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June 6, 2013
ADVOCACY providers who help children and adults to get better social care are “seriously wondering about their future and stripping back their costs”, Wales’s children’s commissioner, Keith Towler, said today.
A Welsh Assembly social care minister said she would be making a statement on advocacy soon but she warned “there simply is no more money” for social services in Wales and savings must be made by an increased focus on early intervention.
Gwenda Thomas, Labour’s deputy minister for social services in Wales, said she was confident that savings would be made with an increased focus on early intervention.
“The key to sustainability is change. Public bodies need to change the way they think about services. I want the social services sector to work with us. If we want to get it right, it will take time. This is a marathon, not a sprint,” she told delegates at the seminar to discuss implementing the Social Services (Wales) Bill, currently out for public consultation.
She added that “we must be clear that the bill does not anticipate local authorities providing all the services themselves”.
Mr Towler praised the work of advocacy in helping young people with their social care. He said: “Brilliant advocates really help families to work well” and he agreed that funding is “ad-hoc and precarious”.
He added that there was a “whole other debate” about the quality of advocacy.
Sarah Rochira, older people’s commissioner for Wales, said she wanted to stop the bill being about “systems and services” and instead be about people.
“All of us post the Francis Report into health should listen to people’s voices. I think there is a need for us to focus on the person, the individual.”
Peter Tyndall, public services ombudsman for Wales, said people who pay for their own care are excluded from his services and “they should be able to have independent redress”.
He said there had been an increase in complaints about registered care homes. “All of the people we deal with are people who are unhappy with the service they receive,” he said.
Mike Kemp, vice chair of Care Forum Wales, said: “We need a lot more co-operation between us to get better quality and cheaper services for Wales,” and he called for “more teeth” to work in partnership.
Martyn Palfreman, head of social services directorate at the Welsh Local Government Association, welcomed funding for transition announced in the bill but called for “a balanced approach to eligibility and assessment”. He expressed concern that some of the improvements were expected to be “cost neutral”.
Adrian Roper, chief executive officer of Cartrefi Cymru, said the bill was a “good start” but “we already have a problem with services being rationed.”


future of the nhs in wales
EMBARRASSING information about the health service should be made available to the public to raise the level of debate, a health expert said in Cardiff today (Monday June 25).

Professor Marcus Goring, director of the Welsh Institute for Health and Social Care, called for wider and better access to “information which reveals the problems that we’ve got”.

He added: “we should stop taking a rather protective attitude”.

Allison Williams, chief executive of Cwm Taf Local Health Board, said: “There is an appetite for a more open and grown up debate.”

Patients Association trustee Ann Lloyd warned that patient audits needed to be acted upon. “That is what Mid Staffordshire did not do,” she said.

“Patients want good information so they can take ownership. They want to feel safe and they want care and advice from practitioners they trust,” she added.

Speaking at a Policy Forum for Wales seminar on the future of the NHS in Wales, Professor Goring said: “How do you get the huge and monopolistic NHS to make change? What’s our alternative to a market mechanism? I don’t have a magic bullet.”

He said that the biggest challenge facing the NHS was in protecting employment and “getting staff on board with these changes”.

Welsh Health Minister Lesley Griffiths said: “I want people to own their health and local services” and added that the NHS must get its financial affairs on a solid footing. She praised the “very open discussions on the future of the NHS” at the seminar.

Tina Donnelly, director of the Royal College of Nursing in Wales, said: “I own the NHS through my taxes so I am entitled not to be treated as a customer but as a stakeholder.”

Dr Paul Myres, chair of the General Practitioners Committee Wales, said: “I think we do need to keep secondary and primary care and I think we need to retain localism.”

Paul Gimson, Royal Pharmaceutical Society director for Wales, said: “Patients are suffering harm because of the fragmented nature of the health service.” He criticised the fact that the discharge system was still paper based.

Dr Charlotte Jones, deputy chair of the General Practitioners committee in Wales, called for “networks and mentors” to help workforce morale and support.

Great emphasis was placed on the issues of obesity, smoking and alcohol abuse as contributors to ill health and Alison Williams called for a shift in focus. “I work in one of the most deprived health communities in Wales. We are experiencing ill health that is greater than the rest of the UK yet we are spending our time managing illness rather than managing health.

“Are we being overly permissive in our pathways of care to our patients?”

She said that more should be done to teach school-leavers to cook nutritious meals. “People are often not making the right choices. Maybe we should start focussing not on how many hip replacements we carry out but on how many we can avoid,” she said.

