The Case for Change

The latest Government consultation relates to a 'who pays for care' argument known as "The Case for Change - Why England Needs a New Care and Support System". The fact that the system needs overhaul is not in dispute; Care Services Minister Ivan Lewis says himself that if he were devising a health and social care system now, he certainly "wouldn't start from here".

But with hundreds of thousands of patients, service users and family carers feeling the pinch of the credit crunch; rising fuel prices affecting care staff and meals on wheels; and social care departments nationally at breaking point, how is this question - arguably the most critical issue affecting public services in years - being asked? A website has been created - and you can find it by clicking on this link.

Local authorities are being asked to "create forums, networks and task groups which involve staff across all sectors, people who use services and carers as active participants in the change process". A very big ask, you might think. A very large price tag to convene all these groups and ensure fair consultation. But help is at hand - the Government is giving local authorities funding to assist.

How much does Kent County Council, with its forty thousand plus staff, its one and a half million residents and its twelve district councils get?

Five hundred pounds.

Out of sight, out of mind?

BBC's Newsnight tonight featured a story on female typhoid carriers who were incarcerated in the isolation wards of mental asylums. Shocking evidence was given by Professor Peter Taylor of the London School of Pharmacy, analysed foetal samples for potential typhoid carriers for Long Grove Sanatorium at Epsom in Surrey, which formed part of the "Epsom Cluster" of Horton, Long Grove, The Manor, St Ebba's and West Park.

Women were still held at Long Grove until it closed back in 1992. However the patient records were not removed, and when vandals inevitably broke in they flung these records everywhere, to be discovered later by archivists researching this story.

Most terrifying was the fact that, although most of these unfortunate women had no mental illness when they were taken in, but developed mental illness as a result of being locked up. There is however no record of any one of these women ever being released. They simply lived and died behind the locked doors of Long Grove, many being buried in pauper's graves in the asylum grounds.

May Heffernan was a ward sister at Long Grove in the 1960's, and says these women were treated like lepers - boiling water flushed through the toilets, and lice soap was used by any nurses who came into contact. Other staff remember 'nice' women, with intelligence, imagination, and lives of their own - who were locked up simply because they were typhoid carriers.

That this national scandal ever occurred is shocking beyond belief - in one case, a lucid and intelligent lady isolated in one small room for five to six years. But altogether darker and more upsetting is the Department of Health's comment that, although the powers for incarceration and isolation of disease carriers exist, they deny that such powers have ever been used.

Working across party divides is so powerful

I drove down to Ashford Borough Council's offices this afternoon to attend one of the regular Member Briefings organised by Kent Adult Social Services (KASS). Since I became Cabinet member for KASS, I've been really keen to ensure that County Councillors were both kept up to date with social care developments in their area, but also briefed on the issues and pressures facing the Directorate in general. More important than either of these, is that our Councillors need to know that they're being listened to - after all, who better to keep us up to speed with the latest local feeling and the politics behind the scenes?

And crucially as I said this afternoon to County Councillors Elizabeth Tweed, Mike Angell, Derek Smyth and George Koowaree - when KASS does something to affect the delivery of social care in their area, they'll be the first to get calls from local residents, so it's vital that we keep our Members up to speed.

It was a really productive meeting - senior officers from social services were joined by colleagues from the NHS and mental health to update on a range of issues, and we also had a chance to discuss some of the major strategic issues affecting the delivery of health and social care - such as the cost of choice; the effects of the credit crunch; Ashford's future development plans and the excellent work being done by the Ashford District Partnership Group for those with learning disabilities.

What a shame our outcomes so often become embroiled in party politics - working across party divides is so powerful.

TeleHealth and the County Show

I forgot to tell you - when I visited the County Show last weekend, I got chatting to the Social Services officers manning the TeleHealth stand. The TeleHealth programme, you may recall from earlier postings, allows Kent residents with limiting long-term conditions such as COPD, diabetes, high blood pressure etc, to receive equipment from Kent Adult Social Services which enables them to take readings such as blood sugar, blood pressure, blood oxygen, weight and so on. These readings are then sent by telephone to their GP and thus avoids the need for surgery visits or hospital appointments.

Our staff told me that two people had specifically visited the County Show this year for the purpose of finding the Kent TeleHealth stand. It seems that at last year's show, both people volunteered to have their readings taken on the stand.

