Well after the sort of admission from Cllr. Woodward yesterday I thought that it might be worth seeing what the Portsmouth Hospitals NHS Trust had to say.
I sent this letter to them way back in January 2015:
"After the article on Radio 4 yesterday (06/01/2015) and the Daily Mail article and in light of the public examination into the proposed Welborne development may I ask the following question?
Are you quite certain that the hospital and ambulance services in this area can cope with the amount of expansion proposed in South East Hampshire? We were assured at the public examination that your services were consulted and that you appeared to have no comment to make, however in the documentation I see that you have been contacted but there seemed to be no response. With a further 6000 dwellings in Welborne plus the major expansion in Horndean, Waterlooville, Havant and subsequent in-filling are you still confident that our Health Service will be able to cope or should we all be more concerned that the service is getting, or has even got to breaking point? A reply at your earliest convenience would be very greatly appreciated so that, if it is necessary, they can be passed to the public examiner."
And their reply
So I went back on 17th January with:
"Dear Ms Rushton,
I enclose a copy of a letter sent to Ms Ursula Ward of the Portsmouth NHS Trust and a copy of her reply. As she has very neatly sidestepped the question may I now raise it with you?
In light of the latest crises that seem to be happening in most parts of the country over accident and emergency provision, are you of the opinion that our local health service can cope with the intended increase in numbers in the local population that will be caused by the 6000 dwelling expansion in Welborne, along with the developments that are taking part in Waterlooville, Horndean, Havant and all other areas that form a part of your remit?
I realise that the above is a somewhat generalised question and can only be answered in a very non-committal way. A more specific question is what sort of consultation took place between yourselves and Fareham Borough Council over the Welborne development? Have you raised any concerns over the population increase or are you completely satisfied that you will be able to cope with the increased demand that this will create, not so much in the local provision, G.P.s and the like, but in A & E, maternity, geriatric provision and other similar departments that are not really covered by the general practitioners?
I apologise for the lateness of this letter but as the next meeting is organised for the 21st January a swift response that could possibly be used at this meeting would be very gratefully appreciated. My e-mail address is firstname.lastname@example.org if it is possible to reply by this means of communication then this should save postage time. Many thanks."
With this response I am afraid that I gave up.
So I have started the ball rolling again with this e-mail sent today:
"I wrote to Ursula Ward back in January 2015 with regard to healthcare provision in South East Hampshire, original letter and reply attached to this e-mail.
Last week it became apparent that the residents of Fareham have been misled over the provision of primary health care when the new 6,000 house Welborne development gets underway. Because of this and the recent stories about Queen Alexandra Hospital having major problems with its OPEL rating, the number of days that it has been on black alert over the last twelve months and the loss of £7M of funding partly due to local authorities failing to meet their responsibilities in setting and implementing care plans. I was wondering whether you would care to update your views on secondary and tertiary health care in the region?
With regard to the comment about the South East CCG, in Fareham and Welborne we come under the Fareham and Gosport and West Hampshire CCGs.
A reply would be very gratefully received so that I can disseminate the information to other members of the Inform Fareham Focus Group and hopefully to the rest of Fareham and Wickham residents."
Let's see what happens.
Queen Alexandra Hospital is under extreme stress, can't cope, doesn't have the facilities or manpower and is responsible for a rapidly expanding catchment so instead of trying to resolve the problem they get penalised. Michael said after his meetings with the Fareham and Gosport CCG that STF was simply a cost-cutting exercise and here is the proof.
Quote from an article in The News
"SEVERE bed-blocking has led to Queen Alexandra Hospital missing out on more than £7m of extra funding.
Portsmouth Hospitals NHS Trust – which runs the Cosham hospital – has revealed that it missed out on £7.6m worth of Sustainability and Transformation funding (STF) from the government in the last financial year due to ‘adverse financial and operational performance against trajectories’."
Surely a large part of the problem lies with our local councils not managing to implement care plans and the like - after all it is their responsiblity to ensure that those patients blocking beds are housed and cared for properly, Q.A. is just covering for them and being penalised in return. Perhaps our low level of council tax is starting to hurt in unexpected ways.
An excellent article on just what sort of damage is being done to our NHS, written by a GP in Portsmouth ⇧Top⇧
Link to 38 Degrees petition page.
