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Health & NHS

NHS’s winter pressures: will GWH get some of the government’s new winter money?

In an exclusive story, the Health Service Journal (HSJ) says the government has found another £150 million to help ease this winter’s pressures on hospitals.

It is now clear the government is petrified that the NHS may face unsustainable pressures in the coming months – especially in already over-busy A&E departments.

The HSJ says this new money will be announced within days.  It will be on top of the £250 million already allocated and will go to help hospital trusts which, like the Great Western Hospitals Foundation Trust (GWH), got nothing from the original £250 million fund.

GWH applied with the Swindon Clinical Commissioning Group (CCG) for a share of the first £250 million. That money went to 53 CCG’s to support their local acute hospitals – the average amount was £4,170,000.

The money was allotted to trusts that had not coped well last winter or that are considered to be in such financial straits that they would not cope this winter. Some said the money was a reward for failure.

GWH got none of that £250 million and has been putting into place its winter planning using its own funds and financial assistance from CCGs.

During last winter GWH saw a ten per cent increase in people coming into its A&E department as well as a 6.7 per cent rise in emergency admissions.  This winter’s pressures are already being felt at GWH’s A&E department.

GWH’s bid for extra funding included extra spending on community health services, on end of life care, increased staffing in A&E and support for the timely discharge of patients.

As MNO has reported GWH have already recruited more nurses and midwives and a full re-design of their A&E department will be completed before Christmas.

Working with Wiltshire and Swindon CCGs, GWH have already put in place a number of steps to alleviate this winter’s pressures on staff and facilities.

They have invested £3.2 million in extra medical beds and doctors. And have employed three extra emergency medicine consultants – bringing the total up to nine consultants. And they continue to recruit more nurses.

Wiltshire’s community health services – run by GWH – now have Care Coordinators in each locality to help patients live well at home for longer and reduce unnecessary and unwelcome stays in hospital.

GWH have also launched an incentive scheme for nursing staff, midwives and health professionals like physios.  This will enable staff to earn extra pay for working extra shifts – reducing the use of agency staff who may not be familiar with the hospital or with patients.

A GWH spokesman explained: “Paying staff in this way is better value for money for the taxpayer as it’s more cost effective than using agency staff.  Our staff work incredibly hard 24/7, 365 days a year, often in challenging circumstances and this is an extra thank you to those who are willing to help out at our busiest times.”

It’s not just the number of people arriving at the front door services like A&E that cause problems.  It’s also pressures at hospitals’ back doors: patients who cannot be allowed leave hospital wards once their treatment is complete because they have nowhere appropriate to go.

These are called ‘Delayed Transfers of Care’ or DTOCs and they cost CCGs a great deal of money.  They used to be called ‘bed blockers’ - as though it was the patient’s fault.

Reducing the time patients wait to leave hospital involves close coordination with local authorities’ social care services who have to ensure patients – often the frail and elderly – go to an appropriate nursing home or rehab ward or can be cared for safely in their own home.

Oxfordshire CCG, which has had one of the worst DTOCs record in the country, has allotted more than a fifth of its £10 million extra winter funding to Oxfordshire Council to help reduce its costly level of DTOCs.

It is worth noting that Oxfordshire CCG identified 23 temporary schemes to alleviate winter pressures at their hospitals.  Some of these are to last six months.

Oxfordshire CCG aims to recruit skilled staff to fill more than 50 new full-time roles to work over the winter period – as well as an unspecified number of other extra nursing staff.  Whether they will be able to recruit this number in time and within budget will doubtless feature on their risk register.

But the scale and cost of winter measures in Oxfordshire, underlines the seriousness with which the NHS is facing the approaching cold weather.

GWH’s A&E or as they call it ED for Emergency Department:  Some days ago we published a story headlined “Twelve patients a day had to wait on A&E trolleys in great western hospital probe reveals.”  

This was a report of story first published in the Daily Mail.  MNO understands that GWH’s Freedom of Information response stated that “up to twelve patients” in a day had been waiting on trolleys in a corridor. 

This, by some sleight of hand, was changed in the published story to read “12 patients a day have to wait on trolleys in corridors in A&E” – clearly implying it happened every day.  