Armed with these readings, one person apparently visited their doctor, who alerted by our TeleHealth data, identified a limiting long term condition which can now be treated in time. The other person shared the data with his GP, who as a result then reduced the medication which this patient has been taking.

Neither of these stories represents a sound clinical case study of course, but just imagine the difference in health outcomes if all Kent residents had access to TeleHealth equipment?

Delayed Transfers of Care in Maidstone and Tunbridge Wells

Later this afternoon, I travelled to Portcullis House at Westminster, for a meeting with Greg Clark and Sir John Stanley, Members of Parliament for Tunbridge Wells and Tonbridge and Malling respectively.

The meeting had been called to discuss the issue of Delayed Transfers of Care (bed blocking, or DToCs as they're often referred to) from hospitals in Maidstone and Tunbridge Wells.

Although punctuated by the division bell calling all Members to the Lobby to vote, it was a productive meeting, and I was able to explain some of the successes of our joint working with both the Primary Care and the Acute Trusts, and some of the outstanding issues which need to be addressed.

Above all, it was great to see our local MPs taking such a keen interest in this issue, which is one of the most critical aspects of the Government's "Our Health, Our Care, Our Say" White Paper last year. If we can't get the joint working right, none of the aspirations can possibly be delivered.

Vocation? For some, but clearly not for all.

On a visit to a respite care unit this afternoon, I was introduced to a chap who was clearly much younger than the others. He'd been there for seven weeks, he thought, and began to tell me his story. He'd been a scaffolder, until two years ago when his career had been ended by a stroke which left him paralysed on his left side. He was duly admitted to the Stroke Rehabilitation Unit at Sevenoaks Hospital.

One night, he'd wanted to use the toilet and pressed the emergency call button. The nurse took a while to come, by which time he's messed the bed. This happened twice, at which point one of his nurses "turned against him", and among other hateful taunts, had told him "of course, you'll never walk again."

Well, two years later, and he's been coming to our KCC unit regularly to give his wife and son a break. Whilst there, he's been working with the physiotherapist, and - at last - he can now walk along parallel bars, and last night, walked from the dining room round to his room aided by a four footed walking stick.

I was struck by the courage, spirit and sheer pluck. He admitted he could be "a bit grumpy", and that it took a while to get over the humiliation of being changed and bathed by staff, but full of praise and admiration for the care staff.

And - clearly a far better man than I - bore no malice against the nurse who got into his head and gave him so little hope.

Vocation? For some, but clearly not for all.

Another vague "customer knows best" plan?

So it's finished. After a painstaking twelve months of work and after collating the views of around sixty thousand patients and staff, Lord Ara Darzi has finally pronounced on his review of the NHS. I well remember in early September last year going to the London Beach Golf and Country Club in Tenterden to join a luncheon hosted by Lord Darzi and David Nicholson, Chief Executive of the NHS. The small but select audience were treated to a few opening comments about the review. It promised to be exhaustive; to be brave. It promised to be innovative and not to be sidetracked. So?

It's the patient, stupid. Their views will affect funding, their death rates will be published, their choice of drugs and treatments will be respected, and their GPs will be funded differently to make it easy for them to change practices.

But how many times have we heard this? The GPs I've spoken to since taking responsibility for Kent Adult Social Services have all told me how heartily fed up they are with bright idea after bright idea; with reorganisations on average every five years, and never enough time allowed to bed down changes before the next bright idea comes along.

Some ideas - like personal care plans or access to personal budgets for those with long-term conditions - are things which social services departments have been doing for some time now. Others - like the option to travel to Europe for treatment in UK waiting lists are too long - rely on the patient being able to travel, and the preferred country having the right medical team, the right pharmaceuticals, and hospital or clinic capacity.

Judge for yourself. But I'd rather have seen some real blue-sky thinking building on the dedication of the hundreds of thousands of dedicated staff in the system already, rather than another vague "customer knows best" plan.

A fantastic ambassadorial effort

Today I went up to the House of Commons with Deputy Leader Alex King and Chief Executive Peter Gilroy, where Kent County Council and policy group Westminster Advisers hosted a conference on TeleHealth; an innovation which uses new technologies to assist those with chronic long term conditions to monitor their vital signs, such as blood pressure, blood oxygen and blood sugar from the comfort of their own homes, sending the data to their GP by telephone.

