On Sunday (I know it’s Tuesday, what can I say? Too many things, too little time to write about them) I went back to BBC Radio Leicester to talk to the breakfast show team about my Advent Food Bank Box project. You can listen to it here from 1 hour 41 for about six minutes should you so desire. The project is going well and we’re going to be helping with a food bank drive at the Co-op at our local Christmas Fair and banging the drum for a bit more Advent box goodness.

Yesterday I had a serious book cull and sorted out eight carrier bags full of children’s books I was holding onto for sentimental purposes and donated them to my friend’s school library. It took me ages to sort them as I sat on the floor reading some of my favourite ones and feeling a bit sad that my children no longer want me to read to them, although I think Walter the Farting Dog will enjoy his new home, and hopefully make whole classes of children laugh as uproariously as my children did when we read it.

There has been a lot in the news over the last few days about the NHS’ new STP programme. It isn’t really new. It’s been around for months, only it has been confidential. Except that most people who are interested in the NHS at all know that it is basically another vehicle for massive cuts which will pretty much be the death knell of the NHS.

STP (they love their acronyms) stands for Sustainability and Transformation Plans. These will be implemented across the UK. They are supposed to partner and logically extend something called BCT (told you), which stands for Better Care Together.

Better Care Together is something that has been being steadily implemented pretty much alongside it being consulted on, which shows you what a complete and utter nonsense NHS consultations are.

In theory BCT sounds brilliant. It is the idea that most people do not actually want to be in hospitals, and would rather be at home. It is the idea that at home, a lot of people get better more quickly because they are less stressed, less likely to become cross infected by super bugs and the like. It is, at this level, something that almost everyone you speak to about it including me, would really get on board with.

But then you look at what it means in practice. In practice it is an extremely clumsy tool for getting rid of what the NHS call ‘bed blockers’. Bed blockers are people who the system has pretty much failed, dementia patients, elderly people with no family to care for them, long term chronic patients etc. These people need continuous, ongoing care that they are not receiving in the community. They will probably be discharged and admitted tens of times into hospitals, and they are part of the reason hospitals are in crisis. With an increasingly elderly population, this problem is only going to get worse. The solution is BCT.

BCT puts the patient back in their home. For every six patients at home in their own bed, this will be called a ‘virtual ward’. These beds will then be counted in hospital bed counts to make it look like beds are not being lost. This is absolute bollocks.

These patients at home will be picked up by community care, which will look after them at home with a complete care package including visits four times a day and everything they need.

This is also bollocks. We have a pilot scheme of this running in certain areas of Leicester. Councillors are hailing it as marvellous. It is marvellous because they are making it the exemplar to justify rolling it out to hundreds of patients, so it has to be marvellous. It is a lie, however.

There are many problems with BCT, not least of which is that not every house is suitable for setting up as a virtual ward, and nobody says what happens to patients when they inevitably get sicker and need to genuinely go back into the hospital their bed has been removed from. (they are not keeping all the empty BCT beds by the way. It’s not financially sustainable. Over 100 beds have been already closed in our most under pressure, over worked hospital). Nobody says what happens to these virtual wards when patients die. It’s not like we can just pop a needy person into someone else’s bed, because the NHS have designated it as a hospital bed.

Other problems include the fact that all this extra care will fall onto what is known as primary care, i.e. GPs, district nurses etc. Currently, in Leicester alone we are nearly fifty GP’s short of what we need in this city. A GP should see twenty patients a day. Ours are seeing, on average, sixty. That’s before BCT and STP really kick in. We do not have sufficient practice nurses, nurse practitioners or district nurses to cope with what care in the community needs doing now. That’s why these poor buggers keep being admitted into hospital in the first place. How will we manage when hundreds of chronic, needy patients are released back into the community with comprehensive 24/7 care needs?

The fear is that people like Richard Branson, who has just swept up another few hundred million quid’s worth of care contracts from the NHS, will sell carers to the system to cover this, except that the care industry is poorly regulated and requires people to have little to no qualifications. So your patients could be seen by literally anyone. Worse, there is nobody to monitor this care. If you think the exposes of what happens in old people’s homes is shocking, wait until thousands of people are at home, being cared for by random, barely qualified strangers with nobody checking on them.

