Ministers and Civil servants on
the PFI gravy train
Alan Milburn, Health
Secretary from 1998 to 2003
Alan Milburn is listed in his declaration of members’
interests at the House of Commons as a director of
Covidien, which describes itself as “a $10bn global
healthcare products leader”. He is also a member of
Lloydspharmacy’s Healthcare Advisory Panel. Milburn is
an advisor to the European advisory panel of leading
private equity firm Bridgepoint, which specialises in
healthcare investments. Milburn declares his income from
these senior appointments as over £30,000 a year from
Bridgepoint; over £25,000 from Lloydspharmacy; nothing
listed for Covidien; and a further over £20,000 as an
advisor to Pepsico.
Charles Clarke Education
Secretary from 2002 to 2004 Home Secretary from 2004 to
2006
Charles Clarke a non-executive director of the LJ
Group, which supplies teaching materials and equipment
to schools and training services, including through the
Government Building Schools for the Future programme,
which Clarke initiated as education and skills secretary
in February 2004. Clarke is a consultant to KPMG on
public sector reform, for whom he wrote a booklet
promoting the use of co-payments – service user
contributions – to the NHS and other public services. He also advises Charles Street Securities investment
bankers/private equity fund managers. In addition,
Clarke is a consultant to Beachcroft LLP, a legal firm
that specialises in advising PFI/PPP deals.
Patricia Hewitt Health
Secretary from 2005 to 2007
Patricia Hewitt is now senior adviser to Cinven, a
private equity-backed private hospitals and healthcare
group (payment, over £55,000 pa). She is also special
consultant (payment over £45,000 pa) to AllianceBoots,
which is owned by private equity firm KKR. In addition,
Hewitt is a director of BT Group, which is
providingbusiness outsourcing, IT and telecoms services
to a range of public bodies. Hewitt established the
telecoms and media regulator Ofcom in an earlier job as
secretary of state for trade and industry and was in
charge of the National Programme for IT – in which BT
won one of the largest contracts – while secretary of
state for health. According to BT’s submission of
details to the US Securities and Exchange Commission,
Hewitt will be paid an initial £60,000, but with an
expected increase as she takes on more responsibilities,
in return for working at least 22 days a year.
David Blunkett Home
Secretary from 2001 to 2004 Education Secretary from
1997 to 2001 and Work and Pensions secretary in 2005
David Blunkett is now an advisor on business
development to A4e Ltd, for which he is entitled to be
paid at least £25,000 a year, but which (according tohis
Parliamentary declaration of interests) he has not yet
been paid. A4e describes itself as a “market leader in
global public service reform”.
Lord Warner Health Minister
from 2003 to 2007
Lord Warner had specific responsibility for reform of
the NHS – overseeing the introduction of more private
sector involvement. Since he stepped down from that role
he has taken on a directorship with UK HealthGateway and
is chairman of the Government Sector Advisory Panel for
Xansa plc – a leading provider of business outsource
services to public bodies and holder of the £1bn NHS’s
shared business service centre contract, providing
accounting and finance services to the NHS. Lord Warner
is also an advisor to Byotrol (a provider of micro
biological health treatments), Apax Partners Worldwide
(a private equity firm, with strong connections to the
Government and which has invested heavily in health
providers seeking contracts with the NHS), Deloitte (an
accountancy and consultancy firm, with large incomes
from government agencies) and DLA Piper (a legal firm,
which, like Deloitte, specialises in advising on private
contracting to the public sector). Lord Warner remains
influential within the NHS as chair of the NHS London
Provider Agency.
Hilary Armstrong secretary
of state for local government from 1997 to 2001 for the
Cabinet Office from 2006 to 2007
Hilary Armstrong has recently taken a position as
chair of wastecompany SITA’s advisory committee.
Nick Raynsford a Local
Government and Housing minister from 1997 to 2005
Nick Raynsford is now non-executive chairman of local
authority recruitment agency Rockpools PLC and of
Hometrack, a lettings service.
Ian McCartney Trade Minister from 1997 to 1999 and
again from 2006 to 2007
Ian McCartney is a senior adviser to the US Fluor
Corporation, an energy contractor that is believed to
have ambitions to win nuclear clean-up contracts in the
UK. McCartney is paid at least £110,000 a year for his
advice. The former Department of Trade and Industry had
responsibility for energy policy.
Stephen Byers Trade and industry secretary from 1998
to 2001
Stephen Byers is now non-executive chairman of water
treatment company ACWA and Ritz Climate Offset Company.
Richard Caborn Trade minister from 1999 to 2001
Richard Caborn is now a consultant to AMEC assisting
them with their work in the nuclear industry. His
payment for this is at least £70,000 a year. He is also
a former sports minister and now a consultant to the
Fitness Industry Association, for which he is paid at
least £10,000 a year.
Brian Wilson Energy minister from 2001 to 2003
Brian Wilson is now a non-executive director of AMEC
Nuclear and is UK chairman of the renewables company,
Airtricity.
Stephen Ladyman transport minister from 2005 to 2007
Stephen Ladyman is now an adviser to It is Holdings,
a company selling traffic information, for which he is
paid at least £10,000 a year.
