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Health & NHS

Critical dementia care: who’s deciding Wiltshire’s health policy? Is it you? Or is it local politicians?

A consultation is expected to be begin soon on how to provide specialist hospital care for Wiltshire’s severe dementia patients who suffer serious crises as their condition develops.

The number of patients needing this level of care each year in Wiltshire is about 120.  But a hospital stay to stabilise their condition averages 84 days.

The provider of Wiltshire’s mental health care is the Avon and Wiltshire Partnership (AWP.)  Last February they had to close the 24 dementia beds at Charter House in Trowbridge.  As a temporary replacement similar beds were established at Amblescroft South in Salisbury.

The consultation (from December 1 to February 28) will put forward three options for a permanent solution:

1. To renovate and improve Charter House – and close Amblescroft South.
2.  To move all specialist dementia care to an upgraded Avebury Ward at Green Lane Hospital, Devizes.
3. Make Amblescroft South into Wiltshire’s sole facility for this level of dementia care.  (There will still be the opportunity to send some patients from the north and west of the county to AWP beds in either Bath or Swindon.)

The first two options have ‘significant financial implications’ – in capital costs and in consequent annual interest charges for the private finance needed.  Only the Salisbury option is capital and annual cost free – indeed it would give the Wiltshire Clinical Commissioning Group (CCG) a £440,000 a year saving.  And you get the chance to advise the CCG how they should spend that saved £440,000.

The Charter House/Trowbridge option involves extensive works, but it is not stated how these will overcome “the stand alone nature of the site” which was one of the main reasons for its ‘temporary’ closure.

For many people in Wiltshire deciding on their favoured solution will probably be about geography more than money.  And if Salisbury is chosen, there will be a renewed feeling north of the Plain that ‘everything goes to the south of the county’.

However, much of the significance of this consultation is basically about politics.

The first public acknowledgement of this plan and its consultation comes in papers – now published – for Wiltshire Council’s Cabinet meeting on Tuesday (November 11.)  The draft of the consultation document had been agreed at a private meeting of the CCG in September.

And the CCG’s senior accountable officers can only sign the consultation papers off once the Cabinet has agreed them – it is the CCG that will bear all the costs and most of the risks.

There appears to be something of a turf war developing between Wiltshire Council and the CCG over the county’s health provision.  Several sections of the paper for Cabinet discussion explain (some might say ‘justify’) the Council’s involvement.

The basic argument is spelled out in this lengthy paragraph:  “Whilst the commissioning and provision of specialist dementia hospital care is health-led, it is acknowledged locally that these services make up only a small element of the whole dementia pathway that people living with dementia may pass through. In addition, it is recognised that any changes to a service within the pathway will impact upon other care and support services, including those commissioned and delivered by Wiltshire Council.”

The paragraph continues:  “For this reason and in its role as a community leader, Wiltshire Council is supporting Wiltshire CCG in developing and delivering specialist dementia hospital care, including them proceeding to consultation on these options, pending approval from the Cabinet.”

You do not have to read between many of those lines to see the gist of the Council’s real position.

Council and CCG have worked together on the county’s “Dementia Strategy 2014-2021” and on the Better Care Plan (BCP.)  However, the latter was negotiated through the Health and Wellbeing Board.  There is no mention of the Board in this Council document.

The BCP involves passing millions of pounds from the CCG’s budget to Wiltshire Council.  The savings for the CCG that the BCP aims to make from reduced hospital admissions costs will be very small compared to the sums the Council get.

[It has just been revealed by the Health Service Journal that of the £5.3bn pooled by councils and CCGs, £2.07bn will be spent on councils’ social care services, and £1.66bn on community healthcare provided by the NHS via the CCGs.]

Consultations, tender processes for contracts and lawyers fees are all lines of the CCG’s budget that are ballooning.  This consultation exercise involved paying for cost estimates for the building work.

The government has frequently told us that sort of ‘bureaucracy’ was being cut – instead it is increasing.  It is not yet clear how much this consultation will cost – but it is a cost that will be borne by the CCG and not by Wiltshire Council.

