News dot2left cropped500pxt
  • Mop-Fair---10-10-09------08
  • 4MI-2013-11-28 030
  • Xmas-Lights-2011-11-24 10
  • Torch-2012-05-23 093-
  • TdB-Pewsey 044
  • Marlborough-2013-04-18 St Peters-2
  • D4S0472
  • Silbury-Sunset---10-06-08-----07-2
  • Civic Selfie1
  • Duke-of-Kent 086
  • Big-Bull
  • Hares 017cropped
  • D4S9273
  • Bluebells-in-West-Woods-10-05-09------30
  • MYFC 005
  • Landscape
  • Sunset2
  • Christmas-Lights 15-11-20 097
  • D812668
  • IMG 8472-2
  • Camilla-2012-10-19 152
  • ARK Manton -2012-01-14 49-
  • Town-Hall-2011-05-03 08-2
  • IMG 9097-2
  • Jazz Fest Sat 572

 

This email address is being protected from spambots. You need JavaScript enabled to view it.

Notice

Lack of access rights - File '/images/images/Health/NHS_RED_3_LOGO_450_.jpg'

Health & NHS

The NHS crisis: "Slow down! Diversion ahead - consultations underway"

Changes to the NHS are hurtling towards us as the service lurches from crisis to crisis - and even, in some cases, is running out of cash.  

As Marlborough.News has been reporting - at some length, we're afraid - the Sustainability and Transformation Plans (STPs) will almost certainly have to find savings not just in the 'back rooms' of hospitals and GPs' surgeries, but in front line service reductions that will affect patients - affect us all.

But of course the changes will not be hurtling anywhere.  They will be held up by complex consultation processes and rows between councillors, local politicians and NHS managers and clinicians.

Councillors in Salisbury have already cried foul at changes made by Wiltshire Clinical Commissioning Group (CCG) to the opening times of the Salisbury Walk-In Centre.  From August 1 the Centre's opening hours were changed from 8am-8pm x 365 days a year, to providing an out of hours service in the evenings and at weekends.

Councillors took the opportunity of an extraordinary meeting of the full City Council on August 8, to pass a resolution noting the lack of consultation on the changes:

"The council calls on NHS Wiltshire CCG to consult fully on the proposals to reduce opening hours of the Salisbury Walk-In Centre from 84 to 41.5 hours per week and reconsider these reductions in service."


During debate at the meeting - which the Chairman opened to 'members of the public gallery' - another sentence was added to the resolution: "If the evidence suggests there is a need for 84 hours for the CCG to make arrangements to increase them accordingly."  The resolution was passed by 15 votes to one.

No change in the NHS can be taken on its own and councillors were worried this change would simply end up "...transferring costs to the Accident and Emergency Department at Salisbury District Hospital."

But perhaps the key statements came from local residents who "...voiced their concerns that money was being saved at the cost of local people..." and one of the residents commented "...on the short consultation period of 14 days."

There will obviously be a flourishing growth in NHS Nimbyism when all these changes are announced: how can they plan to save money "at the cost of local people"?  On the other hand, how can NHS money ever be saved without being at the cost of local people?   

And if money is not saved, and if the government fails to find the Gove-Boris Euro billions for the NHS, the cost to local people could soon be in collapsed services.

Like the proverbial super tanker, the NHS takes a good while to turn about.  But there is no 'good while' available here for some services will almost certainly run short of cash to pay staff before the end of the year.

Into this argument - which is central to the STPs that are very soon (we hope) going to be published for all to see - steps Roy Lilley.  He is a well known health service policy analyst, who runs the nhsManagers.network and writes entertaining and wise columns for them.

In a column this week he looked at the delays to change and savings that lengthy consultation periods bring - defying the urgency of the changes, in some cases obscuring their necessity and merely postponing savings that had to be made.  He wrote:

"The solution must be a new, fast-track consultation process.  Something like:
    •    Seventy days max, starting with the presumption... change will happen.
    •    No consultation documents longer than two sides of A4.
    •    No one may object unless they have actually been to a public board meeting and listened to the arguments.
    •    Social media [to be] the backbone communications route.
    •    Paramedics have to give an opinion, in public.
    •    All changes must be clinically led.
    •    ... and, NHS managers have to talk plain English and stripped-pine truth about money and why they are doing, what they're doing.
The changes the NHS needs are urgent.  They should not defy the democratic process, they should dignify it with the speed and clarity it deserves."