Having looked back at the wording of their FOI response, GWH have now issued another statement:

“The number of patients treated in ED can change greatly from one day to the next. We have never shut our doors and always do everything we can to treat and care for our patients using the space and resources we have at the time.”

“There are occasions when we have been extremely busy, this means we have asked patients to wait on a temporary trolley until a suitable bed is available. Any patient waiting on a trolley will have been assessed and will have a dedicated nurse caring for them and observing them until they are moved to a ward.”



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Physio practice brings Hollywood-style foot treatment to Marlborough

Podiatrist Emma Ansell giving Karen Shields a Med-pedPodiatrist Emma Ansell giving Karen Shields a Med-pedA Marlborough physiotherapy practice is offering an exclusive Hollywood-style treatment for something that is walked all over every day – feet.

Clients from as far away as Bath and Gloucestershire are already coming to the Hughenden Yard practice for this new exclusive treatment, which has previously only been available in London.

Podiatrists – the new name for chiropodists – and salons usually concentrate on one thing: either foot health or foot beauty.

Now, James Hatt & Associates has combined both approaches in its new glamorous med-ped treatment.

The Medical Pedicure is given by a highly trained and qualified podiatrist. It involves a comprehensive health check and treatment of the feet followed by a pedicure.

But this goes even further than feet feeling and looking great. Many musculoskeletal problems, such as with knee joints and backs, can be caused by feet, and the early warning signs of some illnesses - such as the increasingly common diabetes and the number one cause of death, blocked arteries - can be spotted through foot examinations.

“Feet are important to health, so we thought: why not make it a luxurious experience? We want to encourage younger women in particular to have their feet pampered and their health checked at the same time,” said practice director, Amanda Hatt.

“We also didn't want to send clients away to a salon for the finishing touches of a pedicure, and perhaps not having such a good service as they would with our podiatrist.”

Karen Shields receiving her Med-ped from Emma AnsellKaren Shields receiving her Med-ped from Emma AnsellIn the hour long appointment, the med-ped offers a diabetic, neurological and vascular screening; a foot bath, foot scrub and foot mask; gets rid of the dreaded cracked heels in one treatment – with, unlike salons, the added hygiene security of medically sterile equipment – and nails cut and painted.

And feet are left looking like they belong on a movie star.

To offer this treatment, James Hatt refuses the bread and butter of most podiatrists, the fifteen minute toenail-cutting service.

“We would be doing our clients a disservice with such a short treatment. It's better to offer a proper, rounded consultation.” Amanda adds: “It may not the quickest way to way to grow this new part of the business, but it's the best way for our clients.”

Regular client Karen Shields, from Pewsey, pictured receiving a med-ped from Heath and Care Professions Council registered podiatrist Emma Ansell. “I came in for knee problems, and I've had physio, massage and podiatry.

“This time I've tried the med-ped. I love Emma's approach with a comprehensive overview of the problem. It's a long term solution rather than a quick fix.”

For more information visit www.jameshattphysio.co.uk or ring 01380 730473.

Reader offer: get a Hollywood-style med-ped treatment with James Hatt Associates. Pay for a podiatry treatment (£45)and upgrade to med-ped (normally £65) free of charge only with the coupon on this week’s Marlborough News Online newsletter. Not currently a newsletter recipient? Sign up for free today!

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Campaigning to save the NHS: Wiltshire’s determined activist is up for the challenge

Christine Gale Christine Gale It was the first demonstration that Christine Gale had ever been on.  On the last Saturday of September when the Tories were assembling in Manchester, she – with her partner Guy – and about 49,998 other activists marched to protest against cuts and in favour of protecting the NHS from the coalition government.

There were several other protestors there from Wiltshire and the Devizes constituency.

Saving the NHS has become Christine’s mission in life.  Disarmingly she says: “I’m just an NHS user.”

She and Guy live in Castle Combe. Both are retired and Guy brings to her campaign a career’s worth of experience in design and typography.

Christine is no ordinary protestor. She has always been a ‘political person’ and a life-long Conservative voter.

Her grandfather was a traditional hardworking Tory who stoked boilers. Her father was a very successful self-made businessman who was a tremendous admirer of Prime Minister Thatcher.

Looking ahead to 2015, she told Marlborough News Online: “I’m going to vote for the party that reinstates the NHS as a public service.”  