This consultation on critical dementia care is not a simple box-ticking exercise.  It requires complex balancing of financial and many other factors and shows again the complexity of the CCG’s role.  

The Lansley reorganisation of the NHS in England – now described by Nos. 10 and 11 Downing Street to The Times as the coalition government’s ‘greatest mistake’ – was supposed to put patients in charge of choosing their treatment and clinicians in charge of commissioning how those treatments are provided.

In fact only 25 per cent of CCG’s accountable roles are held by GPs. Now we have more and more involvement at the edges of commissioning by unelected council staff and politicians.  And the government is now talking about encouraging more ‘joint commissioning’ between local authorities and CCGs.

Is this what was meant to happen or are we drifting into the choppy waters of unintended consequences?  Or is this the way the government is planning to try and make good its ‘greatest mistake’?

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Public gets first look at Wiltshire’s new Air Ambulance

Wiltshire's new Air Ambulance - picture by Chris Watkins MediaWiltshire's new Air Ambulance - picture by Chris Watkins MediaWiltshire’s new Air Ambulance – with distinctive green and yellow markings and a big W on its belly – has been unveiled.

A fly-in and landing happened at Trafalgar Park, near Salisbury on Friday, and Sarah Troughton, the Lord-Lieutenant of Wiltshire, officially welcomed the new helicopter, a 180mph Bell 429.

The helicopter will come in to service in January, when Wiltshire Air Ambulance’s 24-year partnership with Wiltshire Police comes to an end.

Operating its own helicopter means the charity will need to raise £2.5 million a year – or £6,850 per day – to stay in the air.

The new helicopter will be leased from Heli Charter, Bell’s UK agent, based in Manston, Kent. Under the ten-year contract there is the option for a replacement helicopter to be provided after five years.

Wiltshire Air Ambulance’s chairman, Mandy Clarke, thanked supporters, volunteers and staff and said: “We are delighted to receive our new helicopter and begin a 10 year partnership with Heli Charter, who are providing the aircraft and the pilots.

“Our patients will benefit as the Bell 429 is fast so we can get patients to hospitals very quickly.

“We hope that the new colours and the distinctive ‘W’ will enable people to recognise us more easily when we fly and they can be proud to know that we are flying to save lives.”

The crew on the air ambulance will be a pilot and two paramedics. A doctor will fly with a paramedic on occasions.

Paramedics will continue to be provided by South Western Ambulance Service NHS Foundation Trust (SWASFT). All of the paramedics have Critical Care Skills and have all worked on Wiltshire Air Ambulance previously.

Ken Wenman, chief executive of SWASFT, said: “I am delighted that SWASFT is able to continue its longstanding association with the Wiltshire Air Ambulance.

“Our crews on board the helicopter work tirelessly to provide seriously injured and ill patients across the county of Wiltshire and surrounding areas with the best possible care.

“This new helicopter will undoubtedly provide a benefit to patient care as well as providing the crews with a vehicle that is top of its class.”

Training for the pilots and paramedics will begin next month (November) and the air ambulance is due to start operating on January 1.

The air ambulance will fly up to 19 hours a day. Initially it will operate in the daytime with night flying commencing in Spring 2015. This is to allow the pilots to accumulate experience with the aircraft and operating area while at the same time training for night flying.

The air ambulance will operate from a hangar at Wiltshire Police Headquarters, Devizes, until the charity has found a suitable site to build a permanent home and visitor centre.

A shortlist of potential sites are being actively considered and it is hoped that a new base could be operational in two to three years.

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Better Care Fund for Wiltshire: the costs, the rewards and the risks

Having just successfully sorted out the change from Primary Care Trust to Clinical Commissioning Group – or for that matter from Lansley to Hunt – there’s a new health service name claiming its place in the headlines:  Better Care Fund.

It has not yet been reduced to a generally accepted acronym (which it surely must if it is to be fully accepted in the NHS) because they cannot make their minds up whether it should be known generically as a Fund or a Plan.  Some term the whole scheme ‘the Better Care Fund plan’. That’s a bit confusing.