What do Marlborough.News readers think about his suggestions?  Are they worried about the future of the NHS?  Send us your thoughts: This email address is being protected from spambots. You need JavaScript enabled to view it. 

Print Email

Great Western Hospital: as the junior doctors plan their strikes, patient safety and staff shortages still top the agenda

Thursday morning (September 1) and GWH's Academy, down in the hospital's extensive basement, is full of staff from many departments and members of the board.  They were all listening to an inspiring talk on patient safety - the start of a day-long Speak Out on Safety event.

Martin Bromiley (Photo Medical Protection Society via YouTube)Martin Bromiley (Photo Medical Protection Society via YouTube)The speaker was Martin Bromiley, an airline pilot who has become a much respected expert on patient safety - speaking to and advising nurses, government ministers and NHS managers.  

Tragically, his wife died during a routine operation - due to human error.  In response he founded the Clinical Human Factors Group - a charity which seeks to help healthcare workers understand how human factors relate to patient safety and quality of care.

Thirty minutes later the board members went upstairs a couple of floors for their monthly meeting - to face so many factors that impact on patient safety.  Uppermost in their minds was the junior doctors' decision to start a series of five-day strikes, which if directors did not prepare for appropriately might also impact on patient safety.

They are today starting their planning for the strikes - but do have the experience of the junior doctors' previous two-day strikes to build on and learn from.

The strikes aside, the main risk for the GWH as the year proceeds is that it will not meet its financial target - or, in a worst case, run out of cash.  At the moment the books look pretty good once the Department of Health's top up funding arrives.  

£2.25million arrived suddenly last month - it had been expected in July.  And if GWH ticks all the right boxes, another cheque will come through in October.   

Apart from the financial squeeze, there are two major pressures on GWH at present: the Emergency Department (they call it ED, other people call it A&E), and staffing.

Basically the ED problem is that they are well away from meeting the national target of 95 per cent of people arriving at ED being treated and either sent home or admitted to a bed within four hours.  

While it is fairly simple to admit someone (if there is a free bed), it is much more complex to discharge them - especially if they are old and infirm and need care at home or somewhere else.  And 'delayed transfers of care' (DTOCs) - or blocked beds - means there may not be a bed free and so someone has to stay in the ED.

During July - "an extremely challenging month" - 7,545 attended GWH's ED - 500 more than in June and 400 more than in July 2015: "The relentless pressure in ED during the month contributed to 76 patients enduring stays of greater than 12 hours in the Emergency Department..."  

Around one in three of those 7,545 will need admitting to hospital (besides those sent directly by the GP.)  GWH should be operating with 85 per cent of its beds occupied by patients.  

At present its bed occupancy stands at 111 per cent - meaning they have brought into use every possible extra bed space they have.  Daily bed occupancy "...has not been below 100 per cent in the last two weeks of August."  

As one director pointed out: "111 per cent - with 80 patients who don't need to be there."  Which brings us to DTOCs...

There has been a summit meeting on DTOCs and Wiltshire Council has assured NHS Improvement and NHS England that its new social care provider (Mears) will sort the problem out. In July there was a rise of 83 per cent in DTOCs that was down to Wiltshire Council's inability to find appropriate after-hospital care. And the problem with Swindon's social care is yet to be resolved.

Sitting in the meeting you could feel some sympathy with the patient's story presented to the board.  After eight hours in ED, he wrote: "I think this hospital is too small for the high demand of Swindon emergencies and desperately needs more space and extra staff."

The board was told that putting in 100 extra beds was the equivalent of adding lanes to a motorway - they would give "a few days leeway" and then they would simply fill up.  However, it is clear that Swindon's population growth has out-stripped what the NHS now provides.  

But even 70 extra beds would pose the immediate problem of finding those 'extra staff'.  And shortage of staff is a severe current problem - affecting risks to patient safety as well as risks to the hospital's finances.  