She was cheered to hear Labour’s Andy Burnham say at the Manchester rally that they would repeal the Health and Social Care Act that’s the basis of the current £3 billion reorganisation of the NHS.  But before Labour gets her vote she wants to see that promise in their manifesto.

Christine & Guy ready for the Manchester protest marchChristine & Guy ready for the Manchester protest marchShe believes that it is a waste of time campaigning on small, local issues, and that defenders of the NHS should concentrate on campaigning nationally: “What we can do is to say to MPs ‘In the next election we won’t vote for you unless you protect the NHS’.”

By protecting the NHS she means keeping it as a National service rather than a ‘notional’ service; keeping it public and out of the hands of private providers or profiteers; and stopping the Americanisation of the NHS.

Christine finds it ‘really scary’ that the forthcoming trade deal with the USA (watch out for its full name –Transatlantic Trade and Investment Partnership or TTIP) will leave the NHS open to almost mandatory privatisation by big American corporations.

Under this agreement the NHS would never again be able to be the ‘preferred provider’ of health services so campaigners are demanding the NHS is exempted from the TTIP.

She has mixed feelings about doctors and the part doctors have been given in commissioning NHS services: “Doctors should be making people well and efficient and accountable managers should be running everything else.”

Why did Christine take on the role of defender of the NHS?  After her parents had a bad accident, she saw how the private sector could not cope but the NHS gave them ‘fantastic care’.

Later, when two other family members had cancer she saw again the worst of private care  – but also great NHS treatment and some very poor NHS care leading to a case of MRSA and terrible bed sores.  She knew then that the NHS must be protected and improved.

She did not believe the current government’s reorganisation and its firm belief in privatisation was the way to do it.A banner that caught Christine's eye: 'NHS is for people not for profit'A banner that caught Christine's eye: 'NHS is for people not for profit'

“When I started campaigning, I found it very difficult to get people interested enough to run local groups.”  So she took her campaign out and about – and onto the internet.

She and Guy spent two days at the music festival at Little Somerford – going to a music festival was another first for them both. They handed out 1,500 of Christine’s wallet-sized protest cards and she was asked to give several short talks from the platform about the threats to the NHS.

She joined 38 Degrees activists for the Wiltshire petition against privatisation that was delivered to the new Clinical Commissioning Group at its Devizes headquarters in April. And she was appalled when she heard a politician dismiss 38 Degrees as people making vulnerable people anxious.

As someone who missed out on further education, she has surprised herself by making speeches at events. She once introduced herself as a “Wiltshire bumpkin” and had the audience enthralled by her passionate defence of the NHS.

Now she has taken to the internet and become part of the very busy network of campaigners aiming to keep the NHS strong, free and un-privatised. She started with a Yahoo group site but now has a website of her own which carries lots of evidence of what is going on behind the daily headlines.

She is in touch with NHS Action who want to put up NHS candidates in the 2015 general election – though Christine is not quite sure about single issue MPs - and with the KONP (Keep our NHS Public) campaign.

She certainly got fresh impetus for her campaigning from the Manchester march and was especially enthused by the ‘passionate speech’ by the TUC General Secretary, Frances O’Grady.

But she was utterly appalled to find barely any mention in the newspapers or on the BBC of the Manchester demonstration – the biggest the north-west of England has ever seen. “Even in what we call a democracy it seems it’s becoming harder and harder to get heard.”

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

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Friends of Savernake Hospital give patients the chance of some fresh air and a chat

Four Ailesbury patients with their health care support workers (in light blue) and l to r Rosemary Pike, Val Compton (Trustee of The Friends of Savernake Hospital), Sister Emma Bazell and Sister Helen Hodges (in dark blue) . Four Ailesbury patients with their health care support workers (in light blue) and l to r Rosemary Pike, Val Compton (Trustee of The Friends of Savernake Hospital), Sister Emma Bazell and Sister Helen Hodges (in dark blue) .

Savernake Hospital’s Ailesbury Ward has a sizeable balcony leading off its day room.  The balcony’s surround was painted battleship grey and its glass panels had a green film from the surrounding trees - not very inviting.

Now with a grant of £2,451 from the Friends of Savernake Hospital, the balcony has been completely refurbished the surrounds have been painted a bright green and the glass has been cleaned.