Just under a hundred delegates attended from the NHS, local authorities and primary care trusts, as well as service users and their carers and families. I made the point in my welcome that it wasn't about the cost, or the process, nor about whether it was health or social care who got most benefit. It was about the outcomes, about how this programme was changing people's lives for the better.

Speakers from KCC, the NHS and the British Heart Foundation came next, together with a fascinating question and answer session chaired by Nigel Hawkes, Health Editor at The Times.

After the formal session, there was a formal lunch in the Cholmondeley Room at the House of Lords, where Earl Howe, the Shadow Minister for Health gave an excellent address in support of our project and giving a clear vision of health and social care under a Conservative government. Finally, Peter Gilroy gave a typically incisive view of how demand was moving forward rapidaly and what KCC was doing to shape future provision.

Alex King summed it up. "One of the best seminars I've been to in years..." he said "...and a fantastic ambassadorial effort by KCC."

A New Settlement

In the light this week of Gordon Brown finally owning up to a funding crisis in Social Care, I was interviewed by Kent TV on the subject a day or two ago. Entitled "The Ageing Timebomb" - http://www.kenttv.com/programmes.php?CID=27&SCID=63&PID=1269&Title=The+Ageing+Timebomb I discuss the demographics in Kent which will see an extra 60,000 pensioners in the county over the next eight years. I tlak about the complexity of people's needs and the cost of providing the levals of freedom and choice which the Labour Government espouses.

In the second part of the film, you'll see an explanation of TeleHealth and TeleCare initiatives which use new technology to provide freedom and independence to hundreds of people across the county.

Kent has been successful in bidding for funds to extend its TeleCare and TeleHealth programmes, and was recently selected by the Department of Health as one of three national pilot projects, alongside Cornwall and Newham, representing the 'Whole Systems Demonstrator' exemplar of joint working between Social Care and Health.

Health Secretary Alan Johnson has this week announced the start of a six-month consultation on models of funding for health and social care. Care Services Minister Ivan Lewis admitted at a recent event where we spoke form the same platform that "you wouldn't start from here".

Let's just hope that this time the Government are serious. We need a new settlement with Government for health and social care.

The lives of thousands of frail, elderly and vulnerable people depend on it.

Don't be so naieve

Dr John Sewell of Hythe has written an interesting letter to the Saturday Observer in Kent - "Abandon Hospital PFI". Dr Sewell's message is clear - he feels that PFI as a means of raising finance for building public sector buildings is expensive, dangerous, and unpredictable.

His letter states that "PFI has been called a millstone around the neck for new NHS hospitals", reducing their flexibility to respond to rapidly changing healthcare needs. He suggests that the NHS "should reconsider ... before signing this 30-year, tightly worded, risky and constrictive contract".

Well, Dr Sewell, I have news for you. Most of the rest of the public sector feels exactly the same way as you do about PFI, but sadly, it's the only game in town. If we didn't accept the Government's gracious capital funding mechanism we'd have no schools, hospitals or care homes in Kent or anywhere else for that matter.

So, Dr Sewell, if you can come up with a better means of funding Kent's new build public estate, then please let us know. In the meantime, please don't be so naieve.

Pembury finally got what it deserves

After what seems like an age - after months, even years of Government vacillation, yesterday saw the Health Minister Ben Bradshaw give Government's blessing to Pembury's new hospital. A parliamentary question from Tunbridge Wells MP Greg Clark ended years of uncertainty for Pembury.

The brand new super-hospital will be the first in the NHS to offer en suite facilities in every one of its five hundred and twelve, and will feature the latest in technology to assist nursing staff.

With demolition work already in progress, construction is to start later this month, with its first admissions early in 2011, and project completion in 2012.

Of course, this is fantastic news. But what a chequered journey - remember the "alternative site" at Knight's Park? Remember the "experts" who tried to convince us that building on the existing site was the wrong decision? And whilst the arguments raged, remember the threat that - if the new hospital didn't go ahead - we'd see seven hundred and fifty new homes on the disused site?

It's been a long and, at times tortuous journey. But thanks to a long line of very committed and passionate people over a number of years, Pembury finally got what it deserves.

The 6.15 to Brighton

The Government last year published its much-trumpeted White Paper "Our Health, Our Care, Our Say" which said that Health and Social Care providers should be giving much more freedom, independence and choice to its users. That five percent of funding for acute health care should be redirected to 'community settings' to create more local, and preventative delivery. This White Paper followed hot on the heels of the public consultation creatively entitled "Your Health, Your Care, Your Say".

