On Friday I met the Chairman and the CEO of the Berkshire Healthcare Trust. Part of our discussions were about matters which are national as well as local in their impact, so I am posting this report here as well as on my local pages.
We met against the background of Mr Hunt announcing that in future an elderly patient coming out of hospital will be under the guidance and protection of his or her own GP, who will be responsible for ensuring their continuing care and treatment goes well. I welcomed this. The Trust replied that some GP s work on their own, and all GPs need time off, so they were sceptical about how this responsibility works. I suggested they could help provide the backup to the GPs, with a telephone answering service with qualified people to ensure that out of hours calls can be dealt with promptly, and if something urgent is needed the right professionals can be put in touch with the patient. This did not get in the way of the GP being responsible for orchestrating the self treatment and nurse treatment needed for continuing care in his or her normal business hours, and ensuring appropriate services including emergency cover are in place.
I explained the problems for patients – and the consequential issues for taxpayers – that the current arrangements can produce, based on conversations and case histories from my local experiences.
Problems for patients
1. Difficulty in securing the correct supplies for continuing treatment
2. Lack of support when issuing new medical equipment for home use
3. Lack of support in providing maintenance and repair for home based medical equipment
4. Attendance by health professionals who may not have the knowledge or information to answer the actual query of the patient, even where the query is known in advance of the home visit
Problems for taxpayers
1.Wasted home visits by people who cannot deal with the patient’s query or problem
2.Issue of supplies that are incorrect for the patients needs
3.Oversupply of items required, leading to write off at end of treatment
4.Failure to get medical equipment and reusable supplies back at end of treatment
Solutions
1. Proper analysis of patient needs on exit from hospital or on first diagnosis of a home based condition
2. Suitable training for patient where they have to use medical equipment or handle supplies for self treatment, from people who know the equipment
3. Back up supply and maintenance service for medical equipment and self treatment supplies by people who are expert in these matters
4. Attendance of nurse on visit where nursing skills are needed, with the nurse properly briefed on the treatment
5. Inventory and audit of medical equipment, to ensure return of reusable items at the end of the treatment, and safe disposal of other items.
Not all these matters require home visits. Some patients can be helped over the phone or by internet where they are happy with these methods.
November 18, 2013
Indeed all obvious things that would not need to cost very much. Indeed they save overall by reducing the need for new hospital admissions. I doubt it will happen though, the NHS so rarely seems to work on logic.
It so often is more concerned with pushing people on to others rather than creating an efficient, integrated system to actually serve the public.
November 18, 2013
Like the BBC it has no control when spending our money. How many mangers and quangos does it take to get it right? How many select committee reports before they realise politicians are to blame for an over expensive NHS. Spending should not be ring fenced for political point scoring against the opposite team, we the public do not care about the twaddle most MP s speak we want an efficient service for less money. No more freebie access to the World Health Service or incentives by limited payment to bring more people around the world to use it encouraged by Useless Jeremy Hunt.
Who was sacked for the £12 billion waste not he compute system? Who was sacked for the thousands who died? Who was charged with criminal manslaughter for the deaths? Come on, where is the action?
November 18, 2013
Individuals in the state sector are almost never to blame it is always “the system” or “the computer program” the equipment, stress, lack of training or some private sector contractors they have (usually incompetently) engaged.
Mind you Cameron’s daft employment laws largely prevent them (and the private sector) from sacking incompetent staff without endless hoops to jump through so is it any wonder they are often so useless?
November 18, 2013
They keep telling us that “lessons must be learned”.
They should make sure that they employ people that already possess the right skills, and the ones that don’t cut the mustard should be demoted or sacked.
November 18, 2013
Co-Op bank. Banking hits a new low (etc – gives e.g.s of conduct I have not checked out ed) To much regulation. I blame it on labour and the unions..
November 18, 2013
It usually goes like this:
Too early to speculate (or comment).
We do not have all the facts yet
We do not want to prejudice the inquiry/legal action.
The inquiry then reports.
Then they say lessons have already been learned this was after all a long time ago and the systems are very different now.
Then the cycle repeats itself.
Lessons are never learned, no one gives a dam but lawyers do make small fortunes.