The ward’s clinical services manager, Rosemary Pike, says she is very thrilled to be able to get patients out into the fresh air and give them a real change of scenery.

The Ailesbury is a medical rehabilitation ward and is part of Great Western Hospitals Foundation Trust.  Ownership of Savernake Hospital was transferred to GWH when Wiltshire’s Primary Care Trust was abolished as part of the government’s restructuring of the NHS.

The ward has 24 beds and takes patients who live in the area and have been having in-patient treatment in one of three local acute hospitals: GWH in Swindon, RUH in the Bath and Salisbury Hospital.

Sometimes patients come to the Ailesbury who have been treated at specialist units as far afield as Oxford or the south coast.

The balcony boasts some new and sturdy chairs and tables, very smart parasols and planters complete with plants. It is sheltered by the row of mature trees along the edge of the cricket field.

GWH is on the look-out for volunteers to help on the Ailebsury Ward.  Volunteers can assist medical and support staff in a number of ways - such as admin tasks, befriending patients or leading patient activities.

The balcony from ground levelThe balcony from ground level

People able to volunteer should contact Carol Orrow, GWH’s voluntary services manager on 01793 605248.

And the Friends of Savernake Hospital also need to find volunteers to help in their hospital shop and with the trolley shop.  Check out their website.



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Introducing Healthwatch Wiltshire: the new health & social care watchdog

Christine GravesChristine GravesOver the past few days, Christine Graves has been taking a special interest in the morning’s headlines about the NHS.  News of cover-up, inadequate reports, disarray at the Care Quality Commission (CQC) and the terrible distress of parents over the Morecombe Bay baby death scandal, strikes home for Christine Graves, the Chairman of the new Healthwatch Wiltshire organisation.

Christine Graves has almost forty years’ experience in social care.  She worked with the stroke rehabilitation unit at Marlborough’s Savernake Hospital for ten years.  More recently she was commissioning mental health services for Wiltshire Council.  She retired last September and was chosen to lead the county’s new patient involvement body.

Healthwatch Wiltshire is part of the new and complex geography the coalition government designed for the NHS in its restructuring of organisations and responsibilities. It started life on April 1.  

Marlborough News Online asked Christine Graves how the launch was going: “Are we up and running? No we are not. But it’s more important to get it right than get it quick.”

Part of the challenge has been the proper transfer of staff from the previous patient organisation – the Wiltshire Involvement Network (WIN – and see below.) This process ends on July 1.  Then she and the directors will be able to see whether they need to recruit more staff.

Healthwatch Wiltshire is commissioned by Wiltshire Council and funded by money from central government passed to the Council, but not ring fenced.  In Wiltshire’s case the full amount has gone through to Healthwatch Wiltshire which will cover both health and social care involvement throughout the county.

Their budget is not large: “I’m not saying we wouldn’t like more resources – but it’s mainly about the skills of our staff and engaging with people.”

This local Healthwatch will be independent of both Wiltshire Council and of the central, umbrella organisation, Healthwatch England. Indeed they are so independent that they have to pay Healthwatch England for use of the logo.

Besides Mrs Graves, they have at present an office, four directors and are established as a Community Interest Company. One of the four directors is Marlborough resident Paul Lefever who used to chair the Friends of Savernake Hospital.

Chairman and directors are voluntary positions.  The chairman’s role was advertised as involving a commitment of 3-5 days a month.  However, in order to get it up and running, she and her directors are presently working on tasks normally done by officials, they are discussing whether they should get some pay for the first year.

As though the present spate of NHS headlines were not enough of a warning, Chapter Six of Robert Francis QC’s final report on the many unnecessary deaths and appalling care at Mid-Staffs hospital shows how essential a proper health watch organisation can be. His chapter is titled: “Patient and public local involvement and scrutiny”.

In Mid-Staffs the succession of local patient involvement bodies (see below) failed over the years in their prime duty. They failed to alert the right people to what they were learning about the care in hospitals in their area.  The Staffordshire LINk group (equivalent to our WIN) was simply considered to be ‘dysfunctional’.

