Clinical Commissioning Groups- who guards the guardians?

I have been following the decisions made by the recently formed local Clinical Commissioning Groups with some interest. They seem to have something of the iconoclast about them. Firstly, the change a long established arrangement with the local drug and alcohol treatment provider ADSIS that has existed for many years for a Birmingham based service.

Shortly afterwards I read that the GP out of hours service in Basford is under review. The service which has been run as a not for profit organisation by local GPs fear that a large private health organisation will take over the contract and that a company with no local knowledge will have a detrimental impact on patient services. Continue reading

Something for nothing- private health and the N Staffs Health Economy

Something for nothing- private health and North Staffs Health economy

There is much talk in the media nowadays about ” something for nothing” society and “welfare dependency”. Usually these comments are directed at someone who has been on benefit for a long time and is deemed as putting nothing in to the community. And barely a day goes by that the newspaper exposes someone for fraud.

There is another form of dependency, which costs the taxpayer far more than those felons reported on in the pages of the Sentinel. Continue reading

PFI, Defrauding taxpayers an open letter

Dear Sir,

Having l articles on benefit fraudsters such as Sandra Edwards who defrauded taxpayers of £11,000 is all very well, but there are bigger fish who have cost the exchequer multiples of £11,000.

The national media of the last week has highlighted the huge waste of public money in a number of projects by the Labour Government. In ascending order we had the £500 million wasted on the reorganisation of the national call centres in the fire service. But this is peanuts compared to the £12 billion lost on the national computer scheme for the NHS, the folly of which has been known about for nearly a decade. But top of the heap of malfeasance and waste is the Private Finance Initiative started under the Tories but fully exploited by Gordon Brown as Chancellor of the Exchequer. The cost of new NHS private- financed schemes will stay with future generations of taxpayers up to 2049. Hospitals that would have cost £11 billion under the old Treasury arrangements of financing public projects such as hospitals will now cost £75 billion. An absolute disgrace which dwarfs the £11,000 stolen by Edwards. If Edwards deserves jail what fate should be in store for the politicians and civil servants that sanctioned this grand larceny?

Of course there are other projects funded through PFI including City schools. I hear horror stories of local schools been charged astronomic amounts for even minor repairs or maintenance. The whole PFI sorry saga requires more scrutiny then it has so far generated.

Bill Cawley

Job Cuts At University Hospital North Staffordshire

The Guardian and the TUC are reporting this morning that 50,000 jobs are to be cut in the NHS over the next few years although the NHS is supposed to be protected from public sector cuts.

According to information gained from FOI requests University Hospital North Staffordshire is looking to reduce staff by over 1300 or almost 23% in the next 5 years.

The positions under threat over the next 5 years are:

  • 2010/11
    • reductions not clear. Figures are subject to review.
  • 2011/12:
    • Medical & Dental – 43.28;
    • Nursing & Midwifery – 190.06;
    • Other Clinical – 38.74;
    • Other – 100.48.
  • 2012/13:
    • Medical & Dental – 49.96;
    • Nursing & Midwifery – 219.42;
    • Other Clinical – 44.4;
    • Other – 115.99.
  • 2013/14:
    • Medical & Dental – 32.6;
    • Nursing & Midwifery – 143.17;
    • Other Clinical – 29.46;
    • Other – 75.69.
  • 2014/15:
    • Medical & Dental – 30.83;
    • Nursing & Midwifery – 135.4;
    • Other Clinical – 27.6;
    • Other – 71.58.

Should the NHS & UNHS be protected from the cuts? What affect with this have on people in Stoke-on-Trent who have a lower life expectancy that the rest of the UK

Figures are for Whole Time Equivalents.

Adult social care services are “Ëœperforming well’

Social care services for adults in Stoke-on-Trent have received their highest ever performance rating from independent inspectors.

The Care Quality Commission (CQC) has awarded Stoke-on-Trent City Council its second highest “Ëœperforming well’ accolade for services across the board.

The annual inspection builds on a strong performance last year, and means the authority has improved on last year’s adequate rating in categories for improving residents’ quality of life, and in maintaining the personal dignity and respect of residents.

Other services to continue to be rated as performing well are:

* Improving health and wellbeing.

* Making a positive contribution to residents.