Frank Field welfare reform minister from 1997 to
1998
Frank Field is now a director of Medicash, which
operates a healthcare cash plan.
Sir Michael Barber former head of the Prime
Minister’s Delivery Unit
Michael Barber oversaw public sector reforms in
health, education, transport, policing, the criminal
justice system and asylum/immigration. He is now the
expert partner in consulting firm McKinsey’s Global
Public Sector Practice.
Baroness Sally Morgan
Sally Morgan was a close aide to Tony Blair when he
was Prime Minister and she was director of government
relations in Downing Street and subsequently was made a
minister and a member of the House of Lords. She is now
a director of the largest care home operator in the UK,
Southern Cross, which has expanded substantially as a
result of government reforms to the structure and
funding of social care. She is a member of the advisory
panel of Lloyds Pharmacy, which is expected to bid for
contracts under the Department of Health's £1.25bn Alternative Provider Medical Services programme.
Morgan is also a director of Carphone Warehouse.
Sir Gerry Loughran
Sir Gerry Loughran was head of the Northern Ireland
civil service from 2000 to 2002. After retiring he took
on a number of private sector directorships. These
included Phoenix Natural Gas, which is owned by the
Terra Firma private equity firm, and he soon became chairman upon joining the board. While a senior civil
servant, Loughran chaired the Strategy 2010 project,57
to sell and leaseback the civil service property
portfolio. After leaving the civil service, Loughran
became a director and chairman of Partenaire, where he
led the company’s (unsuccessful) bid to win the £2bn
Workplace 2010 contract that resulted from Strategy
2010.
Lord Wilson of Dinton
Lord Wilson of Dinton was, as Sir Richard Wilson,
head of the Home Civil Service and secretary to the
Cabinet – as such he had the overall responsibility for
seeing that the Prime Minister’s policies on public
sector reform were carried out. He was afterwards
appointed a director of Xansa (now part of the Steria
group), one of the main providers of business process
outsourcing services to the public sector.
Lord Turnbull
Lord Wilson’s successor as head of the Home Civil
Service was Sir Andrew Turnbull, now Lord Turnbull. Lord
Turnbull’s current directorships include British Land
(active in the PFI/PPP market), Prudential (also active
in the market) and Frontier Economics (which advises
private sector clients on public sector reform).
Turnbull is also chairman of Brevan Howard Global, an
investment management company.
Sir Peter Gershon
Sir Peter Gershon was brought in by The Treasury in
1998 to reduce government expenditure and improve
efficiency – he conducted a series of reviews in the
period to 2004. He became a civil servant in 2000 as
founding chief executive of the Office of Government
Commerce. Sir Peter is now executive chairman of Vertex,
one of the largest suppliers of business outsourcing
services to the UK public sector. He is also
non-executive chairman of the General Healthcare Group,
the largest private healthcare group in the UK – owned
by the private equity group Apax Partners and the South
African healthcare company Netcare, which has ISTC and
other supply contracts with the NHS. In August 2008 Sir
Peter completed a review of ICT procurement policy for
the Australian government.
Chris Woodhead
Following his period as chief inspector of schools,
Chris Woodhead set-up the Cognita group of independent
schools, using funds supplied by a private equity firm,
Englefield Capital.
Sir Steve Robson
Sir Steve Robson was one of the most controversial
senior civil servants of recent years, who oversaw the
privatisation of British Rail on behalf of Sir John
Major. Robson went on to become second permanent
secretary at HM Treasury until he retired in 2001.
During his earlier career, he was seconded to 3i while
remaining a civil servant. He oversaw the Government’s
policy on PPPs while serving the current Government at
the Treasury. Since retiring, Sir Steve has been a
director at Partnerships UK, JP Morgan Cazenove (a
global bank), Xstrata (a mining group) and the Royal
Bank of Scotland (one of the leading investors in PPPs)
and is a member of the Chairman’s Advisory Committee at
the accountancy and consultancy firm KPMG (a leading
adviser to PPP and PFI schemes).
Simon Stevens
Simon Stevens was Tony Blair’s health advisor within
10 Downing Street and, with Alan Milburn, was the key
architect of the NHS reform programme. He is now
chairman of UnitedHealth UK, which has won contracts
with the NHS to manage and advise primary care trusts.
The company’s executive director, previously chief
executive, was, until late 2007, Dr Richard Smith, a
former editor of the British Medical Journal. He is now
working for UnitedHealth in the US.
Tom Granatir
Another US-based healthcare group with serious
aspirations in the UK is Humana Europe. Its director of
policy and research in the UK is Tom Granatir, who was
seconded for six months to the NHS in its Health
Inequalities Unit and was then seconded on a separate
assignment with the influential health think-tank, the
King’s Fund.
Darren Murphy
Darren Murphy
was a special advisor to Prime Minister Tony Blair from
May 1997 to September 2005. After a period as head of
government relations and external affairs for
AstraZeneca UK Murphy became managing director at the
London office of lobbying firm APCO whose clients
include most of the private healthcare firms bidding to
run Independent Sector Treatment Centres.