Jeremy Hunt hired Simon Stevens to take over NHS England in 2014. Before that he was President of global operations for United Health of America where he was a lobbyist for the Transatlantic Trade and Investment Partnership in charge of our NHS! He is driving through a change which will eradicate our NHS and replace it with a US style health service. These new organisations could even be run by US corporations, holding the budgets and deciding what care will be provide and who can get it. This is what the Sustainability and Transformation Plans are doing to our NHS.
See this item in BMJ Opinion
The Masonic Hall Gosport
May 2nd 2017.
These forums are really about the tremendous work a vast army of volunteers do in the health sector. Often under-resourced and under-financed. As was stated at the forum, without these volunteers much of the health sector could collapse. These volunteers get involved in a wide ranging matter of health issues. Their value should not be underestimated.
However, sometimes on the agenda are matters that interest us – such as Clinical Commissioning Groups (CCGs). Some may be aware that several local CCGs want to go into partnership. Among those interested is the Fareham & Gosport CCG. Not joining this partnership is the West Hants CCG. Why is this significant? Welborne, when it is built, will come under the West Hants CCG. Clearly this throws up an interesting conundrum. In the early phasing of Welborne, as far as we can ascertain, there will be no health services. This means that residents will have to seek health services beyond the boundaries of Welborne: Fareham Health Centre and the Highlands Road Surgery come to mind. These come under the F&G CCG (services bought by them but not run by them). This would place an additional financial burden on the F&G CCG. They are already overstretched. Being Welborne is not in their area why would they be happy with that? Would the West Hants CCG be happy to pass some of their budget to the F&G CCG? The West Hants CCG has a big area to cover too - so probably not.
What does come under the West Hants CCG is Wickham Surgery. If the new residents at Welborne tried to sign on there the surgery could soon become overwhelmed. Just a thought!!
Fareham & Gosport, North East Hampshire and Farnham, North Hampshire and South Eastern Hampshire CCGs have clubbed together. Is it of concern that the CCG closest to us and responsible for Welborne is missing?
Quote from an article in The News
"The four CCGs commision health services for 850,000 people with a budget of £1.1bn"
I am sure that there are completely sensible reasons for an accident victim to be flown to Southampton General when an accident takes place just a couple of miles from the front doors of Queen Alexandra's.
Surely for a primary hospital located so close to the most accident prone stretch of motorway (at the end of the crawler lane) and with such a large catchment area to be unable to cope with an incident like this needs some fairly good explanations from the powers that be?
Link to The News article
Residents keep saying this and our Council's response to the problem is to just carry on building 12,000 houses in Fareham and to say that health care is not their problem, it's up to the relevant CCGs to provide the necessary services.
"The NHS defines OPEL 4 as: ‘Pressure in the local health and social care system continues to escalate leaving organisations unable to deliver comprehensive care. ‘There is increased potential for patient care and safety to be compromised.’It is the worst rating out of the four OPEL grades".
Link to The News article
AN ONLINE service offering people medical advice has saved GPs hundreds of appointments in a week. All 10 GP practices in Fareham are now involved in the eConsult scheme, which has been rolled out across the county.
Link to The News article
Received through the post today, nice glossy flyer printed on good quality (probably 100gsm) paper. When making an appointment at the hospital you are asked which one you want to attend. I needed to make an appointment for a CT scan and was told when trying to make it that there was a waiting list at QA, unfortunately they couldn't tell me how long it was, so I landed up making the only sensible choice possible and went to Southampton, so even though WE can make a choice it's a shame that there is no real choice available. Will it get any better when the additional 120,000 houses are added to their catchment area.
To my mind they would have done better to invest in services within the Health Servicerather than paying it to a private company.
It's taken a lttle while to get this all sorted out but the minutes of the meeting that Michael reported on back in February are now available here.
As this is an invitation only event we shall try and arrange for a representative to be at the next one on the 2nd May in Gosport.
Hopefully a video will eventually be made available but as I know only too well, that involves an awful lot of work.
It's amazing how long it takes QA to actually implement a seemingly simple idea that was first mentioned back in November 2015. At the CCG presentation to FBC the representative from the QA had this wonderfully cunning plan to reduce bed-blocking at virtually no cost. The Baldrick effect certainly works well in our NHS.