* Increasing choice and control.

* Ensuring residents are free from discrimination or harassment.

* Providing economic wellbeing.

The report praises the council’s effective leadership, the work it is undertaking to join up services with the NHS, its work in providing personalised budgets to give residents greater choice in the services they require, and establishing partnership boards in areas including learning disabilities, mental health, carers and older people.

{quote=Councillor Hazel Lyth, cabinet member for adult social care, sport, leisure and culture, said] “This assessment reflects the hard work being done to continue to improve services for some of the most vulnerable people in the city.

“We have continued to make sustained improvements to services in each of the last four years, and this is the first time services across the board have been rated so highly.

“The current financial climate and budgetary constraints being imposed on us by government means we are going to have to make very tough decisions on the services we deliver in the next 12 months. But we remain committed to ensuring we provide the highest quality services to every adult in the city who receives social care, and we will work hard to ensure our performance continues to improve in future years.”[/quote]

The report highlights the council’s work in trailing personal health budgets and increasing the number of residents receiving direct payments to 1,000, with 900 people supported by Disability Solutions, which is commissioned to provide direct payments and support services. The council has assessed 2,000 carers over the last 12 months, to ensure they receive the support they need.

The authority has also strengthened adult safeguarding arrangements by developing a joint safeguarding board, raising awareness of safeguarding issues and establishing a safety alert procedure with partner organisations.

The report also praises the council for its work in continuing to develop the skills of managers and training staff.

{quote=Council leader Mohammed Pervez said] “The rating we have received reflects the outstanding effort by staff and our work with partners in delivering the best quality services to residents. I’d like to thank all staff for their hard work and dedication.”[/quote]

The Care Quality Commission is responsible for regulating, inspecting and reviewing all adult social care services in the public, private and voluntary sectors in England. It rates achievement across four areas: performing poorly, performing adequately, performing well, and performing excellently.

Keele World Affairs Group

Keele World Affairs Group is celebrating its 30th anniversary series which starts at the end of September.

The Group, which operates under the auspices of the School of Politics, International Relations and Philosophy [SPIRE] at Keele University, is now the largest Adult Education forum in Europe.

Since its foundation by the legendary Owen Powell MBE, it has grown from a membership of less than 20 to a forum with 450 members most of whom regularly attend its Thursday evening meetings during the university terms.

Past speakers at Keele World Affairs include Lord Carlile, Baroness Jay, Lord Digby Jones, Sir Trevor McDonald, Frank Field, Bruce Kent, Moazzam Begg, several UK ambassadors, and numerous professors from the UK’s leading universities.

Each year, the group examines new themes covering UK political, social, and economic issues, developments in Europe, Asia, North America and elsewhere, and global issues such as the environment, security, and the impact of technology.

The 30th series begins under Owen’s chairmanship on Thursday 30th September at 7.30 p.m. in Keele’s Westminster Theatre. First in the programme is a return visit by Paul Rogers, Professor of Peace Studies at Bradford University on the topic “Where has the new American century gone?” Professor Rogers is an expert on the changing causes of international conflict, terrorism, arms control and disarmament. Much of his work since 9/11 has focused on the western military response to political violence.

This year there will be 25 lectures including the problems of the NHS, Afghanistan, GM crops, our future in space, justice, asylum policy, China, Iran, the extreme Right in Europe, and the geopolitics of the Arctic. A thought-provoking mix! New members are cordially welcomed and details of how to join can be found at www.keele.ac.uk/newsevents/events/worldaffairsseries/

Fat is a class issue

There seems to be a backlash against people who are obese as evidenced by articles that have appeared nationally in the Express and Mail on the number of people who are taking stomach-shrinking surgery.

Issued by the NHS Information Centre, new figures show the number of people having stomach shrinking surgery to help them lose weight soared from 480 in 2004 to 4,246 in 2009, costing the state an estimated £29 million.

Matthew Sinclair, research director at the Tax Payers’ Alliance, is quoted in the paper criticising the increase, saying: “So much is being spent on surgery for the obese instead of on treatment for unavoidable diseases.”

