The Axe Has Fallen

Alan Johnson is determined to make sure that "more services are delivered closer to home".

Thus the Healthy Futures and Making It Better proposals for restructuring health services in the Manchester area have been approved by the Independent Reconfiguration Panel and the Health Secretary himself.

Thus the town of Rochdale will no longer have A & E and maternity services. You can no longer be born in Bury nor Salford.

Reports here and here.

Shame on you Mr Johnson.

Healthy Futures, Making it Better and the IRP - Update

If you recall from earlier posts (here, here, here, here and here), the North West Strategic Health Authority has been planning to “reform” (or “shake up”) the structure of paediatric, maternity and neonatal services across the whole area through the Making It Better proposal and to the healthcare of all in NE Greater Manchester through the Healthy Futures proposals.

(An aside – what the fuck is it with such “trendy” New Labour speak for consultations to be named as “Healthy Futures”? Why not just “A Review of Healthcare in NE Greater Manchester”?).

Our local council protested the recommendations of the proposals, as it will reduce some local services, particularly A&E. Some other councils in the area were also unhappy. As a result, the proposals were sent to the Independent Reconfiguration Panel (IRP), seemingly a non-governmental body of government-paid advisors, that reviews protested health decisions for the Department of Health. The request for IRP review was submitted in Patricia Hewitt´s time (thank you, Patsy, at least you didn´t make a dumb decision this time – but …) and as the submittal date to the DoH was just before her demise and Alan Johnson´s appointment to the Secretary of State for Health post …

The IRP submitted their report on 26 June and was meant to be published (i.e. put in the public domain) on 28 July.

However, the publication of the IRP´s report has been postponed “indefinitely” (quoting a local newspaper report) to give Alan Johnson more time to study its implications.

According to a DoH spokesperson “Given the level of complexity, size and scope contained in the Manchester reconfigurations, the Department of Health would like to understand what plans there are for implementation of any changes and more time to give the matter proper consideration”. (DoH press statement here).

Good on yuh Alan for not making rash decisions – and I am sure you have important things to think about today, 1 August, with the fallout from MTAS and tomorrow or the day after or the day after … with the NHS´s Programme for IT, etc etc.

You have publically committed yourself to send all disputed consultations to the IRP (did Patsy not?). Good on yuh!

However, I am curious as to why the Independent Reconfiguration Panel´s recommendations are not made public before the ministerial decision is made.

I'm a smoker

John at NHS Blog Doctor has posted many times about the stupidity of smoking and the paucity of treatment for the often resulting lung cancer on the NHS. And obviously all the other health problems it can cause or exacerbate. I do not disagree with him one iota …

… but I am a smoker.

A pack a day.

My father died of a heart attack at 67 years old, he´d smoked a pipe on and off during his life and then gave it up at about age 50 – he died more of the withdrawal symptoms of workaholism when he was forced to retire from a job that was his life (yeah, ok the death certificate said something medical). Next to go was my grandmother, at the age of 98 – she smoked, heavily, until she was 70 plus. Every time she got something nasty, she would just stop seemingly with no withdrawal symptoms. She got bronchitis and our GP said “Stop”, she did and she lived another 20 years.

My mum died full of life aged 70 years from a stroke. Got up one morning, got washed, brushed her teeth, dressed and collapsed on the landing. Discovered by a friend with whom she was going for a pub lunch She was overweight, smoked some, drank some and was on the verge of completing her Ph.D. She tried stopping smoking again and again. At least she didn´t suffer. Just dropped.

Shame she didn´t see or even know of her grand-daughter. Shame her Ph.D. thesis almost completed, was never submitted. (On sex education, or lack of, provision in primary and secondary schools in the local education authority - if anyone is interested, I think I can rustle up a copy).

I started smoking at, oh, age 10. Mum would very occasionally send me and me bro´ to the local newsagents to pick up a pack of 10. So off we went … but this time they weren´t for her. A newsagents selling a 10 year old “for Mum” certainly wouldn´t happen now!

But we didn´t really start smoking until we were well into our teens. Old Holborn roll-ups.

I´ve tried giving up. As I said, my Grandma seemed to suffer no Cold Turkey when she stopped. But I know my Mum did – she would stop, start, stop, start, stop, start … never made it. I´ve tried a few times … the cold turkey is real bad, I can´t go through with it. Mum got addicted to the masochism of giving up – she tried acupuncture, hypnotism, Allen Carr etc etc. I´ve given up on “giving-up”. I can´t go through that. Maybe now, in the U.K. with nicotine patches, counsellors etc it would be possible.

When Kezia was admitted with leukaemia, the hospital asked if anyone smoked in the house. I don´t really know why – some kind of epidemiological survey? They are, after all, still looking for the causes of leukaemia

Fortunately, though, we live mostly outside here. I smoke outside. The ceiling in our house here, almost six metres high with no ceilings dividing upstairs from downstairs, and no glass-enclosed windows, is the height of our rented two storey ceilinged and windowed terrace in the U.K. But when I visit them in the U.K., I go outside and freeze my bollocks off.