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New Continuing Care webpage
click here
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Camden Community Mental Health
SUMMARY OF REPORT:
This report summarises research carried
out in April and May 2008 in response to
concerns from Councillors that some
people with mental health conditions
living independently in the Council’s
housing estates were not being provided
with adequate support from statutory
services, and that nuisance to
neighbours can occur as a result.
click here
At a meeting of HOUSING AND ADULT SOCIAL CARE
SCRUTINY COMMITTEE held on TUESDAY 27th MAY 2008 at
7.00 p.m. in Committee Room 4, Town Hall, Judd
Street, London WC1H 9JE.
COMMUNITY MENTAL HEALTH SUPPORT SERVICES - EVIDENCE
The Committee considered the report of the Director
of Housing and Adult Social Care introduced by
Rebecca Harrington, Assistant Director, Strategic
Planning and Joint Commissioning. Also present for
this item were Councillor Martin Davies, Executive
Member for Adult Social Care and Health, Councillor
Kirsty Roberts, Mental Health and Substance Misuse
Champion, Colin Plant, Camden Mental Health Trust
and Shirley Scott-Norton, Camden Mental Health
Consortium.
click here |
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New blow for NHS
e-record system Health
correspondent, BBC News
The
programme will revolutionise the way
patient records are stored
Plans to computerise the NHS in England
could face further delays after a
contract with a key supplier was
terminated, the BBC has learned.
The IT
programme, which is already four years
late, will create a single electronic
records system for patients. But
negotiations have broken down with
Fujitsu, who had been due to implement
the plan in the south of England. The
Department of Health said an agreement
over Fujitsu's contract could not be
reached. The estimated final overall
cost of computerising the
NHS in England is currently £12.7bn.
RFH went live 16/06/2008 resulting in
long outpatient queues to register at
clinics and computer crashes. Everything
at the moment is having to be written
down as well. This is quite normal
for change over of computer systems and
should 'bed down' over the next few
weeks.
click
here |
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click here
Legislation:
Local involvement networks: referrals of social care matters (1)
Subsections (2) to (5) apply where a local involvement network
refers a matter relating to social care services to an overview
and scrutiny committee of a local authority.
(2) The committee must—
(a) acknowledge receipt of the referral; and
(b) keep the referrer informed of the
committee’s actions in relation to the matter.
(3) The committee must decide whether or not any of its powers
is exercisable in relation to the matter referred.
(4) If the committee concludes that any of those powers is
exercisable in relation to the matter,
the committee must decide whether or not to exercise that power
in relation to the matter.
(5) The committee, in exercising any of those powers in relation
to the matter, must take into account any relevant information
provided by a local involvement network.
(6) The Secretary of State may by regulations make provision as
respects determining the time by which a duty under subsection
(2)(a) is to be performed.
It is interesting to note that the Act only
talks about referrals of social care provision but not
healthcare. We have taken advice on this and have been told that
there is nothing to stop the LINk referring healthcare provision
concerns to the HSC.
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LINk involvement
in local authority commissioning.
Email to Camden Council PPI Lead
18/02/2008,
Can you please advise what
arrangements the Council are putting in place to involve the
Interim LINk in commissioning decisions from the 1st of April.
regards,
Neil Woodnick
“LINks will also be able to focus on
LINk-wide commissioning issues at a primary care trust (PCT) and
local authority level.” - Getting ready for LINks - Planning
your Local Involvement Network
Response:
Dear Neil,
Thank you for your enquiry.
There are various work streams going
on towards the organisation of
transitional arrangements and the
interim host support to LINk
activity between April and September
08. Once we have clarity about the
interim host we anticipate there
will be discussions about what
activity the interim LINk wishes to
prioritise and how that might
happen. The arrangements for
involving the interim LINk in
commissioning decisions at a PCT and
LA level will be part of that.
As you know we have a current audit
of user/carer and VCS engagement in
joint community health and social
care
commissioning. We also have the
summaries of key points for the
Direction of Travel for community
commissioning intentions 2008-09 and
will be able to provide details of
the range of commissioning group
work taking place. Along with
internal work going on with
colleagues to prepare for the LINk
we see these as part of key
preparation work.
There is a communications process in
place for keeping people (public,
patients, users and
carers and VCS) as well as Council
and NHS staff informed of progress.
We are planning a series of
communications so will be in touch
soon to update you and others on
progress.
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Visiting health
and social care premises.
The role of LINks to to review & monitor a range of the services
by both Health & Social Care Providers (Public/Private & joint
funded) the area of inspection is the preserve of the
Inspectorates HC/CSCI/Ofsted/MHCA.
Of course such visits to children residential services are
excluded ( Social Care).
cLINk will need to engage with
the local authority to develop a template in order to carry out
its function. After 01/04/2008 cLINk should present its
Constitution/Governance arrangements to the council's Adult
Community Care Committee.
But before all that it will require name badges ( issued by the
Local Authority), and CRB checks as required by the LINks
regulations; therefore there is still plenty to do before cLINk
will be able to monitor and review services commissioned for
adults by both Health &
Social Care
Commissioners.
