Category: Health, housing and adult social services

I had to go to Ealing Hospital tonight. I used the Harmoni out-of-hours service, or at least my baby daughter did. We saw a very nice doctor and although it was a bit anonymous it was a pretty good service. Can’t say the same about the parking though.

In a bit of a new parent tizzy and with a middle-aged man’s long-sightedness and a broken light it took me rather a long time to work out how to use the Pay-and-display parking. You get a bargain four hours for only £3.50. That is the minimum charge and most people don’t stay that long – I was there for 34 minutes so paid 10p per minute.

The hospital knows that the British public will in pull together adversity, especially in the face official money-grubbing. Our natural inclination will be to give each other the unused portion of our tickets. Only they have installed new ticket machines that require you to punch in your car registration.

On returning to my car I commiserated with another user: “Evil system”. He shot back: “Isn’t it just”. As I pulled away he was attaching a note to the machine. It read “Every little helps to pay for more managers”. Quite.

I think I have an item of any other business for the Health, Housing and Adult Social Services Panel on Tuesday.

Today the Healthcare Commission, one of those NHS quangos, published its ratings for NHS bodies, see press release.

Ealing PCT remains “Fair” or in the Healthcare Commission’s words:

Based on our assessment, Ealing Primary Care Trust continued to provide an adequate quality of service to patients. It was good at managing its finances and also made improvements. In a recent survey of trusts in England, patients rated this organisation as poor in terms of their overall experience.

So if your customers think you are “Poor” you can be “Fair” in the NHS.

Ealing Hospital remains “Good” or in the Healthcare Commission’s words:

Based on our assessment, Ealing Hospital NHS Trust continued to provide a good quality of service to patients. It was good at managing its finances and also made improvements. In a recent survey of trusts in England, patients rated this organisation as poor in terms of their overall experience.

Wow! Even if your customers think you are “Poor” you can be “Good” in the NHS.

West London Mental Health Trust has moved up from “Good” to “Excellent” or in the Healthcare Commission’s words:

Based on our assessment, West London Mental Health NHS Trust provided an excellent quality of service to patients, having made improvements compared to the previous year. It was good at managing its finances and also made improvements. In a recent survey of trusts in England, patients rated this organisation as satisfactory in terms of their overall experience.

So if your customers think you are merely “Satisfactory” you can be “Excellent” in the NHS.

The headline ratings for two local health bodies showed no change but there was welcome improvement at West London Mental Health Trust. Coincidentally all three bodies moved their “Use of resources” score, that is financial management to you and me, from “Fair” to “Good”. Hopefully this bodes well for the future of these three local bodies. If the finances are under control you have to hope there is scope to improve the services we get.

For more information see Ealing Times story.

Remember Gordon Brown’s windy rhetoric in Bournemouth last week:

So let me set out how we take the NHS into a new era.

Our great achievement of the 1940s was a service universal to all. In 2007 we need a service that is accessible to all and personal to all.

Our great ambition now: a National Health Service that is also a personal health service.

Today both the Telegraph and the Guardian are reporting how far the NHS needs to travel if it is to get to the point where it is valued by its customers in the way that health systems are valued in the wealthiest countries of Europe. Both of these newspaper reports are based on a report from an organisation called Health Consumer Powerhouse.

It is clear from the table above (click to enlarge) that the UK is not getting value from its healthcare system. Three groups are apparent. The elite group of wealthy countries have scores in the range 687 to 806. These are the countries you might expect to have good health systems, the Nordics, Austria, Netherlands, France, Switzerland, Germany Belgium and Luxembourg. It is a national scandal that the UK is not in this group.

Instead we languish in a group of countries that were until recently considered to be the poor men of Europe. Between Lithuania at 496 and Estonia at 633 there are fifteen countries. The UK is scored at 581 which puts it bang in the middle of a group of countries which we might once, in our arrogance, have written off as “poor Mediterraneans” or “former Soviet block”.

We are just not getting value for our health spending. Brown has had ten years. Brown has spent the money. Brown has failed.

Last night we met at Ealing Hospital. The substantial items on our agenda were:

• changes to sheltered housing
• Ealing Hospital’s foundation trust application
• Ealing PCT’s finances
• 2006 Adult Social Care star rating
• Adult Social Care complaints.