Currently GWH is showing a vacancy rate of 10.5 per cent.  And a consequent rise in the spend on agency staff. Overseas recruitment is starting again and this month a new cadre of newly registered nurses from the local Oxford Brookes college starts work.

Then last week came the news that the Treasury, who apparently have not understood that the NHS is in financial difficulties, is cutting two per cent (equivalent to about £48 million) of the education and training cash paid to hospitals.  Health Education England will make the money up this year, but it will vanish from next year's budget.

Just another pressure point for a hospital confronted with a register showing 25 risks scoring 15 and over and 14 risks concerning patient safety.  Currently the top risks relate to staffing levels for unscheduled care, the design of the emergency department and patient safety on an understaffed ward.

Which gets us back to Martin Bromiley. He has learnt from the best safety systems and rules used by his own industry - aviation - by Formula One motor racing and the nuclear industry.  But it all comes down, he says, to having "rules that make it easy to do the right thing".  And of course to having the staff to work to those rules.

Print Email

In the midst of its worst financial storm the NHS is hit by a perfect media storm

The secrecy surrounding attempts to re-fashion NHS services - and keep them within the government's tight funding limits - has suddenly become a major issue of media interest - and of public interest as well.

We first reported on the Sustainability and Transformation Plans (STPs) last March.  Since then deadlines for the plans completion have come and gone - the next one is in October and may well be missed by some of the 44 'footprints' running the STP process.

Led by BBC News, the media have leapt on the STPs and the cuts to services they are likely to bring, as a strong August story.  And while politicians are away - or simply keeping a low profile - the story has got, as they say in newsrooms, legs.  And the 'story' may well run and run.

The online lobbying group 38 Degrees is actively involved in this news frenzy.  They are drumming up support by telling members what cuts they think STPs will bring to their area and asking them to get their MPs to' lift the lid' on the secretive STP process:  "...will you sign the petition asking Claire Perry to lift the lid on the plans for the NHS in your area?"  
 
For the STP 'footprint' that includes the Devizes constituency - this 'footprint' covers Wiltshire, Swindon and Bath and North-East Somerset and is known as BSW - 38 Degrees have been told some changes to frontline services are coming: "...but the exact services haven't been nailed down yet."  

They have also published a figure of £490 million as the deficit in NHS and social care to be faced by 2021 across 'BSW'.  That must be a large under-estimate as the shortfall for BSW's health organisations alone will rise to £337million a year by the end of 2021.  And we know that local authorities' social services and public health programmes are hurting badly from the government austerity cuts and should be counted into that deficit.

38 Degrees claim they have "uncovered Jeremy Hunt's secret plans for our NHS" - the truth is that many STPs are nowhere near complete, which may be just as worrying while the financial crisis threatens to engulf the service.

However many people sign their petitions, 38 Degrees are unlikely to get much joy from the majority of MPs who have, we should not forget, backed their governments' low level funding of the NHS - which has caused this crisis.   Over the last six years this funding has edged up point-one-of-a-percentage-point (that's 0.1 per cent) over inflation - just getting over the promised 'real terms increase' threshold.

In the process MPs have wilfully ignored the NHS' own levels of inflation - rising drug and treatment costs and the big rise in demand from a population increasing in numbers and also ageing.

Coming un-invited onto budget spread-sheets are extra costs the NHS has to bear following cuts to social service budgets (causing, for instance, rising numbers of delayed transfers from hospitals - those 'blocked' beds), the government cuts to public health budgets (now also squeezed by local authorities to whom public health was passed) and government inaction on obesity and air quality.  

All the while not forgetting the estimated £3billion costs of the Lansley reorganisation.  These costs are still coming through - recently two Commissioning Support Units set up under the Lansley Act were closed costing £6million in redundancies.  STP may well bring many more redundancy and closure costs.

As the media storm moved onto the Sunday newspapers, one former Health Minister woke up to the size of the problem and began talking about extra tax raising powers for social care.  Why?  Because cuts to social care were undermining the NHS.

The problem with secrecy is that it leads to a welter of half-truths and rumoured truths.  The latest guidance from NHS England says that STP 'footprints' should be careful about asking for capital spending to re-jig their infrastructure or connect with new IT schemes.  