The LINk can visit care homes whether public or private, these
arrangements are for the Local Authority to inform the private &
independent providers of care homes in the area, so visiting
teams will need to check that this has occurred. One concern
would be that pre-notification of a visit could greatly change
what is viewable or show the premises as a more favourable
environment than residents normally enjoy. Therefore it is
necessary to discuss with the Council if it would be possible to
write in an 'emergency inspection' procedure into the viewing
arrangements. It should be anticipated that the Council may
respond that these situations are better dealt with by the
statutory inspectorates.
Viewing social care premises is going to prove far more
challenging to set up than PPI Forums inspecting NHS premises.
Legislation for
viewing
Arrangements for authorised representatives for the purposes of
entering and viewing
3.—(1) The requirements referred to in regulation 2(1)(e) are
that a local involvement network must—
(a) have and publish a procedure for the making of decisions by
the local involvement network about who may be an authorised
representative;
(b) if any amendments are made to the
procedure referred to in sub-paragraph (a), as soon as
practicable publish the procedure as amended;
(c) comply with the procedure referred to in sub-paragraph (a)
as may be amended from time to time;
(d) maintain and publish a list of individuals authorised by
that local involvement network as authorised representatives;
(e) provide each authorised representative with written evidence
of that individual’s authorisation; and
(f) ensure that only an individual to whom paragraph (2) applies
may be an authorised representative.
(2) This paragraph applies to an individual if–
(a) a criminal records certificate under section 113A of the
Police Act 1997(10) has been obtained in respect of that
individual;
(b) a person nominated by the local involvement network
(“nominated person”) has considered that certificate; and
(c) the nominated person is satisfied that the individual to
whom that certificate refers is a suitable person for the
purposes of entering and viewing, and observing the carrying-on
of activities on, premises owned or controlled by a
services-provider.
(3) For the purposes of paragraph (2), the nominated person must
not be the individual to whom the certificate refers.
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THE MAIN ROLE OF PCT's
click here
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IS THE PUBLIC INVOLVED IN THE
ACCOUNTABILITY OF PCTs?
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Apportionment of the grant to
Camden Council for the LINk
From: neil woodnick
Sent: 29 June 2008 15:55
To: Stokes, Dean
Subject: RE: LINk budget allocation meeting 20/06/2008
Thank you Dean for your co-operation in defining the apportioning of the
grant in respect of the cLINk.
I think it was a necessary exercise at this early stage of the LINks’
development in order to ensure that there is no confusion in the future.
Could you please consider forwarding this email to those organisations
who are Tendering for the HOST so that they are fully aware of our
understanding in this matter.
regards,
Neil
p.s. do you have any objection to this email going on to my website ?
From: Stokes, Dean
Sent: 29 June 2008 15:40
To: neil woodnick
Subject: RE: LINk budget allocation meeting 20/06/2008
Dear Neil,
Belatedly thanks for coming to the Town Hall on 20 June.
Your points 1) and 2) are in line with our discussion.
I would just add on point 3) that the four categories identified below
seemed to usefully capture the distinct aspects of LINk funding; in
particular the point that a proportion of the funding will be spent by
the LINk, as opposed to the host. We noted the fact that VAC as
transitional LINk host have broken down the budget in this way and that
the approach VAC has taken in this respect is working well.
I hope this is helpful.
Regards,
Dean
From: neil woodnick
Sent: 20 June 2008 17:29
To: Stokes, Dean
Subject: LINks budget allocation meeting 20/06/2008
Dear Dean,
Could you please confirm that you are in agreement with the points I
have detailed below as a result of our meeting this morning.
1. that Camden Council (LA) recognises the value of public and
patient/carers involvement (PPI) in health and social care in the
Borough and fully supports the mandate of the Camden LINk to monitor
these services and work with Providers/Commissioners in order to
guarantee the highest possible service level delivery to residents
within a context of ensuring value for money.
2. That the LA will endeavour to ensure that grant money recommended to
be used for PPI by the DoH over the next 2.5 years will be maintained
for this purpose.
3. that the HOST will have the grant money allocated into 4 different
categories:
a. LA – to pay for the monitoring of the Contract by the LA
b. CORE – items such as salaries, office rental etc that the HOST incurs
in its role of administrator of the LINk
c. DISCRETIONARY- monies that will be spent with the approval of the
LINk Steering Committee i.e. advertising, public meetings, education etc
d. CONTINGENCY - the balance of the money after a),b) and c) are
allocated in order to provide extra support to the LINk e.g. hold
additional public meeting , employ a specialist community engagement
company to advise on recruiting from ‘hard to reach’ groups etc
Thank you for addressing our concerns regarding the allocation of the
grant.
regards,
Neil/Arthur
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Mental Health
Liaison Meeting 13/11/2008
Service User Jason
Roberts stated that Councillor Kirsty Roberts who is the local
'champion' for mental health patients was an employee of the
Camden & Islington Mental Health Foundation Trust (MHFT).
Councillor Roberts denied that she worked for the MHFT stating
that she received a small payment from the Trust to support her
mental health work. It is alleged that the small grant amounts
to £8,000 per year.
Councillor Roberts register of interests
(click here)
At a recent meeting of the Housing & Adult
Social Care Scrutiny Committee Councillor Roberts represented
patients by questioning Colin Plant MHFT Borough Director
regarding the proposed changes for Highgate Day Centre.
