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Ramblings, thoughts, facts and opinions about political things - starting point council tenant participation with my land-lord Camden council and council tenant reps plus other housing issues, and whatever.

NHS Sustainability and Transformation Plans in Camden

Thursday 4 May 2017

According to the NHS England website HERE, the NHS and local councils have "come together in 44 areas covering all of England to develop proposals and make improvements to health and care. These proposals, called sustainability and transformation plans (STPs), are place-based and built around the needs of the local population." [my emphasis]

STP's are a five year Plan which "will be supported by the six national health and care bodies:
NHS England,
NHS Improvement,
the Care Quality Commission (CQC),
Health Education England (HEE),
Public Health England (PHE) and
the National Institute for Health and Care Excellence (NICE)". HERE

" Proposals have now been published for every part of England. They are all at different stages and now patients, the public and NHS staff must help to develop and shape them." The Plans are HERE

The London Borough of Camden comes under the North [Central] London STP HERE. It was updated in Feb 2017 and lists the Partners and Providers.

It doesn't list Connect Physical Health but CPH works with the CCCG and has a 5 year Plan as well HERE which was first published in 2014.

CPH are wanting to 'help' GP practices lessen their work load by being first point of contact instead of GP referring patients to CPH as well as reducing hospital admissions.

"For example, where community MSK services have been fragmented (through General Practice Fund Holders then Any Quality Provider) quality has diminished, onward referrals into hospital have increased and poorer outcomes in the community also mean greater cost. Conversely MSK services based in primary care/community but centrally managed have provided a positive ‘pull’ to GPs and patients because they are ‘user friendly’ and deliver better outcomes. And the taxpayer gains too." HERE

In my case I don't believe the 'care' I received and my overall experience of CPH and being onwarded to the RF hospital had anything to do with what route I came to be a CPH patient but by CPH mis-management of my 'care'.

"Through our experience and expertise in musculoskeletal services, we’re able to provide high quality, patient-focused care that consistently attracts exceptional feedback from patients." HERE
and  "We put patients at the heart of everything we do."
Not in my case though and I wonder in how many others in Camden?

I do understand that in order to provide patients with good care, staff should in general be of good health themselves and that anyone who isn't should receive the support and care they need. But as the case may be I suspect not all staff will ask for help, or even admit it to themselves, and may make mistakes and other staff will cover up for them, which isn't good practice in my view.

In Dec 2016 the then Leader of Camden council, Sarah Hayward had concerns about the Plan HERE and some Doctors also had/have concerns HERE 

As for the Camden Clinical Commissioning Group HERE who I suspect deal a lot better with positive feedback from patients, then they do with negative feedback.  In my case they buried their heads in the sand and this may be the normal practice in the CCCG but it isn't [in my view and probably many others] good practice and puts patients [as well as staff ] at risk.

6 May 2017
Day v Health Education England HERE and
"Junior doctors win greater protection to act as whistleblowers, judges rules" HERE
Dr raised issues about staff shortage and patient safety - career destroyed by  NHS administrators/managers. Will things change? who knows.

7 May 2017
 Primary Care Trusts [PCTs] and local authorities are required to produce a Joint Strategic Needs Assessment [JSNA] of the health and well being of their local community HERE 
" Health and wellbeing boards are at the heart of our plans to transform health and care ...." "Leaders from across the local community will come together in ......."

This is a requirement of The Local Government and Public Involvement in Health Act 2007 HERE.
Part 5 Co-operation of English authorities with local partners,  etc section 116 HERE and includes Part 14 Patient and public involvement in health and social care sections 221 - 234 HERE.

The Health and Social Care Act 2012 HERE sets up Clinical Commissioning Boards and Health and Wellbeing Boards

 Camden councils Health and Wellbeing Board [HWB]was set up in June 2013 HERE
" Pioneer Project was at the discussion stage and that it could provide opportunities to work strategically and creatively across health and social care with partners on commissioning and contracting services." Good luck with that.

Members: at least 1 camden councillor, 3 council directors, [chair]GP of CCCG, GP rep, chief officer CCCG, patient rep, 1 Healthwatch rep and 1 community centres rep and they can appoint other members.

