Liecestershire/Rutland patient transport improvements promised

Back in July it was reported that in a recent Care Quality Commission (CQC) report said Arriva Transport Solutions' service which provides hospital patient transport in Leicestershire and Rutland had been failing people. The report said that there were problems with staffing the service, the management of the service and that the service was failing in respect of care and welfare. This lead Leicester deputy mayor Rory Palmer saying that "Too many patients are receiving an extremely poor service from Arriva Transport Solutions." They were given three month to clean up their act or face the threat of fines.

Examples of poor care reported include the case of Olive Burns, who was taken to Leicester Royal Infirmary after a fall, waited in the discharge lounge from 08:30 until 19:30 BST before she was taken to her care home. And this is just one extreme case and their have been others where patients are discharged to the holding lounge to wait for hours and hours. These I have seen with my own eyes when the same thing happened to me. Many of the patient waiting were old, frail and in some cases very confused as to why they weren't being taken home.

Today Arriva Transport Solutions' said it was investing in staff and punctuality was better. this was in response to the claims that patients were "often" arriving late for appointments, and taxi drivers with "poor attitudes" being used when other resources were unavailable. In a recent public meeting the company's managing director, Jonathan May, said he was "disappointed" with the delays but claimed "improvements" were being made. To solve the problem the of vehicles has been increased by 14% and the number of staff by 20%. The company are promising that this will improve the service.

Before the service was handed over to Arriva Transport Solutions' to reduce the cost of patient transport the service patients were transported by East Midlands Ambulance Service. And the mess lead Leicester deputy mayor to say "This is yet another example of big, national companies winning lucrative NHS contracts up and down the country and letting patients down." To me it is an example of private companies providing public services and cutting everything to breaking point to preserve profits. It is the one reason why the NHS should be privatised in part or as a whole. People deserve better.

Hospitial Parking Charges

Given the state of the hospital transport system, especially since it has been put out to private tender as part of the repeated Government plans to slowly privatise the NHS it is good to see something coming down from Central Government to try and reduce the cost of hospital car parking in England. Especially since this has be the subject of a lot of debate and anger for many people visiting sick relatives or having to go to hospitals for treatment.

This especially affect people living in rural area who don't have access to public transport to their nearest hospital and have to depend on the car. If you live in Rutland their are four major hospitals you could end being referred to in one of three cities and one large town. As can be seen from the table below the charges vary greatly, with it costing you an astonishing £4.00 to spend fifteen minutes dropping off a elderly relative and seeing them into the building in Nottingham, which in my opinion is daylight robbery.

	Leicester	Peterborough	Nottingham	Grantham
upto 30 minutes	£1.50	free	£4.00	£1.40
upto 2 hours	£2.50	£2.50	£4.00	£3.40
upto 4 hours	£4.00	£2.50	£5.00	£3.40
upto 6 hours	£6.00	£4.00	£6.00	£4.00
upto 12 hours	£10.00	£6.00	£6.00	£4.00
over 12 hours	£12.00	£6.00	£6.00	£4.00

In 2011 it was reported in the press that hospitals made some £32 million pounds from car parking charges in England, however this figure is misleading as it doesn't include the costs of running the car parks. One hospital, Epsom, released figures that showed from £782,000 it took in car parking charges some £605,000 was paid to an American company called Associated Parking Company of America (although this figure did include purchase of new parking equipment). All the same it show that private companies are profiting from NHS car parking as well as the hospitals themselves. 

The current guidelines issued today state that concessions, including free or reduced charges or caps, should be available for the following groups:

• people with disabilities
• frequent outpatient attenders 
• visitors with relatives who are gravely ill 
• visitors to relatives who have an extended stay in hospital 
• staff working shifts that mean public transport cannot be used 

Before going to recommend hospitals should waive fines if a visitor or patient overstays through no fault of their own, for example because treatment took longer than planned, or when staff have to work beyond their scheduled shift. Health Secretary Jeremy Hunt said: "Patients and families shouldn't have to deal with the added stress of unfair parking charges". However this Government so far has rejected calls to regulate charges or get rid of them completely.

Opponents of hospital car parking charges such as Conservative MP, Robert Halfon , has said that "Hospital parking has become a stealth tax on the vulnerable” and although he saw it as a "Massive step forward" he still wants to see the charges removed completely. While the opposition parties have called to an end to hospital car parking charges altogether, and included it in their last election manifesto, something that has already happened in Scotland and Wales, and according to the press saved people millions of pounds. 

