I can see you

Transparency is a terrific buzz word, isn’t it?

It is very much a buzz word in the politics of health care and provision. Everyone claims that they want to be transparent these days. It is almost as fashionable as kale crisps, and about as palatable.

Transparency, it appears, is very good for all of us.

What transparency is supposed to mean in real terms is that when a body is acting on behalf of their community for their welfare, that that community should be able to see exactly what is being done on their behalf. They should be able to understand why these things are being done. They should be able to ask questions about the process from beginning to end and they should be provided with answers that make sense and which are clear.

Clarity is important.

This all seems absolutely splendid. I am all for it.

Apparently the NHS is as well, in principle. In practice and in certain areas of its administration, not so much, it transpires.

Now I’m going to talk about my new, best friends, the CCG.

You have been warned.

We have, in the last few weeks, received a fair amount of communication from the CCG. Much of it is written  in terms very similar to those I describe on yesterday’s blog post about spin.

Spin is another buzz word. It’s a posh phrase for hiding the truth by either lying, omission, or saying ‘Hey! Look at that ruddy great elephant over there! He’s stealing your pies!’ then using the moment you are looking at the elephant to steal all your pies.

Spin pretends that it is transparent. It isn’t. It provides just enough truth to throw most people off the scent.

This kind of transparency allows them to say: ‘We told you to look. It was there in plain sight. It’s your fault you didn’t see it.’

In the interests of further transparency, the CCG are required to divulge any and all care providers they have business interests in, so that we can see that they have nothing to hide and no shady dealing is going on.

They also have a duty of care to state when one of their members has a conflict of interest with any issue they have to deal with.

They are required to provide assurance that these people are not directly involved in decisions by which they may benefit.

This all sounds brilliant. It’s all so transparent you can see right through it.

To the other side.

On the other side of this you realise that knowing which care providers your CCG members are involved in, in no way stops them from awarding those care providers contracts which they pay for with tax payer funds.

This means that as long as they tell you that they are lining their own pockets, they can keep lining their own pockets.

On the other side they can and will tell you about a member of their board who has a conflict of interest in a matter that you might want to understand better because it affects you.

It does not stop that member having influence outside of the one decision making meeting they have to step out of, which might affect how the people inside that meeting are voting.

On the other side, they are free to set up whatever regulations regarding conflict of interest they like, no matter how flimsy or spurious they may seem, because they set their own rules and largely regulate themselves unless someone turns whistle blower and has enough evidence to over-reach them into the heady heights of NHS England.

Who would be brave enough to do that, when the livelihoods of those inside the system depends on whatever meagre crumbs that CCG choose to throw them in terms of their career and funding?

Neat isn’t it?

What transparency means here is performing a magic trick, and showing you how it’s done at the same time.

It’s Find the Lady, and every time they win, and every time they take your money, and they show you that they are doing it, and what they are doing is not illegal.

It’s just unethical and immoral, and greedy.

And it’s being done with our money, and eroding our health service and helping to break it, not heal it.

And they’re asking us to support it.

Transparency means me being able to go to a public board meeting of the CCG, which I did yesterday.

It’s like the circus.

The members sit round the largest board room table I’ve ever seen and perform tricks, and we, as the audience, sit in the cheap seats, tossing peanuts and occasionally being allowed to ask questions, most of which are answered with more spin.

Occasionally they throw you a bone, sacrifice something that doesn’t mean much to them or to you, but does make it look like they are trying to help you, so that they can still be seen to be complying with their mandate.

And all of this is transparency.

Yesterday some things became very clear, despite their attempts to hide in plain sight.

We all know that the priority of the CCG is patient welfare through the successful administration of first and second line services to the community.

Yesterday as I listened to a litany of failures across the city at the hands of the CCG, what is as plain as a pikestaff is their inability to do this job.

Here’s what they would admit to:

The failure of their transport contract with Arriva to hit targets for the third year running. The service is admitted by all to be shocking, but the CCG are finding it hard to get out of because of contractual issues. It means that this will continue to fail for months to come. There was the admission that interim measures put in place to force Arriva to up their game had only temporary success and the situation is now as bad as it was before.

The failure to deal with escalating crisis with regard to Leicester Royal Infirmary A&E and the ambulance service, as 17 more ambulances were stuck in bays with patients waiting for beds on Monday of this week. You will recall I mentioned this also happened last week.