So I hope Jaime, Kezia and Nanda have not suffered too much from passive smoking.

At Rochdale Infirmary and the Royal Manchester Children´s Hospital, the PCTs had both officially banned smoking even outside on the grounds. At the former, the entrance to A&E was disgusting with butts all over the ground, the one rubbish bin overflowing – ok it was a Sunday and maybe there had been no-one to clean up over the weekend. At RMCH, a slightly more constructive approach - perhaps a recognition that us smoker parents were stressed out enough without the need to stress us further about smoking – the hospital has a dedicated smoking room, albeit pretty discouraging (let us wallow in our own dirt, smoke, ash and threadbare carpet – I have no problem), but their attitude was that this was better than a miscreant sneaking off to the toilets, lighting up and setting off the fire alarms. Does the RMCH smoking room still exist since 1 July?

I´ll be interested to see how our local pub in the U.K., where most of the customers seem be smokers, is coping with the July 1 ban.

The approach taken in South Africa when we visited in 2001 seemed more constructive and needs much less state “policing” (and thus expense?). Bars and restaurants were given a choice of an outright ban or creating a segragated space for smokers. Many chose to create an, albeit smaller and perhaps a little less salubrious, but nevertheless not a fleapit, space for smokers. But then South Africa introduced a ban on free plastic bags in supermarkets and shops years ago … they have all gone over to free reuseable rigid paper bags. Ok, so smokers there don´t feel as ostracised as in the U.K. … but is ostracisation a motivation?

And I do like doctors who smoke. S/he can tell me to stop … there´s more empathy with the patient - I know s/he knows what we´re experiencing. A holier than thou doctor´s attitude about smoking just makes you feel guilty …

And let´s hope I have my grandmother´s genes …

P.S. Kezia seemed alot chirpier yesterday - must be coming down from the Dexamethasone.

Healthy Futures and Making it Better Review

The reviews of the Healthy and Making it Better "reform" programmes by the Independent Reconfiguration Panel were submitted to the Health Secretary yesterday but will not be available on their website for approximately a month.

I'm sure, given George Brown takes over as Prime Minister today and is expected to announce cabinet reshuffles today and tomorrow, we cannot expect an immediate decision.

In related news the local Rochdale MP has criticised the Pennine Acute Trust for publishing a business plan for developing a £3 million children's A & E unit and £25 million maternity unit ant North Manchester Hosiptal ahead of the IRP's review and the health secretary's decision.

Healthy Futures - Accessibility

I drew attention here that the “analysis” of public transport access to two (of four) hospitals in the Joint PCT Committee´s submission to the Independent Reconfiguration Panel’s review of the Healthy Futures (A & E provision) compared Apples with Oranges.

It gets worse …

Fairfield Hospital, on the borders of Rochdale and Bury councils, has been proposed for A & E cover of Rochdale.

There are three routes with 11 working daytime buses per hour from Rochdale Bus Station to Rochdale Infirmary. According to the Greater Manchester Public Transport Executive, service 468 runs from Rochdale Bus Station hourly in the evenings, on Sundays and public holidays and service 469, every 10-20 minutes only in the early evenings and hourly in the evenings, on Sundays and public holidays.

I am not a transportation analyst but someone in the Joint PCT Committee seems to have it in for Rochdale Infirmary …

No Change not an Option

Three options were presented to those consulted in the Healthy Futures (A & E) consultation exercise. Five in the Making it Better (Paediatrics and Maternity) exercise.

An option for no change to existing provision was not included in the Healthy Futures consultation (stated in the IRP’s Healthy Futures template).

Rochdale Council’s report questions the SHA’s interpretation of the consultations’ results. Many responses, interpreted as positive, express “qualifications, caveats and concerns” with very few which are clear endorsements.

Although many want services to be retained locally, they appear to have been hoodwinked by talk of “urgent care centres” and “centres of excellence” and that these will local and not so local levels of service will provide the same level of service as existing facilities.

Joe and Jane Blogg can easily be convinced that a Nurse Specialist will provide the same level of expertise as a doctor.

There are many concerns that the expansion of community, as opposed to hospital, services will be underfunded. It would seem that the financial planning for centralising services has been impeccable (sic), but both the logistical and financial planning for expanding community services (e.g. children’s community nursing teams) has been neglected. Quite possibly (and very probably) these community alternatives will not be in place before hospital services are withdrawn.

It would also seem that two separate consultation exercises, one for A & E, the other for paediatrics and maternity, may have been an attempt (or at least perceived as such) to “pull the wool over our eyes” over the totality of cuts. I am sure those who offered their opinions in the two consultation exercises were not the same.

If I knew there was no Paediatric department there, I wouldn’t take Kezia to their A& E and vice versa. As it is, the local hospital may well end up with neither … and we’ll have to make a long bus trip to the nearest hospital with both.

I note

… from the Independent Reconfiguration Panel’s website that the template document for the review of the Making it Better: Making it Real (Paediatric and Maternity provision) proposals is basically empty. Why?