The capital funds available will be "extremely constrained".  There is even talk of STPs being advised to explore land sales to raise money.  This is really weird as the NHS Property Services (known widely as PropCo - a company owned by the Secretary of State and probably on a fairly fast track towards privatisation) have been hoovering up NHS estate and ordered to charge commercial rates for its use.

We are told that that this is about collaboration where there has been competiveness - for instance acute hospitals vying for 'business'.  But how far collaboration gets beyond sharing 'back office' staff and costs remains to be seen.

The eminent King's Fund tells us: "STPs must also cover better integration with local authority services."  A similar line comes from an NHS Manager writing anonymously and entirely sensibly in the Guardian.  

'She' puts a very positive spin on the STP process: "The benefits of STP could be huge...we must bring health and social care services together..."  How this is can happen when Wiltshire Council has only been a 'consultee' on the BSW STP board is unclear.

NHS England is determined we should not think of the STP boards as new organisations within the NHS.  Who then makes the final decisions? 

Presumably if the clinicians on the more locally responsive - and empowered by statute - CCGs do not like a closure or a money-saving reduction in service ordered by the STP, they will vote it down. Though if they do, they may face some sort of penalty - or perhaps they will all be blacklisted from future MBE handouts.

Print Email

The shape of things to come? Virgin Care named as preferred bidder for Bath's community health care

The Bath and North East Somerset (BANES) Clinical Commissioning Group (CCG) has selected Virgin Care as the preferred bidder for its £700 million community health services contract.  The contract is worth £69.2 million annually over seven years - with an option to extend by a further three years.

The contract covers 200 different services - from district nurses to the falls prevention team - currently provided by 60 different organisations.

The Virgin Care bid looks set to be approved by both BANES CCG and BANES Council during November - with a handover in April 2017.  The CCG is selling this as bringing "more community care, closer to home."

Does this matter to Wiltshire's NHS provision?  It probably matters quite a lot - BANES is part of the new area organisation for Sustainability and Transformation Plans that includes Wiltshire and is currently drawing up new plans for the delivery of NHS-funded sertvices across the STP area.  

In addition, the Virgin Care offer looks very much like a version of an Accountable Care Organisation (sorry - that's an ACO) - one of the new ways of delivering services on the NHS' current reorganisation agenda.  An ACO passes the responsibility for the detailed commissioning of health services from the CCG itself to a single commercial or NHS provider.

In this case the CCG will be contracting with a single organisation to commission and monitor those 200 community health services - that will in effect see Virgin Care acting as an ACO.  A slimming down of CCG staff can be expected to follow the April handover to Virgin Care.

It is understood that Virgin Care will be able to sub-contract as many of the 200 services covered by the contract to other providers - commercial, NHS or charities - as it sees fit.  This change could well result in months of uncertainty for the employees currently delivering the services.

In the CCG's announcement, the BANES Council cabinet member for Adult Social Care, Councillor Vic Pritchard, says people who were consulted on the contract "...asked us to join up services and information so that it’s easier for different professionals to work together to coordinate care. Virgin Care will enable this to happen by bringing people’s health and care records into one secure place.”

He adds: “We will also include a clause in the contract which requires any financial surplus made by the new prime provider to be reinvested into services in BANES.”   This will parallel the Wiltshire deal for children's community care with Virgin Care which Baroness Scott has said has a clause stating that no profit will be made from the contract.

According to the Health Service Journal, Virgin Care was preferred over a consortium led by the Sirona Care and Health (a social enterprise group), in partnership with the Avon and Wiltshire Partnership Mental Health Trust, Bath's Royal United Hospital and a local group of GPs.

It was only six years ago that BANES council put Sirona in charge of its social and health care services - moving 1,700 members of staff into the social enterprise organisation.  Sirona's website still says it is "In Partnership with Bath & North East Somerset Council".  Sirona also have an active role in Swindon's health services.

Recently BANES CCG was given the headline rating of 'Requires Improvement' - as were several others of England's CCGs.  This related mainly to the CCG's failure to meet NHS targets - notably for urgent and emergency care and access to elective care.