The failure of the four hub surgeries that the CCG funded with millions of pounds to take the pressure off the A&E department. These hub surgeries are supposed to operate as emergency walk in centres. They are underperforming across the board. They are operating at an average 70% capacity.

The CCG admitted that there was an issue here, citing the fact that there was no motivation for the hubs to advertise for new customers as the surgeries had reached a cap point in the amount of money they get for patients. This basically means that the extra work involved in treating patients is not worth the money the surgeries are awarded for taking those patients on. The CCG admitted that this was a problem enshrined in the contracts they had with the hub surgeries and that it could not be addressed until autumn 2016.

They will tell you that the problem with Arriva is one they inherited, they’re doing the best they can.

They set up the hub contracts themselves. There is nobody else to blame.

They also admitted that there is a chance at least one of the hub surgeries will have to close by April 2016.

This is a disaster given how much of our money they cost.

It would be interesting to see how many of the service providers at these failing hub surgeries are providers in which CCG members have a share, wouldn’t it?

They touched on their failure to address the GP exodus. This includes Dr. Lenten, but also the poor take up of the Golden Hello scheme, and the rate at which GPs are being shed across the city.

It did cross my mind to ask whether the closure of GP surgeries in the city might help push patients into the failing hub surgeries and save them from a stay of execution. It is, of course, merely a thought, but an interesting one, don’t you think?

They did say, in fairness, that this year will be the year they work on more attractive packages to entice GPs into the city. We know how well those schemes worked last year, so I will reserve judgement.

Far be it from me to question whether the questionable behaviour of our CCG itself has something to do with the fact that we cannot attract GPs to the city.

These are the things that are transparent. These are the things they have to tell us about. Spin notwithstanding, it doesn’t look good.

I wonder what we’re not seeing.

What is utterly clear is that their greatest success is just how much of a mess they have been able to achieve in the less than 12 months that the CCG has had control over their budget.

 

Transparently clear.

 

 

The Sorrowful Language of Spin

So, one of the things you learn when you deal with council members, politicians, NHS honchos etc, is the slippery language of politics/business.

This can be anything from outright lying to question dodging, to anything in between. Anything that means whatever question you want an answer to never actually gets answered, but it takes about twenty minutes not to answer it.

This is in the hope that while you are waiting for some kind of sense to spill forth from someone’s mouth, you will get so bored, you will either wander off and find something else to do, or top yourself.

Also, that there will not be enough time for you to get through the formalities before the meeting is over and none of the really juicy questions have even been put on the table.

Luckily for me, having been trained by small children over many years, I have the ability to keep powering on, even when the talk leads to the dullest of matters. See my capacity to absorb information about the world of Minecraft for reference. Also the life and works of Taylor Swift. I am like the dromedary of tedious meetings. I can go for hours and hours.

I’m also pretty good with repetition. Having been trained again, by the most flexible of tiny terrorists, my own children. Not only can I keep saying: ‘But why?’ for about the time it takes new universes to form and spawn sentient life, I am also really good at hanging on tenaciously to the things other people say and not letting go. Jezza Paxman has got nothing on me.

The language of this bureaucratic landscape (for mental image think T. S. Eliot’s The Wasteland, but without the lyrical poetry and more percentages) is littered with hearty, emotive words that really tug on the heart strings or try to. You will find that these people would ‘love’ to help you. They almost always ‘completely understand where you’re coming from’ until they conclusively prove that they have no more idea of where you’re coming from than I have of how to fly to Mars on a pencil shaving.

This language of overblown sympathy and emotional trigger words is the stuff that Donald Trump uses so successfully. Other people who were really good at it were Hitler and Mussolini. This gives you a base line for the level of interaction and personal integrity we are dealing with here.

There is an awful lot of use of the word ‘but’ in this world. I would ‘love’ to help you ‘but’ I am an evil overlord bent on your destruction and am therefore unable to actually give a toss or move my face into more than a rictus simulacrum of sympathy. How unfortunate.

When they say unfortunate, it usually means for them, not you.