Theres even a Adult Safeguarding Partnership Board "Keeping adults at risk safe has always been a high priority in Camden"

"Writing robust safeguarding clauses into contracts, monitoring providers more closely, and taking swift action on poor care to prevent abuse."

" 3. Listening and engaging
 The views and experiences of our service users, carers and staff improve and develop services across the partnership"

Its a minefield of what should happen but in reality ...... another tick box venture?

back again.
Each year Camden council and the CCCG have to write up and give to the HWB a report of their commissioning intentions. The report from CCCG for 2015/16 HERE is a five year plan.

It says things like:
Patients at the centre 
  • Compassionate, high quality, effective and efficient care pathways shaped by them
  • Care that is integrated and focused around delivery of outcomes defined by them
  • Easy access to services delivered in ways and places convenient to them

Our approach
  • To be open and transparent and encourage everyone to challenge and develop our ideas and scrutinise our decisions
  • Challenge all performance, not just bad performance rather than accept average. Get the basic's right first, welcome complaints, be interested in everything leaving no stone unturned.  
Sounds fantastic doesn't it?

Can you feel the love?

9 May 2017
The Health and Well being Boards do not deal directly with individual cases. Health watch Camden HERE are the body who represent health and social care service users and are a member of the Health and Well being Board.

What worries me about the Safeguarding Adult Partnership Board [SAPB] is that the bar is set way too high for cases that should be addressed but are being discarded without proper investigation.

Camden has a joint Health and Well being Strategy for 2015-18. Improving mental health and well being is one of their priorities.

Apparently the above mentioned strategy wasn't actually agreed etc before the actual start of 2015-18 [3 year cycle] years which I am guessing started from 31 March 2015  - 1 April 2018 or even if the start date is later on in the year, the whole process should have been completed by the start of the 2015 year - shouldn't it or am I missing something?

Camden Councils and the Camden Clinical Commissioning Groups commissioning intentions for the year 2016-17 HERE I think its the case that many contracts are on a yearly basis so that the CCCG can add stipulations to the contracts.

Wow more great stuff:
Commission the delivery of NHS constitutional rights and pledges. Improve the quality and safety of commissioned services. Theres even a redesign of MSK services [UCLH, CH and RFH]. I wonder who got money from the Better Care Fund?

All target driven i suspect which leaves a lot of room for poor care and  performance issues to fall through the cracks.

"Camden CCG is a membership organisation, with 35 general practice members. Our members elect a Governing Body to oversee the work of the CCG. This is made up of Camden clinicians, partner organisation representatives and other groups that have an interest in Camden healthcare. The Governing Body is responsible for our strategies, actions and finances. They also ensure that decisions about changes to local health services are debated openly and fairly."

Not all GPs at my local practice seem aware of the above. The reason I know this is because I don't stick to seeing the same GP. I've seen 3 [could be 4 i'm losing track] different GP's these 5 months and a few others to do with other things in the last 2/3 years.

Now we have Camden council as the lead in all of this - but struggling somewhat to establish their authority on behalf of the local NHS 'service users'.  Is camden council up for the job of making some real improvements [not just tick box ones] or will they fall into line?

13 May 2017
Click HERE for research done by think tank.

Yesterday the NHS [as well as businesses  in lots of other countries]suffered a serious cyber security attack believed to have been caused by an email virus inadvertently clicked on, that spread to some hospitals and GP practices mainly in England but some in Scotland. NHS staff couldn't access computer files, patients medical files, and a message was displayed on the screens about a ransom in bitcom currency to be paid. Its not known if NHS records data has been stolen, copied or changed.

It is said that the NHS computer operating system is Windows XP which hasn't had security updates since 2010.

Talk about timing eh - in the middle of a general election campaign. 

18 May 2017
I can't get my head around the Camden Clinical Commissioning Group [CCCG] being so dismissive of me when I gave them a summary of my experience of Connect Health who they buy health services from on behalf of the NHS for people in Camden. Connect health even have a contract with the CCCG to provide palliative services. I shudder.

keep looking the other way CCCG.

2 June 2017
Up until recently i didn't know there is a NHS Litigation Authority HERE
who are a non profit arm of the NHS who settle negligence etc claims against the NHS. The reason they came to my attention is because of huge amount of money the government spends per annum on claims.