Jason Roberts stated
that the Highgate Day Centre consultation was flawed because
service users were not offered the option of 'no change'
which was the preferred option of most patients at the unit.
The subject of
patients personally controlling their support grants was
presented. The money is paid directly in the patients separate
bank account and they are responsible for paying the Provider. A
service user described how he chose to spend the money booking
recording studio time and paying musicians to play his music.
This therapy has considerably helped the patient recover from
his Mental Health problems.
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cLINk meeting 14/11/2008
A new Interim Steering Committee for the next 6
months was appointed and a democratic election will take place in Summer 2009
to vote in a substantive Steering Committee. Arthur Brill
was voted Chair and Neil Woodnick (who went to the
meeting with a firm resolve not to volunteer for anything)
Vice Chair and Steering Committee member.
Jilia Bond from the
Shaw Trust advised that they now had an office in Camden and
were currently mapping the numerous Public & Patient Involvement
(PPI) organisations in Camden in order to support community
engagement.
Neil Woodnick
complained to Niam McAleer (PPI Lead Camden Council) that
Council staff were deliberately blocking the cLINk in taking a
place at the Joint Needs Strategic Assessment meetings.
The next Steering
Committee will be held in Public on the 27th November 2008
at the Charlie Ratchford Centre at 4pm.
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Sweeping changes are to be made to the regulation of Britain's
13,900 care homes, including a new complaints system and tougher
inspections for large private operators, The Times has learnt.
Elderly people and their families, who pay for care, will soon
be able to take grievances to the Local Government Ombudsman,
whose office currently investigates complaints against local
authorities over school admissions, housing and social services.
So-called self-funders, who make up almost half of the 440,000
care home residents in Britain, have been clamouring for a new
complaints system to be set up after ministers made clear that
the current regulator, the Commission for Social Care Inspection
(CSCI), could not take on this role. This has left self-funders
with nowhere to turn when disputes arise with care home
managers, who can ask residents to leave when families pursue
complaints.
Experts say that this loophole must be closed if standards of
care are to rise when the new “super-regulator” begins
scrutinising 2.8 million staff in the NHS, local authorities and
the private sector next year. The Care Quality Commission (CQC)
will absorb the CSCI into the Healthcare Commission, and the
Mental Health Act Commission, which regulate health and
psychiatric care, in April. Baroness Young of Old Scone, the
chairman of the new watchdog, told The Times that large private
companies that run many hundreds of homes will have to be
registered as a group so that the most senior company managers
can be held to account. The CQC is also promising a tougher
inspection regime for homes and hospitals and penalties
including fines or deregistration for those providers that fail
to provide expected standards of care. Inspectors say that often
the same problems crop up in a number of homes owned by the same
private provider, and there is currently no mechanism to force
the company to take action. All homes are currently registered
individually.
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SUMMARY OF REPORT
This briefing sets out Camden’s Adult Social Care
Service’s response to the developing agenda around
“personalisation” in public services, the key drivers nationally
and locally, with specific reference to the development of Self
Directed Support in Adult Social Care. It also sets out the
progress already made in putting in place the foundations for a
more personalised and responsive Adult Social Care service.
click
here
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PCT Spending: Some Facts
Ealing PCT spends just 47 per
head on cancer treatment while Knowsley PCT spends 118. West
Kent PCT spends 98 per head on mental health while CamdenPCT
spends 297.
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CARERS AND PRIMARY CARE SERVICES IN CAMDEN
At a meeting of the CARERS
LIAISON GROUP held on Tuesday 26th February 2008 at 11.30am
at The Salvation Army Chalk Farm Centre, 10-16 Haverstock Hill,
London, NW3 2BL.
There was a joint presentation by Karen Timperley and Claire
Wheeler.
The meeting was informed that there were approximately 15,000
adult carers in Camden, who provided care and support to adults
or children who were frail or had physical or learning
disabilities, mental ill health or alcohol or drug dependency.
The care that carers in Camden provided had been estimated to
be equivalent to £207.7 million a year but there were often
implications for the health and wellbeing of the carers
themselves.
Camden Carers Centre had received funding from the Neighbourhood
Renewal Fund (NRF) since 2004 for a post that would look at
carers health needs, increase awareness of carers needs
generally and carry out development work with GPs. While they
were successful in supporting carers own health needs, they were
less successful in their development work with GPs. NRF funding
for the post expired in August 2007 but Camden PCT had agreed to
fund the post on a permanent basis from April 2008
The PCT also decided to divert some of the funding to create the
post of Training Services Co-ordinator who would address the
training needs for carers. As part of this the worker will be
developing a network of organisations that can provide training
and courses for carers..
The Camden Carers Strategy was approved by the Councils
Executive on 12th December 2007. This was a multi-agency
strategy including inter alia all Council departments, Camden
PCT, and the Camden and Islington Mental Health and Social Care
Trust. The strategy sought to build on an earlier initiative and
respond to the expressed wishes of carers:-
· to be respected and
treated as an integral part of the caring process,
· to increase their
profile and
· to increase overall
awareness of carers needs.
It was acknowledged that carers in Camden working 20 hours a
week or more were most likely to experience health problems,
particularly emotional distress which often continued long after
their requirement to carry out caring duties had ceased. Many
others complained of back pain and depression.