We will stick with Better Care Fund and for now ‘BCF’.  But then, in Wiltshire the BCF has already given birth to a fully-fledged plan – a joint venture by the Clinical Commissioning Group (CCG) and Wiltshire Council.  What’s more it has become one of the first five in England to be officially signed off by the government.

The idea of the BCF is to concentrate more treatment in the community so as to keep people out of acute hospitals – the average bed in an acute hospital costs £1,785 per week before you count in treatment costs.  And hospital is certainly not always the best place to be, especially for the elderly.

Most of the money for the BCF is not new but comes from funds re-assigned to a pooled budget for use in integrated care by the CCG and Council working together.

Wiltshire’s Health and Wellbeing Board (HWB - set up under the Lansley reorganisation) is the body responsible for the BCF.  Jane Scott, leader of Wiltshire Council and chair of the HWB, wanted the fund to cover patients from cradle to grave.  But the government decreed that in its first full year (2015-2016) it must be restricted to the ‘frail elderly’.

Jane Scott was at the Marlborough Area Board on Tuesday (September 30) to explain the BCF.  Also there were Maggie Rae (Wiltshire’s public health chief), Simon Truelove (the CCG’s head of finance), Dr Jonathan Rayner (Ramsbury GP and a leader of our area’s locality group of the CCG), Dr Abi Griffiths (from the Marlborough Medical Practice) and two frontline representatives from GWH’s community health service.

Wiltshire’s scheme is being piloted this year in three areas – Calne, Salisbury and Bradford on Avon – with brand new integrated teams of social care and health professionals.  

It will only get its full budget of £27million next year to develop integrated community based service teams across the county which should reduce the need for hospital care and protect the existing level of social care services.  The aim is to provide teams for each community of 20,000 centred on GP practices. (Our area’s size will be larger - over 30,000.)

Of the BCF’s £27 million, £15.5 million will be top-sliced off the CCG’s budget – that’s three per cent of the CCG’s total funding for 2015-2016.

Official government guidance states that the ‘expected minimum target’ for BCF plans (there we go again) is a 3.5 per cent reduction in emergency admissions to hospital.  But four of the first five plans have set reductions below that figure.

Wiltshire’s plan is aiming for a 3.75 per cent reduction, but only after the expected annual rise of 2 per cent in non-elective hospital admissions is taken into account.  This equates to a reduction of just under two per cent or, over the next two years, 37,000 bed days.

In financial terms this should save Wiltshire CCG in the Fund’s first full year £3.6 million of its ‘purchase’ of beds in the main three acute hospitals that serve the county.

If it worries readers that the CCG is foregoing £15.5 million of its budget in order to save £3.6 million – the Better Care Fund is not just about money.  It is aiming, as it says on the tin, to provide ‘better care’ – better care before hospital admission becomes essential.

Wiltshire’s Better Care Plan originally envisaged a reduction in hospital admissions of 4.75 per cent, but the government became anxious about the effects on the finances of hospitals and ordered a reduction in the ‘admission avoidance ambition’ to a more realistic level.

The continuing year-on-year rise in hospital admissions has been worrying many acute hospitals.  The Great Western Hospital believes the BCF will allow it to keep operating safely with its existing number of beds.  

Indeed they had expected a shortfall of 55 beds by the end of 2016 if there had not been a change in the care system such as the BCF should provide.

The basic tenet behind the BCF was spelled out by Jane Scott: “We want care in our home…the last place we want to be, unless we have to, is in an acute hospital or care home for the rest of our lives.”  Not everyone, it should be said, agrees with that – among them people who have had experience of services to the frail elderly in their own homes.

There is recognition in Whitehall that the BCF may cause problems – notably that reduced income – for acute hospitals.  So it has been made mandatory to have a “Risk Share agreement with Acute hospitals in the event that acute activity does not reduce in line with plans.”  

But Simon Truelove told the meeting that the BCF was not at all about destabilising the acute hospitals – like the GWH, Salisbury Hospital and RUH Bath: “We absolutely need our three acute hospitals with their specialist care.”

Apart from the risk that there are bound to be cases where people are not admitted to hospital soon enough, there are other risks as responsibilities blur between CCG and Council.