Wiltshire Council wanted the Healthwatch they commissioned to be grown in Wiltshire for Wiltshire, so they did not contract an ‘off-the-peg’ set-up from a national charity or national social enterprise.  Mrs Graves emphasises that “The Council has been and are being very supportive without seeking to influence the outcome.”

The only request the Council made was that Healthwatch Wiltshire use its Area Board network to spread information about NHS services and to gather views of the public.

Healthwatch Wiltshire will be proactive in checking on patient safety.  They have the power to ‘enter and view’ almost all types of health and social care establishment.

It has to be evidence not gossip.  Mrs Graves wants to encourage individuals to act responsibly when they’re visiting a care home or hospital and see something that’s not right: “We should all be brave enough to find someone in charge and say I know you’re going to be disappointed in what I’ve just seen….”  

 “We do have to get involved proactively in quality of care issues.  But the way to really resolve those issues is to get the right services in place for the next ten to fifteen years.”

Healthwatch Wiltshire will have a role in the complex process of commissioning health and social care services.  This role may not be quite as central and influential as originally signalled by the Department of Health.

However Healthwatch Wiltshire does have a voting seat on Wiltshire’s Health and Wellbeing Board which is led by the Council and oversees health and social care services.  And it has a non-voting seat on Wiltshire Clinical Commissioning Group’s (CCG) governing body which has taken over from the Primary Care Trust.

Mrs Graves thinks of Healthwatch Wiltshire as the CCG’s ‘critical friend’: “It’s a very fine and challenging line to keep us engaged and to make sure they hear the message even if it’s something they don’t want to hear.”

“I am confident that the CCG and the Council will listen to what Healthwatch Wiltshire has to say. It will all be advice and evidence from the people we’ve listened to. If they don’t listen to us, we have ‘the teeth’ to make people listen.”

Mrs Graves is passionate about getting a real debate going about health.   Healthwatch Wiltshire will also be proactive in hearing what people think about the services in their area and what they want.

Some of the feedback to their staff will come from twenty or so partner organisations working across health and social care:  “I would just like people to talk either to us or any of the partners we are engaging with – so we can listen.”

“We’ve got to have a conversation about health”.  Mrs Graves does not like to use the terms ‘customer’, ‘client’ or even ‘patient’ – she prefers ‘people’ because it’s inclusive.

The way Mrs Graves wants it to work is by creating networks – perhaps, for example, finding one young mother in as many playgroups as possible who, when they’ve all had their say over a coffee about the latest price of clothes or their husbands’ lack of washing up skills, will start a fifteen minute chat about what they’d like the NHS to do and what care they’d like their parents to have when they’re older. And then tell Healthwatch Wiltshire what matters to these mums.

Watch this space for news of Healthwatch Wiltshire’s phone number and website.

 

 HEALTHWATCH – the background

Organisations giving patients a way to engage with – and complain about – their local health services are not new.  

In 1974 Community Health Councils (CHC) were set up.  In 2003 they were replaced in England by Patient and Public Involvement Forums (PPIF) which reported directly to the Department of Health. In 2005 these were replaced by Local Involvement Networks (LINks.)

Wiltshire’s version was the Wiltshire Involvement Network or WIN. LINks were very local and had no central or umbrella organisation sitting in Whitehall. They were swept away by the coalition government’s radical NHS reform Bill which became law last year.

The 152 local Healthwatch organisations report their findings and concerns to Healthwatch England.  Or if the matter is urgent and vital directly to the CQC or the Department of Health.  Unlike LINks, local health watch organisations will cover health and social care provided for children as well as adults.

One rule the government has laid down is that local Healthwatch organisations cannot be political and cannot campaign. So they will not be on the front line demonstrating against a hospital closure.  But they will be passing on people’s concerns about the consequences of any closure.

 

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Wiltshire’s Clinical Commissioning Group is 100 days old – and into the hard work

Last week the National Health Service celebrated its sixty-fifth birthday – a distinctly wobbly anniversary. This week Wiltshire’s GP-led Clinical Commissioning Group (CCG - which replaced the Primary Care Trust - PCT) is a hundred days young.

It is, of course, far too early to attempt a report on the CCG’s progress. As a commentator said recently, changing anything in the NHS is like turning round the proverbial super tanker.