Having had to use the city hospitals in the last few years and living in a rural are I think it is time to rethink parking charges and make them free for patients, visitors and staff. Clearly something will need to be done by the hospitals, which are often in city centre locations, to make sure the car parks are not used by shoppers, but that is possible in the issuing of parking tickets and automated machines to ensure compliance. I'm sure with the use of modern technology this wouldn't be hard to do.

Of course, this require investment and this could come from a number of sources, either from central government or by introducing a change over period where existing car parking charges have to be re-invested in free parking schemes, and I'm sure hospitals could save money by not giving it to profit making companies to run their car parks. One thing is clear, any money mustn't come from the primary care budget which would affect treatment of patients, staffing levels, operations and more expensive treatments such transplants as well as mental health services which have been cut to the bone in the UK.

Overnight

Recently I had to visit the Leicester Royal Infirmary for a minor operation in the day surgery unit. I must admit the care I received there was excellent on the ward and the nursing staff were lovely, but something is wrong with the system and it all comes down to transport.

With the growth of large hospitals and the closure of more local hospitals and services they provide many people are left have to travel in excess of fifteen or twenty miles to the nearest large hospital for treatment, but there transport needs are never really considered. Take a patient who goes by ambulance to Accident and Emergency only to find once they are released and have been seen there is no way to get home. If you call your ambulance you are not likely to remember you need cash or debit card to buy a ticket for a bus or a train. Why would you when you have bigger things to worry about.

It is all right the hospitals saying they need save money for patient care, that goes without saying but people still need to get home. Not sure how much it costs to keep someone in overnight and then provide them with three meals but it has to be more than the cost of providing those that need it some form of transport to get them home. Not doing so make the whole system of day surgery really unworkable for a number of people, and especially so for older patients. 

In my own case, after day surgery I wasn't allowed to go home or allowed to drive for 24 hours. The hospital had no choice but to keep me there for that time and then find transport for me in the end to get me home after refusing to let me even use public transport 24 hours later. It wasn't like I could even drive to the hospital in the first place and stay 24 hours, the cost of car parking is prohibitive and so limited in a city centre hospital that even the staff have trouble driving to work and parking. 

The Government really need to think about there health care policies and think of the consequences of centring all hospital care in large city hospitals and the effects it is having on the population, especially those who don't have access transport or who are on low income. I can image if you are a lone parent, you don't drive and live in Oakham and you have to go to Accident and Emergency in Leicester at ten at night, getting you and the child home could cost you a reasonable part of a weeks ESA payment.

Children's Heart Unit Closures

The NHS's 'Safe and Sustainable' review of the ten children's heart surgery units in England has recommended a reduction in the number of units to create fewer, larger centres. The names of those units earmarked for closure where announced this week.

Hospitals in Leicester, Leeds and the Royal Brompton in London are to stop performing heart surgery on children under the review some time after 2013. It was the reviews finding that claimed that the specialist staff at the existing units were spread to thinly across the NHS in the existing ten units so it plans to streamline them down to seven.

In announcing the decision Sir Neil McKay CB, Chairman of the Joint Committee of Primary Care Trusts is reported as saying: "This is a landmark decision that clinicians and patients have long called for which will enable the NHS to improve care for children with congenital heart disease. The needs of children have been at the heart of this review. Parents, patients and clinicians told us consistently during consultation that quality of care should be the most important factor."

However, there is a lack of confidence in the whole of the review process, which even saw one of the Hospitals legally questioning the review process in the High Court. A number of Patient Groups and Members of Parliament claim that the review has ignored the facts about travel times and the patient level of flows at some of the units. There are also reports that the parents, patients and clinicians feel that their views have been ignored in the process.

The children's heart units that are closing are not happy about the decisions and nor are the parents, patients or the clinicians involved. Here is what they have been saying on the matter:

Giles Peek, a consultant heart surgeon at Glenfield, one of the units earmarked for closure, said: "Leicester has one of the finest heart hospitals in the country. Looking after children with serious conditions, performing complex surgery, nursing them to recovery and managing them into adulthood is an important service which we expect to remain in Leicester. Loss of children's heart services could adversely affect intensive care services across the East Midlands and the national extra corporeal membrane oxygenation service." He then went on to add "If we were to lose our heart service it would have an enormous impact."

