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?

The day from Hell ... and a curious case of double standards

I was invited to a Ministerial Launch of the Whole Systems Demonstrator Action Network by Care Services Minister Ivan Lewis today. Kent was recently selected by the Department of Health, along with Newham and Cornwall, as one of three national pilots for TeleHealth equipment. TeleHealth allows people with limiting long-term conditions such as COPD, high blood pressure or diabetes to remain independent in their own homes by monitoring their vital signs themselves and sending them to their GP by telephone.

The event started at 2.30pm at the King's Fund at Cavendish Square in central London. I had ordered a County car for 1pm, which at 1.20pm had still not arrived. By 1.35, my PA had ordered a taxi, which turned up at 1.40pm.

My friendly but inexperienced Eastern European driver followed his SatNav to the letter, on a scenic and circuitous route throught the Blackwall Tunnel, through the City - High Holborn was a particularly notable traffic jam - and eventually, in torrential rain and at twenty past three, into Cavendish Square.

The one saving grace was that, although I was nearly an hour late, I was not the last to arrive. That priviledge was reserved for the Minister, Ivan Lewis who arrived at half past three. He spoke for around fifteen minutes and then apologised for having to leave for a Commons vote.
My County driver had been told to pick me up at 2.30pm - the start time of the event rather than the end time! - and so he had to wait around for two hours until we finished at 4.30pm. The drive home was equally fraught, the driver claiming we had broken all records for the longest return from London, at around three hours.

I did feel that the formula was a little skewed - around sixty people travelled for what would have totalled hundreds of hours to Central London, to meet a single Minister who travelled five minutes down the road. Whilst I appreciate it would have been impractical for Ivan Lewis to drive miles out of town, for the sake of his fifteen minute address could we not have used an M25 venue and a video conferencing link?

From a Government who espouse green values and seem to want to heavily penalise road travel, it seems a curious case of double standards.

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."

One of a kind

The front page of this week's Tunbridge Wells Courier carries a salutory headline - "Town's Secret Drink Problem Revealed".

The Kenward Trust (http://www.kenwardtrust.org.uk/) is a Christian charity which operates from Yalding in Kent, helping hundreds to break the cycle of drug and alcohol abuse. Their report on the culture of dependence in Tunbridge Wells makes shocking reading. Godfrey Featherstone, a director of the Trust, is quoted as saying that "people shut themselves in their houses and drink themselves to death".

I've known Godfrey - and the Kenward Trust - for some years, indeed I asked them to come along to Pembury in 2002 with their excellent "Grey Zebra" project for young people. The results were truly remarkable.

Godfrey and I both come from Bermondsey, which gave us something of a common bond. I've always respected his no-nonsense approach and the truly passionate manner in which he dealt with the problems of those around him.

Sadly, on Friday of next week, Godfrey celebrates his retirement from the Kenward Trust. Although noone deserves the rest more than him the Kenward Trust - and those it serves - will be the poorer for his leaving. Godfrey is truly one of a kind.

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...

A Licence to Smoke

From the Government who brought us the smoking ban, who put thousands of publicans and restarateurs in dire straits, last week came the next bright idea - the "£10 Licence to Smoke".

Chairman of the 'Health England' quango, Professor Julien le Grand - yes, that's a real person's name - proudly stated that if his idea was accepted, smokers would have to complete an annual form and submit this with a photo and £10 fee, to apply for a 'Licence to Smoke'. Without this, they would be unable to buy cigarettes in shops. Professor le Grand suggested that having to apply in this way would put off vast numbers of smokers, helping this lunatic control-freak Government towards their next nanny-state target.

"You've got to get a form, a complex form - the government's good at complex forms; you have got to get a photograph." he said "It's a little bit of a problem to actually do it, so you have got to make a conscious decision every year to opt in to being a smoker."

Clearly Professor le Grand feels that a ten pound fee would succeed where cancer, emphysema, thrombosis, lung and heart disease, Government tax greed and more recently, social pariah status has not.