See also the use of the word ‘sorry’. Rather than being sorry for you, this can mean:

  • I am sorry that you asked that question because it the answer is going to reflect very poorly on me.
  • I am sorry that you found that out.
  • I am sorry that I cannot just push you into that hole, because you are getting in my way.
  • I am sorry that everyone is watching me, so I cannot push you into that hole, even though it is really tempting.

There is also a great deal of trying.  The word trying I find interesting. In the immortal lines of Inigo Montoya:

‘You keep using that word. I do not think it means what you think it means.’

I hear it and it means that you are indeed trying. You are trying my patience.

You want me to hear that you are trying to help me.

I know that you are trying, by straining every sinew in your body and mind, not to help me at all (p.s. I know that minds don’t have sinews. I got A at GCSE biology).

So far, our CCG have tried to help us by:

Repetitively going over the same ground. Repeating their letter almost verbatim whenever asked for information.

Sending out vast screeds of information in the hope that the immortal truth that ‘bullshit baffles brains’ will win the day.

Routinely ignoring all requests to have actual questions answered with anything other than a grain of truth and a soupçon of spin.

Lying by omission. (See this article in Pulse magazine. I say the Lentens asked for help from the CCG. The CCG say they did not because they did not ask for help from April to December 2015. We all know the Lentens asked for help in March 2015. How convenient of them to omit March from their statement).

Offering help that is deeply flawed and has problems all of its own that they are not prepared to go into because it would not serve their purpose.

Denying the evidence placed before them by arguing exceptions based on recommendations which are considered to be extraordinary rather than ordinary.

Point blank lying, by claiming they have no control over finances which could help our GP when all evidence points to the contrary.

Refusing to engage with direct questions they cannot answer without looking shabby.

Obfuscation in general and specific terms.

When we have our meeting with them, it is very likely they will offer us some kind of solution which is neither practical, fair, nor desirable. They will use their considerable powers of spin to try and make it look like we are being unreasonable in turning down whatever it is that they offer.

They will trot out their buzz words of ‘sympathy’ and ‘understanding’ and ‘trying’. They will bring in their new, best and shiny buzz word for occasions just such as these. The word ‘reasonable’ will be bandied about a great deal. I suspect that the word ‘reluctantly’ might make an appearance. I’d put money on ‘sorrow’ creeping in.

Let me use my own emotive language. After all, I’m a writer. It’s what I do.

What they will try to offer us is a plaster on a suppurating wound. When we point out that a plaster will only seal in the germs and make the infection worse, and that what we are asking for is for the physician to heal thyself, we will be ignored.

When we, quite rightly, turn down the solution that will only kill our patient slowly and cause them more pain, they will paint us as the bad guys. They will tell you that they wanted to help the patient, but they couldn’t because we wouldn’t let them, even though they tried their very hardest, and they are very, very sorry for our loss.

They will say this, despite the fact that they are the ones who are holding the pillow over the face of our front line services and smiling and smiling and still being villains while the very life is squeezed out of it at their hands.

 

 

Let Me Introduce You to the CCG

In our attempts to keep our local GP surgery open, we have to deal with a body called the CCG.

This stands for Clinical Commissioning Group. All areas of the UK have them.

They were created three years ago, after another major upheaval in the way the NHS is run, through the creation of the Health and Social Care act in 2012.  The job of the CCG is to replace what Primary Care Trusts used to do.

The NHS Clinical Commissioning Group website explains this better:

‘CCGs are responsible for the health of their entire population, and are measured by how much they improve outcomes.’

They control around 60% of the NHS budget yearly. This is currently around £60 million.

They consist of administrators, lay people, nurses, and GPs, all of whom are elected, and who are mandated to act in the best interests of the community they serve.

CCGs work with NHS UK.

NHS UK are responsible for the whole country, and have a duty of care to ensure that what each CCG is doing is:

‘fit for purpose, and are improving health outcomes.’

CCGs also work closely with local councils, particularly the Health and Wellbeing board, to ensure that the focus is on the patients in the community.

We are having issues with our CCG.

Specifically our issue is that the CCG are closing local surgeries and not providing alternative, safe and practical options for patients to register with other surgeries. We are still having patients turned away and fobbed off by other surgeries. Stories come in to us every day since the day the closure letter came out.

We have raised the question of what the CCG has done to try and help our practice stay open. We have had to apply under the Freedom of Information Act to find this out.