John Savage, chief executive of Nightingale House Hospice, said: “Commissioning is a word that is infrequently used and is not carried out universally” and he called for “robust” commissioning processes involving all.

David Sissling, chief executive of NHS Wales, said mortality rates were beginning to decline, there was a 16.5 per cent reduction in emergency admissions, improved quality in orthopaedics and leadership had been strengthened.

He said that the areas to focus on were: 1, Unscheduled care – performance must be improved. 2, Service change to develop quality-based service. 3, Quality and safety. 4, Extend GP clinical engagement. 5, Integration within the health service, and 6, Population health inequalities.

In answer to the following question from the floor, “The workforce are getting battle fatigue. So I would like to know how you plan to make them feel more valued?” Mr Sissling said: “We need to celebrate our success and the many good things that happen around Wales” and he said that they shouldn’t compromise on training developments either.


YOUNG men who take steroids for body building are endangering their own health and there is an immediate cost to the NHS, an expert warned in Cardiff today (Monday June 25).

Ian Cowan, chairman of Community Pharmacy Wales, said that steroids could lead to breast cancer and infertility. “There is a hidden cohort of young lads driven by body image. They access harm reduction services but there are no leaflets to hand out on this,” he said at a Policy Forum for Wales event on the future of the NHS in Wales.

Wynford Ellis Owen, chief executive of the Welsh Council on alcohol and other drugs, also warned about sex addiction.

“Sex addiction comes second to alcoholism. Accessing the internet for pornography is a big, big problem,” he said.

He called for a change in the way the health service treats addiction. “We have to have a range of options,” he said.

Gambling, he said, is a “massive, massive” problem and he mentioned that bookmakers were now advertising on primetime TV in breaks in soccer matches.

He said: “The acute medical model to deal with alcohol and drug problems doesn’t work that well because it is time limited, it has a beginning and an end and these are chronic long term conditions.”

He paid tribute to the Living Room day care rehabilitation centre in Cardiff, set up by the Welsh Council on Alcohol and Other Drugs to support to anyone dependent on drugs or alcohol.

He said: “We put them in the driving seat. We ask them to drive the recovery and we’ve done away with the hierarchical system.”

He called for a fundamental and “seismic” shift in thinking about addiction treatment to reconnect long-term recovery with treatment.BUSINESS IS BRISK IN BEVAN’S NHS
April 28, 2013
THE battle to keep the NHS public not private suffered a blow on Wednesday when the House of Lords rejected a bid to overturn rules on competition, opening up a future service for patients more business than welfare orientated.
I spent that morning in a health seminar to discuss the role of Healthwatch England and was outside the House of Lords with Keep Our NHS Public protestors in the afternoon lobbying peers going in to vote.
The contrast between the plush, almost palatial surroundings of the seminar venue, Princess Alexandra Hall, St James’s Street – where property prices are among the highest in western Europe – and the cold, bare pavement outside Westminster was stark. I saw it as symbolic of the whole debate on the NHS – the “haves” in palaces and the “have-nots” on the pavement.
There were no armed police inside the hall (where it was much more a case of preaching to the converted, hopefully, than placating the protestors) but there were certainly some outside Westminster helping to maintain “order, order” as protestors tried valiantly but failed to convert peers at the last minute.
The seminar was to discuss the future for local Healthwatch organisations, which have taken over the work previously done by patient watchdogs the Local Involvement Networks (LINks).
Sir Stephen Bubb, who has carried out a review into choice and competition in the NHS for David Cameron, and promotes them in his blog said that if Healthwatch goes the same way as the LINks they will fail as they were ineffective and largely ignored.
He said that he would ensure that his parents, who live in Essex, were not taken to Basildon Hospital for treatment if they ever needed it after recent accusations that they covered up the death rates there “because I know that the outcomes would be worse at Basildon Hospital”.
But I wondered if others, perhaps less privileged than Sir Stephen’s parents, really have choices and can truly be called consumers or even customers in a health context? Would they, I wondered, have a guardian and protector like Sir Stephen to ensure they received the best service at the best hospital?
Health activist Shirley Murgraff, who was in the vanguard outside the House of Lords handing out leaflets to noble lords like Melvyn Bragg and Michael Grade, has been demonstrating against NHS cuts for years and fears for the future.
She was wearing a photograph of Aneurin Bevan around her neck on Wednesday to remind peers of the founder of the NHS, who once wrote “The National Health service and the Welfare State have come to be used as interchangeable terms, and in the mouths of some people as terms of reproach. Why this is so it is not difficult to understand, if you view everything from the angle of a strictly individualistic competitive society. A free health service is pure Socialism and as such it is opposed to the hedonism of capitalist society.”
My health board is Aneurin Bevan Health Board because I live in Gwent, where the great man was born in Tredegar in 1897.
The board, Gwent’s biggest employer, with a staff of more than 12,000, had to identify £16m of the £48m in savings it needed to make just to break even, yet it is already overspent by almost £4m.
Cutting workforce costs is seen as the key to making the savings required, and a board finance report says it must “demonstrate a material decrease in head count.”
So, how can we give patients more choice – perhaps it’s a private matter!


