Saturday 14 January 2017

Mrs May and the Act of Scapegoating

In the first week in January, over a quarter of patients in Accident and Emergency waited longer than four hours and only one hospital met the target of treating 95% of patients within 4 hours, a leaked report to the BBC showed (1). More than ten hospitals issued mayor alerts that they were under “unprecedented pressures”, while 66 out of 152 trusts raised the alarm over bed shortages in the same period (2)

January has always been one of the busiest months for the NHS, cold weather always aggravates chronic health conditions, such as respiratory and heart conditions, and icy conditions can cause falls and broken bones, and it is flu season. This year has seen one of the busiest Januarys that people can remember, but this wasn’t without warning. The A&E targets were missed throughout all of last winter (3).

Our government has been slow to act though. Theresa May only admitted that the NHS under pressure yesterday afternoon (Friday 13th) (4), previously she’d avoided saying anything. Jeremy Hunt did make a statement to parliament on Monday, January 9th, but it was a very typical Jeremy Hunt statement (5), slow on any actual help. In it he claimed that the 4 hour waiting time target could be reviewed and only apply to “urgent” patients, and that 30% of people attending A&E “do not need to be there”.

Now we have a new policy change from Theresa May to deal with this whole NHS crisis, but this new policy has left me feeling, what?

Theresa May says she’ll force GP Practices to open 8am to 8pm, seven days a week (6). If they do not do so they could lose extra funding that they deeply need. But will this relieve any of the pressures on hospital A&Es?

The reality is this will not provide any extra GP appointments because this isn’t employing anymore GPs, (Already there are over 4,600 empty GP posts, 12% of the workforce (7)), it is just stretching the current number of GP appointments over seven days instead of five. The reality will see less GP appointments during the week, and will there even be a demand for all these weekend appointments? A BMJ survey from November 2015 found only 2.2% of patients would choice to see their GP at the weekend (8). Also, with all these extra bookable appointments to cover GP Practices will not be able to offer as many emergency appointments. If people cannot get an emergency GP appointment where will they go? A&E?

Also, will these weekend GP appointments prevent all these people who need admitting to hospital? How can GPs manage at home people who need hospital admission? How will these GP appointments prevent the chest infections, the pneumonias, the chest pains, the broken bones that all need admitting to hospital? How will these GP appointments provide the extra social care that is needed to allow patients to be safely discharged home?

This crisis is due to a shortage of hospital beds, there are less than half the number of hospital
beds than there was 1978 (9), we have the second lowest number of beds per head of population of European countries (10), and these beds are filling up with patients who cannot be safely discharged. Social services budgets have been cut by 40% since 2010 (11), which has left social care in a dangerously underfunded state. It can just about fund the people it already cares for, there is little to no spare funding for new people, for home care or residential/nursing home care. This lack of funding has created a bottleneck in hospitals. There is a large number of elderly patients who cannot be safely discharged home because they need social care and there is no funding for them. It is also creating another problem, there are elderly people at home who need social care and are not receiving it. Because they are not receiving it their health is deteriorating and soon they will need admitting to hospital, but there are not the beds available.

Helen Stokes-Lampard, chair of the Royal College of GPs Council, has said general practice is "skating on thin ice" (12). The cut in resources in General Practice and the low numbers of GPs means that people with non urgent problems are waiting four weeks or longer for a GP appointment. In this time a non urgent problem can soon become an urgent problem, a problem that could easily no longer be treatable in a GP surgery. The government’s plan will only add to this problem.

This crisis is down to funding, or the lack of funding of the NHS. Simon Stevens, chief executive of NHS England, described it as, “In the here and now, there are very real pressures. Over the next three years funding is going to be highly constrained and in real-terms NHS spending per person in England is going to go down, 10 years after Lehman Brothers and austerity began.” (13)

88% of acute trusts are forecasting a deficit at the end of this financial year (14). Demand on NHS services has increased by 3-4% on last year (14a), much higher than the current inflation rate, which is 1.2% (15), yet the NHS’s funding is only increasing 0.9% a year (16), and this doesn’t take into account the £22 billion of “efficiency” savings the Department of Health is demanding from the NHS by 2021 (17).

This crisis is due to funding and resources cuts and yet the government reacts by almost bullying GP Practices into working seven days a week, without any extra funding. Our NHS is on its knees and this government is still demanding more for less from it. They are not taking responsibility for the mess they have created and they are doing nothing to sort it out. They are offering no leadership in this crisis.