We have raised the question of what funding is available to help.

This question is particularly interesting. The only answer we have been given so far is that our CCG are not able to fund what we ask for and that this type of funding is not their responsibility.

I refer you to the above quotation, directly from the NHS CCG website.

We have also asked whether there is a conflict of interest which may be affecting the outcome of our request. We note that one of the members of our CCG has a practice which is in our GP catchment area, and is being recommended by the CCG as one of the surgeries we may now want to register with. We believe that there must be a procedure in place to deal with these things ethically, as local GPs are regularly included on CCG boards. We have still had no answer to this question however.

We looked into the matter and found that CCGs regulate themselves. We are troubled by this. We found our reservations are shared by The Kings Fund, who are a research body, often employed by the NHS (and whose papers we are reading on the founding of super surgeries, funded by amongst others East Midlands health care trusts):

‘although new guidance for co-commissioning has tightened up CCG governance processes, the approach to assurance is still reactive, based on CCG self-certification and investigations by exception.’

Given that one of the major stories of last year was the phone hacking scandal which clearly demonstrated amongst other, more sobering things, that having journalists be the watchdog for journalists is not a good plan, I fail to see how a CCG monitoring and regulating their own activities can hope to pan out any better.

At a more general level, we note:

Our CCG is underperforming nationally. There are freely available statistics to prove this. Its rating is slipping year on year in relation to the national average. You would think this would encourage them to work harder to achieve their objectives and not exacerbate what they already freely admit is a crisis.

As I told you in yesterday’s post, Leicester city is one of the worst affected areas in the country by the drain of GPs. We have forty long term GP vacancies which the CCG are struggling to fill, despite using public funding from the Health and Wellbeing Board to offer golden handshakes to new GPs.

They also spent £600,00 of their funds to bring physician practitioners from the USA to Leicester to practice to help relieve the crisis.

 

Our CCG should be measured by the way it is improving outcomes. It should be measured by the health and wellbeing of our community.

There is concrete proof that the health and wellbeing of our community is suffering as a direct result of what the CCG are doing.

We asked NHS UK to look into this, as the regulating body responsible for monitoring what the CCG do and how they do it.

Their response, was an almost verbatim copy of the letter that the CCG sent to us when they announced the closure of our surgery.

It seems that the only health and wellbeing the CCG and NHS UK are interested in, are their own. If all they do is cover each other’s backs, who will cover ours?

Who is covering yours?

 

Drain

I’ve got my activist hat on today, so if you’re not fussed about the state of the nation, do feel free to poddle off and make tea.

As I dig further into the issues surrounding the closure of my local GP’s surgery (you can sign the petition here) it becomes clear how much this is something that will not just affect me and the 2,400 of us who are patients of Dr. Lenten. It will affect, it is already affecting, our whole city.

It will affect the whole country.

This tiny surgery we care enough to fight about, is just one of many. We are the third to go in our area in two months. There are more scheduled to be shut. Soon there will be thousands of patients swilling around the city, looking for a GP to treat them.

Waiting times in our city are already at an average 2-3 weeks for a non-urgent appointment time (you can still get same day appointments at my surgery by the way). That isn’t going to get better as all those of us losing their GPs and local surgeries pour onto waiting lists and into already overstretched practices.

Yesterday, just going through old articles from our local paper I found these figures for our city.

Leicester is one of the worst affected cities in the UK with regard to the GP exodus. Last year we had 40 GP vacancies in our city because of the number of GPs leaving their practices. That is the equivalent of 60 – 70,000 patients in terms of treatment.

These positions are not being filled. The Department of Health wanted to raise the number of people applying to train as Doctors. The number has dropped by 5% in twelve months. Let’s not even talk about the fact that it takes seven years to qualify and the cost of training.

The positions will continue to be unfilled and the problem will get worse. There is evidence of GPs moving abroad, moving into other professions, retiring earlier and earlier, and sadly, a fair number being too ill to carry on working.

This is what we are faced with nationally and for us in Leicester it is at crisis point.

This means that before the closures, our surgeries were already supporting an extra 60 -70,000 patients.  The two surgeries that have already closed and ours which is scheduled to close, will add a further 15,000 patients to that number. Other surgeries are going. The number of patients will only rise, and the number of doctors and surgeries is continuing to drop.