When the BCF plan went before Wiltshire Council’s cabinet, Cllr Ron Hubbard questioned why it stated there were no direct safeguarding implications – his question was brushed away on the grounds that “Officers would of course continue to work closely with the Safeguarding team.”

As Jane Scott told the Area Board: “Funding is going to be a huge challenge – on top of the funding challenges that the Council has, which are huge.”  One risk for the BCF is the looming cost of the new Care Act, which may, from April 2016, set the Council back an extra £15 million.

And there is always the risk of friction between the Council and the CCG.  Already there was talk about this at the Health Fair in the Town Hall before the Area Board met.  

The Council feel they are helping through their efforts on the social care side of the partnership to make savings on treatment costs, which accrue solely to the CCG.  This they feel is not fair.

This quite overlooks the fact that even before the BCF hove into view, the CCG was helping with social care costs. They were, for example, funding quicker exits of patients from hospital – reducing the dreaded ‘delayed transfers of care’ or ‘bed blocking’.  

As we have seen, most of the BCF for Wiltshire comes directly from the CCG’s budget.  And from the pooled BCF budget there is £9.18 million set aside both this year and next to support such Council social care responsibilities as care home admissions, the Council’s Help to Live at Home Service and hospital social work services.

What was that about robbing Peter to pay Paul?

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The NHS and privatisation: now GP practices will be opened up to private providers


They’re marching from Jarrow again – this time it is not about the lack of jobs during the 1930s depression. (*) This time the protest is against the creeping privatisation of the NHS.

A local expression of this dismay and concern came in a recent letter to The Observer  (August 10) – written in response to an example of inappropriate commercialisation of a learning disabilities care home in Doncaster.

The writer, Dr Mike Bishop, is a retired GP who served the NHS for 40 years and now lives in West Overton.  He highlights the ‘tragic effects of profit before care’:  “In an area where hands-on care is the business, the most valuable resource a company takes on is the existing staff.”

“To reduce the pay of experienced, committed staff by up to 35 per cent shows ignorance and disrespect.  For this group to withdraw their services and reconsider their futures is a tragedy for vulnerable patients and a recipe for a commercial and public-relations disaster.”

The way, he wrote, “some areas of the service are being degraded makes me weep”. And he asked when the politicians will wake-up to what is happening to the NHS.

Campaigners against NHS privatisation have just been presented with another target: NHS England has said that all new GP contracts will be open to private providers.  As the doctors’ journal PULSE asked in its headline: “Is this the ‘death knell’ of traditional general practice?”

The Section 75 regulations, which are part of the coalition government’s root and branch NHS reforms, finally made it through the House of Lords after a rearguard action against failed.  They quite blatantly open the NHS up to competition law – and thus to some mandatory tendering of services to private companies.

These regulations have not been gathering dust.  The majority of new contracts to provide NHS services signed off last year went to private companies.  The Financial Times recently estimated that about £5.8billion of NHS contracts are currently being advertised to private sector providers.

Recently a government MP (not the MP for Devizes) wrote to his local newspaper saying all was well with the NHS.  At one point he stated: “The reforms which we have introduced are enabling £1bn in back office savings to be redirected into front line care enabling 1,700 more nurses and 7,000 more doctors to be employed.”

We can note his sly “…to be redirected…” rather than “…have been redirected…”.  But he gives no source at all for this figure and it is doubtful he can find one.

We know in Wiltshire that the Clinical Commissioning Group (CCG) is spending more on ‘back office’ costs than its predecessor Primary Care Trust.  And we know that the budgets for the three regulators (CQC, Monitor and the Trust Development Authority) have all gone up this year – one of them wanted a 66 per cent increase.

Part of the ‘back office’ – the polite word for the more usual ‘NHS bureaucracy’ – work is now done by the Clinical Support Units (CSUs) which were set up to provide these services for CCGs.  They employed thousands of staff from the PCTs and other bodies the reforms abolished – and were supposed to become stand-alone, autonomous organisations by 2016.