However work is going ahead in Wiltshire CCG with some speed. One advance being rolled out across the county is a programme to speed up dementia diagnosis.  Improvements in the care of those with dementia is a much more complex and wide-reaching problem.

The CCG’s first major headache is the government’s new NHS 111 urgent care ‘phoneline.  The Wiltshire service is in the hands of the commercial company Harmoni under an inherited contract.

The service is still not considered safe enough to go live. In this Wiltshire CCG are not alone. A recent survey by the GPs’ journal PULSE of 440 GPs found that only eight per cent believe the computer based triage system at the call centres is safe for patients.

Coming soon will the expense and organisational risk of the tender process for Wiltshire’s community maternity services.
Looking ahead, the CCG have in the pipeline a new plan for community healthcare to bring services closer to patients:  “The agreed approach is to make all health related local services become based in practices with specialist services clearly supporting the practices.”

Already the CCG’s leaders are working with staff at Great Western Hospitals (who hold the contract for all Wiltshire’s community healthcare) to upgrade the neighbourhood nursing teams To maximise the teams’ impact they are employing care coordinators.

It is not yet clear how far the CCG’s plan will bring medical services into practices.  But at last month’s meeting of the CCG’s governing body, its Finance Director, Simon Truelove, gave a warning that “By taking out small elements” from the work the major hospitals do now, there is a “risk of destabilising our acute hospitals”: “We have to be careful about taking out low level services.”

One achievement the CCG has logged is that all their contracts with service providers for the current year have already been signed.  Not something achieved by this stage of the financial year under the PCT – although the PCT had more and wider commissioning responsibilities.

It is very difficult to judge how far the government’s promise in 2010 to reduce NHS bureaucracy and its costs have been achieved with the introduction of the CCGs.  We know that Wiltshire CCG’s running costs are currently about one third higher than were the PCT’s.

Staffing levels are impossible to compare accurately due to the CCG’s reduced amount of commissioning and their outsourcing of various ‘back office’ elements – including HR and finances – to an independent Commissioning Support Unit. And they have no buildings to maintain.

In June 2011 the PCT employed 240 commissioning staff.  By 31 August 2012 this headcount had fallen to 203.  The CCG employs (as at May 31 this year) 95 people.  But some of those are part time and that total equates to 83.81 whole time equivalent staff.  They are still recruiting.

On top of those staff numbers and costs are the GPs who have to be replaced at their practices when they attend CCG meetings and events.

Under his recent Spending Review for 2015 George Osborne intends to take £3.8 billion from the NHS budget to hand to local authorities to deal with rising social care needs – and costs.  He also plans to cut NHS administration costs by about another tenth.

This has already roused one Midlands CCG chairman to worry in a blog about “Running Costs”:

“The £25 [per head] running cost is already a blunt tool, not taking into account size of organisation or local health needs. The commissioning system has already lost a significant number of experienced staff and is more fragmented.”

“CCGs are already incredibly lean…There’s a point where a lean organisation becomes an ineffective one.”

Some of England’s 211 CCGs have been quick to arrest the decline in investment in primary care by significantly boosting budgets for enhanced local services.

The ‘locality’ or sub-division of Wiltshire CCG which includes the Marlborough area is NEW – for North and East Wiltshire. NEW has announced details of their 2013-2014 budget for these enhancements.

Their aims are quite clear:
“Reduction in urgent admissions to acute hospitals from care homes – reduction in urgent admissions through appropriate primary care interventions – increased delivery of local services i.e. patients managed by GP or outpatient services provided in the primary care environment.”

In addition the agreement will help achieve the NHS savings target – known by the acronym QIPP (a very serious level of savings unfortunately pronounced ‘quip’.)

The money to be divided among NEW’s nineteen practices (with 165,338 patients) through this agreement is £1,192,087.  Of this nearly a fifth (or £248,006) is described as the ’Basic Commissioning Element’.

It covers some of the locality’s organisational costs:
“Each practice to have a named Commissioning lead GP – GP attendance at 70 per cent of regular locality meetings… – Carrying out 100 per cent of audits as agreed at locality meetings… – Create a register of between 0.5 and 1.0 per cent of patients in each practice most at risk of hospital admission…– A representative from each practice to attend their appropriate local area board meeting (or health equivalent) annually – Attend regular GP clinical forums.”