Eventually, and not too far into the future as far as I can see it, it will put an intolerable strain on a system which is already close to breaking point.

The thing is, when we talk about systems at breaking point, we miss the actual point. What begins to break are patients lives. That is why this is so important at the end of the day.

Take away the politics of it for a moment. Take away the cost issue (which I know is not simple). Reduce this to what matters. What matters is our health. What matters are our lives. It doesn’t matter at the end of the day if you are a dyed in the wool Tory or a card carrying socialist.  What matters is that if you think your child has meningitis, you need to see a qualified, competent doctor and you need to see them quickly.  What matters is that when your elderly parent has a fall, you need to see a doctor who will treat them like a human being and not a nuisance.

That is what is under threat. For ALL of us.

 

 

Hollie McNish does not work out with Davina McCall

I will get back to the justice warrior posting soon, but I just wanted to catch this snippet of my life before it flies out of my tiny, incapacitated brain.

I went to a poetry slam event last Sunday, arranged by my friend, the brilliant, performance poet, Toby Campion. I’ve posted stuff about Toby on here before, and really I cannot recommend his work enough. He is truly gifted.

It was at Leicester University, and we saw the finals of an all day slam where four teams of students competed against each other for a place in a grand slam event in Texas. It was tense stuff.

To be honest, when I went, I thought it would be a lot of adolescent moaning, circa my own Sylvia Plath inspired maunderings of the late Eighties. I was nervous.

Turns out I didn’t need to be. Modern teenagers are much more literate, politically erudite and talented.

Thank the tiny, baby Cheezus for that. There is hope for the future.

Not only did we spend three hours listening to some stunning poetry from the students, we also got to hear Hollie McNish.

Hollie is the incredibly brilliant woman who wrote and performed the poem Mathematics, which did the rounds of Facebook a while back.

She was SO good, and when I got home I ordered two books of her poetry, one which was being published on Thursday. I was so excited I actually pre-ordered it. Praise indeed.

On Thursday a parcel arrived from Amazon. I ripped it open expecting poetry, only to find Davina McCall’s Fifteen Minute Work Out.

To say I was traumatised was understating things.

We all know how I feel about exercise (the devil’s work) and Davina, well, she’s exhausting even when she’s not bulking up her abs in orange lycra.

I opened my account details. Had I done crazed shopping while in some kind of sleep deprived ecstatic haze? No. Thank God. I could rule out expecting more random items, sheds, four pounds of apricot jam, weasel hair coats, etc.

I thought about it. Sometimes lovely people send me surprise gifts. This was truly a surprise. I interrogated Facebook. Nobody confessed. I interrogated Jason in case it was a surreal way of him saying thank you for the life size Tom Baker cut out I bought him last week. Nope.

Later, after more investigation it transpires that the tired worker/drone in the Amazon warehouse had grabbed McCall instead of McNish. I think Hollie would be delighted to know she shares shelf space with Davina. It is a gorgeous juxtaposition.

I have to return it, or they will charge me for 15 minutes of Davina I don’t want.

I thought it would be easy. Pop to post office with returns label. Job’s a good ‘un.

Nope.

I had to choose an Amazon locker delivery site. This is the modern world.

WHAT?

They have lockers all over the city, apparently. You deposit your item in there, using the secret code they give you, and some mysterious stranger comes and empties the lockers and whisks Davina back to the underground bunker she came from.

There are about twenty of these lockers in my area. It transpires however, that most of them are already full of returned Davina work out DVDs, and the only one I can get access to is at Morrison’s cheese counter on Aylestone Road.

So today, Davina and I are taking a trip to Morrison’s cheese counter with our secret code.

I will wear a hairnet, so that I blend in, and the job can be done in appropriately stealthy fashion.

 

 

Saving Grace

I’m learning a lot this week.

It has only been a week.

Holy crap, what a week.

Not only am I learning every day about what the NHS does and doesn’t do, I’m learning about what people do and don’t do.

What I’m learning, is, I am absolutely delighted to say, what I suspected all along.

What I’m learning is that the real capacity for change comes from the bottom up, not the top down.

Take note, you people who talk to me about how much voting matters.

I’ve said it before, and I’ll say it again. Voting only matters if, when you’ve finished ticking the box in the polling station, you get up off your arse, and you do something about what you believe in.