This process is steaming ahead and has already opened the door to bidders from outside the NHS.  So the fate of CSUs brings us back to privatisation – or externalisation as the official transitional documents euphemistically put it.

Sixteen bidders have been selected in the first stage of re-defining the CSUs.  These include all the current CSUs either on their own or with third parties including Capita, BT and KPMG – i.e. multinationals into which the CSUs may be consumed.

One NHS manager explained to Marlborough News Online that this could solve the NHS’s ‘CSU problem’ in one of two ways: “Either the private organisations will pitch this as loss leaders and knock the CSUs out of the picture, or the CSUs will be swallowed up by the likes of Capita and BT because of their staffs’ knowledge and specialisms.”

And we are not talking about a negligible part of the NHS empire.  The combined income of the nineteen CSUs is about £800million.

So this ‘all’s well on the Titanic’ MP will now have to subtract from his £1bn in savings money that will go not to frontline staff, but to shareholders of companies and to pay first the inflated salaries of their directors, and secondly the inflated salaries private companies will offer to lure staff away from the NHS.

The future of GP surgeries following the government’s decision embodied in Section 75 will be uncertain to say the least.  There are, of course, private GP practices, but the vast majority are and always have been independent partnerships funded and regulated by the NHS.

How the arrival on the GPs’ doorsteps of the big beasts of private health care will fare is anyone’s guess.  The problem is that doctors, despite their involvement in the CCGs as commissioners of services, are not a happy bunch – many believe they are sailing pretty close to the iceberg.

This is how one GP Partner responded to PULSE’s exclusive report on the opening of new GP contracts to private providers: “Next it will be opening up existing contracts to all private providers…however I suspect many of us would probably feel relieved if our contracts were taken over by someone else.  The current contract gives GPs totally unfair contract terms and a level of funding that makes practices almost non-viable.”

“The patients (which includes us) will suffer most. It can’t get much worse than it already is for primary care medical staff.”

There is one unintended consequence for this move towards privatising GPs: what happens when doctors working for “Angel Healthcare Inc” sit on a CCG (which has to have clinical membership) and hands out a huge contract for another primary care or acute service to “Angel Healthcare Inc”?

Or perhaps it is an intended consequence – completing the privatisation circle.

However, the privatisation bandwagon has just shed a wheel.  Serco has announced it is withdrawing from its clinical NHS contracts – having lost £18million.

As the respected health service blogger Roy Lilley wrote: “Why should the private sector be any better at running NHS services than the NHS? The simple answer is it isn't.”

“Because NHS staff come to work and wear a different badge does not make the systemic problems of the NHS go away. There are too many patients and not enough money. Sustainability is as much of a problem to the private sector as it is the NHS.”

* You can follow the march here – they reach London on Saturday (September 6.) 


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Is a serious shortage of GPs the next major crisis to hit the NHS?

Many experts believe the next crisis to hit the NHS will be a perfect financial storm which will make landfall just before or just after the 2015 general election.

It does not give much reassurance when, at the end of the last financial year, Wiltshire’s Clinical Commissioning Group (CCG) has to return £5million to the Department of Health – a percentage of its budget that dwarves the increase it was given at the start of that year.

Just yesterday (May 21) the Health Service Journal discovered - under Freedom of Information requests - cases of hospitals asking for extra cash to fend off unpaid suppliers and keep the electricity from being cut off.

However, anxieties expressed forcefully at this week’s board meeting of Wiltshire CCG indicate that there may well be a ‘shortage of GPs’ crisis that will hit the NHS even sooner than the full force of the financial crisis.

With GP numbers down across England, Celia Grummitt put the matter plainly: “GPs are feeling under pressure and under-resourced. We need to send a message to the centre: the NHS is not looking well and they need to do something.”

Dr Grummitt, who is vice chair of the CCG’s Sarum Group and a GP at the Cross Plain Practice with surgeries in Shrewton and Durrington, went on: “We are losing young doctors from this country in droves.”

Dr Toby Davies, chair of the CCG’s Sarum Group, gave an example of the number of GPs opting for retirement in one area set against the number of newly trained doctors leaving the country. He cited the pressures on GPs from the coalition government’s recent contract for GPs.

