NHS and Health in High Peak – Question Time

New Mills Town Hall, Thursday 17 May 2018

Speakers:

Ruth George MP (Chair)

Dr Debbie Austin, Deputy Clinical Chair of North Derbyshire Clinical Commissioning Group

Craig Whyles, Service Delivery Manager at East Midlands Ambulance Service

Dave Williams, Deputy Director of Operations at East Midlands Ambulances

Dr Laura Halls, GP Partner at Arden House Medical Practice

Lucy Padkin, Practice Manager at Arden House Medical Practice

Rebecca Guy, Mental Health Practitioner and Unison Steward at Pennine Care

Dr Ian Bowns, Former Director of Public Health for High Peak & Dales PCT

You can watch the film of the meeting here: https://youtu.be/PBmzeSE09Qg

Introductory Remarks

 Ruth George MP

  • Many thanks to everyone who has attended tonight.
  • Whilst there is no obvious crisis here and now, I want to give a general idea about what is happening in our health services.
  • At the election hustings here a year ago I said I wanted our public services to be more open and engage more with people locally.
  • That’s the reason for this meeting and the recent High Peak Police meeting.
  • Our health services are under financial constraint, but staff working in it are doing the very best they can, often under huge pressure.
  • There is an increase in demand – partly due to our ageing population, which is good, but means there are more very elderly people needing care
  • There is also an increase in expectations from our health service.
  • After the speakers, I’d like to hear your concerns and suggestions for improvements and I hope we can have a constructive debate.

Dr Debbie Austin – North Derbyshire CCG

  • I have been a GP for 18 years and lived in this area for over 20 years.
  • A member of North Derbyshire Clinical Commissioning Group (CCG) for 5 years or so and now deputy chair.
  • I urge residents to come to the CCG’s open meetings where you can ask questions.
  • At these meetings we make decisions on how to distribute money fairly.

Craig Whyles, East Midlands Ambulance Service (EMAS)

  • Worked in Ambulance Services for the past 19 years, in Nottinghamshire, Lincolnshire and Derbyshire.
  • I am still a paramedic, and I enjoy responding to patients.
  • In Derbyshire, there are 17 stations and roughly 450 staff.
  • We have around 80 resources (ambulances, cars etc.).
  • Volunteers and Community First Responders (CFRs) are also vital.
  • EMAS are developing new systems including urgent care teams to deal with people who need attention, but it’s not an emergency.

Dave Williams, Deputy Director of Operations at EMAS.

  • Thanks for allowing us to be here – it is important to share what is happening with the public.
  • EMAS deal with a 999 call every 32 seconds.
  • I’ve worked in the NHS for 36 years, over 30 years in ambulance services.
  • Last winter was the toughest time I have seen whilst working in the NHS.
  • Staffing is a challenge. We are at least 295 staff short.
  • Yesterday (16th May), we agreed a new funding settlement with £20 million additional investment per year to bring in new staff.
  • This will allow us to deliver safer and more consistent services.
  • We are working with colleagues and communities to improve services.

Dr Laura Halls, Arden House Medical Practice

  • Demand has increased for health services for a number of reasons.
  • There are more ill patients coming home from hospital, and a lack of social care.
  • At the same time as this demand increases, I feel we are being asked to perform even more tasks.
  • As GPs, the buck stops with us. There’s a feeling we are being squeezed.
  • Our job is about managing demand, not the purse strings. It is about juggling, and determining the difference between need and want.
  • Staff and recruitment are real issues.

Lucy Padkin, Practice Manager at Arden House

  • Prior to my new role as Practice Manager, I was Community Care coordinator.
  • Over the last few years, there has been an increase in demand for social care.
  • There is no palliative care in this part of High Peak.
  • This is due to outsourcing. Care providers cherry pick where they cover, based on profitability.
  • Blythe House in Chapel-en-le-Frith is picking up a lot of those who need palliative care.
  • GPs and district nurses are facing an increase in pressure.
  • There is a challenge in balancing needs against availability.
  • My biggest worry is the lack of palliative care as people are left stuck in hospitals.

Rebecca Guy, Mental Health Practitioner and Unison Steward at Pennine Care

  • I have worked in mental health for 34 years.
  • I am based in Stepping Hill.
  • I have seen a decline of mental health provision during my career.
  • When it comes to sectioning, often there are not the beds available to section somebody, meaning we have to wait for weeks to be able do so. This is dangerous for the individual, and for those around them.
  • I also liaise with ambulances and police, and coordinating between these two can be difficult when both are under resourced.
  • As a steward for Unison, I deal with the considerable pressures that staff feel.

