The draft Northumberland, Tyne, Wear and North Durham Sustainability and Transformation Plan has had an inauspicious start to life
John Whalley, KONPNE Co-ordinator and retired mental health nurse
Openness, transparency, partnerships, collaborative working, joint decision-making, engagement and consultation??? Sound familiar??? Fantastic ideas, but in addition to doing the talk, there is then a need to actually walk the walk.
The draft Northumberland, Tyne, Wear and North Durham Sustainability and Transformation Plan had an inauspicious start to life in November 2016. Cloaked in secrecy from the very start, this top-down decree from NHS England via the local CCG had local North East councillors scratching their heads. The claim was that it came from both health and local authority – when Councillors hadn’t even seen it. Inspires a lot of confidence in our local CCG (not).
And now, over four months down the line, we still don’t have the full picture. Most people (including many local Councillors) are blissfully unaware that we have been provided with just half a draft Sustainability and Transformation Plan. The all-important appendices to the STP, which contain key operational information, have been kept tightly under wraps by Newcastle Gateshead CCG despite both informal requests (in conversation and in emails) and formal requests (Freedom of Information applications) from Keep Our NHS Public North East. We wonder why this is the case?
Newcastle Gateshead CCG respond to our request to see the Appendices by maintaining
“an early release of this information could potentially result in a reduced quality of data, which clearly would not be helpful….it is in the wider public interest to ensure that this information becomes available to all members of the public at the same time through an official publication process”
Mark Adams, Chief officer, Newcastle Gateshead CCG, 20th March 2017
Well, our first request to have sight of the draft STP appendices was made on 30th November 2016. And still no sign. If we were of a suspicious nature, we may think that the CCG has something to hide.
But, interestingly, the plot thickens.
The CCG have just hosted what they feel to be a period of “engagement”. The part of the draft STP which was made public is a process heavy weight which is largely undecipherable and remains inaccessible to anyone outside CCG land, and thus requires translation.
In considering the six acute hospital sites in the STP footprint, we find the following words tucked away in a corner of the draft STP document and we quote:
“The analysis considers a range of scenarios in which either one or two of the six sites would be turned into cold sites by shifting out non-elective procedures and using freed up capacity to shift in elective procedures from the remaining hot sites in the patch”
from “Optimal Use of the Acute Sector” page near the end of the Nov 2016 NTWND draft STP document.
Now, our understanding is that to be a ‘cold’ site patients must be stable and unlikely to need intensive medical input – so this means no A&E, no medical admissions, no surgical admissions, no ITU or HDU. This is what Northumbria have done – Cramlington is ‘hot’ and N Tyneside and Wansbeck are ‘cold’. So, in reading the draft STP, our initial thought is that the closure of A&E and other acute services are being considered as an option for one or two more hospitals in our STP footprint, with the shifting out of non-elective (emergency, unforeseen) procedures to ‘hot’ hospital sites, and shifting in planned (non-critical) treatments and care to the one or two proposed ‘cold’ sites.
Important stuff – no doubt. Tucked away in a corner of the document – certainly. Highlighted so as to welcome peoples feedback – no. A great move in building trust (not).
A local population has a right to information and a right to present views – and that is what true engagement is about. KONPNE asked about this specific hot and cold clause at one of the “engagement” meetings, but the response was inadequate and fudged. We remain interested, and when we wrote to Newcastle Gateshead CCG within the engagement period and listed four very specific questions about this one specific issue, we were disappointed in that the CCG considered it fit to reply again with a totally fudged
“Since the publication of the draft plan, ‘the optimal use of the acute sector’ workstream has been analysed, and we are in the process of developing a more detailed plan which will help to support the sustainability of services”
Mark Adams, Chief officer, Newcastle Gateshead CCG, 20th March 2017
Back on planet earth, the process is straightforward. The CCG write a draft paper and invite comments or questions. A person reads the paper, find that clarification of part of the document is required, and writes with clear, specific questions. The convention is that the questions are then answered in a full and timely manner. What we have, in fact, received back is more CCG doublespeak – vague and coded, and with absolutely no answer to any of the questions. Quite frankly, we consider this response to be dismissive and disrespectful.
We have written to Newcastle Gateshead CCG again on 24th March 2017, as we still require a response to the four specific questions we originally posed about the hot and cold sites, but we still have no reply. Maybe they have gone cold on us. But we will persist.
We will persist because a very important principle is at stake. It is, of course, both ironic and unacceptable that any large scale proposal for service change which professes to be both transparent and engaging should withhold key information. Newcastle Gateshead CCG have asked members of the public for their opinion about an important issue, but without providing the full detail – both regarding the appendices to the STP and, as described above, regarding a specific part of the document. When additional information about these issues has been requested by members of the public, this has not been forthcoming from the CCG.
This does little to instil a sense of joint working, ownership and confidence in the process.
Initial engagement? Totally underwhelmed.
But we need more action and we really do need to be all in this together.
My abiding memory from the #OurNHSdemo in London last Saturday 4 March? Marching through Trafalgar Square. Traffic at standstill; police marking the way; chants of Whose NHS? Our NHS; tourists snapping in awe. A black helicopter whirring high above us. It felt historical. Monumental.
