Better Care Together – Or Is It?

I don’t write much about my health campaigning on here anymore, but I am moved to do it after attending a meeting last night about the future of healthcare across Leicester, Leicestershire and Rutland, or ‘where I live’, as I like to call it.

Let me set the scene.

Three years ago, when I started health campaigning it was a steep learning curve, particularly with relation to all the acronyms flying around. The favourite at that time was BCT which stands for Better Care Together. At its broadest it means that hospitals are trying to push care back out into the community in order to try and manage the increasing number of largely elderly patients who are currently and will continue to take up hospital beds. Right now, across my region they estimate that between 15 and 33% of patients in hospital don’t actually need to be there. BCT wants to put them somewhere else to free up the beds for those who do need them. Obviously there is not a lot we can do about not ageing, I am not suggesting that people stop, more that the NHS has ignored the issues of an ageing and increasing population.

In theory the broad strokes of this plan are great. It looks good on paper, or a fancy graph.

They start by reminding you that nobody likes to go to hospital (true) and very few people like to stay in hospital (true) and most people like to get out of hospital as quickly as possible (true). They tell you that people generally get better, quicker, in their own homes (as long as they have a home and it’s a nice one). Also true. The Better Care Together model is predicated on these ideas.

Any meeting you go to about BCT starts with this information and the fact that the current NHS is no longer fit for purpose and needs to upgrade after 70 years.  And again, this is all true.

It’s hard to deny this and in fact most of the campaigners I know don’t deny it.

What they have issues with. What I have issues with, are how this BCT model will be rolled out.

A few months after I started campaigning, BCT suddenly went out of fashion in favour of the acronym STP. This was a plan by the government to divide the country into 44 areas and demand a restructure of health care provision in each area that would be Sustainable and Transformative and Planned. Hence the acronym. They had cottoned on to the fact that many previous plans by various NHS bodies were transformative, but not ultimately sustainable.  They wanted each of the 44 areas to submit a plan that would show how they would transform the health landscape over the next five years and how that transformation could be sustained into the future so it would not be scrapped, usually before it was finished, so another plan could take its place.

We, the public, were invited to a series of roadshows and engagement events where we were told what the STP plan would look like.  The idea was to take the three hospitals that currently sit across LLR and turn them into two hospitals. The third hospital would be downgraded to a kind of GP based super hub with a few hospital departments tacked on. The part of the hospital grounds no longer needed would be sold off to developers for housing.

Thirteen percent of all beds across the region were to be closed, along with community hospitals, maternity units etc, because care was to be centralised. The patients however, were assured that this was all part of bringing care back to the local community. There was no mention of how, if you lived at one edge of the region, care would be local, if you needed a hospital which was at the other edge of the region and you could no longer go to your community hospital because it would be closed. There was a lot of talk about integrated care on the part of social services, GP practices, district nurses and specialist teams who would mobilise to help patients stay out of hospital.

Our hospitals were to be modernised, and we were shown wonderful graphics of how they would look when tonnes of NHS money poured into the region as an affirmation of what a great job we had made of our STP plan. We were told that we were certain to get the plan approved and the money for funding.

Earlier this year we found out that the STP plan had not been approved. We were also told that the funding that they were so certain of getting had not been given to our region. Then people stopped mentioning the STP altogether and it was as if it had never existed.

We are now back to talking about BCT again.  It is the same plan with new and improved acronyms.  We are now experiencing a new swathe of roadshows and engagement events, where more money has been spent on more graphics to show the fantasy hospitals of the future, and we are told that they just need £367 million to implement this new and improved plan, and they are sure to get it. We are down to being one of the last six or seven areas up to get this big pot of money. It’s in the bag, lads.

Of course, there are changes to the plan. Where once they were going to cut thirteen percent of all hospital beds, they now acknowledge that they can’t. We are being allowed forty more ICU beds and 20 more regular beds across the whole region.  This, we are told is the exact number we need to sustain the population in hospital for the foreseeable future.

If you question this, they get tetchy. They say that we are ‘scare mongering’. We are supposed to trust them. We are supposed to trust the people that spent the last three years saying that there was a clinical case for removal of hundreds of beds across the region and that we were wrong to question it. Now though, they’ve definitely got it right.

We are told that this plan is a great plan, the best. We are assured that there are hundreds of pages of technical documentation sitting behind this plan that show how well thought out it is.  This infers that we are not clever enough to read it or understand it, but they do. They help us thickos by breaking it down for us into primary coloured graphics and sound bites and small films of earnest looking doctors balanced precariously on gurneys, stroking their beards wisely. This is reassuring.

We don’t allude to the failed STP plan. We don’t mention it.