If this idea of a licence is such a great idea, why haven't Government considered it for alcohol? If young people had to apply and pay for a licence to buy their lager and alcopops; if they had to show this licence to buy drinks over a bar; and - more to the point - if the Police were entitled to confiscate this licence if the bearer were found consuming alcohol in a public place or behaving antisocially under the influence, maybe we wouldn't have out-of-control town centres every Friday and Saturday night up and down the country.

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.

Smokers of the world ignite

In a shrewd marketing move, Marlboro today announced its intention to trial the new "Intense" brand of 'bite size' cigarettes in Turkey.

At just 7.2cm long, the new Marlboro will last an average of seven puffs - just enough for a "quick puff" by harassed smokers forced outdoors in all weathers by the smoking ban in more than fifty countries.

However, it will apparently deliver the same strength at half the size - essentially being double strength. How long before smokers are clamouring for a full-size double strength version?

At the same time, a Liberal Democrat MEP in Brussels has laid down a motion calling for the abolition of low energy-efficient goods - top of the list of which are apparently pub patio heaters. The move, which will cost the British pub and catering trade an estimated quarter of a billion pounds a year in lost earnings, will cause even greater consternation - and presumably even shorter cigarettes - among smokers everywhere.

Perhaps a worldwide protest with the old slogan - "Smokers of the world ignite...?"

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.

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?

Money follows money

You may have heard this week about "Men Behaving Badly" actress Leslie Ash, who recently won £5,000,000 compensation in an out of court settlement from Chelsea and Westminster Hospital.

She was given the award because she contracted MSSA, the sister bug of MRSA four years ago when admitted to the hospital.

The point is though that over 6,000 people have fallen victim to a hospital-acquired infection - that's one for every ten people staying in hospital. Many of these people died, leaving heartbroken and confused families and friends. None of these equally tragic - and arguably worse - cases apparently merited a multi-million pound payout. Ms Ash was able to afford the best legal team around, hence her huge windfall.

So who stands up for the other 5,999 families who don't have that kind of cash? Is their story less important?

MTW Hospital Trust Update

Friday saw an all-day meeting of Kent County Council's NHS Overview and Scrutiny Committee. The entire meeting was dedicated to an examination of Infection Control processes and measures. Following the recent C-Dif news coverage involving Maidstone, Kent & Sussex and Pembury Hospitals, it was the very least we should be doing.

Steve Phoenix, Chief Executive of West Kent PCT was there, as was the new Chief Executive of the MTW Hospital Trust, Glenn Douglas. Glenn was supported by Amy Page, the Acting Director of Nursing.

Members' questions were, in the main, challenging and rigorous - one of the more interesting lines came from Dr Tony Robinson, one of our Tonbridge County Councillors. His line of questioning involved one of the more upsetting facts in the Healthcare Commission report - that patients needing to use the toilet were told to "go in their beds". Tony demanded to know the staff responsible for this, and what had happened to them. After considerable pressure the answer was revealed - four staff were involved. One nurse, and three healthcare assistants.

And their fate? Whilst two of three assistants had been dismissed, the nurse and one healthcare assistant remained.

The story goes on...

To read the Kent Messenger coverage of this meeting, click the following link: http://www.kentonline.co.uk/news/default.asp?article_id=36152.

To see the meeting webcast on the KCC website, click on http://www.kent.ukcouncil.net/site/player/index.php?a=11782

Bound for Bucks!

Travelled up to Buckinghamshire on Monday night, where I'm working for the rest of the week for the Improvement and Development Agency (IDeA) undertaking a Peer Review of Buckinghamshire County County. We've been called in to do a "quick and dirty" report on the Public Health unit, under the title "Healthy Communities".

It'll be interesting to see how they're doing, particularly since Buckinghamshire County Council has been assessed as 'Excellent' and given the maximum four stars by the Audit Commission.

With me is the Chief Executive of North East Derbyshire District Council, a Strategic Director from Staffordshire County Council, and two consultants from the IDeA. We have three days - three days to arrange and conduct interviews, write up our initial conclusions, and put together a presentation for the Leader, Chief Executive, senior members and staff.

If nothing else, it'll be great experience...