I note that the Pennine Acute Trust’s head of human resources Roger Pickering is reported as saying that the cuts should not result in job losses and is quoted in the press as saying "We remain confident that all staff affected by these moves will be offered redeployment …Our aim is to deliver financial recovery while minimising the impact on patient services and staff.".

I note, however, that in the IRP’s template for Healthy Futures (A & E services), the Pennine Acute Trust has stated that one of its aims is the “reduction in posts and jobs” despite Mr Pickering’s assurances.

I also note that in the IRP’s template for Healthy Futures (A & E services) the review of Access and Transport (section 1.3.3) is meaningless. To quote (with my comments in parentheses) …

“Oldham [to the hospital itself? It doesn’t say]: 18 buses per hour weekdays [from where? It doesn’t say], 5 buses per hour at night [from where?]

Rochdale: Least well served by public transport, 900 metres from bus station [so I’m assuming it means the hospital] – ring road makes access difficult.”

Apples and Oranges. Is the IRP going to be able to give Patsy an informed recommendation?

Dr. Crippen, please please link to this before 26 June, your blog is far more influential than mine – maybe someone on the IRP reads NHSBlogDoctor!

I am getting angry! I am angry! I’m tired of being angry. I want to blog about cancer, I want to blog about Kezia’s hair beginning to grow back - not about the state of the NHS!

Our Council Fights Back

Since the application for judicial review of the cutting A & E services at our local hospital was rejected on 8 June (posted here), I have learned some more - the SHA is also planning to cut both paediatric and maternity services.

So, on that Sunday a year ago, Kezia would have had neither A & E nor Paediatric!

(Blimey John, we would have had a Nurse Specialist diagnosing her with malaria based on arriving from Africa, on an enlarged spleen, no malaria test available on a Sunday, not believing African doctors and come back tomorrow).

The local council is fighting back!

I know it is politically expedient for local councillors and MPs to focus on local issues, rather than think of the good of a wider region but I think they may have a point in this case.

The council commissioned a report from a health policy expert at the De Montfort University in Leicester to examine the SHA’s Making it Better: Making it Real (Paediatric and Maternity provision) and Healthy Futures (A & E provision) reviews and to evaluate its decisions to downgrade (or should I say degrade?) services provided by our local hospital. And, obviously, since her paymasters were the local council, she gave them what they wanted to hear.

This document has been presented to the DoH’s Independent Reconfiguration Panel (IRP), reporting to the Health Secretary, by 26 June. The IRP is basically the last line of defense before our Health Secretary makes critical decisions about changes to the National Health Service.

I am wading through the expert’s report … and will certainly post more on it.

But just some quick observations …

In our post on Monday about translation/interpreting services, our SHA (which I noted was positive about the necessity of good translation (sic) provision) highlighted the problems that non-native speakers of English (either for cultural and/or linguistic reasons) might have accessing local public transport systems and that access to familiar local hospitals improved access rates.

We live in a borough with a high proportion of ethnic minorities.

The SHA has paid lip service to the impediments faced by ethnic minorities travelling on public transport. The SHA’s transportation data is based only on ambulance times between hospitals, not on public transport availability and times – so in-patients who do not need ambulance transport and visitors without private transport (33.4% for our local authority according to the 2001 census, above both the national and SHA’s average) have not been taken into account.

I remember very well taking 2 ½ hours one way to travel by public transport the 14 miles from the RMCH to our future home – a bus journey from the hospital to the centre of Manchester, a 20 minute walk from Piccadilly to Manchester Victoria railway station, a half-hour wait at Victoria, a half-hour rail journey, wait for a bus from the destination railway station to the town centre, another bus journey to our future home. And return. Five hours total … and that was with no treatment involved.

Two children in tow, one with leukaemia, not speaking English …

Even now, Nanda is not confident enough to catch a train into Manchester … but, hey, she is confident enough to administer chemotherapy and deal with the RMCH! Good on her!

Clearly, the transport times involved are not as lengthy between us and the RMCH and Lucia and the RMCH. On occasion, when Lucia has needed emergency admission during her treatment for ALL, the always-consulted RMCH has allowed her to be treated at her local Blackpool general hospital. I don’t know the facilities at this hospital compared to our own local hospital, but I’m sure she received adequate treatment and I imagine our local hospital would as well … but I imagine the RMCH makes decisions about distance, time, transport/ambulance availability, clinical need and, I hope, ethnic minority needs (language, availability of Languageline at night etc … do they follow a protocol or does the duty doctor, or even the on-duty nurse make a judgement?).

Yet the SHA recommends cutting services at the local hospital, obliging both native and non-native speakers of English to travel further afield on ropey public transport systems to seek essential healthcare.

The government claims to be increasing patient choice, yet it is cutting services at our local hospital. Limiting choice.

Thank you to our local hospital for having A & E and paediatric services. Thank you to my brother for not being part of the 33.4% - I cannot imagine travelling 14 miles on public transport on a Sunday after 36 hours travel time with my leukaemic daughter – and thank you NHS/RMCH, in spite of everything you are up against, for all you are doing for us!

Patricia Hewitt and Ruth Kelly – up yours!