This paper also invented LINKs - Local Involvement Networks where patients and social care service users could dictate how and what they wanted from their services. The Government have no more idea than anyone else what this will look like - indeed, they appointed half a dozen "early adopter" authorities, most of whom spent the last eighteen months in complete confusion and inactivity.

The previous NHS mechanism - the Public and Patient Involvement Forums, or PPIFs, worked well, although they will be disbanded from 31st March, and there is more than a sense that this whole thing is just a "new idea for a new headline" much like Mr Blair's 'Big Conversation' with the nation a few years ago.

So it came as no surprise when I heard how this LINKs legislation had come into being.

Apparently, the civil servant who was proof reading the White Paper on the train home from London, felt the paper was missing something. Ah yes, some element of "public engagement" - Labour's latest wheeze.

And so it was that PPIFs were killed off, and incomprehensible LINKs were born. On the 6.15 to Brighton...

An eye for an eye

In a week that a report from Professor Nick Bosanquet for the Reform group calls for a constitutional change in the health sector making value for money mandatory, spare a thought for Colin Valder.

An elderly man from Brighton, by his own admission "an out and about person" who 'likes visual things' Mr Valder has "fought for King and Country, never been out on strike, never been unemployed, never broken the law, and paid taxes all my life". Now his eyesight is failing, and he desperately needs an operation.

The NHS however, presumably not wishing to waste money saving both his eyes, have told him that he must go blind in one eye before they will operate to save the other.

Apparently the Government may issue guidance soon which might allow this operation to save both Mr Valder's eyes. In the meantime he will just have to wait and hope.

One suspects that in fighting for King and country, even Mr Valder's enemies could not have thought up a more upsetting torture.

Have we learned nothing from Victoria Climbier?

Today saw the shocking and sickening story of little Jessica Randall, who lived just over two months. She never stood a chance - abused both physically and sexually from the moment she was brought home from the maternity unit.

That her father, Andrew Randall personifies evil is clear. That he could have carried out these acts of cruelty and torture is beyond belief. That her schizophrenic mother did nothing to prevent the slow death of her own daughter is tragic.

A post-mortem found nine broken ribs and a fractured skull among her injuries. During her many visits to Kettering General Hospital, over thirty health workers came into contact with Jessica, yet not one of them saw fit to trigger child protection procedures.

Have we learned nothing from Victoria Climbier?

The ABC of PSTCs

According to evidence unearthed by the Financial Times, the NHS have 'suppressed' evidence which prove projects which were giving "very good value for money" were then scrapped to redirect cash into buying £750,000,000 of private care for patients.

http://www.ft.com/cms/s/0/52ccd0b0-d40c-11dc-a8c6-0000779fd2ac.html?nclick_check=1

Private Sector Treatment Centres or PSTCs - were the 'Great White Hope' of Labour's reduction in hospital waiting lists. Staffed primarily by South African or Scandinavian teams of doctors and nurses, the intention was for these centres to (no pun intended) 'hack' into waiting lists for scheduled procedures, performing routine operation after routine operation, cutting down the numbers of patients waiting for surgery.

The idea had serious drawbacks - firstly these 'routine operations' allowed our newly qualified trainee surgeons to hone their skills on more straightforward procedures. PSTCs cherry-picked all this simple work, leaving trainees with more complex operations and little opportunity to practice. Secondly, the cost of these centres - which to attract overseas "contractors" was much higher than employing home-grown expertise - was topsliced directly from the budgets of the hospitals where they were based, leaving cash-strapped hospital with even less money.

'Independent' review teams called in by Government stated that the £550m spent on PSTCs, together with a further £200m spent on diagnostics, "represented good value for money". Strategic Health Authorities agreed the deal "was appropriate and very welcome".

But just a year later, Health Secretary Alan Johnson has cancelled most of the contracts, claiming that the massively improved NHS no longer needs the help. Already Government is spending tens of millions of pounds compensating out of pocket businesses for the tendering costs they have lost.

UBS's Ken Anderson who negotiated the contracts, left just a few months later, as did Lord Norman Warner, the Health Secretary who pushed the deals through. And the only real losers? You and me - the taxpayers. Just another day, another massive waste of hundreds of millions in public money.

Better luck next time? How long can this go on?

