Thursday, January 31, 2008
The Darzi Report - submission
The following submission was sent in to the Healthcare for London consultation ("Consulting the Capital") by Lib Dem Cllr.John Beanse, who is Vice-Chair of Health Scrutiny in Waltham Forest:
Firstly, I do not find the questionnaire very helpful and cannot believe the results of answers to many questions will do much more than provide some statistics. I cannot believe that they are going to affect or alter current thinking.
- e.g.1a; 2, etc and other questions where agreement is sought.
What I find more relevant is to make the following points:
* More care in the community is a current driver for change - which coincidentally and sometimes too conveniently coincides with the need to cut deficits and save money.
Of course in many cases this may be desirable - BUT there has to be much improvement in community care. People must not be sent out of hospital early to cope on their own with inadequate help or to place an impossible burden on carers - which sometimes leads to them becoming ill themselves.
These matters receive inadequate attention in the report- there is little reference to carers.
Also, local authorities are going to need more funding for Social services - this needs to be urgently addressed.
* There is a tendency to drive down activity at local hospitals by our PCT - through day operations, more care in the community, etc, saving money. Again, sometimes, but not always, there are good clinical reasons for this approach. This can lead to ward closures, staff reductions, etc - not always so desirable. Above all, hospitals must maintain adequate capacity which can be brought into use if there is for instance an epidemic involving more admissions or a major accident, etc.
* Sending people out of hospital earlier is not always "successful". Figures I have obtained show that on average 1 in 10 of patients leaving my local hospital - for whatever reason - are likely to back in hospital within 2 months.
* The section on mental health is inadequate. There does not seem to have been sufficient input from service users, carers, or practitioners.
Also, it is not - sadly - the case that all patients with mental health problems will "recover" - the emphasis has to be on recovery (where feasible) and/or well-being.
There is insufficient awareness of the growing problems of more and more people suffering different degrees of dementia - and the implications. Home-assisted living can become impossible after a time.
We have to retain sufficient capacity in suitable homes.
* I have concerns about the suggested move to polyclinics. In a way we seem to be coming full circle. Years ago, many popular smaller hospitals - incl. "cottage hospitals" - were closed in the name of so-called "efficiency" - usually to much unheeded local protest. Are we now recreating them in a diiferent form?
* It has to be recognised that there are many patients who prefer to be with ONE GP and value that personal service. Is this recognised?
* Moving services out of district general hospitals - either to polyclinics or to specialist centres could bring unwanted consequences. There may be good reasons for having some specialist centres - but having established some, there could be moves to have more. This could downgrade hospitals by stealth.
* Let it be clear. People expect to have a fully funded, fully functioning local hospital. In many cases they are less concerned about CHOICE. Their choice is to have a local hospital - convenient for out-patient appointments and convenient for friends & family to visit in-patients. Is this being fully considered??
* I have serious reservations about the TRANSPORT implications where patients have to be taken on congested roads into central London. Why not have centres on the periphery of London?
* There is insufficient regard of the funding implications in all this.
* Both nationally and locally, proper attention has to be paid to increasing population levels. I am not convinced this is being done adequately.
I hope that all representations will be given due consideration and that the direction for the future will indeed lead to a better NHS for us all. At present I have some serious misgivings.
Firstly, I do not find the questionnaire very helpful and cannot believe the results of answers to many questions will do much more than provide some statistics. I cannot believe that they are going to affect or alter current thinking.
- e.g.1a; 2, etc and other questions where agreement is sought.
What I find more relevant is to make the following points:
* More care in the community is a current driver for change - which coincidentally and sometimes too conveniently coincides with the need to cut deficits and save money.
Of course in many cases this may be desirable - BUT there has to be much improvement in community care. People must not be sent out of hospital early to cope on their own with inadequate help or to place an impossible burden on carers - which sometimes leads to them becoming ill themselves.
These matters receive inadequate attention in the report- there is little reference to carers.
Also, local authorities are going to need more funding for Social services - this needs to be urgently addressed.
* There is a tendency to drive down activity at local hospitals by our PCT - through day operations, more care in the community, etc, saving money. Again, sometimes, but not always, there are good clinical reasons for this approach. This can lead to ward closures, staff reductions, etc - not always so desirable. Above all, hospitals must maintain adequate capacity which can be brought into use if there is for instance an epidemic involving more admissions or a major accident, etc.
* Sending people out of hospital earlier is not always "successful". Figures I have obtained show that on average 1 in 10 of patients leaving my local hospital - for whatever reason - are likely to back in hospital within 2 months.
* The section on mental health is inadequate. There does not seem to have been sufficient input from service users, carers, or practitioners.
Also, it is not - sadly - the case that all patients with mental health problems will "recover" - the emphasis has to be on recovery (where feasible) and/or well-being.
There is insufficient awareness of the growing problems of more and more people suffering different degrees of dementia - and the implications. Home-assisted living can become impossible after a time.
We have to retain sufficient capacity in suitable homes.
* I have concerns about the suggested move to polyclinics. In a way we seem to be coming full circle. Years ago, many popular smaller hospitals - incl. "cottage hospitals" - were closed in the name of so-called "efficiency" - usually to much unheeded local protest. Are we now recreating them in a diiferent form?
* It has to be recognised that there are many patients who prefer to be with ONE GP and value that personal service. Is this recognised?
* Moving services out of district general hospitals - either to polyclinics or to specialist centres could bring unwanted consequences. There may be good reasons for having some specialist centres - but having established some, there could be moves to have more. This could downgrade hospitals by stealth.
* Let it be clear. People expect to have a fully funded, fully functioning local hospital. In many cases they are less concerned about CHOICE. Their choice is to have a local hospital - convenient for out-patient appointments and convenient for friends & family to visit in-patients. Is this being fully considered??
* I have serious reservations about the TRANSPORT implications where patients have to be taken on congested roads into central London. Why not have centres on the periphery of London?
* There is insufficient regard of the funding implications in all this.
* Both nationally and locally, proper attention has to be paid to increasing population levels. I am not convinced this is being done adequately.
I hope that all representations will be given due consideration and that the direction for the future will indeed lead to a better NHS for us all. At present I have some serious misgivings.
# posted by John Beanse @ 9:02 PM 