The CQC, which is the Care Quality Commission that is supposed to monitor how GP surgeries and hospitals etc are doing all around the country are notoriously poor at their job. Their budget was slashed in 2015. They lost hundreds of inspectors and were doing some of their inspections via the Internet using Google. Just one of their reports was found to contain upwards of 200 errors. They temporarily closed a GP surgery in our area for having a dirty fish tank in the waiting room. They often ask GPs to take time out of their already overworked days to provide reams of paperwork and records. They are over stretched and under resourced. Yesterday it was announced that they have been hit by more cuts and the loss of another 400 staff. So who will be overseeing this care in the community?

So that’s BCT.

STP sounds great. Just like BCT. It acknowledges that there is massive waste in the system. It acknowledges that projects are started without clear goals and deadlines and go off track and things don’t get done. It insists that all plans put into place by the NHS are both sustainable and can transform the NHS into an efficient, useful tool for helping patients. So far, so good.

What it doesn’t tell you is that it is also being applied retrospectively for current projects and will not let them go ahead until they have done due diligence and shown their workings. This sounds great. Nobody wants failing projects being unnecessarily green lighted only to crash and burn when they’re implemented. It is great in theory, until you realise that the three year project to try and provide more beds in Leicestershire for mentally ill teenagers has now been halted indefinitely until months more work can be done, for example. And there is no money for any of this extra work. It means that we are still left with ten dedicated beds in the entire region, and that includes Loughborough, Melton Mowbray, Market Harborough and even as far out as some areas of Derbyshire. TEN BEDS. And that’s the way it will stay until STP has signed it off. In the meantime, mentally ill teenagers are left to either fend for themselves or put on adult wards, which is not even less than ideal.

What it doesn’t tell you is that it is basically a massive bulldozer to drive through swingeing cuts that will decimate the NHS. Sustainability is the new buzz word for making cuts the government demands. Transformation means privatisation pretty much.

In Leicester, Loughborough and Rutland alone the reality of STP is that it is calling for the closure of one entire hospital in Leicester, most cottage hospitals in the area and the loss of one third of our already at capacity hospital beds.

And that’s just the tip of the iceberg.


10 responses to “STP BCT CRY

  1. Am speechless. Am sharing x

  2. I hope you don’t mind – I have posted a link to this on fb, hoping that people I know who are carers will read it. People read the headlines but don’t appreciate the devastation this will cause. Pressure is building everywhere.

    We are lucky. We have a brilliant local care company who sort out our four visits a day. It is quite a small team so we usually know who is coming in. They have to cover a large, rural area and I can tell how much more stressed they are as we head into winter. They never let us down but last year two carers wrote their cars off as they tried to negotiate floods and snow in horrendous conditions and under pressure to get to an ever increasing number of clients. Some carers leave because they can no longer afford the motor insurance premiums. I dread the contract being handed to another, cheaper company.

    During the summer there was an efficiency drive over incontinence products. We were put on cheaper products which were uncomfortable, difficult to use and caused sores. Our visits from the District Nurse team increased from one every 2 – 3 months to 2 or 3 a week. They admitted that this was to save in the region of 40p a day. Eventually the decision was reversed and we got our originals back but I seemed to spend two months talking about nothing but incontinence products to anyone who would listen.

    That’s not going into the NHS continuing care assessments to scrape a bit extra funding or the service providing night visits being scrapped.

    I have been a carer for fifteen years and I am told how important it is that I have respite – but no respite beds are available. If I want an evening out or a night away, I rely on the local care home ringing and telling me that they have a night available in the coming week. Nothing can be planned in advance.

    Reading this back, it seems very trivial compared to people without a roof over their head or nothing to eat . . . . but all the trivial, little things build up. The money saving schemes all hit the person at the end of the line until they feel under assault from all sides. Much of it doesn’t even seem about saving money – just pushing it onto someone else’s budget.

    My husband has me to fight his corner. My heart aches for the elderly and disabled who are on their own. They are left with no dignity and little respect.

    • Lesley, this is an amazing post. I am in awe of you and good for you for fighting. I’m sorry you even have to. I’m going to share your response on my FB NHS page. x

  3. We’ve sort of adopted the old lady next door, she has no family close by (there’s a nephew somewhere), the health service has completely failed to look after her and the carers she has in she is afraid of. I check on her regularly, as does another neighbour. She called an ambulance once after a fall (we were at work) and it took them an hour to collect her and she was discharged the next day despite the fact that she couldn’t get her balance because there wasn’t a bed for her. She needs more support, but the district nurses are stretched too thin, carers aren’t qualified and certainly aren’t medics.