Attention was drawn to sheets of paper, which had been left on
the tables around the room. Carers were invited to write down
their top three wishes that they wanted from Primary Care. The
information would then be taken, evaluated and rolled out across
Camden.
At this stage, the following questions were asked, responses
given and points made:-
Q. Carers wanted to flag up the point made earlier that carers
attending hospital had limited time due to their caring
responsibilities. This should be officially recognised by
hospital authorities and provision should be made accordingly.
Q One carer reported problems with Care Line. He had dialled the
number on the Carers Emergency Card but had received no
response. Also, the respite care system was not working as well
as it should.
A. Problems with Care Line were already being addressed.
Emails had been exchanged with Care Line management and a
meeting with Care Line management had been arranged to discuss
the various problems being experienced. The Carers Emergency
Card was being reprinted for promotion across London in April
but this would not take place until it was guaranteed that the
system was working properly. In the meantime, carers were
assured that Karen Timperley had this in hand.
Action By:- Karen Timperley
Q. One carer stated that she did not know about the Carers
Emergency Card.
A. Previously the Local Authority and the PCT relied on GPs to
inform carers of primary care and other services available for
them. Information for carers was currently a big issue, which
was being addressed. PCTs were more aware of the needs of carers
and more projects were being looked at during the commissioning
process with carers in mind.
Q. Would specialist district nurses be appointed?
A. If carers wanted them, they should put this on their wish
list and officers would take this forward.
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From The Times June 27, 2008
Mentally ill are 'jollied along' rather than treated by
psychiatrists
People suffering from mental illness are frequently being
misdiagnosed or receiving inadequate treatment, according to a
group of leading psychiatrists.
The doctors say that patients with serious problems are often
referred to psychologists and social workers rather than
clinicians and do not receive the medical therapies they need.
“Treatment is often little more than jollying people along,”
said Professor Nick Craddock, of the Medical School at Cardiff
University, one of 36 signatories of a letter published today in
the British Journal of Psychiatry.
“If a GP suspected a patient had cancer, he wouldn't dream of
referring him to anybody other than a cancer specialist. A
cancer patient might need jollying along, but what he really
needs is the correct diagnosis and treatment. That's what he
gets from a specialist. But patients with mental illness are not
automatically referred to psychiatrists. If they only see a
social worker, there's every chance that mental illness, or
underlying physical illness, will be missed. Patients are
getting a bum deal.”
Describing their letter as a “wake-up call” to British
psychiatry, the psychiatrists say that the desire not to
stigmatise people has also done damage by implying that there is
no such thing as mental illness. Patients are now known as
“service users” rather than patients — even though, when asked,
67 per cent preferred the word patient and only 9 per cent
service user. Treatments are provided at “mental health”
centres, not mental illness clinics.
Psychiatry, the group says, is the only medical speciality to
adopt an approach that so distorts its original purpose. “For
those with severe mental illness, to avoid medicalisation is at
best confusing and at worst damaging or even life-threatening
... these individuals are being let down by the current state of
affairs.”
The changes came about under a scheme, New Ways of Working,
established in 2005. GPs now refer patients with symptoms of
mental illness to a team of up to eight people, which will
include psychologists, nurses, social workers and a
psychiatrist.
There is no guarantee that the patient will be seen by the
psychiatrist, the only doctor on the team. The psychiatrist, a
clinician with a medical qualification as well as higher
training in psychiatry, is the only member of the team able to
diagnose mental or physical illness with any certainty. The
result, says Professor Craddock, is that patients may be
prescribed “psychosocial support” rather than medical treatment,
only to find in six months' time that they have a treatable
mental illness for which they could have been prescribed drugs
or behavioural therapy.
Physical illnesses that may underlie a mental condition include
thyroid disorder or, less commonly, cancer of the brain.
Professor Craddock and his co-signatories are not claiming that
psychosocial treatments do not have a place, but they claim it
is vital that patients are seen by a psychiatrist first.
“Psychiatrists may not be the best people to deliver treatments,
but they are the best to make assessments,” Professor Craddock
said.
Professor Sue Bailey, registrar of the Royal College of
Psychiatrists, said: “We are in the process of finalising the
development of a questionnaire for our members that will tease
out key issues, and tell us where New Ways of Working is working
well and where there are challenges.”
A spokeswoman for the Department of Health said: “The
introduction of New Ways of Working has been widely welcomed by
service users, carers and psychiatrists. Working with
multidisciplinary teams has allowed the needs of people who use
mental health services to be better met and frees up
psychiatrists' time to work with more complex clinical cases.”
Extent of the problem
— 14,863 deaths were caused by mental health disorders in
Britain in 2006
— 25 per cent of people experience mental health problems each
year
— 29 per cent of women have been treated for mental health
problems, compared with 17 per cent of men
— 10 per cent of children under 15 have a mental health disorder
— 20 per cent of older people suffer from depression
— 400 people in every 100,000 in Britain self-harm
Source: www.mentalhealth.org.uk
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"Public & Patient
Involvement is promoted as a means of improving and modernising
the NHS in the interests of patients - but it seems to be
motivated more by political considerations about connecting with
a disenfranchised electorate"
Public and patient involvement (PPI) is a
relatively new aspect of healthcare. On the surface it seems to
be progressive - enabling people who use the NHS to have a say
in the way that it is planned and delivered, and supporting
professionals to achieve this aim. When you scratch beneath,
however, the picture is more complicated. In fact, the PPI
agenda seems to have created more problems than it has solved -
and does not benefit patients, the public or healthcare
professionals.