Dr Ian Bowns, Former Director of Public Health for High Peak & Dales PCT

  • I worked for Public Health until 2013 when it was transferred to the local authority from the NHS, such as preventable services.
  • Lack of resources in local authorities can mean that funding for public health services such as prevention is used for more pressing problems.
  • Some have stopped anti-smoking programmes and sexual health clinics – economic madness as problems must be dealt with later at greater expense.
  • I have worked for the World Health Organisation. Compared with other Western European Countries, we spend far less on health care and have far fewer Doctors.
  • It is important to recognise these problems. Recruitment and funding are major issues.
  • Life expectancy is not increasing at the rate it was five years ago and has started to decline for some groups (the elderly and poor).
  • The lack of social care means that people are stuck in hospitals who don’t need to be.

Ruth George MP

  • Thank you to the speakers and invite questions.
  • This includes social care as it is so connected to the NHS – cuts in one impact on the other, and I recently led a debate in Parliament on this.

Questions, comments and answers

 Ambulances

  • (1) Ex ambulance driver from Buxton – concerned about ambulance waiting times such as an elderly lady who waited 4 hours with a fractured leg and has since died.
  • Ruth George MP – Waits are a major issue that I heard about during my previous survey on health issues in High Peak. I have visited EMAS’s call centre, and been out with a crew from Buxton. I also led a debate in Westminster Hall on this issue in February. A funding increase of £20m a year has been announced this week for EMAS.
  • Dave Williams – I share your concerns. If anything, this case makes me more passionate, as it highlights the need for even more funding for our ambulance services. I am happy to look into this case offline in detail. Buxton ambulance station is still open, despite Derbyshire being under-resourced. The demand for ambulances has quadrupled, we are using new technologies to keep up, changes to staffing, and reforming the way we triage calls. We are on a journey, but trying to do things differently and more effectively.

Alternative medicines

  • (2) There should be a redesign of the health service, with the objective of preventing ill health. Alternative medicines provide an opportunity to save money.
  • (17) How does the NHS view complimentary therapies and alternative medicines? With an ageing population, there should be an emphasis on prevention, and there is a need to spread best practice in residential care.
  • Dr Debbie Austin – When it comes to other medicines, GPs have a whole system to monitor substitutes and check prices. The CCG cannot commission alternative medicines – every medicine which is commissioned must go through a very lengthy testing process. It must be good value – both in terms of clinical outcomes, and financial cost. Decisions on this are taken at a higher level in the NHS than at CCG. The importance of prevention is on the CCG’s radar, but the responsibility for this has moved to local authorities.
  • Dr Ian Bowns – The reason alternative medicines are rarely commissioned is due to a lack of scientific evidence that they are effective. There are massive variations in different treatment rates. There is a need for better information around the benefits and side-effects of different medicines.
  • Dr Laura Halls – For mental health, it is especially vital to get the preventative side right.

Orthopaedic footwear

  • (3) An orthopaedic footwear maker – concerned about the lack of progress on support, despite numerous reports on NHS commissioned footwear, all of which have broadly similar conclusions – if you spend initially, you will save substantially in the future. Concerned as to whether any panellists are aware of this problem.
  • Dr Debbie Austin – This is not an area that I know a great deal about. But alarm bells are ringing when I hear that the NHS is wasting money. I will look at this.

Mental health voluntary services

  • (4) Work in arts and health for High Peak Community Arts – running a programme on mental distress for eight years with funding from the Big Lottery. Wondering whether there is any way to increase funding in High Peak for such voluntary services.
  • Dr Debbie Austin – In the voluntary sector, there is a squeeze happening to funding. We are trying to work out where things can work better. I have been involved with multi-agency meeting of PLACEs, which hopefully will soon get its own budget.
  • Dr Laura Halls – This programme sounds great, but unfortunately limited resources means money is going to other places.

Side effects of medication for mental health disorders

  • (5) Side effects of medication for mental health disorders are worrying, and can foster dependency. Disappointed that Jeremy Hunt walked out on Labour during a recent discussion in House of Commons on special needs.
  • Dr Debbie Austin – There are side effects to many of the drugs we use. It is important that we ensure that communication between health care professionals and patients is more effective.
  • Dr Laura Halls – You should see your GP if you are experiencing side effects, but sometimes GPs have to weigh up the impact of the side effects against the impact of not taking the medication, and it’s the lesser of two evils.

