Chief Executive).

The Proposed Reforms


The headlines have all been about GP commissioning, but this huge piece of legislation (288 clauses) changes all parts of the NHS. At the same time, there are White Papers proposing major changes to the Public Health Service, and to the training of doctors.
  • PCTs and Strategic Health Authorities to be abolished
  • New commissioning consortia of GPs
  • New NHS Commissioning Board; working only on an annual mandate (so not opportunity for long term planning) to commission GPs as providers, and to judge commissioners.
  • All hospitals to achieve Foundation Trusts status, with no obligation to observe national pay and conditions, and removal of the cap in private earnings.
  • Establishment of Monitor, a new economic and licensing regulator, with a duty to promote competition; and powers to investigate commissioner and providers, and to fine or impose change on them.
  • New Health Education England, new “local skills networks” for training
  • New Health and Wellbeing Boards in each Local Authority
  • Abolition of the Health Protection Agency, new Public Health England
  • Replacement of Local Involvement Networks (LINks, themselves only 3 years old and just getting established) with local HealthWatch, with unclear lines of accountability, and no specification to ensure the bodies are representative of the local population. It is unclear if they can investigate services
  • Hospital procedures will be paid for on a local or a national tariff (as brought in by the Labour Government under so-called “payment by results” – actually a payment for activity)
  • There are number of clauses requiring information to be shared or disclosed, including clinical information which could compromise patient confidentiality.
  • A greater role for the Care Quality Commission

The government is committed to patient choice, any willing provider policies, competitive tendering, and the Secretary of State will have the power to create regulations to ensure that these happen.

The Bill is Unnecessary


Andrew Lansley and David Cameron have said that the Bill is necessary because outcomes in the NHS are not as good as in some other countries. This is true of the outcome they picked out (death rates after a heart attack are lower in France than in any other European Country), but you can pick out many figures in international comparisons, and easily find others in which the UK performs better than France. In fact, on trends since 1979, the UK rate of death after a heart attack will fall below the French rate by 2012.

Overall, life expectancy at birth in the UK in 2007 was 79.5 years, similar to most European Countries and slightly above the OECD average of 79.1 years. European countries have health care systems which are called insurance based, but they are all compulsory and to a great extent underwritten by Governments, which makes them effectively funded by taxation. The OECD country which has the most developed market and least socialised system is the United States. It stands out from the other countries in having a below average life expectancy of 78.1 years, and spending over $9,000 per capita to achieve this in 2007 while most other OECD countries spent $2,000-4,000 per capita. The UK spent about $3,000 per capita.

No-one would argue that the NHS is perfect. However, there are many existing examples of good practice and successful projects, some of which have been touted by the reformers as arguments for the reforms. It must be remembered that these projects have all taken place under the present legislative framework. Passage of the Bill is not necessary.

The Reforms will be Expensive


In the context of the current economic recession, it has already been recognised that health expenditure would be a problem. NHS chief executive David Nicholson’s 2008/09 annual report says the health service should expect to have to make ‘unprecedented’ efficiency savings of £15bn to £20bn between 2011 and 2014. He writes: ‘This is so that we can deal with changing demographics, the implementation of the [NHS next stage review strategic health authority] regional visions and cost pressures in the system.’ This has become known as “The Nicholson Challenge”. It means that although the Coalition have promised not to cut NHS spending in real terms, because there will be more older people, and healthcare inflation is more than consumer or retail inflation, £20bn has to be saved over the next 3 years, from a budget of about £300 bn.

The DH estimates that the proposed reforms will cost £1.3bn to implement. Independent academics have estimated it could easily cost as much as £3bn. This is on top of the £20bn of the Nicholson Challenge. And, as noted in the introduction, the more marketised a system is, the higher the transaction costs become.

The Reforms are Risky


The whole process is very risky: changing all the structures at once means that there will be no safety net if one of them fails. Indeed, in the market the expectation is that some consortia and hospitals WILL fail. The presumption is that other consortia or hospitals (or private providers) will take over the failing bodies, or they will close. Where will patient choice be in all this? Or indeed, any patient rights?

There are very many unanswered questions about how the proposed new bodies will be constituted, exactly which body will have which duty, and where lines of accountability will lie. This is going to be a difficulty for staff and patients alike. When there are problems, and there always are problems in healthcare delivery, it is likely that no-one will be accountable.

The process of GP commissioning carries inherent conflicts of interest, since GPs will be commissioning services which overlap with the services that they themselves provide. For example, a diabetic may be cared for at the GP surgery, or may be referred to hospital. This is even before one considers the problems when GPs set up companies to provide services such as physiotherapy, or minor injuries (which is already happening); or if GPs are rewarded for saving money on prescribing or referral budgets.

The Reforms will be Ineffective.


The proposed changes have not been tested nor piloted. There is some evidence to indicate what might happen e.g. what happened with fundholding, as described in the introduction. There is evidence from health economists to show that competition on price reduces quality. This happens in other markets too: we do not generally go to the Poundshop if we want good quality goods. The Government have backed off a little, and said that there would only be two tariffs for hospital procedures (a local and a national tariff). However, it has been estimated that 70% of NHS activity is not covered by the tariff system.

The Government’s vision is “to modernise the NHS so that it is built around patients, led by health professionals and focused on delivering world-class healthcare outcomes”. This sounds fine, but there is no evidence that the proposed changes will achieve this. The BMA commissioned Ipsos MORI to do a survey in January 2011. 1,645 doctors participated in this. A majority thought that enactment of the Bill would lead to increased competition (88%), which will lead to fragmentation of services (89%), reduce the quality of patient care (65%) and will damage NHS values (66%). They also thought that the reforms would increase health inequalities (66%). These concerns, and many others, were also articulated at the BMA Special Representative Meeting on 15th March. Over 400 doctors, representing medical staff throughout the UK, voted for motions criticising every aspect of the Bill, and agreeing to campaign against it..

So, it comes down to whom you believe: Lansley says it will work, the majority of doctors say it will not. If you are concerned about any of the proposals as well, you can email our MP dowdj@parliament.uk at any time.