Even if this simple solution would save just 10% of the current cost of bed blocking it would give QA another £2.16M a year. The really frustrating thing though is surely that these patients aren't even the responsibiliy of QA but of the local councils involved.
The video of the presentation to FBC is here
Article from The News
"The former military unit, on Haslar Road, saw thousands of people join together to keep it.
But despite their efforts, it was closed in 2009 and planning approval has been given for a £100m project for retirement flats built alongside a care home. The plan is just one of many developments which are taking place at the site. Once finished, it will have bars, restaurants, a doctors’ practice, retirement flats, care homes, stores and a church."
Once again it shows just how immune to local pressure our government is and now we are paying the price for the loss of so many establishments. Article from The News
And now we know how much the external consultants are making from the Sustainability and Transformation Plans (STPs).
Funnily enough this is nationally less than the increase in the business rates increase for Southampton General alone. Tax and tax again for paying outside consultancy firms that ex-MPs can find very lucrative employment at.
One question that needs answering is that the consultancy involved with our CCG is called Vanguard. This is the same consultancy that is advising FBC on how to improve it's profitability. As FBC would love to get their hands on some of the NHS real estate is there any chance of a conflict of interest or do they have a 'chinese wall' in place to prevent any collusion?
Article from The News
As part of a shake-up designed to fill an estimated national £22bn NHS financial black hole by April 2021, senior figures in Hampshire plan to axe £24m from their estates budget.
It comes as new figures reveal £194m is needed to carry out the sweeping changes to the healthcare system in the county, while only £119m has been earmarked – but not yet awarded – by the government.
Article from The News The Great NHS Gamble: Fears over secret list of buildings which could be sold off as part of healthcare shake-up
Article from The News Hampshire’s hospital services ‘under review’ in bid to make them ‘sustainable’
Before the meeting of the Voluntary Sector Health Forum took place I enquired as to whether we could video it for the record. I was informed that the meeting would be videoed and that the organiser felt that there could be difficulties about us getting permission to record it as well.
Quote from e-mail received from Community Action Fareham
"With regard to your initial enquiry about video, we will be making a video of the meeting but would not want anyone else doing that without us first discussing it with the forum members and getting strong majority agreement first."
To date I haven't been able to find the video or any minutes of the meeting and I just wondered whether the lack of the video or minutes could be tied up with this article from The News.
I received this pdf file a few weeks ago but unfortunately it was during a very busy period and I mislaid it in my in-box. It does attempt to explain what Better. Local. Care. is supposed to mean. It seemed fairly straight forward when it was originally written in May last year, but with the massive budget cuts it doessn't seem quite so straightforward any more.
South Hampshire Multi-speciality Community Provider (MCP) or VANGUARD described as Better. Local. Care.
Fareham Community Church
Tuesday February 7th 2017.
The meeting kicked off with a presentation by a Gosport & Fareham Care Commissioning Group representative outlining the CCGs STP – the five year plan to get to grips with a huge deficit and to plan for the future. Nothing I heard today varied much from the CCG meeting I reported on just a little while ago. Frankly, one always gets the impression that these problems are almost intractable and insurmountable and even when these organisations do begin to get any sort of grip on the situation the government comes along and imposes yet more savage cuts and difficulties. He claimed that there were more than enough acute care beds (at QA). This brought murmurs of disbelief. However, from my experience it was probably a statement of fact. In this context he also spoke about the integration of services to provide a better joined-up overall care. For example, I guess, getting community care better organised to stop bed-blocking. I was reminded whilst listening to him that this was a problem even when I was working in the NHS forty years ago. I was wondering how they might be more successful now than they were then, when money and resources were less of an issue. I’m still wondering. It is worth noting that when Knowle Hospital, Fareham, was open it provided 100s of elderly/continuing care beds which were lost when it closed. Multiply this throughout the county and it is not too difficult to see how much of the problem arose in the first place. He also spoke about the ‘digital transformation’ – getting everyone’s health records online so that all health- practitioners can access them. This costly exercise has been going on for years to my knowledge and is still a long way off. I guess in this respect the minds of many listeners may have been thinking about data protection – or the lack of!