Bob Bell, chief executive of the Royal Brompton & Harefield NHS Foundation Trust, said: "It is very difficult to know what to say at times like these. But it is even more difficult to try and understand how this committee could have come to such a decision. Over the past 18 months we have seen respiratory charities like the Cystic Fibrosis Trust and Asthma UK, independent clinicians from around the world, and many anxious parents, highlighting time and time again the damaging effects on specialist respiratory care for children if Royal Brompton's paediatric intensive care unit is closed. 

Mike Collier, Chairman of Leeds Teaching Hospitals NHS Trust, said: "This result flies in the face of logical health care planning and plain common sense. We genuinely believe that the decision will not deliver the stated aims of the Safe and Sustainable Paediatric Cardiac Services review. This decision seems almost perverse in light of the information which became available during the course of the consultation process. We are surprised that the very clear wishes of over 600,000 people from this region appear to have been disregarded."

It would appear that doing a quick search on the News sites about this review is that in many regions it is seen as a backward step and will remove patient choice and mean that families with very sick children have to travel further for the care they need. It is also felt that children's live could be at risk. A 

Locally there are plans for massive investment into children's heart services with University Hospitals of Leicester NHS Trust spending £1.7 million on expanding children's heart services over the next three years. Staff are being recruited and wards expanded and the number of operations are expected to increase from about 320 to over 400 a year. The cut off point the review team have used as the benchmark for if a unit should stay open. A petition to started to save the units to save the unit attracted more than 100,000 signatures so far.

In my view the problem with reviews like this is that they have no compassion or empathy for the people affected by the changes they propose. It is just to mathematical and clinical and shows a lack of understanding about peoples needs. 

If it wasn't for the unit in Leeds my daughters cousin probably wouldn't be alive today. She was born with a heart condition and if hadn't have been for the surgeons at the unit in Leeds her chances of survival would have been significantly less. She just happened to be born in the right place and got the right care, other babies are not so lucky. 

Making this type of care less accessible is in my view a crime and I just hope someone wakes up and realises that before these three units are closed. Please support the Leicester Unit by signing their online e-petition.

Mental Health The Forgotten Service

Just as shocking was the report I read today that the NHS is failing mental health patients so badly. Having known a number of people with mental health problems personally and worked with others and I these stories shocking.

For to many years the NHS has had a policy of treating mental health patients like cattle. Patching them up with various drugs that just offer respite to the patient while causing weight gain and other medical problems to develop over time. 

The system is not investing in people but effectively investing in drug companies who provide the drugs. The drugs should be a short term measure and what these people deserve is long term solutions that require the minimal use of medication. They never seem to look deep enough into the problems that caused the mental health issues to arise in the first place or look at ways of helping the patients over come them.

What is it not helpful that a few staff members are cynical about the patients conditions.  One comment I heard on the Radio talked about the attitude of some mental health workers to people with personality disorders, who they consider them as time wasters, is unacceptable. This is a condition that effects peoples everyday lives and those around them and it can't be dismissed out of hand. The fact that health trusts are not providing enough cognitive behavioral therapy for this condition and many others is just disgusting. It is a very serious condition that affects the individuals and impacts on their families severely.

Metal heallth care is not some kind of secondary health care, it is a primary service they provide as important as any other. It deserves proper funding by the NHS trusts and the government. What the health system needs to think about is the benefits that can be drawn from using other forms of treatments other than drugs. The more mental health workers talk to people with mental health conditions the better will be their understanding and from that will come better methods and quicker cures to mental health problems.

There are specialist units around the UK that do some of amazing work but in the current funding climate it not clear if they we will carry on the good work they are doing. 

Dedicated staff are working in a climate of under funding and increasing work loads. Currently the system is poorly resourced and staff must fear for their own positions as money is directed out of mental health services into other parts of the NHS. It is time that the government ring fenced some of the funding to the NHS to mental health services. This should then backed up by careful monitoring to ensure that the money is being spent where it is meant to be sent and not used to fund other health care.

People with mental health issues deserve the best treatment there is, provided by the NHS, in order for them to have fulfilling lives without being made to feel worthless and unimportant. The need of menta'l health patients matter as much as anyone elses, they can't be marginalized like this. 

Government's NHS Coverup

For a party that claims believes in transparency they did a good job of covering up a report about the NHS today, despite having order by the Information Tribunal to publish the report. The report in question is the NHS Risk Register which lists the possible risks to services and medical care from any changes to the NHS, and it was written as  Health Secretary Andrew Lansley's made his plans to radically reform the Health Service.

