The NHS Debate (Merged threads)

[WearyRhino]

 

Because of my job, I know one area where for an entire area of around 1m people there is ONE single acute mental health assessment bed, if two people dare to be mentally ill requiring immediate assistance then, ah well, that's just unfortunate.  I saw one incident of a 16 year old girl being sent 250 miles from her family because that was the closest bed for her.  It's almost unrecoverable now.  It would take the government to invest many extra billions to stop it failing now.

 

 

Thanks for that Craig. As someone who has personally been involved with local mental health services for much longer than I would have wanted, I know only too well that what you say is true and getting worse, one of the reasons I was so riled by Norman Lamb's speech last week. When I experienced my last mental health crisis a couple of year ago, I was at one point, after spending 9 hours in a police cell in degrading 'rip-proof' clothing, for my own safety, offered an acute bed in Liverpool or Guildford. I was then transferred to the local A&E where I was assessed by a MH crisis worker who fought tooth and nail for another 5 hours for a more local bed in Harrogate. I was transferred in an emergency ambulance at 2.30 in the morning from York to Harrogate, tying up 2 skilled paramedics and an emergency vehicle, for 2 hours. I was lucky anyone needing an emergency ambulance in York might not have been.

 

My experience of services post discharge from hospital was as bad. I got a place in a Therapeutic Community for group therapy for 3 and a half days a week which was then cut to two days a week by the contract holding trust. At the same times cuts were being made in local mental health services, the CCG announced a £2.28million underspend on mental health services because they were using that money to offset overspends in other areas. Sickening!

 

To cap it all, last Friday saw the announcement that the CQC has ordered the immediate closure of York's only acute mental health facility, meaning that all patients are likely to be moved out of the area. The building is literally falling down! The problem has arisen because nobody was willing to take responsibility for the buildings maintenance or replacement (it was declared unfit for purpose 2 years ago), the MH Foundation Trust had no interest as their 5 year contract finishes at the end of this month. This is all a direct result of the fragmentation of services in the NHS.

 

Desperate stuff!

[ckn]

Thanks for that Craig. As someone who has personally been involved with local mental health services for much longer than I would have wanted, I know only too well that what you say is true and getting worse, one of the reasons I was so riled by Norman Lamb's speech last week. When I experienced my last mental health crisis a couple of year ago, I was at one point, after spending 9 hours in a police cell in degrading 'rip-proof' clothing, for my own safety, offered an acute bed in Liverpool or Guildford. I was then transferred to the local A&E where I was assessed by a MH crisis worker who fought tooth and nail for another 5 hours for a more local bed in Harrogate. I was transferred in an emergency ambulance at 2.30 in the morning from York to Harrogate, tying up 2 skilled paramedics and an emergency vehicle, for 2 hours. I was lucky anyone needing an emergency ambulance in York might not have been.

 

My experience of services post discharge from hospital was as bad. I got a place in a Therapeutic Community for group therapy for 3 and a half days a week which was then cut to two days a week by the contract holding trust. At the same times cuts were being made in local mental health services, the CCG announced a £2.28million underspend on mental health services because they were using that money to offset overspends in other areas. Sickening!

 

To cap it all, last Friday saw the announcement that the CQC has ordered the immediate closure of York's only acute mental health facility, meaning that all patients are likely to be moved out of the area. The building is literally falling down! The problem has arisen because nobody was willing to take responsibility for the buildings maintenance or replacement (it was declared unfit for purpose 2 years ago), the MH Foundation Trust had no interest as their 5 year contract finishes at the end of this month. This is all a direct result of the fragmentation of services in the NHS.

 

Desperate stuff!

Where I live in Ipswich, we had a fantastic brand new mental health hospital built to replace the ancient old wreck of the old one, pity the new one has half the beds of the old one.  The mental health trust is in special measures and probably won't survive too much longer if they keep going the way they are.

 

I found Lamb's speech and the adulation he was given as the saviour of NHS mental health shocking and disgraceful. The worst political spinning I've seen in many a year.  Lamb presided over the biggest real-terms cut in mental health budgets in the history of the NHS, he saw the increased demand for these services and cut anyway.  For him to be given any credit at all for his performance as mental health minister is a bit like Harold Shipman being given credit for reducing his patients' suffering.