This theme was continued by the next speaker who talked about the MSP (Multiple Speciality Provider). This too was really about moving towards joined-up thinking. She talked about support services that would be needed to help prevent people turning up at A&E departments. She also mentioned the £3.5billion ‘Better Care’ fund which the government hoped would keep more people in the community. Although this is working in some respects it hasn’t led to a reduction in hospital workloads. GP surgeries and appointments were spoken about and how much (or little) time GPs can give to their patients. In this context she spoke about having a GP ‘Same Day Access Hub’ at Coldeast (the so-called Community Hospital) to cater for those who needed emergency appointments. Leaving aside any obvious concerns and questions she did at least admit that the community hospital was not always easily accessible stuck out at Park Gate. Amen to that statement.
After lunch there was a very interesting representation about the NHS 111 service. The contract for this service is up for renewal soon: It is currently being operated by SCAS (the South Coast Ambulance Service). A recent survey done by the CCG showed that people were generally happy with the 111 service. It must be said, though, that the number of people questioned was just 350 and the lady acknowledged that this was a very small sample: One of the questions asked was ‘would people be happy for their medical records to be accessed by the 111 service?’ Of those asked 71% said yes, 15% said no and 9% were undecided - yes, somebody did ask what happened to the missing 5% but I cannot recall the answer. This was a little bit of a shock to me. Once again though, I suspect that many people would have concerns about data protection and patient confidentiality, a point acknowledged. One matter of this presentation me sit up and take notice - the idea that doctors appointments could be made through the NHS 111 service and indeed the idea of having just one number for all NHS services. Wow!!
There were also interesting and informative talks on diabetes and COPD.
This is only a potted view of the meeting which went on for over two hours and indeed over ran. It was a very ambitious agenda and some of it got lost out of time. That is not a criticism in any way and I’m sure those involved will take that onboard for the future. It was a very interesting Forum organised by Community Action Fareham who also provided a light lunch and tea and coffee: So many thanks to Paul O’Beirne and Laura George and many others who must have worked very hard to get it all together.
Report by Michael Stephenson
If you read the article it makes you wonder just how many more levels of profit taking there are in our publically funded National Health Service - The building is owned and managed by LiftCo, a private company (how much do they charge to change a light bulb?) - The Community Health Partnerships – a Department of Health body - who work with Solent Community Solutions (SCS) another private company, pay rent to them and then the services are paid for by the Fareham & Gosport Clinical Commisioning Group. I wonder how much would be saved if the building were actually owned by the CCG and all of the intermediate profits were saved?
Considering the fact that our CCG is already £10M in debt (see the article immediately below this one), how much of this £1.3M will be siphoned off to help clear the deficit, possibly like Southampton General having their rates hiked by 30% or £610,000. As an NHS hospital they pay FULL business rates, had they been a private company they would have received an 80% reduction, See the article lower down
Link to the The News article
Link to the The News article
Governing Body Meeting
January 18th 2017 – Ferneham Hall
This is the first time I have ever attended a public meeting of the CCG and I have to say it is not something I would like to do frequently. It went on for approximately four hours and was full of jargon and often unfathomable abbreviations – even with my NHS background. The governing body is well populated – at least 20 members representing different bodies and interests. Just for the record FBC was represented by Cllr Bayford - so there is no excuse for FBC to not knowing what is going on! Most of the ‘public’ attending – less than 20 – seemed to have an interest professionally or through voluntary services. The number of merely interested spectators you could count on one hand.