A SYSTEM to accurately measure the recovery of mentally ill people needs to be set up quickly for a payment by results plan to work and service users and carers need to be at the heart of this, it emerged at a health seminar today (Wednesday July 11).

Director of mental health and disability at the Department of Health, Bruce Calderwood, said there was “no set of indicators of mental health recovery and we need to get one in place which is meaningful”.

“There will be an expectation that mental health planning should include the views of service users. Being in control of your life is part of the recovery journey and HealthWatch can get stuck in to that,” he added.

Service user David Serota called for government to “involve us in the design and delivery of services. The language needs to be tailored to those who would benefit.”

Kath Lovell, chair of the National Survivor Users Network, said: “The topic is quite contentious, it is difficult to measure what recovery means for different people.”

She said they had asked their members what they thought of the government’s mental health strategy and 43 per cent said it would have no significant impact while 35 per cent said it would have a negative impact.

Dr Neil Deuchar, co-chair joint commissioning panel for mental health, told the Social Policy Forum seminar on implementing the mental health strategy, held in London, that recovery was not merely the absence of symptoms but a more “holistic” outcome.

Mr Calderwood warned that they needed to identify what the quality and outcome measures would actually be for the strategy to work.

He said: “We have a very crude block contracting system. In some parts of the country there is very little information interchange between commissioners and service providers. We need to assess in a more rigorous way to tell if we are making a difference.”

He said the Department of Health would be publishing in the autumn a set of critical indicators and outcome frameworks

“The initial implementation has got to be very, very simple,” he said.

But Dr John Green, chief psychologist central and north west London NHS Foundation Trust, said: “We lack the vision to see that we can actually link things together.”

He called for:

1, Better understanding of what users want and need.

2, See developing services as an evolutionary business on continuous feedback.

3, Use systematic measures.

4, Use a systematic service improvement model.

Lucie Russell, director of campaigns policy and participation at YoungMinds, warned that children and young people needed to be better catered for because “only 10p in every £1 is spent on children and young people’s mental health” and early interventions were often not happening as early as necessary.

Dr Richard Byng, clinical senior lecturer Institute of Health Service Research, said: “At the moment everybody is scared of making mistakes and getting sacked and we need to change that.”

Paul Farmer, chief executive Mind, paid tribute to the four MPs who recently disclosed their own mental health problems in a House of Commons debate. He called this “an incredibly symbolic sight”.

Former Labour defence minister Kevan Jones talked about having severe depression, Conservative backbencher Charles Walker described having obsessive compulsive disorder for more than three decades, former GP and Tory MP Sarah Wollaston said she had had depression, post-natal depression and severe anxiety attacks, including suicidal thoughts, and MP, Andrea Leadsom, also recounted her post natal depression.

He said: “We are seeing significant reductions in discrimination and public attitudes are improving but very slowly.”

Angela Greatley, chair of the Tavistock and Portman NHS Foundation Trust, said there were three key areas for growth and development: parity of esteem, mental health care for people with physical health problems and talking therapies and their role in implementing the strategy.

“It is not seen in the same light as physical health care,” she said.

Dr Deuchar, a “one time service user and one time carer” called for service user and carer involvement in a “values-based” commissioning system with care plans predicated on strengths and capabilities and how people represent assets.

Carole Green, project director of the Care Pathways and Packages Project, said the key issue was accountability in commissioning.

Andy Bell, deputy chief executive Centre for Mental Health, stressed the need for early interventions to bring about better mental health.

John Hoar, director of business development at Cygnet Health Care, said he welcomed payment by results and added that the public now expects more as customers partly due to increased information from sources like the internet.

A number of people in the audience were able to ask questions and raise concerns. Tracey Simpson, from Community Options, said she was concerned about supported housing schemes not being regulated in any “way shape or form” and Philip King, director of regulatory development at the Care Quality Commission, acknowledged her concern.

813 words GarryWGibbs 11-07-2012

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