[Griff9of13]

I do see your point but it just needs careful thought rather than scrapping.  Without those statistics, we'd never know the true extent of the scandals.  They provide a nice anchor for proper investigation.  That's where the government and the regulators get it wrong, they look at the statistics and swing their political axes rather than looking to see what the root cause of identified problems are.

 

For example, the scandal at Colchester hospital around them fudging waiting lists for cancer patients wouldn't have been caught without the statistical oversight at NHS England level.

 

There's a lot of power in those statistics.  For example, NHS commissioners have at their power access to GP statistics for over-prescribing antibiotics, those who give the most sick notes, those who refuse to use generics and so on but there's not the political will to tackle this.  We can do so much with those statistics if we put the right thought and political will to it.  And this stuff isn't onerous on the clinicians, it's all captured in the background whenever a GP types a prescription or puts a note on the system about a sick note.

 

I’m currently doing work for the NHS in Scotland where we are trying to help manage that data. We are starting to provide some nice shiny business intelligence applications that will be available across multiple platforms (PCs, tablets, smart phones etc.) that will present in a more useful and easy to understand way. It would seem the Scottish government have a slightly different approach; one example is the “once for Scotland” initiative. This basically means anything developed for one health board (the Scottish equivalent to a NHS trust) has to be available to any of the other boards without any major rework avoiding “reinventing the wheel” and associated costs. It’s still very much early days but we believe, done correctly, we can make some substantial improvements in patient care and outcomes and provide some hefty cost saving in the long term.*

 

One thing is obvious, from an IT point of view there has been far too much variation and fragmentation of systems across and within trusts. One of our greatest challenges is pulling together data from a plethora of sources, all too much of which is just an Excel spreadsheet sitting on one person’s PC. That said, there are some new systems being introduced that have been specifically designed for health service management, almost all of which originate in the USA.

*I can’t go into too much detail due to commercial sensitivity.

[WearyRhino]

I’m currently doing work for the NHS in Scotland where we are trying to help manage that data. We are starting to provide some nice shiny business intelligence applications that will be available across multiple platforms (PCs, tablets, smart phones etc.) that will present in a more useful and easy to understand way. It would seem the Scottish government have a slightly different approach; one example is the “once for Scotland” initiative. This basically means anything developed for one health board (the Scottish equivalent to a NHS trust) has to be available to any of the other boards without any major rework avoiding “reinventing the wheel” and associated costs. It’s still very much early days but we believe, done correctly, we can make some substantial improvements in patient care and outcomes and provide some hefty cost saving in the long term.*

 

One thing is obvious, from an IT point of view there has been far too much variation and fragmentation of systems across and within trusts. One of our greatest challenges is pulling together data from a plethora of sources, all too much of which is just an Excel spreadsheet sitting on one person’s PC. That said, there are some new systems being introduced that have been specifically designed for health service management, almost all of which originate in the USA.

*I can’t go into too much detail due to commercial sensitivity.

 

The correct collection of the correct data is not only important it's vital to shaping and improving services. The "variation and fragmentation of systems" of data collection simply reflects the disgraceful fragmentation of commissioning and service provision. It all becomes a farce when you have providers collecting qualitative 'customer satisfaction' data that support the myth of choice. My last visit to A&E with a friend ended with us being asked if we'd "recommend the department to a friend or family member". An A&E department! Bonkers!

[ckn]

The correct collection of the correct data is not only important it's vital to shaping and improving services. The "variation and fragmentation of systems" of data collection simply reflects the disgraceful fragmentation of commissioning and service provision. It all becomes a farce when you have providers collecting qualitative 'customer satisfaction' data that support the myth of choice. My last visit to A&E with a friend ended with us being asked if we'd "recommend the department to a friend or family member". An A&E department! Bonkers!

In some ways the choice thing is good.  For example, if you lived in the Barts hospital catchment area then you'd be subject to increasing waiting times but neighbouring ones are still doing OK, your GP has the power, at your request, to refer you to a hospital with far lower waiting times for your specific issue.  Before the power of choice, you'd just have to lump the long waiting times.

 

Recommendations for A&E though are just silly.  I saw one statistic that said "100% of our A&E patients last month said they would come back to our hospital if they needed more emergency care"   If it were anything but 100% I'd be concerned!  What are they supposed to do?  Slip out of unconsciousness enough to tell the ambulance crew to take them somewhere further away?