“The new contract makes it worse.”  How, he asked, were GPs to find the time to fulfil the need for two per cent of their patients to be given individual care plans?

The pressures on GPs do not only come from the new contract.  Under the coalition government’s root and branch restructuring of the NHS to Andrew Lansley’s plan, GPs have been mandated a central role in commissioning – and for some GPs that takes up a considerable amount of their time.  As Dr Grummitt put it: “We are under pressure to get back to the practice.”

So why are newly trained leaving the country?  It is clear that financial rewards for GPs have been reduced.  So to make up for that loss, they are planning to bid to undertake more treatment services in their surgeries – and that puts new pressures on them.

It probably does not help keep them in this country that the government insists on day-to-day micro-management of the NHS and talks down the qualities of the NHS and talks up the value of private, commercial providers.

News of this looming shortage comes hard on the heels of the critical shortage of nurses in England’s hospitals following the 2010 general election: “Number of NHS nurses falls despite coalition pledge to protect frontline – Almost 6,000 nurses’ posts have disappeared since the general election, official figures show” (Guardian – September 2012.)

For hospitals now facing demands to publicise ward-by-ward staffing levels, the nursing shortage is by no means resolved.  Great Western Hospital has not been alone in sending staff to recruit trained nurses in Ireland and mainland Europe.

But we should perhaps remind ourselves that last summer there was a similar ‘doctors shortage’ scare: “Shortage of GPs will undermine the future of the NHS” (King’s Fund – July 2013).  And a few weeks ago it was a shortage of hospitals’ A&E doctors: “Jeremy Hunt has ‘no clear plan over chronic shortage’ of emergency doctors” (Daily Mirror on a report from MPs - March 4.)

Send MNO a letter if you have had unusual difficulty getting an appointment with your GP: This email address is being protected from spambots. You need JavaScript enabled to view it.

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Is the NHS about to be caught in another and lengthy political fire storm?

It seems the NHS just cannot avoid the headlines – whether it is being named as the top of the league health service (by the American Commonwealth Fund) or whether it is failing one group of patients on Monday and another on Wednesday.  What is going on behind the headlines and at our local hospital?

First though, the endless run of headlines is partly explained by the NHS’ expected position as a key issue in next year’s general election.  This will put the NHS high up the news agenda of newspapers which back the Conservative party – and they will not be looking on the bright side of the NHS.

Two recent polls may have ensured many months of the NHS’ role as main political football even while the election campaign is still fairly distant.  

A ‘phone poll by Lord Ashcroft (who polls for the Conservative party) found that 31 per cent of voters thought ‘public services like the NHS’ would now be better if Labour had won in 2010 – while 48 per cent thought it would make no difference and 16 per cent said the services would be worse.

Another, wider and independent poll of voters across England by the Health Service Journal (HSJ) and FTI Consulting, revealed a widespread fear for the future of free health care.   

With funding at the heart of the political debate, this poll showed 90 per cent of voters agreeing that spending on the NHS should rise as the economy improves.

When asked to score out of 100 how much they agreed with the assertion “free care is under threat”, one in four said 100 per cent.

The average score was 70 per cent – even though no major political party has actually suggested an end to the principle of healthcare free at the point of use – and they are not likely to do so publicly.  

The results also revealed real concerns about the role of the private sector in the NHS.
Which chimes with the new chair of the House of Commons’ Health Select Committee, Dr Sarah Wollaston MP, telling readers of the Daily Telegraph: “Of course, there are…questions to be asked about whether the increased transactional costs from marketization have genuinely improved choice and efficiency.”

“Did we get more bang for our buck alongside better care because of the [Lansley] reorganisation, or was that outweighed by disruptive fragmentation?”  She already seems well-versed in the language of committee-ese.

In the HSJ/FTI Consulting survey the public’s continued support for the NHS is over whelming: 97 per cent of voters believe it is worth fighting for.

Meantime, the NHS carries on.  And so does the Great Western Hospital which serves the wider Marlborough area as well as Swindon.
Recent headlines have highlighted claims that the winter pressures experienced by hospitals have continued as ‘summer pressures’.  In January 2014 GWH had 6,089 attendances at their emergency department (or ED – formerly known as A&E.)  The figure for May 2014 was 6,634.