November 18, 2013
Today we learn it was the commons authority preventing MacShane from being investigated and charged earlier on the spurious grounds of parliamentary privilege, what a disgrace. No wonder so few MPs faced criminal proceedings after the expense scandal and we have others promoted to the cabinet. Clegg was going to shut the gates of Westminster not promote those who fiddled against the system. Clegg talks about patriotism, does he have a clue what he is talking about? Giving away our sovereignty to the EU is not patriotic, joining the Euro as he wished would have made this country bankrupt. Should we all give our children foreign names to show patriotism? Giving free university education to EU students while increasing tuition fees to £9,000 for British students is not patriotic especially promising to do otherwise. Can he remember what he described as the insidious British culture and his comparison to the Nazi culture? He really ought to consider leaving the country as he dislikes it so much, it would make him happier and us!
Reply The reason only a few MPs were prosecuted is only a few were guilty of fraud or false accounting. Most MPs claimed legally under the then system, with invoices or other proof of payments. Subsequently press and public decided the system was too generous and disliked what had been legally claimed. It was a case of collective misjudgement, not of fraud.
November 19, 2013
Like MacShane I suppose? The matter should have been for the police to decide not the parliamentary authority who always had and has a protective interest. Especially as IPSA has so many former MPs. How many times have we heard for resignations and reform from politicians, yet always so slow to look inward and make sure the institution has public confidence. Your last sentence cannot be proved if the evidence is being withheld by the commons authority. Now state press introduced as revenge and to prevent a similar occurrence. Disgraceful.
November 19, 2013
Which employment laws and interesting to see how many have been prosecuted or sacked for the banking scandal or the horse meat fiasco. Do tell us why this is the case. The public sector not checking them properly? Idiot.
November 18, 2013
When the question of foreigners using the NHS comes up its usually trotted out that surgeries are not outposts of the UKBA. Well I had an interesting experience the other day that contradicts this. I went to register at a GPs and before the doctor’s secretary would accept my application she wanted proof of ID (the usual passport, driving licence etc). When I asked why this was necessary she said it was the law. So if that is the case why are so many surgeries slipping up and not IDing anybody who turns up at their door and getting an address as to where they can send the bill? If there is no permanent address then they should get the nationality and bill the appropriate embassy, as is supposed to happen. The UK needs to be less polite, as when I was in America entrance to the trauma room was granted after I had handed over my passport, insurance policy and most importantly my credit card
November 18, 2013
Some doctors are charged with manslaughter if a patient dies however few are convicted because the law regarding gross negligence manslaughter is confusing owning to the fact that it’s common law, rather than statutory law.
November 18, 2013
Corporate manslaughter investigation ought to be started and those in charge arrested, charged and inprisoned. This is not about doctors it is about managers and ministers.
November 19, 2013
Corporate manslaughter is even harder to prove as you have to show that the manager was aware that their actions would result in deaths. As a result managers are usually only charged with corporate manslaughter when they run very small companies or are the sole employee because it’s easy to prove that they were aware of the consequences of their actions. The more remote management is from where the death occurred the harder corporate manslaughter is to prove.
November 18, 2013
I suppose I am elderly and I know my Mum is! (She is nearly 102).
When she got a nosebleed in the middle of the night, we called 999 and got an ambulance. It took her to A&E where we were treated well and quickly. the paramedics were outstanding, I thought.
When my own eye got something really painful in it late at night, my wife drove me to A&E where, again, we were treated well and this time quickly.
We have a new health centre with a bank of doctors each of whom I have visited. They also have a deaf aid clinic where I hope to go this afternoon.
OK – my problems.
I just say this to show that, for me, the system is working perfectly in the countryside. Thank you government. Now – don’t fiddle!
November 18, 2013
I support your response . We have an excellent GP surgery where you can phone it in the am and get an appointment the same day – at most , the next day . The relationship they have with the John Radcliffe Trust hospitals is also first class ; appointments with specialists are quick and the follow-up communications superb . I would not want to live elsewhere due to the efficiency of my GP surgery . An elderly close friend of mine lives in nearby Berks ; he has had hips done , a low grade glioma and various other ailments . His surgery does not offer appointments in under a week and he has often mentioned the poor response he gets from its reception staff . The comparison is enormous ; surely this should not be the case . I point the finger of blame in his case to the attitude of the Senior Partner . Looking at the weaknesses in the NHS overall is one thing ; I suggest much of the criticism should be addressed to the leadership in GP surgeries .
November 18, 2013
Part of the NHS and many individuals in it are indeed excellent and world beating but many other are alas dreadful.