In November last year I was admitted to hospital with pneumonia, this was not because I couldn’t get a GP appointment. My GP had been treating my pneumonia but, because I had caught an antibiotic resident strain, my GP soon reached the end of the treatment options open to him. He had me admitted to hospital because I was too ill to be safely treated at home. How would a Sunday afternoon GP appointment have prevented this?

So where the hell did the government come up with such a useless policy in the fist place? A crowing article in today’s Daily Mail may give the clue, its titled “Open all hours, PM orders GPs: After the Mail exposes half-day surgeries, doctors are told to open from 8am-8pm - or lose cash” (18). Again we see the emergence of that dangerous Government move, policy creation by Daily Main headline. Our politicians are being dictated to by the worst newspaper in the country.

Theresa May has shown that the NHS is a very low priority to her, otherwise why did she leave Hunt in post as Health Minister, and her reaction to this very avoidable crisis only is further proof of this. How will bullying GPs solve the shortage of available NHS beds? Who the hell voted for her?… Oh yes, no one.

Drew Payne

Friday 13 January 2017

Stop Lying Jeremy

“Oh Jeremy, stop lying!”, is the edited version of what I shouted at the television, on Monday evening, as yet again they reported another ridiculous statement from Jeremy Hunt (1).

This time Hunt was hinting that the government could redefine the 4 hour waiting time target in Accident and Emergency. He said that the 4 hour target should only apply to patients with “urgent needs” (1). Again, Hunt was faced with a crisis in the NHS and he responded with weasel words. The NHS is in crisis, it needs strong leadership, it needs help and understanding, it needs resources and funding, all it gets from this Health Minister in an attempt to wriggle out of the crisis. Again Jeremy Hunt fails in his job.

This January hospitals are facing huge demands on their services and Accident and Emergency Departments are breaking under the strains (2). A third of NHS trusts in England had issued alerts that they needed urgent action to cope with demand (3). More than one in ten patients faced long delays, well over four hours, waiting for a hospital bed after being admitted via A&E (4). NHS hospitals are full, no spare beds, patient beds are being placed in day rooms and staff rooms and even treatment rooms, places that were never designed to house patient beds. New patients cannot be admitted until other patients are discharged, the system is blocked.

Two patients died while waiting in a corridor for treatment, at the Worcestershire Royal Hospital (5). Their deaths are currently being investigated by I can’t help but ask, would they have died if they had been sitting on a hospital trolley in an A&E bay?

This whole terrible situation has been called a “humanitarian crisis” by the British Red Cross (6). Mike Adamson, the charity's chief executive, said that the British Red Cross is currently providing support in twenty different A&E Departments (6). Their assessment of the current situation is damning, but what is more damning is that a charity is helping to prop up our A&E departments. What has gone wrong?

Our press is full of claims of mismanagement and over spending, but the truth is this crisis should be firmly laid at the feet on this government.

Jeremy Hunt also said of people attending A&E that “30% of whom do not need to be there” (1). Figures from The Kings Fund show this isn’t true (9). from the Patients’ Survey in 2015, they found that of the 11% of patients who couldn’t get GP appointments when they wanted one, 4% of these people went to A&E. That is 4% of 11%. Not the 30% of all A&E attendees that Hunt was claiming. But the number of patients using A&E because their GP is unavailable could be increasing. Dr Helen Stokes-Lampard, chair of the Royal College of GPs Council, has warned that many patients have to wait four weeks or more for a routine GP appointment, because of the pressures on and short falls in GP Practices (10). In that time a non-urgent problem could easily become an urgent one.

Local Authority budgets have been cut 40% since 2010 (7). This has left social care at
breaking point, it is now very difficult to get new someone home care, and finding a bed in a Care Home is nearly impossible, because there isn’t the funding for it any more. This creates a bottleneck in healthcare, elderly patients cannot be safely discharged because there isn’t the home care available and neither are the Care Home places. But this lack of social care creates another pressure on the NHS, there are elderly people at home who are not getting the social care they need. Because of this lack of social care their health deteriorates and they have to be admitted to hospital. My own local council has seen their social care budget “outrageously” cut (8)

NHS budgets are also suffering too. 64% of trust finance directors and 88% of acute trusts are forecasting a deficit at the end of the financial year (11). This is not due to any mismanagement on behalf of these NHS organisations, this is due to the financial cuts, in real terms, in NHS budgets. Demand on NHS services has increased far higher than the current inflation rate, which is 1.2% (12), yet the NHS’s funding is only increasing 0.9%  a year (13), and this doesn’t take into account the £22 billion of “efficiency” savings the Department of Health is demanding from the NHS by 2021 (14). (The second half of my blog posting Four Corners of the Same Room goes into this in much more detail)

So what has our Government done about the crisis overtaking the NHS? Simply put, not much.