Print Email

As Jeremy Hunt stays as Health Secretary, the NHS gets a dose of reality

After they had reported rumours he was being sacked, the television headlines said simply ‘Jeremy Hunt remains as Health Secretary'.  They did not mention that the NHS remains in dire circumstances.  Nor did they warn that the sacks of gold promised by Brexit campaigners for the NHS are most unlikely - repeat most unlikely - ever to be delivered.

In fact the situation in the NHS is getting steadily more alarming.  Should anyone think that is 'doom-mongering', listen to Jim Mackey, head of NHS Improvement and probably the second most important person in the NHS. On the day (July 14) Mr Hunt kept his job, he told a conference that the NHS is "in a mess."

Finances are tightening still further, hospitals have posted record deficits, recruitment of staff from overseas is under Brexit threats, the latest way forward - through Sustainability and Transformation Plans (STP) - are taking longer than expected to draft and now the safety of patients is being set against cost.

Members of this government have poured scorn on the Labour government on whose watch the Mid-Staffordshire scandal occurred.  Now this government is telling hospitals which are running deficits that they should not automatically employ staff or improve facilities to meet levels advised by the regulator or standards set by royal colleges.

This latter move has shocked those colleges.  The Health Service Journal quoted Royal College of Nursing chief executive Janet Davies: “This gives completely the wrong message to trusts, whose boards are responsible for the care, treatment and safety of their patients, by suggesting that finances are more important than patient care."

The move will create a new splash of red on hospital risk registers which are already facing a blizzard of new rules - such as caps on agency pay and on management pay - and are still struggling to reduce their deficits.

There are warnings in there air of cuts to services and loosening of targets - the four hour target for A&E waiting times is thought likely to be changed to ease hospitals’ woes.

A reality check is being published by Wiltshire's Clinical Commissioning Group (CCG) in a series of paid, full-page newspaper announcements.  The first one came under the headline "Our challenges".  

The CCG warns of "Future cuts - Annual funding is less than needed to meet demand" and talks about the 'impact of the cuts to social care services'  and points to the "£500million funding gap across Wiltshire, BANES and Swindon for 2017."

The first advertisement quotes Dr Richard Sandford-Hill a GP at Market Lavington Surgery and member of the CCG's board: “Providing health care for an increasingly ageing population is difficult. In my own practice a majority of my routine appointments are attended by people aged over 65, and those people often have complex long term needs."

The CCG's text continues: "The NHS is used to doing as much as it can with ever-stretched budgets.  The shortage of people working in social care means that together with Wiltshire Council, we're doing our very best to make sure we can support people.  And it's not all doom and gloom - we're making some great strides forward to make sure we can properly deal with some of the issues we are facing."

The second advertisement in the series concentrates on explaining 'How we support you to live well' and has a careful guide to choosing the right healthcare when someone is feeling unwell.

On the day Mr Hunt was confirmed in his cabinet post, the much revered King's Fund produced a report on Deficits in the NHS 2016: "There needs to be realism about what the NHS can achieve with the funding allocated for the rest of this parliament."

The King's Fund calls on the government to review the promise of a full seven-day service and believes the government "...has a responsibility to be honest with the public about the consequences of the NHS 'offer', particularly in view of its manifesto commitment to 'protect and improve' the NHS."

The Wiltshire CCG is certainly being honest with the public in its series of advertisements.

Wider planning for Wiltshire's health services:

Amidst all this turmoil, senior NHS leaders in the county are working hard and to very tight deadlines on the STP across Wiltshire, Bath and North-east Somerset and Swindon.

Not everyone is happy with how the STP is being drawn up.  One the most vocal critics is Wiltshire Council's leader, Baroness Scott.  Her unhappiness about the process and the role given to the Council and its staff (first reported by Marlborough.News in April) has now been repeated - even more forcefully.

At the full council meeting on Tuesday (July 12) Independent Councillor Chris Caswill, asked when the plan would be made public so it can be scrutinised by the public.  Baroness Scott: "I would love to know.  This is not being led by this Council."

"I was very disappointed when NHS England changed the rules...to the Health and Wellbeing Board (HWB) and the Council being just consultees on it."