November 18, 2013
Mike–I’m no spring chicken either and, perhaps 30 years ago, I one evening rang my GP Surgery’s Emergency number and found myself immediately talking direct to one of the doctors at his home, with, similarly to you, something sharp and painful in my eye. He immediately invited me round to his house where he rapidly got the offender out. I continue to be looked after very well indeed by that same Surgery today but I doubt the above could (Maybe even forbidden now??) be possible nowadays. The doctor who did this for me was not a friend or anything of that nature indeed I had never seen him before (or after). I mention this just to indicate that although you were satisfied with having to go to A&E there might be a better way. My comments also need to have factored in to them that back then there was no A&E–it was called Casualty and you (and your GP) had to abide by your own emergencies. BTW, dunno about you, but I am still in love with Carole in Emergency Ward 10.
November 18, 2013
There have been many reports in our papers about the huge number of ‘managers’ in the NHS, and there have been many reports on the huge salaries being paid to NHS “CEOs”.
To me, your proposals, sensible as they are, are twiddlings around the fringes. It should be possible by now to re-direct money towards employing medical and supportive front-line staff as opposed to box-ticking managers. I believe that doing this would have a huge influence to the good for us, the patients, who pay for all this through our contributions.
November 18, 2013
From recent family experience, the individual elements of care can be excellent, indeed world class, but there is no joining up of the elements.
I doubt that there can be one simplistic solution to this such as Mr Hunt’s desire to dump it all on the GP. He is clearly unqualified to lead such a complex organisation and obsessed with the single issue of the GP’s contract. Indeed the NHS as currently constructed is probably too large to be manageable by anyone.
And from my own recent experience of a minor operation carried out privately, private care brings it’s own alternative bureaucracy with its own peculiarities.
November 18, 2013
Do you remember years ago when all GP practices were in effect single doctors surgeries, some even dispensed their own medicine.
Where some patients after operations and release from hospital went to convalescent homes for intense physiotherapy to aid rapid recovery.
Where we had a bank of district nurses who used to visit and treat patients at home.
Yes medical and drug science has moved on since then (from about 50 years ago), but have we lost sight of the human touch ?
November 18, 2013
Shipman finished GPs working alone and dispensing drugs
November 18, 2013
Archloch
I was not suggesting we go back to how things were, but somehow there seemed to be the impression of more care and concern shown by the majority of the medical proffession then, (unless my memory is tainted by rose coloured glasses) to their patients than now.
Nurses had a pride in their appearance and uniform (which was not worn to go to work)
The impression given then, was that people cared about people, that hospitals had to be clean, and that patients were fed, watered, and given a bed pan when required as a matter of course.
We for the most part seem to have lost that very important human aspect of care.
Ref Mr Shipman, well his crimes were fairly recent so not really relative to the points I made originally, and whilst I certainly do not want to trivialise his crimes.
You will always get the odd bad apple in any organisation, and unfortunately we have had nurses killing patients in Hospital, where there should be many staff around.
November 18, 2013
Seems sensible to me.
As to the use of the internet, this offers tremendous communications potential: speech, sight and data. But two things are necessary for the potential to be realised.
First, the home equipment must be readily usable by the patient, which means the procurement authority must produce a good Requirement Specification matched to the needs of patients, many of whom will not be computer competent.
Second, the speed of the internet connection to the home must be fast enough in BOTH directions for video to be of good enough quality. The upload speed is usually far too slow, and the more beneficial the technology could be, i.e. distant, remote location, the worse the speed is likely to be.
November 18, 2013
And he replied?
i think this will be more telling than your solutions alone!
A good format too – maybe repeat with education, transport etc. ?
November 18, 2013
If the UK healthcare provision and funding was reformed so that it included real choice of provider and an element of personal responsibility in funding for care a much better NHS would emerge. I have had experience of the French system which I have said before is very good and I have outlined the reasons why. Also I have as well as being treated by the NHS, which I found not to be very good overall, I have been fortunate enough to have been treated through private medical insurance which was truly excellent. I noticed staffing levels were considerably lower than that in the NHS but the nursing care was even so considerably better, standards of accommodation, hygiene and cleanliness were also higher. The experiences I have had tells me that the NHS has serious problems that could be cured but only if it is realised that the current structure has to be radically altered and that the NHS is not a sacred cow but a very sick one.
November 18, 2013
“The Trust replied that some GP s work on their own, and all GPs need time off, so they were sceptical about how this responsibility works. I suggested they could help provide the backup to the GPs, with a telephone answering service with qualified people to ensure that out of hours calls can be dealt with promptly…”
I seem to recall a single GP practice many years ago when GPs had 24/7 responsibility for all their patients not undergoing hospital treatment. When the GP went on holiday or needed time off for other reasons, he paid a locum to run his practice, a semi-retired doctor he knew and trusted. In order to avoid the potential of getting out of bed every night for domicilary visits, he shared the burden with another local single handed GP. In order to enable patients to pass messages at all times even if he was not located to where his own phone was switched, the GP paid a telephone answering bureau that specialised in providing support for GPs to act as his receptionist.