In last year’s Autumn Statement Philip Hammond, the Chancellor, announced no extra funding for the NHS or social care (15). it was not as if he couldn’t see this year’s winter’s crisis, the target for treating 95% of patients attending A&E within 4 hours was missed throughout all of last winter (16), and last winter we knew that the cuts in social care was preventing hospital discharges. Even Andrew Lansley, the Conservative architect of the 2011 reforms of the NHS, warned that the NHS and social care needed more funding (17).

Jeremy Hunt told parliament that the 4 hour A&E target might be revised and claimed 30% of people visiting A&E were not appropriate (1) (In 2014, again in parliament, Hunt admitted he took his children to A&E at a weekend because he couldn’t be bothered to wait for an Out of Hours GP appointment (18)). That’s as far as his leadership has gone.

Theresa May criticised the British Red Cross for calling this a “humanitarian crisis” (19). Neither her of Hunt have offered any political leadership or responded practically to this crisis. We cannot expect any more from Hunt, he has show poor or non-existent leadership in the face of previous NHS problems. Theresa May showed how low a priority the NHS was to her when she became Prime Minister and left Jeremy Hunt as Health Minister. Her priority is Brexit and she seems to have so little interest in the NHS.

Again we are faced by a winter crisis in the NHS, this is not a new crisis, it has been happening for several years now, and still we are here again. Our government could have prevented it, instead they react like they were caught off guard by this very predictable crisis. What are these people being paid for?

Drew Payne

Wednesday 11 January 2017

Goodbye George

Boxing Day morning, at 06.00am I was woken by the radio news, the carefully worded voice of BBC Radio news. I was due in working that morning so the radio kicking into life at that hour was no accident. The first item on the news was that George Michael had died. My mind was still awash with sleep and my first thought was that I was still dreaming, a bad and particularly nasty dream. This was not news anyone had been expecting and with a mental punch it woke me.

I have lived through George Michael’s career and I watched the changes in it and him.

I never liked Wham. My dislike wasn’t anything nasty or even based on their musical output. They were very much a pop group targeted at a straight audience. To me they were part of a world that I wasn’t. I was a gay teenager in the nineteen-eighties, and the world around me wasn’t a friendly place. Anyway Wham’s music was very upbeat and I was into much darker and more introspective music, music to suit my mood. Though George Michael was very pretty and very easy on the eye.

When George Michael started on his solo carer I wasn’t surprised but I still wasn’t that interested. His image was still very heterosexual and he was packaged to appeal to his straight women fans. One of the women I did my nurse training with was a huge George Michael fan at this time, she was also the most underhandedly homophobic people I’d met in a long while.

I was aware of George Michael in the following years, his battles with his record label and the videos he wouldn’t appear in, but he didn’t exactly blip on my radar. To me he was still the big haired and straight packaged male singer. Then he released the album Older in 1996.

The single Fastlove snatched at my attention. This was a song obviously written by a gay man, and a song I related too. He sang about watching his friends getting married and having children, watching his friends falling into an alien world. Then there was the heartbreaking single Jesus to a Child, here he was singing to a lost male lover. There was no ambiguity here, his lost love was a man. The songs on this album spoke to me on many different levels, here was a man who’d had so many of the same experiences as me, who was looking at the world the same way as I was, as someone who was not in the centre of it.

When I met Martin, my husband, I found he was a big fan of George Michael, and he had all of George’s albums. I now listened to them with different ears. George Michael slipped in so many different and subtle lines into his songs. The record company may have been sculpted his image into that of the straight singer but inside there a gay man struggling to come out.

Then he was caught in that public toilet in LA, and EVERYONE knew. With a smile and a shrug he laughed it off and then released Outside, a very upbeat song celebrating outdoor sex. I loved him for this, a shrug of the shoulders and a smile but no grovelling apology. He made a joke of it all.

George Michael has written some of the best pop songs we have had but he is more than that, his ballads and soulful songs are maybe some of the best songs written. My Mother Had A Brother tells such a lost story about such a lost person, the gay uncle he never knew.

His death has been such a shock and such a frustrating loss, he was due to start recording a new album in February. Those songs are now lost to us.

I will continue to listen to his wonderful albums and lose myself in his songs. As for those Wham songs, those bubble gum pop songs, well the subtle subtext of them is now fascinating.

Drew Payne