[gingerjon]

 

*I can’t go into too much detail due to commercial sensitivity.

 

Pint?

[Stevo]

The correct collection of the correct data is not only important it's vital to shaping and improving services. The "variation and fragmentation of systems" of data collection simply reflects the disgraceful fragmentation of commissioning and service provision. It all becomes a farce when you have providers collecting qualitative 'customer satisfaction' data that support the myth of choice. My last visit to A&E with a friend ended with us being asked if we'd "recommend the department to a friend or family member". An A&E department! Bonkers!

 

I have (succesfully) argued that the family and friends test was useless to the point of absurdity in the context of involuntarily detained patients in mental health trusts and have been told it'll be "reconsidered following consultation with stakeholders".

 

You're right on the myth of choice. Not only are there many health care situations when there just isn't one (or one isn't needed!), or there isn't time to consider options, but there are also way too many competing groups all arguing for how particular performance indicators intended to inform "choice" should be presented. Spend some time on NHS Choices, and see if you can find any surgeons whose post-surgery mortality rate is indicated as being outside of expected norms...

[MaverickX111]

I've had access to the NHS on several occasions in the last few years due to the ill health of my mum, the fact that my sister is a nurse and the fact I've acted as a recruiter for specialist health companies

For me whilst the people in it are largely good people the system as a whole has created an enormous creaking monster ready to explode. Poor moral , poor communication , exhaustion, really poor quality care companies in the community and a private health care sector attracting the creme

The Tories would love to privatise but they dare not

So what they will do is treat more and more people outside of the hospital environment

And if the Tories get in again in 2020 they will start to privatise huge parts of the health service

[Saint Toppy]

and the fact I've acted as a recruiter for specialist health companies

 

Do you recruit for the NHS ?

If so then your part of the problem. These greedy recruitment firms have made it so attractive financially that staff are leaving the NHS's own employment to go contract which has driven up wage costs significantly across the whole service (and making a tidy profit for the recruitment firms in the process). Recruitment firms were supposed to help 'fill in the gaps' but instead they're drainaing the best talent straight from the NHS and then selling it back to them at a hugely inflated cost.

One of the best reforms the government could bring in is to put a cap on the amount contract staff can be paid in relation to their full time NHS equivalents. 

[Griff9of13]

Top Tory claims HALF of NHS beds are facing the axe fuelling fears of health privatisation

[John Drake]

NHS facing £2bn deficit and 'worst financial crisis in a generation'
http://www.theguardian.com/society/2015/oct/09/nhs-trusts-in-england-run-up-almost-1bn-deficit-in-three-months
 

All going according to plan, then...

 

We know what the eventual 'answer' to this NHS crisis will be: full privatisation and charging.

[Griff9of13]

NHS facing £2bn deficit and 'worst financial crisis in a generation'

http://www.theguardian.com/society/2015/oct/09/nhs-trusts-in-england-run-up-almost-1bn-deficit-in-three-months

 

All going according to plan, then...

 

We know what the eventual 'answer' to this NHS crisis will be: full privatisation and charging.

 

[Trojan]

Apparently they had these figures last week. They just didn't release them before the Tory Party Conference.  Under Labour funding for the NHS increased in real terms by 6% pa until the recession.  Under this lot there has been a real terms freeze for 5 years. No wonder it's in a mess.  YOU CAN'T TRUST THE TORIES WITH THE NHS!

[Ramite]

NHS budget increase for this year is about 3.2 billion , that's a fair chunk of money. Budget will then be about 116 billion. How much more money does the NHS need ? 6% a year is about 7 billion so is this enough ?

[amm]

THIS

[Saint Toppy]

Under Labour funding for the NHS increased in real terms by 6% pa until the recession.  Under this lot there has been a real terms freeze for 5 years. No wonder it's in a mess.  YOU CAN'T TRUST THE TORIES WITH THE NHS!

What's the 'like for like' comparison - How much did the funding increase under Labour during the years of recession compared to the years of the last Government, also in recession ?

[ckn]

My entire working day so far has been spent dealing with a private healthcare organisation that runs a number of services.  80%+ of their patients are NHS ones where there isn't capacity in the system.