We are not allowed to really question the man yesterday who was there to up sell the three to two hospital idea, and thought it would be good to start by telling us that they had such faith in this plan that they had already tried it in 2000, and if it weren’t for the fact that costs spiralled to £900 million and the plan had to be abandoned, we’d have two hospitals today.

We are not supposed to question the wisdom of the decision to not bid for other government funding that was up for grabs the first time round, that could have improved services, because they were so busy shoring up the disastrous £900 million plan. That’s unfortunate. That’s not bad planning. It’s definitely not evidence of poor planning, because they are really good at planning. Look at this cute infographic to prove it.

We mustn’t ask about the fact that this is actually the third time that they have tried to sell the public and the NHS this idea, and nobody bought it then, so who is going to buy it now? And don’t, for goodness sakes ask why it has taken 18 years and counting to come up with what is essentially the same plan and yet nothing has been done, and nothing is improving.

And we definitely mustn’t ask how much public money has been wasted on beautiful graphics and films of people in hospital beds looking jolly and endless rounds of meetings where we are told we don’t know what’s good for us.

We mustn’t mention that we have a brand new, state of the art £50 million Accident and Emergency department which is actually not able to work to capacity because there are not enough beds behind it. We mustn’t question the wisdom of the decision to build a department that can now take 200,000 patients where it could only previously take 100,000 patients, but in a hospital where the back end of things has stayed the same, there are not enough beds in majors and people (me) have to be sent back out into the brand new A&E waiting room and then treated on a chair because there are not enough beds for the throughput of patients.  We particularly mustn’t mention that it’s much, much harder to shift patients through the system. That would call into question their ability to plan, and look at the lovely plans. They’re so shiny.

We mustn’t mention the fact that the non emergency ambulance transportation contract has been given to a provider constantly on the verge of bankruptcy and patients are persistently unable to use them, and this was after they had to admit that their last contract for non emergency patient transportation had failed but they couldn’t back out of it because their contract negotiation was so bad, they couldn’t afford to leave it. Because look at the plan. Remember, community care is being seamlessly integrated into the hospital system so that patients get ‘Better Care Together’.

We mustn’t mention that the hospital records and the GP records still don’t talk to each other because they are on separate systems and that there is little to no evidence that any integration is happening or will happen.

Or that they cannot say what will happen to social care, because actually that’s not their pot of money to allocate, because social care funding is down to the councils.

Or that the average wait for a GP appointment is now 3 weeks or more and you can rarely get home visits.

Or that district nurses operate on a skeleton crew and are increasingly unable to cope.

Or that we are down by about 600 nurses across University Hospitals Leicester alone,  and we cannot train or recruit fast enough to make up numbers.

Or that we are short of midwives, and people are being encouraged to have home births to take the strain off the hospitals, but it takes two midwives to deliver a home birth. Or that this doesn’t actually fit in with their current plans to shut the midwife led birth unit we currently have in Melton Mowbray, because apparently it’s more dangerous than giving birth in hospital. Or explain how we are going to have a marvellous, state of the art maternity hospital when they are closing down the maternity unit in one hospital completely, despite UHL having one of the busiest maternity units in Europe and delivering 11,000 babies a year.

Or that they said they had to close the intensive care unit at the hospital they want to downgrade three years ago, and they didn’t fulfil their legal obligation to consult on it. They said it was dangerous to patients lives and it was imperative to close it, but they have kept it open for the last three years and now they’re moving it and still not consulting but apparently that’s fine. But questioning that is dangerous and irresponsible. Keeping a department open for three years after saying it was imperative to shut it though, that’s not dangerous and irresponsible at all.

And this is only the beginning of the things you’re not allowed to ask questions about, in a session that was specifically designed for you to ask questions.  And if you do ask questions you are told that they can’t answer them until after they have funding. Or they can’t answer them until this piece of work or that piece of work is done, but you can be sure that they are listening.

And you must absolutely trust the people who sent out the reminder email on the day of the meeting saying that it was on Wednesday 19th of November and then had to send out a correction to say that it was actually on Monday 19th of November, because they have an incredible grasp of facts that allows them to not explain sixteen hundred pages of detailed documentation that is too complex for your tiny brain to comprehend.

And you must particularly trust them when they send you an email to say that the meeting will take place between 5.00 p.m. and 7.45 p.m. and you will be allowed to ask questions, when they start the meeting by saying that the errors in time and date were down to campaign groups sending out the wrong information (even though you have several emails from their Comms team sitting in your inbox).

You must categorically trust their grasp of complex figures and sums too heady for you to dream of doing, when they try to shut the meeting down at 7.00 p.m. and again at 7.30 p.m. when there are still hands in the air waiting to have their questions answered, and the meeting was scheduled to finish at 7.45 p.m.

They don’t understand why there has been a breakdown of trust between them and the public.

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