It sets out to address what the government perceived to be the
major problem with the NHS - a lack of openness, with patients
kept at arm's length by over-powerful professionals
(particularly doctors) - as well as to respond to growing public
expectations of the service. This is said to reflect a radical
change in the way that the government attempts to engage with
people on the issue of health, improving healthcare by the
creation of a dynamic, consumer-driven health service, with
patients at its heart and choice and personalised care the order
of the day.
PPI is promoted as a means of improving and
modernising the NHS in the interests of patients - but it seems
to be motivated more by political considerations about
connecting with a disenfranchised electorate than it is by
health priorities or public demand for change. The consequences
are likely to be a further undermining of trust between health
professionals and patients, and an added strain upon the
relationships between health professionals, who will find
themselves pitched against each other.
Extract from an article by a London PCT PPI Lead written in 2004
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Local organisations and partnerships who work with the cLINk
 .
click here
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8. YOUTH VIOLENT CRIME
DEBATE
Consideration
was given to oral evidence on youth issues affecting the Somali
Community from Abdulkadir Ahmed, a Youth Worker from the Somali
Youth Development Resource Centre, and Mohammad Hassan, Director
of the Somali Development Trust.
click here
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The Changing Workforce Programme
of the NHS Modernisation Agency is
planning the development of a new category of
health professional. Originally to be called a
‘physician practitioner’, the name has now been
changed to ‘medical care practitioner’,
though why this is felt to be less misleading is
unclear. The idea is derived from the US model
of physician assistants but has been given a new
title. It is very difficult to understand the
renaming other than as an attempt to deceive the
public. Both proposed titles imply that the
person is a doctor, a practising physician who
will deliver medical care, whereas the proposal
is that ‘medical care practitioners’ will be
science graduates with only 2 years further
training. Those in charge of this development
anticipate that these new health professionals
will be able to function at the level of a
senior house officer (who has, at that stage had
8 years of dedicated medical training). Further,
‘medical care practitioners’ are described as
having ‘the skills and knowledge base to deliver
60% of the generalist treatment within … [a]
general practice team’.
Over the
last 40 years, general practitioners (GPs) have
demonstrated, through their enthusiastic pursuit
of the development of multiprofessional primary
healthcare teams, that patient care is
strengthened and enriched by different
professional perspectives and that it is
possible, and indeed desirable, to delegate a
large range of healthcare tasks away from GPs
themselves. However, the core GP task of
providing a first-line medical diagnostic
service, without recourse to excessive,
unnecessary, and potentially harmful
investigation and referral, is not one that can
be delegated to anyone who does not have a full
undergraduate medical and postgraduate GP
education.
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Cancer
sufferers will still
end up footing large bills that
most people would now expect to
be covered by the NHS - costs
that occur as a result of the
private treatment, such as blood
tests and scans.
A
Department of Health
spokesperson said: 'Patients
will have to pay for all
additional care, not routinely
provided by the NHS, including -
if the patient has purchased
additional drugs - the cost of
administering medication and
blood tests. Where additional
private care has predictable
side effects, the cost of these
will be met by the patient as
well. The NHS will not subsidise
private care.'
Cancer Patients Lose Chance of
Longer Life as U.K. Curbs Costs
Nov. 17 (Bloomberg) -- Jack
Rosser's doctor says taking
Pfizer Inc.'s Sutent cancer drug
may keep him alive long enough
to see his 1-year-old daughter,
Emma, enter primary school. The
U.K.'s National Health Service
says that's not worth the
expense. Rosser, 57, was told
the cost of Sutent, £3,140 per
treatment for his advanced
kidney cancer, was too high for
the NHS -- the government agency
that funds the nation's health
care. The resident of the town
of Kingswood, in southwest
England, has appealed the
decision twice, and this week
may find out if his second plea
is successful.
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The Guardian,14/11/2008
Patients get poorer healthcare in
Britain than
in the former Soviet republic of
Estonia where services are provided
for a fraction of the cost,
according to a league table of 31
European countries published
yesterday.The Euro Health consumer index,
compiled
by a Brussels-based Swedish research
institute, shows that the
Netherlands and Denmark have the
most consumer-friendly healthcare
systems.
Britain's NHS is ranked 13th, two
places
below Estonia and one above Hungary.Johan Hjertqvist, the president of
the Health Consumer Powerhouse,
which has been compiling the annual
index since 2005, said:
"The UK's improvement in patients'
rights and information should be
applauded. However access - for both
waiting times for treatment
and uptake of modern drugs - remains
a problem."
That claim provoked a furious
reaction from
Alan Johnson, the health secretary.
"This
report is not anchored in any
reputable
academic or international
organisation. It uses flawed
methodology and old data. It is not
in the same category as the
respected Commonwealth Fund report."