We covered the social services issues in one block. Cllr Ian Green, Cabinet Member for Adult Services & Housing, talked us through the rationalisation of sheltered housing. The council is looking at taking out of service 4 schemes which are unpopular and under-utilised. Cllr Green reckoned that he would not want one of his relatives in one of these schemes. The panel welcomed the council’s sensitive and measured approach. The panel also welcomed the 2 star rating achieved by the council’s adult social services and congratulated the council’s staff on achieving this rapid 2 year turn-around. Mary Umrigar went over the latest complaints stats in adult social services. The evidence of systematic collection and analysis of this information and its use in driving service improvements must surely be one of the reasons why adult social services has been turned around.

Fiona Wise, Chief Exec of Ealing Hospital and her Chairman, Tony Caplin, talked about the hospital’s application to be a foundation trust. Ealing Hospital will be in the 6th wave. The timetable will probably involve a consultation in April with a view to becoming a foundation trust in 2008. They may try to recruit members before April. In trusts members elect governors who in turn elect the hospital’s chairman and non-execs. They are looking at recruiting 4,500-5,000 members, people like you and me. The hospital’s 1,619 staff will have to opt out if they don’t want to be members. Staff members will elect 5 staff governors. Some 3,000 local people will be able to elect 17 governors representing patients and public. It will be a big task to recruit these members and keep them engaged.

Finally, Robert Creighton, Ealing PCT’s Chief Exec, talked though the financial outlook for the PCT. In many ways the outlook is good. Next year will probably see the last big increase in revenue with an increase of 8.1%. After that increases are most likely to level. No doubt this will depend on the outcome of the Comprehensive Spending Review, but the PCT is using 3% per annum as a planning assumption. The financial stress in the NHS, especially in London, has had its impact though.

The PCT was top-sliced this year and will be next. In February 2006, just before the start of the financial year, a 3% top-slice was imposed. This means the PCT was forced to lend Patricia Hewitt £12.3 million to bail out poorly performing PCTs across London. As a result service improvements planned for this year had to be postponed. In November 2006 the PCT was informed that it would be expected to lend another 3.6% in 2007/8 or £16.4 million. These unsecured loans total £28.7 million that should be spent in Ealing this year and next but won’t be. The NHS bureaucracy has promised that this money will be repaid over the succeeding four years. In other words jam tomorrow.

I pressed Creighton to confirm that all we know is that we have had £28 million taken off us and we don’t know when we will get it back. He suggested that I might have an alternative career as a barrister but had to agree that this was the case.

If we really do get this money back over the four years (2008/9 to 20011/12) this may turn out to be a good thing. Much of the rise in NHS funding over the last few years has been badly spent because it has come at NHS bodies too quickly. These loans may have a useful smoothing effect that will ensure health resources are better used in Ealing – although the revenue rises will not be as large as expected they will trail off more slowly.

We live in hope. If we are to get this money back we have to hope that the badly managed PCTs in London can reform themselves to the extent that not only do they start living within their means but also they equip themselves to actually repay this money. It also assumes that the Comprehensive Spending Review doesn’t cause all the rules to be changed again. Ealing is relying on Patricia Hewitt’s good will to get is £28.7 million back. I am not sure I trust her. Do you?

Cllr Greenhead, the Labour councillor who had a go at me in the Ealing Times after my last report of this meeting, turned up as an alternate. She showed her deep concern for these issues by being 40 minutes late and leaving early. She made no contribution on any of the topics discussed.

Last night we had the Chairman and Chief Executive of Ealing Hospital, the Chief Executive and Director of Finance of Ealing PCT and the Cabinet Member for Adult Services & Housing. It is a shame that so few members of the public turn up to these sessions and miss out on the chance to meet these people and ask them questions.

The Ealing Times has done a piece on me today. You would probably call it a hatchet job.

It is an entirely respectable argument to point out that Labour are using the language of reducing health inequalities to direct NHS resources at their own voters. The traditional approach to the allocation of NHS resources has been clinical need. Any combat medic or A&E doctor has to practise “triage”. The logic of tackling health inequality does take you in the other direction.

