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Health & NHS

NHS nursing crisis: Lili is from Romania & works at GWH - but the flow of EU nurses has now dried up

Lili Baleanu is a Romanian nurse working at Great Western Hospital - one of the steeply declining number of EU nurses to arrive since the Brexit referendum.

Lili graduated as a nurse in Romania in August last year and arrived at GWH in late November. She passed the obligatory English language test (the IELTS - more of which later) and will become a fully registered nurse in a matter of days - getting her Pin number from the Nursing & Midwifery Council (NMC).

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STP WATCH: Did anyone notice? NHS Sustainability and Transformation Plans have become Partnerships - and permanent

 

There was a bit of noise during the election campaign around the government's latest move in the continual and discreet reorganisation of the NHS - the STPs aka Sustainability and Transformation Plans.  This noise of protest centred on rumours of cuts some STPs are going to make.

This kind of noise will get very loud indeed as the plans of some of England's 44 STPs focus on money saving closures of services and buildings - all in the name of sustainability with reduced funding.  But in case we got frightened by 'plans', the STPs have had their 'P' changed to the cosier and much more user friendly 'Partnership'.

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“The Doctor will see you now’”…but in the future? Maybe not

The general election brings - as usual - a wealth of promises and opinions about the NHS.  There is not, however, much talk about the GP crisis.  

About ten per cent of NHS doctors (not all of them GPs) are EU nationals - so unless the post-Brexit status of EU nationals to remain is not fixed soon, the shortage of GPs could get a lot worse.  A poll in February found that nearly two out of three EU doctors in the NHS were considering leaving the UK.

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NHS funding crisis: Wiltshire's part in plan to balance Department of Health's end of year accounts

Squaring the circle of the NHS' financial position at the end of the financial year 2016-2017 is proving a complex process - one that changes almost daily and which calls for the proverbial wet towel around the head and a strong cup of coffee.

We will not be encouraged to show any surprise at all when Wiltshire Clinical Commissioning Group (CCG) - which buys primary (GPs etc) and secondary (hospitals etc) health care for all the county's residents - ends the year with a 'surplus' that runs into eight figures.  It will be in excess of ten million unspent pounds.

The previous financial year (2015-2016) ended badly with the Department of Health overshooting its total resources.  Balancing the Department's books is done by setting those parts of the NHS that are underspent (NHS England's budget and most of the CCGs) against those parts that are overspent (mainly hospitals.)

If the whole system has overspent its agreed financial resources then Jeremy Hunt has to explain himself to the Treasury - and the NHS may simply get less the following year.

This financial year the NHS' finances have been stretched every which way.  Basically the hospitals are, as the providers of acute health care, deeply in deficit for 2016-2017 and the commissioners (the CCGs) who buy services from them (and from others) are largely in surplus.  That, anyway, was how it looked at the end of the third quarter of the financial year.

So what is this £10m to be left as a surplus on Wiltshire CCG's annual accounts?

Over £5m of it is the one per cent all CCGs have to put by as a 'surplus' - which is returned to them for use the following year.  The second £5m-plus is being used as a new way to try and balance the Department of health's books for 2016-2017.

Without getting into all the figures, each year the CCGs have to keep back another one per cent of their resources - known as 'headroom'.  This money is held to spend during the year on redesign and transformation costs for local services.  

Sensing the financial problems to come, for 2016-2017 the CCGs were required to hold back this one per cent as a 'risk reserve' for the NHS as a whole.  It could only be spent with Treasury permission.  Across England this 'reserve' adds up to about £800m - which would go part of the way to making up the hospitals' deficits.  

Now CCGs have all been told to add this money to their bottom line - making many CCGs' surpluses look alarmingly healthy.  How does this help the NHS as a whole?

Wiltshire CGG's Chief Financial Officer, Steve Perkins, explains: "Within all the available resources, there are differing pressures between the providers and the commissioners. This money on our bottom line is in the system - with providers in deficit and commissioners in surplus - this money will balance the books."

That was then.  And then was the beginning of last week.  Since then new figures have emerged for February which make the challenge of balancing those books look harder still.  And there is now only one month left to get things back on track.

Many of the CCG cavalry that had been riding to the rescue of the NHS accountants clutching their underspends, have suddenly gone lame.  

As the Health Service Journal reported: "The figures released today (March 30) show that the financial position of the CCGs has worsened by £180m - nearly 50 per cent - in just two months, with approximately a third of groups predicting an overspend at the end of February."  (Wiltshire CCG is not among those predicting an end of year deficit.)

Now it looks as though all the CCGs' £800m-that's-not-allowed-to-be-spent may only just bridge the gap.  It is going to be a very close run thing - or as NHS England's finance director put it: "tantalisingly close".  

Unless the March figures show some serious depletion of funds following February's very high demands for treatment, the result across the whole NHS system could show it is in the black by £34m.  Not at all bad out of a total 2016-2017 NHS budget of £120 billion.

The NHS has reached a financial 'precipice' point just as it is about to plunge over the Brexit precipice.  As we have reported, the already perilous staffing crisis is threatened with a catastrophic departure of EU clinical and care workers.  