Do not, not for a single second, think that those that hold the power are going to do one, solitary thing for you if you don’t ask them, write to them, make them.

Make an example of them.

What I’m learning is that ordinary people, ordinary people like me, like you, can do extraordinary things.

We are doing extraordinary things.

We have come together as a community to not just protest, but to effect change, to focus our energies, to shape an agenda and bring it onto a stage where people who don’t want to listen, who want to push what we have to say under the carpet, have to pay attention to us.

We have taken a tiny, local story, a story that is just like stories all over the country, and in one week, we have managed to put it on a national stage.

We have rallied together. This weekend, people in our community, the people who make the word community real and meaningful, are spending their weekend pounding the pavements, delivering flyers to thousands and thousands of houses in our GP’s catchment area.  We have spoken to teachers, priests, vicars, politicians, journalists, shop keepers, families. We have spoken up and we have spoken out. We have shared our stories and our anger, and our hope that things can be different.

Things are already different.

It is times like these, things like these, that make us pull together, speak to each other, look each other in the eye instead of pass each other in the street. These are the times that test the mettle of the person you are and the people you surround yourself with. We are doing more than trying to save our doctor. We are saving ourselves, and it is good.

Worry

We are still all about the medical here. It is like being on Casualty, but in the boring, back office, where nobody shouts CRASH! CHARLIE! and runs around in crocs, throwing blood up the walls.

Now I’ve just read that back to myself, I’m quite pleased. I’d be terrible at blood. Let us not even think about what vomit does to me.

Mine, or other people’s.

One of the things that makes me cross about this situation is how many bureaucrats are worried about this. That might sound counter intuitive. After all, I should want them to be worried, right?

Yes, but I want them to be worried about the right things. What I want them to worry about is people with long term, chronic conditions being able to manage their lives with the help of GP’s they trust and who they can choose to see more than once in a blue moon. Not like the lady I spoke to today who has seen a different GP every week since she has been forced to move to one of the government friendly, large practices. What I want them to worry about is supporting GPs that are good at their job and not putting them in a position where they feel they have to resign.  What I want them to do, is to focus on helping from the bottom up, not the top down. What I want them to worry about is patient care.

Not self care.

What worries the bureaucrats, from all the evidence I’m seeing at the moment, is being shouted at by people like me. What worries the bureaucrats is what the media think of them. What the bureaucrats worry about is whether they will lose their bonuses, and their comfortable jobs. What worries some of them, is being found out.

 

It worries me that this is the mentality I’m discovering in the middle levels of the NHS. God knows what the upper echelons are like. I am not talking for one moment about those  who are on the front line services by the way. All my sympathies go to them. They are doing a hard job in trying circumstances, and much like us patients, they re being made the scapegoats of all this.

It worries me that for the management committees, and the groups and the bureaucrats it is all about what’s on the surface, not what’s underneath.  It’s all about platitudes, and patronising phrases that ooze with false sympathy and mean nothing. It’s all management speak and obfuscation.

Is that what we want from health care?

Guess what? Birth is grisly, living is a messy business, and dying is fucking horrendous. Health care is at the gritty end of things. That’s its job. That’s what it does. We don’t expect it to look lovely. We don’t expect  it to speak nicely, and wear expensive clothes. We expect it to work.

We expect it to get down into the guts of the matter and fix things. It needs to fix people. It needs to fix lives. It needs to help us give birth, it needs to ease living, and soothe the dying. It isn’t about forms and management committees and balance sheets, not where it really matters.

At the sharp end it is about making sure my baby is delivered healthy and well. It is about holding my hand while I’m dying and giving me the dignity I deserve because the life I have lived demands it. It is about making it all better. Even the terrible things can be handled so that they’re better. We all know that. It’s not magic. It’s just care, and patience  and being allowed to help people.

What absolutely frustrates me is that what I’m seeing with the middle men is the language of helping and the actions that make that a lie, that are the opposite of that. What I am seeing is them helping themselves, while we go without.

When the bureaucrats start worrying about the right things, I’ll start believing the things they say. When the evidence matches the words, I’ll start listening. When what they do matches the promises they make, I’ll start backing off.  Until then, I’m carrying on.

And I’m still worried.

I think I have every right to be.