And it was. It was the largest NHS demonstration in history. Peaceful protesters marched from Tavistock Square… past Nelson’s Column… down Whitehall… past Downing Street and the Department of Health to the rally in Parliament Square. However, only one Sunday paper ran with this huge event on their front page the next day. There were online news reports and postings on Twitter and Facebook, but people at home seemed dismayed with the scant TV coverage. The BBC reported tens of thousands took to the streets – I think they needed to add another zero – as the police estimated 250, 000 people took part. That’s monumental.
The march and rally, organised by the People’s Assembly and Health Campaigns Together, had an impressive line up of speakers too: Jeremy Corbyn, John McDonnell, Jacqui Berry, Len McCluskey, Danielle Tiplady, Mark Serwotka, Jeeves Wij, Dr Tony O’Sullivan and many more. The rally began at 2pm and lasted a couple of hours. But due to the vast number on the march, not everyone managed to get down to Parliament Square in time to hear all of the speakers – this is not a criticism, but further testament to the amazing turn out of committed people.
Unions such as Unite, PCS, GMB, The BMA and Unison were represented. People were armed with banners, flags, PA systems, megaphones, whistles and voices. And after a seven hour coach journey from Newcastle, I definitely was up for making some noise.
Everyone was there for different reasons. Everyone had their own story to tell. If you search on youtube you will find amateur and professional footage of the day. Or search for journalist Steve Topple, filming his first documentary for The Canary, by garnering facts and opinions from some eminent people such as Dr Phil Hammond and Jolyon Rubinstein. He even nabbed Corbyn and McDonnell for comment.
Words and phrases such as underfunding; STPs; no NHS cuts; appreciation of staff; Hunt Must Go and political choices were repeated throughout the day by speakers and interviewees. But we all had one thing in common – every one of us and everyone at home who couldn’t make it – we all had one main aim – to defend the NHS and tell the Tories it’s OURS.
I’ve often said that my GP has been steadfast in my corner when times were tough. So Corbyn’s speech resonated with me. He said:
Defending the NHS is defending a basic human value and a basic human right.
He then continued:
You don’t walk by on the other side, when somebody is in difficulties or needing help and support. You put your arms round them and give them the love, the support and the comfort that they need. That’s what our NHS has been doing for all of us for all of our lives.
That certainly is true for me and my family. We are indebted. That was the reason behind my 57 tweets to Jeremy Hunt last year – one for every year I’ve needed our NHS so far.
Owen Smith MP tweeted on the day: what was the point of the march? He obviously wasn’t there to feel the camaraderie and to know how it feels to be stronger together. He obviously didn’t hear Corbyn say: “Defend the NHS with all of your might.” He obviously doesn’t realise that people can then take the energy and momentum from such a massive demonstration, to lobby their MPs and councillors… and to fight local cuts and closures. Just yesterday I was part of a group collecting signatures outside a Walk-in Centre in North Tyneside, which is facing closure this October, along with another centre. We will be left with one instead of three. We were asking residents to say no to the closure of primary care services in the community. Surely such closures will compound the pressure on GPs and A&E departments? And there would have been countless other campaigns going on across the country yesterday too. People defending our NHS and our right to healthcare. It is a right. It is not a commodity.
John McDonnell began his speech by paying a “debt of honour to the junior doctors who took strike action last year.” Part of their message was to highlight the plight of the NHS. And today they still blog, tweet and write articles about the front line pressures and the risk to patients. Nurses and other NHS staff are fighting a pay restraint and urge people to back their #scrapthecap campaign. McDonnell said he and Corbyn will stand on the picket lines and carry on taking to the streets, if any further industrial action is needed to be taken by any NHS healthcare workers. That they will do whatever it takes to save the NHS. All fighting talk.
But we need more action and we really do need to be all in this together. We can’t leave it to some doctors, nurses, campaigners, activists and a few MPs and councillors. Hammersmith Labour council have said no to their STPs. Labour needs to call out to all of their councils to reject STPs and austerity cuts. The NHS Bill needs supporting, which will stop further privatisation and will reinstate the NHS as an accountable public service. The NHS, Social Care and Mental Health services need to be fully resourced. Hound your local MP and councillors and hold them to account. After the disastrous budget last week then email, tweet or write to your MP, asking them to be part of the debate this Tuesday, in Parliament, re the NHS funding crisis and to represent your needs.
Defending our NHS needs to be the responsibility of all of us – cross party, trade unions and their leaders and patients together. The NHS has shown us so much love; it’s our turn to show it some love back.
There were 250, 000 voices last Saturday and just as many, if not more, at home in spirit – we are not invisible – we exist and we are not giving up without a fight. Jolyon Rubinstein summed it up for me at the end of his speech on the day:
As Nelson Mandela said: It always seems impossible until it’s done.
More from #CreativeGeordie is at https://creative2926.wordpress.com
Somewhere along the line we have lost the plot, but now we’re coming out fighting and hopefully it won’t be too late.
A blog from two in a thousand
For me, one of the strongest feelings associated with a March is the acceptance that we are all different – we don’t necessarily know who is walking in front or behind us – but also that we are all one. We share at least one belief in common.