And talking of Brexit, that £34m figure is, of course, less than 10 per cent of the post Brexit bonanza the NHS was to expect once we have left the EU - remember the 'Vote Leave' bus and its extra £350m a week for the NHS?

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Young people want better access to mental health services in Wiltshire 

Zoe Tonks & Elley-May Timmins with the Young Listeners report - ready to present it to the Wiltshire Health & Wellbeing Board (Photos: Tim Gander)Zoe Tonks & Elley-May Timmins with the Young Listeners report - ready to present it to the Wiltshire Health & Wellbeing Board (Photos: Tim Gander)A group of Wiltshire young people are on a mission to change the way mental health services are run for their peers and will be presenting a report to Wiltshire’s Health and Wellbeing Board next Thursday (May 18).

Young Listeners from Healthwatch Wiltshire spoke to 174 children and young people in the county to find out how they felt about using health and care services.

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A Wiltshire GP practice disappears as staff shortages hit NHS and social services

On Wednesday (March 29) the Prime Minister will trigger Britain's departure from the European Union.  This will undoubtedly leave the estimated 57,000 EU nationals who work in the NHS feeling even more unsettled and anxious than they have been since June.

We know that Brexit is already having an impact on the NHS.  During 2016 2,700 EU nurses left the NHS - compared to the 1,600 EU nurses who left in 2014.  And only 96 nurses joined the NHS from other EU countries in December 2016 - compared to 1,304 who joined last July.

A morning spent at the Wiltshire Clinical Commissioning Group (CCG) board meeting offers ample evidence of the way the NHS is already, in pre-Brexit times, struggling with recruitment - and the shortage of staff is also hitting social care which in turn affects the NHS.

1)   It was the impossibility of recruiting two GPs to the Marlborough and Pewsey GP surgeries that has caused their merger.  Now, "due to unforeseen GP shortages",  the Smallbrook surgery based in the Warminster Community Hospital has collapsed - leaving its 4,300 patients unsettled and anxious.

This surgery - which in December had been rated 'Good' by the regulator - lost one GP to maternity leave and then two partners suddenly left.  Recruiting one doctor  - let alone three doctors - in a hurry proved, understandably, impossible.  The surgery has now been 'integrated' - temporarily? - with the Westbury Group Practice.   

Smallbrook is still open for three hours a day with priority for appointments given to those who cannot travel to Westbury. The CCG are working on more permanent plans to make sure those 4,300 people have a full and local GP service.

2)  The Avon and Wiltshire Partnership (AWP), which provides the county's adult mental health services, shows a scary example of the endemic recruitment shortfall.  Their teams in Wiltshire have 117 vacancies - a vacancy rate of about 22 per cent.

3)  There was some wry laughter during discussions on the ongoing 'crisis' in A&E and the missed four-hour-wait target. The CCG Board heard that capital money was available to meet NHS's insistence that GPs should be placed at A&E 'front doors' to act as a first line of triage.  The elephant stalking that room was simply: "Where are they going to find all those doctors?"

4)  The CCG and Wiltshire Council's Better Care Plan work to keep the elderly out of hospital and, if they do have to go into hospital, to get them back home faster, will be supported from April 1 by an experimental scheme involving 30 Rehab Support Workers - a new role.  

The plan is for them to help people during their first ten days at home and, over a year, should effect 1,091 timely discharges from hospital.  In the first year they will be costing £1.2million.

Seven of those thirty recruits have come from Wiltshire's Help to Live at Home  providers - leaving them, in turn, short of seven staff who should also be helping patients get home from hospital - and at a time when their work is getting harder.  

A report to the CCG Board stated: "Help to live at Home providers are experiencing increased acuity and are delivering more hours of care, supporting the same number of clients".  

As one CCG director put it, when it comes to recruitment "We are all fishing in the same pond."

5)  Virgin Care which last April took over community health services for Wiltshire's 110,000 nought-to-eighteen year-olds, is also having recruitment problems.  In January their nursing vacancy rate rose by eleven per cent.  

In the last quarter of 2016 they were short of six whole-time-equivalent school and community nurses and currently have clinical vacancies equivalent to 22 whole-time-equivalent posts.

That is probably enough examples to show how great a problem Wiltshire faces.  Why is Wiltshire affected so much by these shortages?  Recruitment plans and staff retention plans abound.  To some extent it is true that "We are at the mercy of the market." But it may be much more of a cultural issue.

AWP appears to have no problems of recruitment for its services in the Bath and North East Somerset area.  Presumably the cultural and night-life of Bath solves their problem.

Facing the closure of Smallbrook Surgery, one Warminster town councillor was quoted as saying: “The town council doesn’t have much on a say on healthcare, but what we can do is do our best to make the town a more attractive place to live - to encourage more GPs to want to come and work here.”

Locally these staff shortages may be partly due to cultural and partly to housing costs.  The problem may be partly a matter of rates of pay and, more generally, of government imposed pay restraint. 

But as Brexit proceeds and EU nurses, doctors and surgeons (and for that matter those from beyond the EU) feel even less welcome in Britain than they have been made to feel since the EU referendum, then recruitment and staff retention could well become the next great problem that threatens to break the NHS.


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