    On top of that there’s my grandparents, when my Nan was diagnosed with demetia and clinical depression over 10 years ago, she went into the mental health ward for a bit. Then she was discharged into Grandad’s care. He has always done his best, but his health is poor too. Luckily they have family to take care of them because the district nurse no longer comes round and he struggles to care for her when she’s really poorly. She was removed from the list of patients needing medical care at home because there weren’t enough nurses to go round – but my 88 year old Grandad is seen as sufficient to provide that care. Thank goodness my mum and aunt are both nurses and can advise him.

    It’s absolutely criminal the way the health service has been let down by government’s too worried about what they’re going to write about in their memoirs, to actually do their jobs and look after the vulnerable in society and safeguard a nation’s health.

    • We will all have to do this if this goes ahead. It’s why it’s even more important to build community, talk to our neighbours, connect with each other, but also fight these cuts where we can. x

  4. My mother was diagnosed with cancer eight years ago, she decided that she didn’t want to undergo surgery or chemo as she felt it would be a waste of time and resources at her age. She also decided she wanted to die at home.
    My brother and I agreed to care for her, the original plan being to each spend a few days a week with her and rely on carers etc so we could retain some kind of a life. That never happened, her condition deteriorated far quicker than predicted but, as is often the way, she also lingered longer than expected.
    We were in many ways very fortunate, my mother and brother (who had taken early retirement) were financially comfortable and could help support me, so that we could both become full time carers. She lived in a 4 bedroomed house with a layout suitable for a hospital bed to be installed downstairs. Many people can not afford to put their lives on hold for months and live in accommodation that is far from ideal, I have no idea how they cope. Many deal with this situation alone, I don’t know how I would have managed without being able to share the burden with my brother.
    In addition to daily visits by the district nurses, we also received support from the local hospice nurses a couple of times a week, because mum spent some time there after her diagnosis (but this is discretionary as it is a charity). These visits became a lifeline, but patients don’t develop complications exclusively in the 20 minutes you have company, we learned to make notes so that we didn’t waste any of the time we were given.
    Typically crises most often occurred in the middle of the night, if you call the out of hours service you will (eventually) get to speak to an operator, who will decide whether a doctor will call you back, who then decides whether they will come out. This can take hours, some of the longest of my life, because there are not enough duty doctors available.
    It was without doubt the worst of times and I still get the nightmares to prove it. It is not just the physical care (which can be formidable enough) or even the emotional and mental stress, it is the responsibility that destroys you. You are expected to make choices and decisions that you are not qualified for, at a time when you are least able to think clearly. I was stunned by the amount of control we were given, even down to the level of medication she received towards the end, it is probably the only time in my life when I would have preferred to just do as I was told.

    I have told my daughters, in no uncertain terms, that if I am ever unable to care for myself they are under no circumstances to take over. If there are no other options available they have my full permission to push me over a cliff.
    Of course we all like the idea of care in the community but it requires an exceptional support network to make it viable. Anything less and patients and/or their families suffer, not something that seems to concern this government overmuch, not compared to saving money that is.
    They can not justify making cuts to the existing services, even if they were prepared to invest heavily in community care instead, which they aren’t. Ideally they should be increasing funding for both, the nation’s health and well being is not a commodity that can be traded. Unless of course your aim is to kill off the ailing NHS and you couldn’t give a rat’s arse about the people you are supposed to represent.

    • Yes, it feels like we are just bargaining chips doesn’t it? And for what?

      • I don’t think it’s a coincidence that so many Conservative MPs, past and present, are affiliated to private healthcare companies….

        In other news I just signed a petition that may interest you on Care2 Petitions; Wonder Woman Should Not Be the UN Honorary Ambassador for the Empowerment of Women and Girls. I would post a link but it won’t let me! There are no words.

      • Yes. the wonder woman thing is a mockery of a sham.

    • Gerry – I think you and your brother are fantastic for what you did for your Mum but I absolutely agree. As carers, we are expected to just get on with things we have no knowledge about. Because I didn’t know stuff, some professionals treated me as if I was foolish rather than clueless. When my husband came home, after months in hospital and a fight to get him back, he needed a special bed, hoist and was totally wheelchair bound. The only leaflets I got were about finances, nothing about care issues. The support ranged from very good to completely useless. One support worker came to look at the house (an old Victorian terrace) and advised we must have a shower fitted in the adapted downstairs bedroom (which would have meant no room for either hoist or wheelchair) and ideally a toilet cubicle in the (quite small) kitchen!

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