Saturday 4th February 2017, and we joined together in Lovers Lane. Nothing clandestine or indiscreet on this occasion, but driven by a need to show emotion or to tell the world.
My friend happened to be marching alongside someone who fessed up to being an overworked NHS doc, and here is his message “….morale amongst my colleagues is at an all-time low, and we fear that the general public has been blinded by the subversive and stealthy nature of the various attacks on the NHS, and the misinformation in the media. We also fear that we are alone in the fight to defend our health service, but after seeing the turnout today, and hearing so many people talking openly about the real causes of the problems our health service faces, there is hope again that the fight isn’t yet lost. I am so happy that the general public is starting to see through the smoke and the lies, and that so many people are so passionate about keeping our NHS”.
We walk shoulder to shoulder on the March, and I truly hope that this doctor will also remember the other 999 people here today when carrying out his day-to-day work. We respect what you, and the other docs, and what the thousands of nurses and all the other NHS staff do for us every hour of every day. Somewhere along the line we have lost the plot, but now we’re coming out fighting and hopefully it won’t be too late.
Without the dedication of nurses, doctors, physios, radiographers, pharmacists and porters of all nationalities, the NHS simply would not exist.
A North East doctor
I have been working in the NHS for 18 years.
I used to love my job.
I used to enjoy the thought of going to work.
I used to sit in the car on the short journey to the Emergency Department and look forward to the day ahead- the teamwork, the buzz of the department, the challenging cases that would pose diagnostic dilemmas, the different patients from all walks of life, hearing their stories as I stitched their wounds, or holding their hand explaining a life changing diagnosis, or the death of a loved relative.
This enthusiasm has somehow been lost along the way.
My friends have noticed it; I have noticed it.
I now have a lurking sense of dread when I think of the up and coming night shifts, the waiting times, the work intensity, the inability to provide good care, simply because of the numbers of patients in the department.
We are continually improving the way we work. We are striving to become more efficient, having implemented new systems to provide better and more effective care to ambulatory patients (medical and surgical), frail elderly patients and to aid quicker discharge. We are streaming at the front door, to identify the best place for patients to be seen, whether in urgent care centres, urgent GP appointments or in our Emergency Department. But this will only get you so far.
We need more space, more rooms, more staff, more time to see patients. But of course this all costs money.
My colleagues are some of the hardest working and kindest people I have ever met but staff moral is at an all-time low.
The department is full, the corridors are full, the resuscitation room is full.
It is not full with people who should have gone to their GP, it is not full of young patients with minor issues, it is full of unwell patients with severe acute medical and surgical problems, many of whom are elderly with complex medical problems and health needs.
As senior medics, we should be seeing and assessing these patients, teaching the more junior members of the team, educating the nurses and reviewing patients to assess if they are suitable for discharge or not. Instead we are pushing trolleys with patients on round the department, or desperately trying to find a space to see an elderly patient with chest pain who is in the waiting room as there are simply no rooms anywhere, or phoning wards and pleading with them to find any space at all to admit the patients from our department into.
This is not what I went into medicine for.
The waiting time this morning in the Emergency Department was 11 hours.
Elderly patients are apologising for attending- they have heard the stories on the news about A and E departments being overcrowded and they delay turning up with their acute pancreatitis, or their heart attack as they don’t want to be a burden.
The inpatient beds are full- full with record number of patients that need admitting, and patients who are ready for discharge but do not have the social care and support to ensure a safe discharge. We, as an A and E department are therefore continuing to look after medical and surgical patients who should be on a specialist ward. We simply cannot continue to do our own job and look after these patients who would otherwise be on the ward. The department is so busy, we often do not have time to clean patients who are incontinent, or simply sit with patients and reassure them if they are frightened, or answer their questions fully about a new diagnosis. The work intensity is such that we are exhausted and deflated. This is unsustainable.
Somewhere, somehow this has all gone terribly wrong.
We are deep in the midst of a crisis. How much longer can we go on like this, before the system breaks completely….?
6 months ago, my colleagues and I joked that it could not possible get any worse as we arrived onto a shift with a 6 hour wait. How wrong we were. Now we wonder- how much worse will it get?
And yet, somehow we continue. We continue to turn up to work. We continue to smile and apologise (again) to patients for the long wait. We continue to care. We continue to support colleagues, patients and relatives through difficult and emotional times.
I’m not sure how much longer we can do this.
Last week I explained to an elderly woman, as I held her hand, that she was dying and probably would not survive through the night. Her family were at her side and she bravely accepted this with a smile and a peaceful awareness that it was her time. I tried to ignore the controlled chaos of the rest of the department and sat with them as I explained the diagnosis and the end of life care that we would provide. Despite the sadness I am reminded in these situations what a privilege this job is. I am reminded of the excellent care and empathy that the nurses and doctors around me continue to provide, despite the intense pressures of the department. These small positive reminders, through the emotional sadness and the daily struggles, make me realise we must continue – for without the dedication of nurses, doctors, physios, radiographers, pharmacists and porters of all nationalities, the NHS simply would not exist. We cannot let it fail for those who need it most.