This money, like the rest of this local budget, will be paid quarterly “on the production and review of the appropriate evidence” to satisfy the CCG’s executive that the tasks have been completed. Quite an administrative job in itself.

During the on-off progress of the government’s Health and Social Care Bill, it was claimed locally that savings made by the future CCG on the £25 per head running costs budget would go towards front line services. It is now clear that, over and above the £25 per head set by the government, some of what are essentially  running costs for the ‘locality’ are shown as coming  from ‘front line’ budgets.

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GWH moves to improve nursing skills and fill vacancies

The Great Western Hospitals NHS Foundation Trust has started to recruit nurses from Scotland, Ireland and Portugal. It has at present fifty-seven whole time equivalent nursing vacancies across the Trust.

Of these twenty-one are on wards at GWH Swindon and thirty-six are in its community hospitals and Neighbourhood Teams across Wiltshire.  But it is not just a matter of numbers that Hilary Walker, GWH's Chief Nurse, wants to rectify.

During a review of staff just after she joined GWH last year, it became clear that the mix of nursing skills was not quite what the hospital required as the kind of treatments and balance of patients’ needs were changing.  They were employing fewer registered nurses than they now needed.

To redress the balance between auxiliary and registered nurses the Trust has committed £1.1 million for a recruitment campaign and additional salary costs – adding more nurses to its basic establishment.

The campaign began in April with its own website and events bringing interested nurses to see the hospital.  It has been showing some successes.  But, Ms Walker told Marlborough News Online, “We have not yet broken the back of the new posts.”

So they are now looking beyond England with Portugal chosen because it teaches English as the second language in its schools – it is, after all, known as ‘Britain’s oldest ally’.

GWH’s work on improving its nursing staff anticipated the calls in the final Francis Report on the Mid-Staffs hospital scandal for better nurse training and better ratios of nurses to patients.  At the end of last year it adopted a plan across the Trust’s premises and services: “Nursing Together – a strategy for improving patient care”.

The government’s instant response to the Francis Report was to call for all nurses to serve time as auxiliaries before they started their training.  This was supposed to prove those wanting to nurse were committed to caring for patients and with their nursing degrees were not, as some politicians would have it, ‘too posh to wash’.

Hilary Walker, Chief NurseHilary Walker, Chief NurseMs Walker is doubtful this would help: “I would be interested to know why the government think it’s a good idea. Training currently focusses on bedside care – I’d be interested in learning what additional benefits we’d get from that.”

Ms Walker’s has two strands in her work to bolster standards of nursing at GWH.  The first is to concentrate on the leadership skills of senior nursing staff.  They are spending a quarter of a million pounds on leadership training and stressing the importance of talking not just to patients but to relatives too.

“We’re doing the things we think are important.”

Secondly they are paying much more attention when they recruit new nursing staff to values and behaviour and attitudes – ensuring that recruits have caring characters and can show empathy. As Ms Walker says “Society doesn’t value social behaviour until it’s needed.”

Hilary Walker admits that nationally “It is safe to say we have not been the best planners in the world – our workforce planning was not perfect.  But it never will be – you’re trying to anticipate what you will need in five years’ time – that’s not an exact science – it’s a very long way from it.”

And locally there is some evidence of moving targets.  The new Wiltshire Clinical Commissioning Group (CCG) is currently working with GWH to upgrade the services provided under the contract for community care.  

This centres on the eleven neighbourhood teams one of which is based at Savernake Hospital. The CCG plan to employ Care Coordinators to improve the teams’ work: “GPs and the staff recognise there’s a lot more they could do particularly for people with a lot of health problems – the complex cases.”

Above the current contract costs, new investment is being made – some of it in kit so that the neighbourhood nurses can file their records to base from their cars.

The contract has been extended until June 2015.  However, whatever happens to the community services contract for Wiltshire, other services operate at Savernake Hospital which is now owned by the GWH Trust.  

After his recent visit to GWH and Savernake Hospital, Dr Peter Carter, the General Secretary of the Royal College of Nursing, told Marlborough News Online: “I was very impressed with what I saw during my visit, and very much enjoyed meeting hard-working staff. Although Savernake is clearly a very busy hospital, the standard of care I saw was extremely high.”



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