Better Health Better Care- Improving Your Experience of Care

This first section of the document has my favourite statement 'There will be a clear policy presumption against centralisation'. Glory halleluiah! So many of the problems that the NHS has been dealing with at an organisational level have been based on the wrong assumption that bigger is always better. It also has a specific promise to bring in a Local Healthcare Bill, which will include direct elections to health boards.

Some people are against the idea of health board elections. They think that this will mean that people who are not qualified to comment on health, will stand. What is not generally realised is that on healthboards, there are actually quite a lot of people who are not experts in health and the only reason that they are there, is because the ruling political party has put them in. So you get retired councillors, election agents and all manner of connected people who have no connection with health, but have plenty of connections with politics.

If elections were brought in for about half of the seats on the health board, as was mooted in the original Bill Butler bill, people who have an interest in health could stand. Retired doctors and nurses could apply. People from carer's forums could stand.It would actually throw the door open to the professionals who work at the coalface, not the office desk. And it would mean that we would have meaningful consultation on health policy changes in a local area. If you have a vote, you have a voice.

Going on, this section touches on the fraught area of independent scrutiny within service change. It states that proposals should be 'robust, evidence based,patient-centred and consistent with clinical best practice and national policy.

Two areas have to be tackled to make this possible. Firstly, the issue of commercial confidentiality. Health boards have taken to slapping 'Commercial Restriction' on every document that they don't want made public, especially when it involves something contraversial. So when NHS Lothian were asked if Stracathro was value for money, (an ACAD run by a private company that has been contracted to do operations on behalf of the NHS) the information could not be obtained because it came under commercial confidentiality. This cannot be obtained by the Freedom of Information Act either.. Now, if public money is being spent on something (in this case £15million) then those spending it should be publicly accountable.

Connected with this,is the status of health care providers in relation to the General Medical Council. If you are an individual GP, you are accountable to the GMC. If you work for the NHS, you are accountable. If you have been sub-contracted by a private company to work for the NHS, (ie staff at Stracathro) you are not accountable to the GMC. This means that if there is malpractice, a court action has to be raised; there is no middle ground. It is also undermining the regulatory function of the GMC. It must be addressed.

Otherwise, a very good chapter. More tomorrow!

Better Health, Better Care- a Better Document

First, apologies. I do realise that I have not blogged for a couple of weeks. This is because rather a lot has been happening at this end and I have been running around like a blue -bahookied fly. But time to get back to blogging and my bedside reading just now is this document - 'Better Health,Better Care'. It's a discussion document that was brought out by the Scottish Government in August and submissions are due in November.

Documents like this are tricky to get right. Too much detail,and you are accused of having already drawn your own conclusions. Too little, and you are accused of having nothing to offer. This document has got the balance just right.

There are several specific targets

Abolition of prescription charges; direct health elections;an end to hidden waiting lists; free school meals;a new dental school in Aberdeen; a waiting time no longer than 18weeks from referral to appointment;

It has a specific policy direction

The document has statements like 'There will be a clear policy presumption against centralisation'.

It is ambitious

This is a wide ranging document. It is looking at every area of healthcare and has the feeling of ambition about it. In modern politics it's very difficult to have a big idea or big government. Politicians are accused of bringing in the nanny state when they do this. If they fail in any of their objectives, then this is forever cast up to them. Politicians have therefore been careful-too careful in my opinion, to go for it, and attempt make a real difference; they end up picking around the edges of legislation, rather than attempt something that may leave them exposed to criticism. This document throws that approach out of the window. It is a breath of fresh air.

It is in plain English.

Not a sign of 'synergy' anywhere. Need I say more?

I will be discussing this document over the next few posts, and how the aims in it might be achieved. Watch this space!

Beyond Parody..

You have just finished writing a sarcastic post on bureaucracy terms. Then you learn over at Aphra Benn's, that the Department of Health has just brought out a document on the MMC scandal. It was printed on 12th September. They want comments and submissions in by the 25th September, So they want feedback, but not that much,then.
You couldn't make it up..

Glossary of Health Board Terms

Your intrepid blogger found this little book of terms on the health board chief's desk..

Conference - a dull day at a hot hotel, talking hot air, but it's not work and there's Black Forest Gateau.

Synergy- a really exciting word peppered through boring documents.

In synergy with - you have just been yoked together with a department that has nothing to do with you, wants nothing to do with you and which is sharing half your annual budget.

Consultation- the management have decided what they want-now the management will decide what you want.

Downsizing - you're all fired

Facilitator- that big 20 stone bloke with the earpiece

Synergy - a really exciting word peppered through boring documents.

Fit for the 21st century - a new building of plasterboard, half the needed size, but with a kettle.

Fit for purpose - An old building, given a lick of new paint, with a kettle.

Fit for use - An old building, given a lick of leftover paint, without a kettle.

The latest in computer technology - works if you switch it on and off a couple of times.

Merger - You're all fired.

Pay Rise - never heard of it.

Synergy - a really exciting word peppered through boring documents..