 

Shameful.  All about the money.  Couldn't care less about the clinical state of a patient.  Their view is that they will discharge people regardless of clinical need if their extra and new financial demands are not met.  Such a vile, bitter, hateful set of meetings that has done absolutely nothing to improve my perception of private healthcare companies.

 

Anyone who thinks a private healthcare system would be better than the NHS really needs to have their head checked.  By the NHS.  If you can find a bit of the NHS with capacity.

 

I need a very large whisky.

[ckn]

I'm waiting on the newspapers doing their releases on this but I've just read a press release from this morning about mental health figures within the NHS.

 

In the last decade, the amount of people referred to mental health and learning disability professionals has almost doubled with a huge spike from 2010/11 onwards.  Yet since 2010/11 the budget for those services has reduced by 8% in real terms.  The people needing an immediate "place of safety" has gone up 11% in one year alone.

 

The number of compulsory detentions under the Mental Health Act has gone up by 10% in one year alone while the non-compulsory in-patient admittances has gone down significantly.  This is simply because there is no capacity for non-compulsory admittances due to bed and ward closures, psychiatrists know that the only way patients will get a bed is if they section them.  A blatant misuse of the system but there's really no other choice available to the patient or psychiatrist.  The over-capacity needs of these patients is met by the hugely expensive private hospitals.

[shaun mc]

One of the group I was on holiday with is a NHS Practice Nurse. She despises the current government for the way they are debasing and degrading the NHS. Just mention Andrew Landsbury and she goes on a rant, as well as the Lib Dems who backed Landsbury on his bill to allow greater privatisation. Didn't know the Lib Dems backed him.

[Saintslass]

I'm waiting on the newspapers doing their releases on this but I've just read a press release from this morning about mental health figures within the NHS.

 

In the last decade, the amount of people referred to mental health and learning disability professionals has almost doubled with a huge spike from 2010/11 onwards.  Yet since 2010/11 the budget for those services has reduced by 8% in real terms.  The people needing an immediate "place of safety" has gone up 11% in one year alone.

 

The number of compulsory detentions under the Mental Health Act has gone up by 10% in one year alone while the non-compulsory in-patient admittances has gone down significantly.  This is simply because there is no capacity for non-compulsory admittances due to bed and ward closures, psychiatrists know that the only way patients will get a bed is if they section them.  A blatant misuse of the system but there's really no other choice available to the patient or psychiatrist.  The over-capacity needs of these patients is met by the hugely expensive private hospitals.

Why was there a 'spike' in referrals from 2010/11 onwards? 

[Saintslass]

One of the group I was on holiday with is a NHS Practice Nurse. She despises the current government for the way they are debasing and degrading the NHS. Just mention Andrew Landsbury and she goes on a rant, as well as the Lib Dems who backed Landsbury on his bill to allow greater privatisation. Didn't know the Lib Dems backed him.

She is bound to despise the current government: they are a Tory government.  In the same way a large proportion of teachers are leftwing, a large proportion of nurses are leftwing.  The answer to the problems of the NHS is not to throw loads of money at it.  The Labour government did that and there was no improvement in services.  It just meant that nobody threatened strike action.

 

I don't think the answer to the problems within the NHS is to throw loads of money at it.  Some trusts and individual hospitals do fine on their budgets.  Others are abysmal.  There should be best practice taken from the successful trusts and hospitals and adopted in those who aren't managing their services well.  There have been no cuts to the NHS in spite of what propoganda has been spouted by some on the left.  The NHS has been one of the protected budgets and that has caused consternation among some government departments which have had to take the hit for it.  But money alone is not enough. 

[ckn]

Why was there a 'spike' in referrals from 2010/11 onwards? 

Funding was cut almost instantly to allow for diversion of the funds to acute (hospitals) and primary (GPs, etc) care as that was what the media were whining about at the time.  It's something that all parties have done over the years, diverted funding away from the hidden mental health system into the rest to fill gaps.  Seriously, no party politics with this one.  No-one wants to defend mental health properly, the one who said he did, Norman Lamb, actually presided over a 10% bed cut and 8% funding cut all while saying he was the only one who could save it.