Alan Kaminski from Abbey Hulton who had the operation is featured in the Sentinel deploring what he considers to be an attack on the obese and indicating that for a number of other health reasons such as diabetes and his weight that exercise and other methods proved unsuccessful

Three years ago, Alan found himself in an appalling position when health bodies haggled about who should carry out his treatment and he found himself having to spend 200 days in the UHNS whilst the arguments were sorted out.

Now I know Alan Kaminski who lived in Eaveswood Road when I was growing up. I don’t want to embarrass him but Alan is a highly intelligent and extremely capable man. For some years he was a worker at Hanley CAB I would think that he would make an excellent Councillor for the Abbey.

But there is an issue over the increase in obesity. You only have to look around the public places of North Staffordshire to prove this claim.

I am a fan of the Mitchell and Kenyon series of documentaries of film on lives of people in Edwardian England based on film discovered in Blackburn about a decade ago. I was watching a clip of working people parading around Blackpool in 1904. Not one of the people in the film was overweight. Fat in the context of 1904 was a rich man’s disease characterised by the bulky presence of King Edward VII described by Kipling as a “corpulent voluptuary” which probably explains why Kipling never got a knighthood.

But the film evidence is there. Obviously hard manual work, diet and access to food and skills in cooking are all part of the problem. But it always seems to come down to a culture of blame and the fat are usually labelled as lazy, stupid and lacking control which is why I mention Alan Kaminski who clearly is not stupid or lacking in focus.

A couple of years ago I heard Judith Bell, Public Health Director of North Staffs Primary Care Trust on BBC Radio 4 on a programme in a series on the 60th anniversary of the NHS justifying the conditions imposed on patients who drink, smoke or who are overweight before they can access procedures such as surgery. The radio programme gave examples of the sort of protocols that are currently in place for those patients who for example have a body mass index of over 30.

I would imagine that these policies would have been accepted at board level.

They certainly raised comments from members of the panel who were debating the issue there was talk of “management diktat” and a “black and white approach” adopted by North Staffs PCT. Perhaps the sharpest comment came from a spokeswoman from the Patient Association who was scornful of the consequences of such moralistic decisions on people in poverty and that it was”easy for skinny rich people who make these decisions, much harder if you are having a tough life”.

She was supported by a Rotherham GP on the programme who gave an example of a patient whose knee injury restricted her ability to tackle her obesity which she dearly wanted to do. He regarded the approach as unethical. All the critics of the restricting or denying access approach suggested too much of a “stick” approach, they felt that to make changes requires time, energy and money factors as well as support which can be lacking.

To cite my own experiences of health services in Leek I have found it very difficulty to access the exercise on prescription scheme which eventually proved insurmountable or discovering that the weight control clinic at my practice I use has had funding removed by North Staffs PCT. It therefore seems paradoxical to demand changes by individuals and not provide the opportunities for self help or support within primary care.

But my main objections fall into two main categories. As David Edgar the distinguished playwright suggested that by denying treatments it means that you are denying treatment to people who may have been paying taxes and National Insurance contributions for many years. Where would be the fairness in that as well as being against the ethos of the NHS! Similarly, if it a question of punishing or checking unhealthy behaviour then the logic would also mean that you would also restrict access to services, for example, for those who did not practice safe sex or those individuals who engaged in sports or activities which have high risks of injury.

Secondly, the whole issue smacks of a patrician, top down attitude to health and social care. It invokes the 19th century attitude to the poor and of deserving and undeserving cases. In short, it is more to do with morality than health. It reminded me of a quote by an eminent figure from that century the great philosopher and social reformer JS Mill in his essay “On Liberty” who captured this attitude which has never gone away, “Wherever there is an ascendant class a large part of the morality emanates from its class interests and its class feelings of superiority”. No doubt these feelings of moral censoriousness in authority existed before he was writing in the 1850s, but certainly they exist now as evidenced by North Staffs Primary Care Trust in 2008.

As one Dorset GP explained in the last minutes of the programme the approach being applied by North Staffs PCT was entirely the wrong approach, the impact of social deprivation should be directed upwards towards Government’s whose actions are seeing an increase in poverty rather than in downwards in chivvying the patient to make changes that they will find difficult.

Don’t be a dummy ““ know the dangers of smoking in cars

Stoke-on-Trent City Council and Staffordshire Fire and Rescue Service will be showing you how to avoid being a dummy next month – and cut down on your smoking into the bargain.