Turning in his grave?

An update to my earlier post about my daughter's dental treatment. You may recall that the orthodontist told us that his waiting list for NHS treatment was at least a year long, but that - miracle of miracles - we could go private and receive super-deluxe treatment - essentially a couple of hours' worth of surgery and a brace - for just three thousand pounds.

A colleague of my wife's told her today that he and his family actually go to Poland for their dental treatment - and pay around ten percent of the private fee in Britain.

Poland? What on earth has happened to our National Health Service? Aneurin Bevan must be turning in his grave.

Choice and Dilemmas

I spoke at a recent seminar for local government - "Choice and Dilemmas: The Future of Local Adult Social Care" with Ivan Lewis, Minister for Care Services at the Department of Health.

A small invited group of officers and politicians from London boroughs, county councils, professional bodies and social care media joined myself, the Minister, and Annie Stevenson, Senior Policy Adviser with Help The Aged.

It seemed to me sensible to set out the pressures and issues affecting Social Service departments - the cost of the Government's choice and personalisation agenda; the need for better access to health and social care for all; and how a simple change in legislation would allow us to build much-needed capacity in the voluntary and community sector.

The Minister agreed that fundamental change was required - we needed to rethink the way we delivered health and care services if we were to cope with more demand, from more people, with less money. And although I had to contend with the odd jibe about Kent TV, it was refreshing to leave politics aside for a while to find that everyone in the room had common ground - better services in a changing society.

Mr Lewis will be seeking the views of us all in his Green Paper on financing adult social care later this year. I really hope he's still in listening mode.

Deciding to admit or admitting to decide?

This afternoon was fascinating. Seven members of the KCC Cabinet, including myself, visited Kent and canterbury Hospital, where the Chief Executive of the East Kent Hospitals Trust showed us around various units. The hospital boasts a newly-built multi-million pounds renal dialysis unit with thirty beds, a new operating theatre suite in the old Pfizer wing, and a new children's wing - the "Pink Palace" - which caters for children with both physical and learning disabilities.

Innovation was clearly at the forefront of a major service reorganisation, intended to provide an efficient model of care. There is no longer a traditional "Accident and Emergency" at Kent and Canterbury. Instead paramedics are trained in precisely which East Kent hospital each case should be taken to, depending on their condition. Scarce resources are then concentrated, rather than spread too thinly.

Of most pride though, was the Clinical Decision Unit, or CDU. The idea here is that patients will be admitted, be assessed, and begin an appropriate course of treatment either in hospital or in their own home, all within twenty four hours.

The new ethos, we were told, was one of "deciding to admit" rather than the old "admitting to decide". From the results that the East Kent Trust seem to be achieving, their approach is working.

Who cares?

Nobody who saw today's "Politics Show" could fail to have been moved by the story of Roger and Anne Tuson. Roger suffered a brain haemorrhage, and his wife Anne looks after him around the clock - washing, dressing, bathing and so on.

She sends her husband to a care home for six hours, twice a week to give her some respite. But she pays for this from her Carer's Allowance - leaving her just three pounds a week in acknowledgement of the job she does.

The Audit Commission published a report last week - "Positively Charged" - which suggests that local authorities should balance their budgets by charging more for care to those who can afford it - something Kent did last year when it raised its charges for domiciliary care in order to keep its eligibility criteria at Moderate in the face of ever decreasing funding.

Isn't it time we stopped looking for sticking plasters? Why can't Government just admit once and for all that the balance of funding between health and social care system is fundamentally flawed, and needs a total and radical overhaul.

Thank you and goodnight - NHS style

Rose Gibb, ex Chief Executive of the NHS trust at the centre of the C-Dif scandal, is to receive a £75,000 payoff. You may recall that at the height of the fatal outbreaks in Maidstone and Tunbridge Wells, Health Secretary Alan Johnson stood before Parliament to decry any payout, insisting that he would personally intervene to make sure Miss Gibb's original £400,000 would not be paid.

During a recent conference "up north" I was told by a local authority Chief Executive that it was not even possible to withhold payment from an employee who was arrested - and subsequently convicted - of a string of horrific serial killings. It seems treason is the only reason such an agreement can be broken.

Surely these contracts should revoke any entitlement to a payout in the case of incompetence or misconduct? For the sake of the dedicated staff, for all those who died, their friends and their families, isn't it time to look at the law again?