The language I used was easy misinterpret but Benedict Moore Bridger of the ET is really taking the Mickey. When you try to highlight how New Labour are singing the song of health inequalities while at the same time reducing health spending in Ealing you might think that the local paper would spot the real issue not just have a go at someone’s turn of phrase.

The only excitement at last night’s full council meeting was Labour Councillor Greenhead quoting my blog.

She quoted from a paragraph that I had written in my report of the last Health, Housing and Adult Social Services Panel.

Greenhead complains about my robust turn of phrase but refuses to acknowledge that the Labour government has made massive cuts to preventative health services right here in Ealing in spite of the best efforts of our own PCT. This year Ealing PCT was planning to spend £5 million on new preventative health measures. Over the summer, as a result of the current financial crisis in the NHS, Ealing PCT’s entire budget was top sliced by 3% and instead of having £5 million to spend on new services they were looking at taking £6 million out of their current spending plans.

Now that Greenhead has highlighted my “insensitive and inappropriate comments” I would be interested to hear her views on local NHS cuts which are actually destroying services designed to help Ealing people make better choices and improve their own health.

The full paragraph was:

Ruth Barnes gave a presentation on health inequalities and pointed out that health inequalities are Ealing PCT’s number 1 priority. That is fine but it is a bit obvious that those that make all the right choices all their lives, whether it is in education or health, will have better outcomes than those that make crap choices all their lives. The presentation kept referring to the good outcomes in places like Hangar Hill where homes cost about £2 million. If you live in one of these you have probably been making cute decisions all your life and you will probably have a long life. If you follow the inequality logic to its natural conclusion you end up pushing all of your health resources at people who are basket cases. It does seem though that the PCT is responding to this priority in the right way with behaviour changing initiatives – unfortunately these are just the services that they are having to freeze or cut due to Labour’s mismanagement of the health service.

No amount of huffing and puffing from Labour councillors is going to hide Labour’s mismanagement of the health service.

Last night we decamped to St Bernard’s Hospital, next to Ealing Hospital, which is the headquarters of West London Mental Health Trust (WLMHT). WLMHT meets the mental health needs of people across Hammersmith and Fulham, Ealing and Hounslow.

We had another full agenda covering:

• Nuffield Speech and Language Unit – again!
• a presentation on health inequalities
• childrens’ and adolecsents’ mental health services
• stopping smoking.

The review of the Nuffield now seems to be safely in the hands of Ealing PCT who are starting right at the start and looking at demand for the service across its whole catchment area, basically anyone who can get there in an hour. They will be running a proper consultation process in the new year. None of this will be cheap as they have effectively hired an interim manager for at least 6 months to run the process.

Ruth Barnes gave a presentation on health inequalities and pointed out that health inequalities are Ealing PCT’s number 1 priority. That is fine but it is a bit obvious that those that make all the right choices all their lives, whether it is in education or health, will have better outcomes than those that make crap choices all their lives. The presentation kept referring to the good outcomes in places like Hangar Hill where homes cost about £2 million. If you live in one of these you have probably been making cute decisions all your life and you will probably have a long life. If you follow the inequality logic to its natural conclusion you end up pushing all of your health resources at people who are basket cases. It does seem though that the PCT is responding to this priority in the right way with behaviour changing initiatives – unfortunately these are just the services that they are having to freeze or cut due to Labour’s mismanagement of the health service.

Trevor Farmer gave an overview of the childrens’ and adolecsents’ mental health services these seem to be undergoing reorganisation right now to ensure that people are kept out of the most intensive service provision. This is a good thing in its own right, if it is the right choice for the individuals involved, but I am afraid that a major driver is budget cuts. It looks like the service will lose £200,000 next year so will in effect suffer a 10% budget cut on its £2 million overall revenue budget.

We had a brief discussion of the stopping smoking service. At £250K per annum this may be money well spent. The question I failed to ask was how many people are stopping! Damn!

We have decided to ask the PCT for a breakdown of its funding last year, this year and next so that we can understand budget pressures and their impacts on services.

The meeting closed just before 9.30pm. Time well spent on the whole.