GWH is busy all the year round as demands on the NHS grow from long-term illnesses, an older population and increasingly complex and expensive treatments.

Elizabeth Price, GWH’s associate medical director for unscheduled care, told Marlborough News Online: “The emergency department is extremely busy all year and although we are seeing slightly fewer ED attendances compared with last year, this is because we are streaming some patients direct to medical and surgical assessment areas and other services.”

“Overall demand for Trust services continues to increase and emergency admissions to the Trust have actually increased 11% since April 1st.”

In fact efforts to reduce attendances at their ED have begun to pay off: last year from January to May 32,458 people went to GWH’s ED.  The same period in 2014 saw a four per cent drop to 31,278.

GWH have not only re-designed and enlarged their ED (and added a children’s ED) and recruited more staff.  They have also been working with other providers to make sure people who think they should ‘Go to A&E’, actually go to the right place where they will get the most appropriate attention and treatment.

GWH is also working with GPs to make sure patients go to the right department within GWH and  has supported the Choose Well campaign run by Wiltshire and Swindon CCGs.

And choosing well is important since it is estimated that at least one in four people attending ED could be treated more quickly and effectively elsewhere.

In addition there is the new urgent care centre on the GWH site open 24/7/365 to provide advice and treatment outside normal surgery hours.
With pressure still on GWH and another winter looming, Swindon CCG are planning to pilot new walk-in centres to help keep people from clogging up the hospital unnecessarily.

Last winter the NHS England handed out extra money to help hospitals through the winter.  GWH applied for £4.2 million and got nothing.  The Royal United in Bath got £4.4 million.

In a second round of extra money (in November 2013) Swindon CCG got £1.1 million.  None of this money went directly to GWH.

More than half of it went to SEQOL – a social enterprise organisation that provides health and social care services in Swindon. £300,000 went to fund additional beds within nursing homes.

The emphasis was on reducing “unnecessary admissions to hospital”, getting patients out of hospital faster, caring for the frail elderly at home.

Which brings us to the stark warning from Dr Wollaston’s Commons committee that cutting back on hospital services in England before community services are ready to provide ‘care close to home’, is a “recipe for disaster.”

The committee’s warning looks ahead to the Better Care Fund which starts this year, but comes into full effect next year.  This ‘Fund’ takes huge sums of money from hospitals and hands it to social care.

As Marlborough News Online has reported, the process of making this change rings alarms bells and will turn risk registers across the NHS in England bright red for danger.

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GWH’s new chairman looks ahead as the NHS changes – and to Savernake Hospital’s role

Trust Chairman Roger HillTrust Chairman Roger HillRoger Hill has been chairman of the Great Western Hospital Foundation Trust (GWH) for just two months. But he has been a non-executive director there since 2008 so he knows the hospital and its staff well.

He could not have taken up his important new post at a more testing time for major NHS hospitals.  As he told MNO:  “The era we are moving into is the most complex, most difficult and most high risk.  If we get it wrong…what’s next?”

The challenges increase by the week. GWH has had a pretty fraught winter with staff stretched and target watchers circling.  This year sees the start of the government’s Better Care Plan which will scoop money from hospital budgets.  And there are vital contracts to be tendered for.

Roger Hill retired some years ago after an international and successful career in the computer business – he was chairman and managing director of the UK subsidiary of the American computer giant Intergraph.  And he has also set up companies himself.

He lives in Aldbourne and has been chairman of Marlborough Golf club for four years.

GWH seen from the southGWH seen from the southMany people see GWH as Swindon’s hospital – even Swindon’s ‘community hospital’. But one third of its patients for acute treatment and of its income comes from Wiltshire.  It also attracts patients from Gloucestershire, West Berkshire and Oxfordshire.

One of its problems is Swindon’s ever growing population.  Another is the ageing of the population: “There is a material increase in the older population and a growing need for us to provide care for the frail elderly.”