Two special “test dummies” will be helping with a demonstration at Stoke City’s Britannia Stadium on Saturday 7 August to highlight the dangers of smoking in cars. Both were part of a study done in the West Midlands to find out the damage done to people travelling in cars by fellow passengers or the driver.

As part of the demonstration, Staffordshire Fire and Rescue will be filling a car with “safe smoke” to show how it can circulate quickly in an enclosed space, and how it can affect those travelling in the car. It has been estimated that smoking just one cigarette in a car, even with the window open, creates a harmful concentration of tobacco smoke. The largely invisible smoke, clings to the car’s upholstery, children’s car seats and passengers, putting people at risk of serious illnesses.

A recent study carried out in the West Midlands shows that people who inhale cigarette smoke while they are in a car, can inhale as much as three times the amount that would be considered safe to inhale over the course of a day. Even with the car’s windows or air conditioning on, it didn’t reduce it by a significant amount. The toddler sized dolls used in the study and the results from the research will be on display on the day, to highlight the effects of second hand smoke, in particular, the harmful effects on children.

Councillor Terry Follows, cabinet member for environment, waste management and neighbourhood services, said: “People may think that just because they have the windows open or the air conditioning on, then it’s ok to smoke or be with someone who is smoking, but in reality, it could have a serious effect on your long term health.

Claire McIver from NHS Stoke on Trent said: “Passive smoking in children and young people is a significant problem locally with over 50% of young people in Stoke on Trent exposed to other people’s tobacco smoke in the car, and around 1/3 in the home. It can lead to bronchitis, asthma, inner ear infections and even worsened behavioural problems and child development.

In addition children who are regularly exposed to smoking in their homes and cars are three times more likely to take up smoking themselves. The best thing you can do to protect others from the dangers of passive smoking is to make your home and car completely smoke free.”

As part of the demonstration, Staffordshire Fire and Rescue will also be flooding a car with “safe smoke” to show how it can circulate quickly in an enclosed space, and how it can affect those travelling in a car.

Firefighter Jim Taaffe from Staffordshire Fire and Rescue Service, added: “It is important that people are aware of the dangers of smoking whilst in the car, as not only can the smoke itself cause health problems but it is also a distraction to the driver.

“It is also important to bear in mind that other people smoking in your car could distract you just as easily and distractions whilst driving can lead to serious accidents.”

NHS Stoke on Trent is very keen to support initiatives like this. The Stoke on Trent Stop Smoking Service offers support to any smoker who wants to quit in a wide range of settings across the city. Stop smoking medicines (such as patches and gum) are available for the cost of a prescription (or free to those who don’t pay for prescriptions). For more information about free services available to you locally call 0800 085 0928.

In praise of the New Government

I was talking to a friend about feelings to the new Government. I told him how impressed I was with the vigour in which a coalition Government had set about its task although having my ideological doubts about some aspects of the administration.

He agreed with me. It is the speed and the confidence with which they seem to move that is breath taking. Take one issue, which appeared in the news this week, the question of removing the age barrier of 65 for workers. The Government did this in the face of groups such as Institute of Director’s and the Confederation of British Industry. They did it within a few months. Like that sorted.

When one looks at the way in which New Labour dealt with age discrimination in the work place with voluntary codes before deciding on legislation which came into force in the autumn of 2006, 9 years after they came to power. The pace was leisurely. I have to admit that I have a particular interest in the issue because I suffered from difficulty in finding work since I hit my 40s. I was interested in seeing the social injustice of people being thrown on the scrap heap when they reached a certain age addressed. I had hoped the Labour Government would approach it with some dispatch. I was to be disappointed. If there seems to be one thing that characterised New Labour was its hesitancy and is unwillingness to upset powerful interests such as the CBI. unless one counts the Trade Union Movement.

This directness of the new Government of is refreshing and already the list promised for new acts and legislation is impressive especially when one considers this is a minority government dependent on Liberal Democrat support.

In Education they have already have legislation in place.

In Health the proposed changes are far more sweeping than was ever envisaged by Mrs Thatcher in her pomp when she took on the reform of the Health Service in the late 1980s.