 

There is typically one acute "place of safety" mental health bed for about 1 million people on average across England.  Those are where the police or standard hospitals can safely stick mentally ill patients while waiting for a bed.  Those are usually full, it's a rare night that they're not used.  The scary thing is that anyone under 18 who is sectioned and there's not a bed stays in a police cell in the majority of the time, they can't go on adult wards.  The police try their best but struggle badly with this and it has a proven seriously negative impact on the poor kid who needs help rather than imprisonment.

 

Mental health in the 90s used to be 85-90% voluntary referral, i.e. those who could convince a psychiatrist that they were so ill they needed inpatient help, that's down to under 10% now because there are so few beds left.  Psychiatrists know they have to section under the Mental Health Act to have a reasonable chance of getting a bed for patients, even though 10 years ago those same patients would never have been considered for sectioning.  Even then, patients are often sent hundreds of miles away to wherever in England there's a bed, I even saw a few cases of patients being sent to Scotland from the south of England because there were no beds at all in England or Wales.

 

Then you have the local mental health trusts who have to use non-existent money to send critically ill patients into private hospitals at very high prices.  Private mental hospitals typically have 70-90% NHS patients.  What's worse is that in the past those who would benefit most from expensive intensive private therapy were sent there but now it's just filling beds because there's nowhere else to go.  There are some seriously and disturbingly ill patients being sent there and being so disruptive it's affecting the other patients when in the past they'd be in specialist places for them.

 

I have seen critical risk reports from areas where people have made a credible suicide attempt, have said they'll try again but are released to their family's care because there's nowhere for them to go.

 

It really is now money or nothing if you are mentally very ill but not ill enough for inpatient care.  There is not the capacity in the NHS system to deal with anything bar the lowest threshold (done through GPs) or the highest (done through overstretched psychiatrists).  If you have the money then you can get good care, if you don't then, well, tough.

 

If Labour get in, it'll still be the #### child of the NHS that gets too little care at the expense of mainstream hospital waiting lists and GP surgeries.  I do despair.

 

Then there's the idiot notion of competition.  You have mental health trusts having to have marketing and bidding teams plus far too many contract management staff and the finance people that go with it.  All because someone thinks that competition between NHS trusts is a good thing.  Scrap the ridiculous internal competition for NHS mental health and you'll save many millions almost instantly plus those who clamour for non-clinicians to be sacked will get their wish.

[ckn]

If Maggie Thatcher had cut 10% of hospital beds over 5 years there would have been riots.  It was national news in the 80s when single wards were cut with even Tory MPs calling it scandalous.  I heard of a whole ward being closed on Friday because the hospital couldn't afford to hire replacement nurses for a bunch who had resigned to become agency.

[Roughyedz]

NHS facing £2bn deficit and 'worst financial crisis in a generation'

http://www.theguardian.com/society/2015/oct/09/nhs-trusts-in-england-run-up-almost-1bn-deficit-in-three-months

 

All going according to plan, then...

 

We know what the eventual 'answer' to this NHS crisis will be: full privatisation and charging.

 

 

True all this , veveryone with half a brain knows that we will get 3 more yeaqrs of the Govt feeding the media with stories why the NHS HAS to be privitised to make it better / save it . The truth is that it will be the Govt M.P.'s that are first in line, with most of them either already owning Companies or Just about to buy shares in companies, or buy new shares at a massive discount in a New Private Company bidding for contrats, All profits going to the shareholders, just as we have had for last 15 years with the Housing in this country since Thatcher and Blair sold all the council houses off. What happens the money from tax payers in benefits goes to landlords and straight into their bank account in lieu of the old council estates where the money went into building more homes and repairs..... Same will happen in ther NHS unless the electorate in this country WAKE UP .........and Soon  

[ckn]

The number of people admitted to hospital suffering from malnutrition as a primary or secondary diagnosis has gone up by 51% since 2010/11.

 

2010/11 - 4,883

2011/12 - 5,409  

2012/13 - 5,810  

2013/14 - 7,145  

2014/15 - 7,366

 

50% of those with a primary diagnosis of malnutrition were over 60.  You are 250% more likely to suffer from malnutrition if you live in the most deprived 10% of England.

 

Source for this is HSCIC, a government statistics agency.

 

Vote Tory (or Lib Dem), get Tories.