"That is not what I think should be happening if we are going to integrate health and social care."  She did say the HWB was getting updates on the planning talks.  But ended her reply: "I haven't seen it yet."

Print Email

The NHS crisis: short of nurses and short of money - how will costs be reduced?

The NHS does not, of course, close for the summer holidays - unlike schools.  But August has traditionally been a quiet month in the health service as executives prepare in earnest for the winter ahead and prepare to open their finance directors'  half yearly budget forecast.

This year as nurses take their annual summer breaks, executives have to find cover for them that does not breach the new spending rules on agency nurses.  Money and nurses - and the shortage of both - are inextricably linked in the twists and turns of this NHS crisis.

So let's take a look at these two elements of the crisis.  First nurses.  And the initial point to make about nurses is that the NHS is short of tens of thousands of them.  The second point is that the supply gap in nurse training was supposed to be closed by 2019-20.  But this month it was announced that the shortage will continue beyond 2020.

The reason given for this is the bizarre assertion that the 2020 end date was only achievable if hospital trusts obeyed NHS England's Five Year Forward View plan to reduce 'hospital activity'.  This seems to be 'chopped logic' on a wilful scale: one way hospital activity is reduced is by treating more people in the community - where they need nursing care. In addition, as the NHS knows all too well, the population is ageing and the elderly's conditions are getting more complex and costly to treat.

A money-saving shortage of nurses was identified in the Francis Report as the main cause of the Mid-Staffs scandal - several hundred patients died due to poor care between January 2005 and March 2009 at Stafford Hospital.  

Robert Francis' call for safe nursing numbers has fallen foul of the Treasury's tight funding of the NHS - and contrary guidance on safe nursing numbers seems to come round in time with the warnings about NHS overspending.  Earlier this month, as part of a 'financial reset', the trust regulator tried to show that some hospitals' clinical care bills were too high - too many nurses etc etc.

Last week the former chief of the Royal College of Nursing, Peter Carter, laid the cut 18,000 nurse training places over three years, at the door of the coalition government.  He believes Brexit will be a disaster for healthcare and that "...the Brexit people seriously misunderstood just how dependent we are on people from overseas to staff the health service."

Indeed, the nursing gap has been filled in part by the recruitment of very many EU nationals (especially from Spain, Portugal and Italy) - and with nurses from further afield.

The attitudes exposed - and encouraged - by Brexit campaigners will undoubtedly make recruitment of nurses much, much harder. Immigrant nurses may be loved and valued when they are in uniform, but off-duty they will be as likely as any other immigrant to be shouted at and abused in the street.

News of this new brazenness in anti-immigrant behaviour will precede the recruiters as they travel abroad seeking more nurses to look after all sorts and conditions of British men and women - whatever their attitudes.

One thing is almost certain: nurses' pay will not rise enough (after years of one per cent increases) to make the job of recruiters and those offering training places any easier.

So we get to the money.  At the end of the last financial year the Department of Health escaped Parliamentary humiliation for overspending its budget by some clever accounting wheezes and a major raid on its capital budget.

This year it looks as though there will be a gap - otherwise known as a 'deficit' - of £1.2 billion.  That figure relies on major savings being achieved by Clinical Commissioning Groups and the acute hospitals - and savings means trimming services.

It may also mean a 'reset' for the controversial Sustainability and Transformation Plans (STPs) reorganisation programme.  If savings targets look liable to sudden deficit warnings, then STP plans - due for completion during September - may turn into much more of a programme of reductions in services.  (You will notice the word 'cuts' was not used in that last sentence.  It may have to be dusted off as the autumn proceeds.)

Print Email

Changing of the guard for Wiltshire's NHS - just as Brexit poses new problems for health services

Deborah FieldingDeborah FieldingHaving steered Wiltshire's Clinical Commissioning Group (CCG) as its Chief Officer through its first - and pretty difficult - four years, Deborah Fielding has left to return to her home territory of Essex and a new NHS commissioning role.  Her place will be taken by Finance Director Simon Truelove - until he leaves in September.

Marlborough.News went to see her on her last day at Wiltshire CCG's Devizes headquarters - we wanted to find out what her legacy would be and what the future holds for the CCG itself.  And she had important news about NHS111.