Powerpoint - the guy didn't know enough to write a paper on the subject, so he did some slides instead.

Public Meeting - held at 6 o'clock teatime, in a boarded up building, in the part of town where the police dogs go in twos.

Preference Scoring - can you guess which department we're shutting?

Rationalisation - you're all fired.

Re-organisation - half of you are fired. The other half are getting their pay cut.

Review - we tried to shut you down. You threw half bricks at us. We'll try that one again..

Synergy - a really exciting... ok, you get the idea..

Parking Mad

Another bit of welcome news - Nicola Sturgeon announced today that there would be a review of car parking charges at hospitals. I was a witness at the Health Committee meeting that was held about this last June in Holyrood and I was distinctly unimpressed by the reasons given for having a charge in the hospital car parks. Basically, the argument went that there was all these fly parkers going in so the charge had to be imposed. The fact that the fly parker would pay for his ticket and then leave it there for the rest of the day, didn't seem to bother Consort. All suggestions about having a barrier, car park tokens, showing your appointment card and all the things that are used at public buildings as a matter of course to prevent this problem, cut no ice with the car park owners. Staff that were travelling to the hospital, were having to pay; in effect having £500 docked from their wages before they even crossed the threshold of the door. There was a suspicion that these charges esp at the Royal Infirmary of Edinburgh, were being used to pay for the interest on the PFI loan that built the hospital.

However, this problem is rather more complicated than it would first appear. One of the features of modern hospitals is that they tend to be built out of town. This is because some years ago, capital charging was introduced on NHS properties, to encourage the NHS to get rid of buildings that it wasn't using. So if you had a hospital in town ie Glasgow Royal Infirmary, then the capital charge on that would be prohibitive. If however, you had a hospital out in the middle of nowhere like Hairmyres, then the capital charge would be much lower. So the NHS started building out of town.However the downside is that many of these hospitals do not have good transport links and the only practical way to get to them, is by car.

One of the worrying features of this, as I mentioned in a previous post, is what would happen if you needed all your staff if there was a major incident. By definition, none of them would live near the hospital, and all of them would have to travel a considerable distance to get to the hospital. If the incident occured on say, the M8 and you had to travel along it to get to the hospital, what then?

If the hospitals want their staff to leave their cars behind, they are going to have to rethink their transport links, and on a wider scale, the government is going to have to rethink the whole centralisation issue. Bigger isn't always better. However, there is one thing that could be done fairly easily to encourage people to travel by public transport; re-man railway stations at night, and bring back bus conductors. It would make everyone feel a lot safer, and cut out most of the boorish behaviour and vandalism that we have come to accept as normal on trains and buses. You don't believe me? Well, when I was going to school in the eighties, I travelled on the trains when the stations were manned; there was very little bother on them. When they de-manned the stations, within weeks, gangs of neds appeared on the trains and by the end of the year every station from Coatbridge to Glasgow had been burnt down. Its time for a review of this, and time for a review of transport in general.

A Broken Trust- the Pamela Coughlan Case

Last November, the Scottish Health Campaign Network met with Andy Kerr to discuss various health issues. I was with them, and for that particular meeting I chose to ask a number of questions on mental health provision and care in the community. One of the questions I asked was; what was happening about the funding of people who were moved from continuing care beds in hospitals, into care homes in the community? The reason that I asked this question was because of the Pamela Coughlan case down in England, which became a benchmark case in health care.

Pamela Coughlan(above)was severely injured in a road accident some twenty years ago. She needed professional medical care, as well as help with feeding and dressing, which came under the title of personal care. At first she was placed in an NHS nursing home which specialised in long term care of this type. However, when plans were mooted to shut the nursing home and move the patients into local authority residential homes, Pamela was told that the funding of her care was no longer the NHS's responsibility. The social services were to provide funding and this would be means tested. Pamela challenged this decision in court, and to cut a long story short, she won. The court decided that the NHS trust had acted unlawfully and that they were responsible for the funding of Pamelas medical care. The social services would be responsible for personal care.

This issue is now coming to Scotland. In my own area, Lanarkshire, Kirklands hospital which catered for people with severe learning disabilities is closing. Hartwoodhill, which dealt with brain injury and psychiatric disorder, is closing. And the number of continuing care beds is being reduced. In short, there is a considerable number of people with significant medical needs being put into the community or nursing homes. But is the funding going to follow them?

Last week Frontline Scotland attempted to come up with an answer to that and they found that, like England, we are seeing a situation where people like this are being asked to fund their own care and they have no idea that the NHS should still be funding them. . This involves huge sums of money; medical care is more expensive than normal nursing care and the only way that the person can fund it is to sell their home. The buck for funding these people has been passed from the NHS, to local authority, to the person themselves and it's completely illegal. But because the NHS up here has not been challenged on this point, it is still following the old guidelines and hoping to get away with it. It's time it was challenged.

Two Cows

Do have a look at Barry Monk's latest post, 'Two Cows- Political Analysis for Beginners'.