Health: Let’s avoid rushing into irreversible solutions brought about by panic

Hartweel Care Home, in Ecclesfield, which is due to close
Hartweel Care Home, in Ecclesfield, which is due to close
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Being left alone, maybe stripped and gowned, on a trolley or in a cold secluded waiting area is among the most dismal hospital experiences.

As you ponder the next stage of treatment, staff and others scurry past, busy with other patients, other issues. You are in transition, handed over by one team to another whose members you often have not yet met, so you don’t know how to ask what is happening.

Classed as unstable at best, our healthcare system lies in a political corridor, partially curtained off by the man in charge

It’s just as bad in the community when, after referral by one team or agency to another, you wait for someone to contact you.

Making enquiries is fraught with potential problems. Your referral may be in a pending pile or a bursting email inbox, misfiled or even not sent.

Participants in a recent Shaping Sheffield discussion felt that these divided responsibilities were rarely anything to do with patient needs but with how services are commissioned and organised – particularly adult social care.

Service users and third sector providers all wanted systems which ensure continuity and responsiveness, which are easily understood both by staff and by patients, and which treat patients as people not as sets of symptoms or needs.

Yet the logic of the Coalition government’s so-called NHS reforms of 2012 went in completely the opposite direction.

The competitive market process often produced a plethora of providers, many in the for-profit sector, with no obligation to communicate with each other and whose bottom line is financial.

The dismal local consequences for social care were documented in a report presented to the council’s Healthier Communities Scrutiny Committee earlier this month.

In 2015-16 Sheffield’s social care service users reported some of the worst outcomes in Yorkshire and in England for quality of life, delaying and reducing need, ensuring a positive experience and keeping people safe.

The relatively new director of adult social care, Phil Holmes, made no bones about the causes – not just the budget (other authorities did better despite severe cuts), not staff who were dedicated and hardworking, but a bureaucratic system combined with a commissioning approach based on ‘let the market decide’.

Panicked by the cuts, the council had centralised services for efficiency reasons, and commissioners had gone for ‘cheap is best’, leading to tenders which underestimated costs and ended up with Sheffield paying some of the lowest rates for care in the country.

Management was remote, staff became deskilled, care assessments were unrealistic and providers were faced with severe staff shortages because of the poor pay and conditions. Care homes are closing. It’s a tribute to those who kept on working that the outcomes have not been much worse.

Mr Holmes told councillors that a new approach is showing more positive results in some services; there are plans for collaborative commissioning with more emphasis on quality, increased rates for providers and the relocalisation of staff into integrated neighbourhood services.

As he admitted, this was partly a return to previous practice. The jury will be out for some time on the success of these measures, but how many vulnerable people have suffered from this unthinking adoption of free market principles?

Meanwhile the NHS itself is also on a trolley wait. Classed as unstable at best, critical at worst, our healthcare system lies in a political corridor, partially curtained off by the man in charge, Jeremy Hunt. People rush to and fro, muttering Brexit or, more hopefully, social care.

The only people to stop are quacks like management consultants or accountants. Other recesses, reaching beyond view, house education, the criminal justice system, house building and other services, all competing for time and resources.

Lying on its trolley the NHS contemplates what it has been told is the only available cure - a process called Sustainability and Transformation Planning.

Our local STP claims that by 2020 we should have better local services, higher quality specialist services more available across the region, and a lower need for hospital admission because preventative and community services will be better.

Few will quarrel with these aims but before signing consent for an operation patients are warned of the risks. STPs disguise the risks partly because nobody is clear how radical the surgery needs to be. In the edition of March 16, in this column, David Wood called for an end to the blame game and an adult debate on what sort of healthcare system we want.

Yes, fine: it’s important not to have kneejerk reactions to challenging proposals for instance on the extent to which urgent care should be centralised.

But when the terms are being dictated by a Conservative government unsympathetic and in some quarters hostile to healthcare as a public service, the gap is not just one of funding but of trust. Let’s not rush into panic solutions which may not be reversible.

n On April 1 there is a regional march for the NHS - assemble at 11.30am outside Leeds Art Gallery. Then on May 4 at 7pm there is a Festival of Debate and Sheffield Save Our NHS discussion on the future role of hospitals. Log on to www.sheffieldsaveournhs.co.uk for details. Visit www.smybndccgs.nhs.uk/what-we-do/stp/staff-and- public-conversations to comment on the STP before tomorrow (Friday).