The very next day we got evidence of a major part of her legacy: from July 1 the county's adult community health services are in the hands of a partnership or joint venture between the three major hospitals that serve Wiltshire (RUH in Bath, GWH in Swindon and Salisbury Hospital) under the title Wiltshire Health and Care.  

They were commissioned by the CCG after a long and careful tender process: "The joint venture gives us the opportunity to continue collaboration."  She sees this collaboration as key to the Sustainability and Transformation Plans (STP) she has been working on with Bath and Swindon CCGs and the three hospitals during her final months in Wiltshire.

"The STP could be the solution.  I think it could be a real opportunity for Wiltshire.  There's unparalleled collaboration. Not everything can be commissioned at local level."

However STP will alter the position of CCGs in the NHS organisational hierarchy: "The role of the CCG is changing.  I think the CCG has a really important role in developing primary care and community based services.  Eventually those services will become Accountable Care Organisations (ACOs) - commissioners and providers.  The CCG will be needed to manage and monitor ACOs. But it'll become smaller."

"We have", she says, "improved collaboration across the system".  She came to Wiltshire for the CCG's start-up period and her first task was to prevent Wiltshire having three separate CCGs - both the south and west of the county wanted to go their own way - on their own.

She and her team set-up one CCG for the county with a three locality structure: "We developed a common strategy that could be implemented locally - depending on local conditions - based around integrated teams of health professionals serving populations of around 20,000."

How have these changes to the NHS in Wiltshire come about: "Partly economic necessity, partly leadership - including the leadership of our GPs.  We're lucky in Wiltshire to have such good primary care."  One result will be a new building to house Devizes urgent care service - the application for planning permission will be made in September.

From time to time during her four years relations between the CCG and Wiltshire Council have been strained - sometimes very strained, for instance over the ownership of NHS funding: "Relationships have been repaired. We have to work through the challenges. The government haven't helped by funding social care particularly badly."

She says Council leader Baroness Scott has the needs of the people in mind: "Strategically working together is not difficult - because we both work through localities and both want Wiltshire patients treated within Wiltshire.  The population needs to become paramount - at the local level."

The controversial contract for the NHS111 telephone service for Wiltshire comes up in 2018: "We are working on a more integrated urgent care structure which will include 111.  It will be more locally sensitive and make better use of clinical skills and new technologies - so patients are directed to the right place at the right time."

"Safety is not the biggest problem with the current service - if anything they're over cautious - sending more people into A&E."

We spoke to Deborah Fielding during that strange gap in contemporary history between hearing that Gove wanted to be the new Prime Minister and that Johnson realised he could not be the next Prime Minister.  So Brexit was much on our minds and will be hovering over the NHS for years to come.   What would the impact of leaving the EU be for the NHS?

Deborah Fielding says there are two really big and important things that affect the care you will get - money and people - and both are put in jeopardy by Brexit: "If Britain goes into recession there will be less money for the NHS - there is no doubt about that."   The people part is all about the workforce: "The NHS is dependent on our European workforce and that's dependent on the free movement of people."

Then our talk turned to a photo [see below] that had been whizzing around social media that morning.  It shows the surgical team a hospital in England.  Just one member is a British citizen (of Pakistani origin), the rest are all European (that's European as in 'from the EU').

Print Email

More Articles ...

  • Silbury-Sunset---10-06-08-----07-2
  • Christmas-Lights 15-11-20 097
  • D812668
  • TdB-Pewsey 044
  • Camilla-2012-10-19 152
  • Mop-Fair---10-10-09------08
  • Bluebells-in-West-Woods-10-05-09------30
  • IMG 8472-2
  • Marlborough-2013-04-18 St Peters-2
  • ARK Manton -2012-01-14 49-
  • Xmas-Lights-2011-11-24 10
  • 4MI-2013-11-28 030
  • Jazz Fest Sat 572
  • MYFC 005
  • Sunset2
  • Town-Hall-2011-05-03 08-2
  • Landscape
  • Duke-of-Kent 086
  • IMG 9097-2
  • Civic Selfie1
  • D4S0472
  • Big-Bull
  • Torch-2012-05-23 093-
  • Hares 017cropped
  • D4S9273