The decision to turn the work of a GP into a 9 to 5 job has been a total disaster and is correlated with an upsurge of attendences at A & E as well presumably as massive cost increases to pay for out of hours cover and attendance by entrepreneurial businesses, usually by supplying someone with no knowledge of the patient. There has also been the strange case of a GP living in Norfolk contracting with Croydon to provide night cover which he operated single-handed due to an inabilty to attract a retain staff; if a patient got through to him after several hours trying, he advised them to go to A & E; if they got bored with trying to get throught to him, they went to A & E directly.
If our medical services are to some extent not value for money or fit for purpose, it is because some of our politicians and civil servants are not fit for purpose either.
November 18, 2013
Off topic (maybe).
I see Paul Sykes is donating to UKIP as he thinks Cameron is pulling a fast one. Just wait ’till after Xmas when we get some party political broadcasts showing the (problems ed) uncontrolled immigration has caused here and in Europe.
When the lights start to flicker and everyone knows that only the UK is saving the planet by de-industrialising us and transferring CO2 production to China, what will Davey’s response be and Cameroon “because it’s the right thing to do”. Yeah keep trying sunshine.
I hope you have plenty to occupy you after the next election John.
November 18, 2013
Is there the infrastructure in place to identify which equipment a patient will need when they leave hospital and a maintenance system to provide help if anything goes wrong? If not how much will it cost to create and maintain?
The part about identifying which things that can be reused is good, though it may have some problems if the patient will be using a reusable item for a long period of time, such as a wheelchair for the rest of their life. This system will need a way to distinguish between short-term reusable items and long-term ones to prevent it becoming cluttered.
November 18, 2013
“I suggested they could help provide the backup to the GPs, with a telephone answering service with qualified people to ensure that out of hours calls can be dealt with promptly” (JR)
GPs are now compulsory members of Clinical Commissioning Groups (CCG) under NHS England. I am not sure that a “Healthcare Foundation Trust” like you visited, would supply any services to a CCG unless that CCG paid for them. A CCG is responsible for contracting out-of-hours services, if it doesn’t do it itself. The rest of the job the PCT used to do will be done by Local Area Teams (LATS). “The LATs across England have taken on direct commissioning responsibilities for GP services, dental services, pharmacy, and certain aspects of optical services, while some LATs will lead on specialised commissioning across England. A smaller number of LATs will carry out the direct commissioning of other services, such as military and prison health.” (NHS Choices).
It appears that the CCG will be allowed to contract services as long as NICE or CQC don’t wag a dissenting finger at them. CCGs are the designed entry point for the private sector to move in. Don’t be surprised if eventually all the GPs and Nurses in your CCG are all wearing the same colour uniforms.
The NHS is just as big a structural dogs breakfast now, as it was before April 2013. It appears that Monitor and the CQC are doing the same job in parallel and jointly issue licences to operate in the NHS, why?
If I were Secretary of State, I would ask Tesco and all the other big supermarket groups if they would like to take over the NHS in England and fix it. See if they can cut 10% off of last years costs, £109 billion, and introduce a statutory (government financed) and voluntary top-up insurance schemes, that work in any public or private healthcare facility.
November 18, 2013
Well re the recent announcements about special measure for old folks, and supposedly removing the catchment area nonsense and allowing us to register with any GP we like (I’ll believe it when I see it).
On the old folk one my biggest concern would be those places where folk go to retire, and where the population is a much higher proportion of old folk than normal, places like Bexhill are like this. The GP’s are already in effect specialists in old age care, I am not sure giving such GP’s extra boxes to tick is going to help? But open to hearing about it.
On the catchment area thing, I passionately want to see it happen, we need empowered patients able to move away from poor GP’s and local cartels that refuse anyone outside their catchment area. This will be for the best for everyone. But it does mean in those rare times when home visits are needed, such as terminally ill patients, some other measure needs putting in place. In practise the GP’s hardly ever visit folk at home these days, but we do need to figure out what’s going to happen for those rare events when it’s essential. I imagine home visits will become something like the best out of hour care provision, a spread workload?
November 19, 2013
The points you have laid out very basic Nursing Management skills,with nurses making the trained for, medical decisions where equipment is needed. Problems arise when certain products are requested and either stopped because they are too expensive and pharmacies automatically deliver another or the trusts will disallow certain needed supplies.
I am afraid most doctors will not be able to handle this as they have little idea of these requirements.