Some of the risks, contained in the leaked draft version of the Risk Register, were the risks of rising costs of GP care, poorer response to health emergencies and the high chance that managers might lose financial control of the NHS. For this reason it was felt by many that this document should be released so that the public has an idea of the risk the Government are taking in restructuring the NHS with such radical reforms.

The Health Secretary Andrew Lansley said publication was blocked because governments needed a "safe space" to develop policy and he beleieved that the document would be open to "misinterpretation and misuse", however opponents of the move are accusing the Government of a cover up. Claiming they are hiding the risks of the NHS reforms from the general public.

The Information Tribunal, who oversee and adjudicate on freedom of information requests, believe that the public have a right to such information because of the "exceptional" nature of the NHS overhaul. If found that "there is a very strong public interest in transparency and accountability in relation to the risks involved in introducing the NHS reforms,", before going on to argue that it is in public interest to understand and debate the risks involved. The tribunal said it would provided the public "with a far better understanding of the risks to a national institution which millions depended on".

Head of the Royal College of Nursing, Dr Peter Carter, commented that the refusal to publish the risk assessment was "astonishing" and that "Despite overwhelming opposition, the government is undertaking the most radical restructure of the NHS at the same time as the service faces severe financial challenges." and he went on to say that "the public are only being presented with a partial picture of the NHS reforms". While the Labour former spokesman, John Healey called the government's latest move a "desperate act", before adding "This decision will only fuel doubts and distrust about the government's NHS plans, as people rightly ask: 'What are they hiding from us?'"

The Health Secretary Andrew Lansley continues to claim that the government and his department believe in transparency and that he feels that publishing the report could harm the quality of future advice from civil servants, while the oppersition are claiming that the real reason it publication is being blocked is that the public would never forgive them if they could see the scale of risk they are taking with the NHS. Given the massive opposition from the health care professionals across the board, it would seem that the real reason is more likely to be that the risk register backs up their fears about what the reforms will do to the NHS.

My view is the same as Andy Burnham, the Shadow health secretary, who believes it is a  major step backwards in government transparency and is a step towards  to secrecy and closed government, something Conservative governments and councils are rather good at historically, despite all their fine talk. It is clear that it is in the public interest that the risk register should be published, so the public know what could go wrong with the reforms that are now taking place. Not only it will create a healthy public debate but it will allow health professionals, mangers and processional bodies to know the risks of the reforms and flag up problems early so that action can be taken. 

The fact is, in time like these, we need government that the people can trust, that are open and transparent. Moves like this as well as other recent decisions by the government have made make them look every bit as secretive as past Conservative governments who have pursued have a secret agenda laid out by those have the ear of the Minsters and Prime Minster in private. The government are the servants of the people and they would do well to remember that.

NHS Direct

Whenever you are at the Doctors or a Hospital there are posters up urging you to call NHS Direct if you have any kinds of concerns about you health or your families health before you turn to the Doctor or the emergency services. The aim is to lighten the load of the front line medical services by giving people the information to self treat themselves when the use of the front line services is not needed.

Now here comes the problem, in order to do that NHS Direct has to have the manpower to do their job effectively, and in these times of cuts, this service seems to be crumbling under the pressure. If there aren't enough people able to give advice then what is the point of the system. Now it could be that the service has just been too successful and people are over using the service, or it just be it is under funded. Either way there are not enough staff to meet the demand. People with less urgent cases are being told there is a six hour wait to be called back by a nurse only to find they call back some fifteen hours later. By this time they have given up and take themselves off to a local doctors out of hours service or in the worse cases take themselves to accident and emergency. This clearly defeats the purpose of having NHS Direct, by putting the strain back on to front line services. 

Clearly what is need is more funding being put into this service to make the service work. In this economic climate that  funding is highly unlikely to appear, although it would create jobs and hence a degree of growth in the economy, while providing a service that people use that is needed. My concern is if the service is this bad now what is going to happen to it when the planned Government changes come into place. Being a central service who and how is it going to be funded in future. My fear is that a service we all use, and need from time to time, will find it's funding cut year after year. I have already noticed the systems that NHS Direct have developed are already being employed in regional out of hours services, provided by private companies. The people in future holding the funding won't be looking a the national picture just at the can provide in their own area's.

I guess with the Government not listening to the health professionals and being set to do what they want do, however unpopular, we will see this service getting worse and worse until it disappears altogether. Personally I think that would be one of the biggest steps backwards and could cost lives