The meeting started with a member of the governing body outlining something called an STP – a Sustainability Transformation Plan. The object of the STP is to try to bring under control a CCG deficit of a projected £10million over the coming year or so. This will eventually have to be paid back so the implications of that are obvious – Cuts and big changes are in the pipeline under the five year STP. Even the CCG admit that this plan is extremely ambitious with no guarantees of success. After what I sat through you can say that again. To be fair to the CCG, I think they are faced with an impossible task. It would seem that the CCG largely hope to achieve this by redefining roles and by making better use of resources. The representative (Richard Samuel) went on to explain that there is a shortfall of human resources in many disciplines – not the least in GPs. Other specialities suffer too – like specialist nurses etc. These comments also encompassed a lack of training in many sectors of the NHS. GPs are leaving in quite large numbers and many are going overseas. I did discuss this with a GP. Not wishing to be too controversial he virtually acknowledged that many good UK doctors are being lost overseas and may be replaced by less than adequate doctors coming the other way: Hmm. Richard Samuels admitted that needs are not being met. He went on to say that it was the wish of the CCG to engage local people in the process. I think he probably had professionals and voluntary workers in mind rather that the general public. He spoke about aspects of services going online whilst acknowledging that this would not suit everyone. He expressed the concern that people are not being cared for appropriately. Children with mental health issues were specifically mentioned when they are moved around the country because of the lack of places in their locality. I guess this is one of the downsides to centralising some aspects of care in certain hospitals or areas. This bought an interjection from a CCG member who expressed her concerns about patients/clients, call them what you will, being moved up and down the M27 with its associated problems concerning congestion etc. Concerns in acute services remain unresolved. There is an acute lack of mental health care beds. I asked about this and it was talked about with reference to the governments promise to put more money into health care. There was much scepticism about this and to be honest things do not look good in this respect. Welborne was brought up by a member of the public. Welborne will come under the West Hants CCG - whose headquarters are currently in Eastleigh. Nevertheless, it was acknowledged by the Fareham & Gosport CCG that Welborne WILL have an impact on acute services –
One member of the CCG expressed concerns that government policies are actually making people ill: I assumed by that she was talking about cutbacks in welfare payments – such as to the disabled etc, and withdrawing support where it is desperately needed putting added pressure on those already at risk. It was also expressed that Housing Associations are not helping by cutting back on help for what they deem to be undesirable tenants – at least I think that was being implied.
Southern Health Foundation Trust also cropped up. An outside consultancy has been employed to undertake a review of their services. So still problems there. There are problems at Elmleigh Mental Health Care Unit at Havant. This is run by Southern Health so no further comment required methinks.
QA was talked about. Whilst A&E has improved it was still at risk. There was also a report about SCAS – the South Coast Ambulance Service. The lady delivering this report tried to put on a brave show but this brought scepticism from one CCG member. I don’t think it helped when she made comments like ‘ambulances queuing outside A&E could be just waiting for their next job’. She didn’t mention lack of ambulance staff and the need to employ private ambulances - nice try lady!! Bed-blocking was mentioned. It was acknowledged that care beds in the community are just not there. This was a social services issue (Nobody was there to speak up for them) but again this was laid fairly at the door of cutbacks.
The 111 Service. The feed back from this service was very, very small and this seemed to cause concern.
This has really been a very brief summary of what was a lengthy meeting. Overall, I don’t think it is unfair to say that the picture painted was, in many respects, quite dire. Any hopes some may hold that the clinic at Park Gate – often referred to as the Fareham Community Hospital – will expand are fooling themselves, it will remain just that, a glorified clinic. There is NO money: By saying that I imply absolutely no criticism of the people who work there currently. I think generally, government claims that more money is being ploughed into the NHS was largely discredited insofar as the figures they often give are far from the truth. A figure of .3 million pounds was quoted as being invested (somewhere) by the Fareham & Gosport CCG. Sounded good, but as one member of the public pointed out this is actually £330,000 set against £500,000 of under-investment in the past in the particular area. At those figures the CCG is not even treading water. There are so many unfunded costs it is difficult to see how any services could function effectively – and they patently don’t. I think it is quite obvious that in many areas of the NHS – locally and elsewhere – the services are kept going by the sheer hard work and goodwill of those that work in them –
How they keep going at the level they do is a minor miracle.
"The national tax hike is expected to have a serious impact on hospitals such as Southampton General. Its annual bill will jump from £1.92 million to £2.53 million, leaving it with £600,000 a year less to spend on patients.
Last night Cllr Dave Shields, Southampton City Council’s Cabinet member for health, said: “It seems bizarre that private hospitals are exempt from business rates and NHS ones aren’t - it’s an anomaly the government needs to sort out.
“I believe NHS hospitals should be treated in the same way as private ones that have charitable status.”
Personally, I find it bizarre that they pay any rates at all - talk about giving with one hand and taking with the other, it's not in it. Link to The Daily Echo article
Whether it will have any effect waits to be seen. The survey actually seems more about how many of the GP services can be passed onto the now underfunded pharmacists.
Interestingly 25% of the questions relate to ethnicity, religion, sexuality and whether or not you have a disability. Why is it important for them to know your ethnic origin, sexuality, religion or disability - do these have an effect on health provision? If you need to see a medical professional then you need to see a medical professional no matter what your colour, creed or sexual orientation.