In Law and Order ASBOs have been done away and the Government is pressing ahead with a root and branch review of the Police service. It has also put forward rather pungent changes to the prison service.

A referendum is promised on voting reform for next May when all we had from Labour was the drawn out Jenkins Review on PR of the late 90s before New Labour had a death bed conversion to the principle in the dying days of the Brown Government.

The new Government has successfully sold the idea that wholesale cuts will be required.

Today the Government is setting out its proposal to reform the benefit system making it more simplified and attempting to remove the poverty trap that bites when people move from benefit to work

And in the Big Society the Government seems to have hit a nerve in that people were generally irritated by the “nanny state” approach of the last administration. I experienced myself when I took my 3 month old daughter to a Sure Start Centre in Ellesmere Port in the spring of 2004 to a baby massage treatment to be told by some health visitor that white men do not know how to look after their children. I think the Big Society idea reflects that unfortunately that there were too many agents of the sate who took the view that ordinary people could not be trusted to organise their own lives. And of course it was all backed up with the target culture.

The problem with the Labour Party that all too frequently it helped to put in place some of the structures on which the new Government will build. I signed up to a facebook page that wanted to build a national protest against the new Government’s changes to the NHS. But did not Labour encourage greater use of the private sector into the NHS? Which Government pushed through Foundation status for Hospitals? Who weakened patient rights by abolishing the Community Health Council’s? Was it not Labour who continued the use of the Private Finance Initiative when they came to power in 1997? I seemed to recall Frank Dobson the first Health Secretary quietening critics by saying that PFI “was the only show in town”.

It cannot be helped that Labour has yet to choose its leader, but I consider the choice to be less than overwhelming and all with the exception of Abbot are deeply implicated in the policy decisions of the Labour administration. And in terms of personality the senior figures of the new Government seem to work well together and we do not have the grotesque farce of the eternal triangle of Blair-Brown-Mandelson continually played out consuming so much energy and time.

At the head of the Government we have David Cameron and I feel that his performance on the whole has been superlative. There was his impressive response to the findings of the Saville Inquiry on Bloody Sunday. His more reasoned approach to Britain’s relationship with the US so refreshing compared to the fawning attitude of Blair. His condemnation of the Israeli action against the Palestinians again to Blair’s apologist response to the disproportionate military action in the Lebanon in 2006. I also think that Cameron is right about the Turkish membership of the EU.

I am not a Tory supporter or am I likely to vote Tory but I am pointing out one unvarnished truth to the Labour Party that you use power to get things done and done quickly. The time and energy that New Labour spent in trying to win over the Daily Mail readership in the end was wasted effort. In the end it is about class and promoting your class interest. Labour left office with an indifferent record made the more miserable when one realises that poverty increased to levels last seen in the 1920s despite the much vaunted target on Child Poverty.

The new Government has presented a test example of the Churchillian adage of “action this day”

Why the changes to the NHS should worry us all

The plans for yet another reorganisation of the NHS should worry people greatly especially those who live or care for people in the disadvantaged areas of North Staffordshire. The NHS resembles a pinball being catapulted around at the whim of whatever governing party is in power.

In the last 20 years prior to which we had 40 years of comparative stability we have seen several major changes. In North Staffs the purchaser/provider split came and went followed by GP Fundholders then Primary Care Groups. Then ten years Stoke had three Primary Care Trusts and then two and then one. Newcastle and the Moorlands have also seen changes in how health care services are run. We have seen District Health Authorities, Strategic Health Authorities whose abolition has now been announced today come and go.

The Patient Voice has also been changed from Community Health Councils to Patient Public Involvement to Links with the influence of the user of health care service being progressively weakened until we end up with the appalling case at Stafford Hospital. This obsession with structure and reorganisation, which both Labour and Tory suffer from, has come at a cost, both financial and human.

Another change poses even more worrying questions. The transfer of resources directly to GPs echoes the Fundholding experiment of the 90s which had a rupturing impact on health care widening even more health inequalities in the poorer areas. GPs in the more affluent areas tended to acquire more resources and facilities at the expenses of GPs in the deprived area.

These reforms were not mentioned during the recent General Election, but these changes open the door to privatisation and the effective death of a socialised health service. We should sleep even more uneasily in our beds tonight.