For example from Jan 2012:
"The Department of Health has confirmed that a £185m emergency bailout fund has been found for the NHS Litigation Authority (NHSLA). Clinical negligence claims against the NHS reached an estimated value of £1bn last year, after rising from from £5,697m to £8,655m over the preceding five years." HERE

 I read on Anna Raccoon  site HERE that a much larger sum is paid out but I can't find it now.

On another issue of Intergrated Care in Camden: I'm trying to work out how exactly it works.

An example of services being intergated from 2010 can be fund HERE.

In present day 2017, The Camden and Islington NHS Foundation Trust who provide mental health services to people in the catchment areas, have only recently decided to intergrate mental and physical health and only for people with serious mental health difficulties - many people with MH conditions also develop physical problems.

I'm not in the serious caterogy [thank goodness and I'm hoping to keep it that way] but it seems to be about MH nurses taking on some minor roles in accessing the physical health conditions of some NH patients HERE. 

Somehow I imagined the intergration thing as being between mental health professionals and physical health professions but that doesn't seem to be the case.

 The Camden Clinical Commissioning Group[CCCG] via the the Camden Patient and Public Engagement Group [CPPEG] is holding an open day on the 12 June 2017 HERE 

5 June 2017
Guide to Patient Choice Rights HERE

Some 'referral' systems in Camden are a bit odd I think like the ones where the GP doesn't afer choice and refers a CCCG commissioned health service provider to a patient who then has to  'self refer'. Who is accountable when things go wrong?

The GP, the secondary service provider or the commissioner? All I think, but not willing to accept all of their responsibilties.

I really wish I hadn't been put in the position that triggered me to have a closer look at things in the NHS - I'd have enough of that sort of thing with Camden council. Not always a pretty sight with either and in regards to CC, put me off volunteering for life with the council.  I can't be in these sorts of environments for to long as it affects me negatively too much - and gets in the way of all the good stuff that happens and and could be better. Humans eh. My policy is to keep 'them' at arms lengths if one is thinking of 'getting involved' in local/national politics.

But then some folk don't seem to mind the environment, relish in it, know how to play the game [behind the scenes mostly] hidden from public view. The repulsion rises within me and I have to move away from it. Its safer on the outskirts for those who don't have the stomach for it.

Yeap fight or flight kicks in and I really can't do the fighting from the inside, its too dark and toxic for me. But there are good things as well but it can be hard to not let the negative dominate.

7 June 2017
I'm having a read through some of the reports given to the Governing body of the Camden CCG 9 March 2016 meeting HERE  Long report, lots of information, so well done for that. Bet ya nobody reads all of the report.

Wow think I'll have to make a day [or 3] of it [to try to] read it all with food, water, tea, coffee, tic tacs to suck on in between the cuppa's, [my mouth gets dry] and other essential supplies, and breaks in between.

Going back in for a little while, wish me luck.

I can't do it i'm too knackered.

9 June 2017
Am still on March 2016 [443pgs] document but thought I'd note the following:

" Page 82
3.2.1.Stage 1: Data Analysis
The CCG receives a range of data relating to a variety of indicators on the quality of commissioned services. Key performance indicators [KPIs]included within the quality schedule in the standard NHS contracts are regularly monitored and scrutinised. To ensure that the focus is on people and not just targets, analysis of data will seek assurances about and hold providers to account within the domains used by the Care Quality Commission.
Safe By safe, we mean that people are protected from abuse and avoidable harm.
Effective By effective, we mean that people's care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence
Caring By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect. 
Responsive By responsive, we mean that services are organised so that they meet people's needs
Well-led By well-led, we mean that the leadership, management and governance of the organisation assures the delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture.

am still reading through report and its not looking good for the Camden CCG and shall I say why from my perspective as a patient:
Problems that where known about back in March 2016 may not have been ironed out - I suspect many weren't by the time I went to see physiotherapist in Sept/Oct 2016.
Lack of accurate data given by providers, difficult to ensure patients outcomes are met, difficult to compare with other providers, no clear ownership or  accountability [I suspect that is still the case]

Community based services not performing as good as hospital based.
53% rated their experience of community management of condition "very poor" or "poor"
15 % of appointment not attended.

Wow. Its gets better as I read along.

15 June 2017
Camden CCG Annual Report 2016-17 HERE
Serious Incident Framework HERE

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