GWH has just recruited three more consultants to their geriatrics team.  Their successful drive to recruit more nurses continues and they have already increased nursing staff in the last year by 130 - over and above nurses retiring and leaving the area.

This has been a very tough winter for the GWH.  Having put into action a whole list of ways to cope with extra pressures – those pressures kept on coming.  They did not meet the target for 95 per cent of A&E patients to be seen with four hours – and for one week were in the bottom ten of hospitals in England.

Having analysed the statistics for the whole hospital rather than just their emergency department, Roger Hill knows that their ambulatory care unit (for walk in rather than ambulance delivered patients) and their surgical assessment unit certainly helped filter patients through the system.

Now with winter over some of the extra beds are being mothballed again and planning has already started for next winter.  

However, GWH is facing a year-round and steep rise in the number of patients it sees. In January and February this year they saw a ten per cent increase in patients who have not chosen to have operations – the majority following referrals by GPs.

Recently GWH, with about 500 beds, has been accepting 350 admissions every week. To handle that level of demand needs some very astute planning and a tight control over ‘blocked beds’ so people can leave hospital quickly when they are ready to.

How will a hospital under such pressures cope when the Better Care Fund not only takes away some of its budget, but with the integration of health and social care for the frail elderly also tries to keep them away from hospital?

Hospitals will have to change their ways.  Roger Hill tells MNO that GWH has saved £500,000 in the last year by holding thousands of ‘virtual clinics’: if a patient needs no further treatment, they can be signed off over the ‘phone by their consultant rather than having to make time to travel to GWH.

As it costs £1 million a year to run a ward, that £500,000 is a very worthwhile saving.

Roger Hill believes the NHS in Wiltshire is “ahead of the game” when it comes to integration of health and social care services.  He is full of praise for the Council’s Health and Wellbeing Board and the way the Wiltshire Clinical Commissioning Group is working.  And GWH is fully on board: “All the time we are actively involved in the integration of care – we want to participate in the way care is delivered.”

They have employed the new Care Coordinators that are the advance guard of the Better Care Fund’s aim to treat people at home for as long as possible. Some are clinically trained, but in the Marlborough Area they are trained in social care.

As Roger Hill sees these developments, it helps both provider and patient when instead of sending three services to look after a frail and elderly person, you can send just one.

As someone who has first-hand experience of computers, he wants to get GWH staff in the field fully set up with appropriate IT systems.  That is a challenge when Wiltshire’s open spaces have gaps in mobile ‘phone coverage.

A distinct change in the life of a hospital administrator is the constant round of tendering.  The bid to continue GWH’s contract for community maternity services was not successful – the service went to the Royal United Hospital in Bath.

Now they are starting their bid for children’s community health services in Wiltshire.  This is complex because while at present GWH runs the main part of the service, there are several other providers, some of them working across county borders.

Wiltshire CCG wants either to give the whole service to one provider, or to find an organisation that would have overall responsibility for a group of providers.  

GWH has found, Roger Hill tells MNO, it needs a small team looking after all the Trust’s bids for service contracts: “We have to be able to manage bids professionally.”  

Not exactly a boost to the front line of the NHS and another unintended consequence of the Health and Social Care Act’s policy to favour non-NHS providers.

Roger Hill is bullish about the role for Savernake Hospital – which GWH now owns.  He says the hospital’s space is full at the moment and he is pleased consultant clinics are being held there, extra beds are in place and the mobile chemo truck visits.

GWH is now looking to see how they and the Prospect Hospice (which serves the Marlborough area) can accommodate an end of life ward at Savernake.  This would support the work Prospect does with its home care service.

As always there is an element of uncertainty about Savernake’s future – something GWH’s new chairman is very aware of.  Next year GWH will be tendering for the contract to provide adult community health care across Wiltshire.

The results of that competition could mean Savernake Hospital – and its hefty annual PFI payments – might be sold.

How does Roger Hill sum up the coming years? “Significant strides have been made as to how we are going to achieve integrated care – it’s got to be done as a system – and there is no evidence that the acute [hospital] element of the NHS is under threat.  I am fairly confident we will make it happen.”

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