The ten GP practices in Fareham, Southern Health NHS Foundation Trust, Fareham and Gosport CCG and the voluntary sector are working together to improve local services. Your views can help us to ensure these services meet your needs.
Fareham and Gosport Clinical Commissioning Group, Southern Health NHS Foundation Trust and the voluntary sector have joined forces to produce a 20-question online survey.
The survey is available here
Link to The News article
"Richard Samuel, who is leading the Hampshire STP, said: ‘The STP is effectively the coming together of all the local plans that have been developed in local places.
It’s about trying to fix the things that can be fixed on a bigger scale.’
"Dr Iain Maclennan, a former GP in Portsmouth, said the plan was a roundabout way of delivering more cuts to health services.
‘Overall, I am not encouraged by it,’ he said.
‘It is the last in a long leg of stages that will lead towards the full privatisation of the NHS. I appreciate that times are changing and we have got to move with the times and the situation we have today with people getting older and sicker is quite different.’"
Quotes from article in The News
Fareham MP Suella Fernandes said: ‘Southern Health has faced huge challenges. There were serious doubts about its governance so I welcome the news that improvements have been made and I hope this will continue.
So that's alright then but no information on what improvements have been made.
Link to The News article
Link to The News article
One heading in the article is
FUTURE OF SUSTAINABLE HEALTHCARE IS IN THE COMMUNITY but the thing that seems to be missing is how they intend to address the problem of another 60,000 plus houses
due to be built in its catchment area.
QA HOSPITAL HAS FACED A SERIES OF CHALLENGES THIS YEAR
Quote from Cllr. Woodward
"As previously reported in The News, leader of Fareham Borough Council Sean Woodward is keen to see the hospital used for more services.
Link to The News article
He said: ‘In Fareham we have seen a lot of hospitals closing.
‘Fareham Community Hospital is probably the most under-used, under-utilised health facility in the south.
‘Half the hospital isn’t used and there is space about the same size of the site right next to it which I want to see used for expansion."
What a shame that QA couldn't keep up the service levels that they achieved on 16-08-2016 for very long and now it looks as if it is actually causing problems on the roads as well.
"The road leading to the emergency department in Cosham has been closed except to allow ambulances through"
This doesn't bode well for the winter
Link to The News article
"...there are also minor injury units available if your injury is not serious.
And of course we have a building that is underused and could well offer another minor injuries unit sitting at the 'Fareham Community
‘This will allow our emergency department staff to concentrate on people with serious, life-threatening conditions and will save a potential long wait.’
Clinic Hospital' but they can't afford to open it.
Quote from the last page of the minutes of the Friends of Fareham Hospital meeting
"Apparently there were originally plans for beds but it was felt that there would be insufficient call for them when the unit was first developed. There is though, a facility for a
minor injuries unit but it would is too expensive for services to use, apart from which there would need to be a few beds for overnight stabilisation. Sara Tiller said that if they can
become the sole lessee then that could be unlocked and the costs could then be charged against Southern Health."
Link to The News article
Having attended the meeting sans recording equipment it was pretty difficult to give an absolute true record of what was said but I have attempted to do my best.
There were a lot of interesting comments made by the two presenters but because of this there was only time for a few questions. One of the prime questions to my mind that was missed was the inaccessiblity of the place with absolutely NO public transport available. So it's fine for those that are capable and have a car but anybody else is going to need a taxi - joined up thinking or what.
My report is available here PDF File 947KB
I have been refused permission to video the presentation by the CCG at the Friends of Fareham Community Hospital meeting on 29th September. Whether this is at the behest of the Friends or
the CCG I am not sure, but it does make one wonder if somebody, somewhere is afraid that their words may go on record - rather like their bed blocking and patient discharge videos
or for some other reason I know not. (see the various videos on the videos page).
Shame really that we will be deprived of the record but ce'st la vie.
Link to the 38 Degrees petition
Here's what our investigation found for Hampshire and the Isle of Wight:
At least there is some good news from QA - triage times have been reduced thereby reducing the waiting times for unloading ambulances.
Link to The News article
Unfortunately to offset this, waiting times for patients for May and June never managed to get above 82% despite the Government set target of 90%. At least the Government have, I believe, stopped fining them for missed targets so the money that they would have taken from the ratepayer funded Trust will now be able to be used to try and improve their performance.