Funding for the NHS

  • (6) The crux of the problem is that we should be looking to get more funding, and this will be possible only by paying more tax.
  • (7) Health spending as a % of GDP has reduced from 2010, from 9.6% to 6%. CCG’s are now told to moderate certain procedures, with a RightCare approach used.
  • Dr Debbie Austin – There is more funding going centrally, but funding is not everything. In the past, funding has been siloed. A lot of work is going on in the background, especially in relation to CAMHS (Child & Adolescent Mental Health Services).
  • Dr Laura Hall – In reference to RightCare – from my experience, this is used mainly for cosmetic procedures.
  • Lucy Padkin – My job is about rationing. The NHS cannot afford everything, so it is about finding value. There is a need for an honest debate on what the NHS can and should afford.
  • Rebecca Guy – Working in the NHS often feels like a balancing act due to limited resources.
  • Ruth George MP – North Derbyshire CCG is in a huge deficit through no fault of its own. Tax levels and funding levels for our health services are related. Since 2010 NHS funding has increased by 1.5% per year – Labour would put this up to 7% per year. It was at 8% under the last Labour Government.

Staffing and training in the NHS

  • (8) The number of nurses in training has decreased, as bursaries have been cut. Meanwhile, the number of agency staff, who cost more, has increased.
  • (9) Daughter is a nurse – she received support in training, but not since. NHS workers must be supported, since they see awful things.
  • (13) Had great experiences with NHS workers whenever I have dealt with them. The abolition of nursing bursaries would prevent me from being able to train to become a nurse. Immigrants make great contributions to our NHS, and an NHS Doctor from abroad saved a family member’s life.
  • (15) Student nurse – amongst the last intake of those who received a nursing bursary. Would not have been able to train without it or without her parents who she lives with and who help with her childcare.
  • Rebecca Guy – Working for Unison means that I see the difficulties regarding retention of staff first-hand. The employer has a duty of care, recommended NHS to take a TUC stress test if they were worried about their mental health. Stress faced by employees can be caused by targets, and their constant monitoring.
  • Ruth George MP – I wish I could bottle what has been said about the importance of trainee nurses receiving bursaries and take it to Jeremy Hunt. I think the Government know they are wrong, but they won’t admit it. I get correspondence from constituents from EU countries about the problems they now face from the Home Office and some are leaving. We are now facing shortages of health and care staff and can see how valuable the foreign nationals are who are working in our health services.

Privatisation within the NHS

  • (10) What are the implications to NHS staff and buildings when NHS contracts are transferred to the private sector?
  • (16) How hard do those at the CCG resist outsourcing? Concerned about privatisation, and shareholders being prioritised rather than service users.
  • Dr Debbie Austin – There are no plans for moving contracts to the private sector that I am aware of.
  • Rebecca Guy – Problems regarding privatisation are heightened in an urban setting, where certain services are cherry picked because they are more profitable. I know of one patient who was refused treatment at Stockport dialysis centre because he was seen as too high risk. I attend many meetings which are about targets, and not about clinical need. Plenty of NHS money is spent winning and retaining contracts – this is not the best use of clinicians’ time and skillsets.

 Local health services

  • (11) It is important to sing the praises of local health workers. Granddaughter had tonsillitis, called 111 and an ambulance came from Chesterfield, took us quickly to a medical practice where they received a diagnosis and antibiotics. By the time her parents came home, the child was already recovering.
  • (14) The out of hours service in New Mills saves A&E visits. Concerned about possible repercussions of Greater Manchester health devolution for High Peak. The rural nature of High Peak also brings challenges.
  • Dr Debbie Austin – The out of hours centre in New Mills is something that I am very proud to have been part of setting up, as it is doing excellent work.
  • Ruth George MP – I am meeting with Stepping Hill and with the Manchester Mayor regarding health services and transport between High Peak and Manchester.

NHS mental health services

  • (12) Daughter has autism. Has experienced the cuts to the NHS first-hand – to social care, paediatrics, and mental health. One year ago, her daughter had a breakdown and was suicidal. Couldn’t get an appointment with CAMHS, despite the GP’s pleas. She had to drive her child to Stepping Hill hospital whilst she was having a fit, where they could only offer her a crisis bed for one night since they are Derbyshire residents. One year later they are still without support, and her daughter is now out of school.
  • Dr Debbie Austin – Mental health is on the CCG’s radar – I would say roughly 60% of our consultations are about mental health issues.
  • Dr Laura Halls – CAMHS is a major health care concern. People are forced to go to private healthcare providers due to a lack of help from the NHS.
  • Rebecca Guy – There is not enough support for Asperger’s Syndrome and Autism services nationwide. In mental health, I feel that funding flips between different services depending on the flavour of the month. At the moment, the focus is on early intervention, but that means people with existing long-term conditions are not receiving support.

Concluding remarks from Ruth George MP

 Many thanks to all who have attended tonight.

  • Labour has committed to getting rid of the NHS and Social Care Act.
  • I share the concerns about many of the issues raised, such as competitive tendering and the lack of money on the frontline.
  • Bringing health and social care together is good, and it is positive to see this happening in Glossop.
  • I will have further conversations with the CCG’s after this meeting, especially regarding mental health issues.
  • Hopefully this meeting will help us work together – both between services, and across the local community.