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.