The fund will today publish its
rankings that
show the NHS offers better access to primary
care than healthcare systems in
seven other leading global
economies,
including the US, and is one of the
most cost effective.
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Discharge procedures at RFH &
UCLH
This
report notes the arrangements that are in place
to ensure effective discharges from hospital for
people requiring support from Camden Adult
Social Care and actions taken to ensure
continuous improvement.
click
here
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No
more antibiotics, doctors told.
Doctors are to be
told by the National
Institute for Health and Clinical
Excellence (NICE) that they must stop prescribing antibiotics
to patients suffering from minor ailments in a bid to halt the
development of
drug-resistant infections. Under new NICE guidance, doctors must recommend other forms of
recovery from
ear infections, sore throats, tonsillitis, colds,
sinus infections, coughs and bronchitis, such as staying at home
and resting for the course of the ailment or prescribing
painkillers.
The Government launched a £270m ad
campaign yesterday to warn
patients that
coughs and colds are not curable with drugs
and
that instead using antibiotics and the like can lead to the
spread of superbugs such as MRSA or Clostridium difficile.Up to 38 million prescriptions were written
by GPs last year,
with two-thirds of all
antibiotic scripts being written for
respiratory illnesses.
Extract from
'Buckeye Surgeon Blog'
Antibiotic Nazis
This was quite interesting. I operated on a little girl the
other night for a perforated, gangrenous appendicitis. Laparoscopically, I removed the nasty little bugger and washed
out her entire peritoneal cavity with liters and liters of
irrigant fluid. [On a faintly related
tangent, I still can't
believe anyone is routinely doing open appendectomies anymore.
Only laparoscopy allows you the capability to drain and lavage
the peritoneal cavity for complicated appendicitis]. The next
day, she looked remarkably better (normal WBC
count, afebrile, etc) but I usually keep kids in the hospital
for a few days for IV antibiotics, especially for perforated
appendicitis. As I reviewed her chart, I noticed that her Zosyn
had fallen off the
med list. I asked the nurse
and she replied that "pharmacy had
called earlier notifying that they were terminating the IV
antibiotics 24 hours post surgery."
At this point my jugular vein started
throbbing in my neck and
my face turned a
deep shade of Buckeye scarlett. Why was
pharmacy unilaterally cancelling my antibiotic orders and making
crucial decisions on the
care of my patient?
Here's the deal. My hospital has now implemented a policy of
limiting unnecessary
use of antibiotics by giving the pharmacy
the power to cancel antibiotic orders that extend 24 hours past
a patient's surgery date. On the surface, it seems like a
reasonable policy. Unnecessary courses of antibiotics have
certainly contributed to the preponderance of such modern
dilemmas as widespread
MRSA infections and toxic megacolon from
C Diff colitis. And surgeons who lazily/
carelessly forget to
cancel prophylactic
operi-operative antibiotics are certainly
much to blame. But there's a difference between antibiotics for
prophylaxis versus antibiotics
for the treatment of an
infectious process.
For perforated appendicitis, I'm not giving
Zosyn to reduce my rate of superficial surgical site infections,
but rather to actually
treat an established, complicated
infectious
disease.
I spoke with the lead ID pharmacist and he was cool and
apologetic about the misunderstanding. But the policy remains
unchanged. It is now the surgeon's obligation to write in the
post op orders "antibiotic to
be continued post operatively for
X-disease process (appendicitis, diverticulitis, peritonitis,
etc)"
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Extract from Minutes of Health Scrutiny Meeting
June 2008
June Swan, Secretary of the Camden( Neighbourhood
Association, had been
invited to give evidence and
she explained how her members felt about the new GP
contact at Camden Road. She explained that she had
also spoken to people who were working at the
surgery. She indicated that patients, particularly
elderly patients, were most unhappy. The Camden Road
practice had been in existence for many years and
patients were used to making an appointment to see
their own doctor who knew them and their medical
history. A doctor who had been there for 18 years
had not been kept on and two nurses had left.
Patients were worried that a private company with no
previous connection to the area would destroy the
continuity that patients found so reassuring.
Patients were also worried that the Practice might
soon not exist and they would finish up having to
travel to the UCLH when they needed medical
assistance. Liz Wise (Camden PCT) commented that she was
concerned to hear that people were saying that they
might have to go to UCLH. She explained that all
staff had been transferred to United Health Europe
under TUPE arrangements and the maintenance of
continuity of care was highly valued and had been
included in the contract specification.
She added
that the GP who had decided to leave had been
working in a locum capacity and she understood that
the two nurses had left earlier in the year,
pre-dating the transfer.
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click
here |
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Hospital hits back over complaints by
1 in 10 patients
21/05/2008
(Camden Gazette)
NHS Trust bosses have defended
standards at
the Royal Free Hospital
after one in 10 in-patients said
they wanted to complain
about the
care they had received.
click here
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IN LIGHT OF THE UHe/OOH
DEBATE IN CAMDEN SHOULD PRIMARY CARE
TRUSTS BE MADE MORE LOCALLY
ACCOUNTABLE?
A King’s Fund
discussion paper.
Increasing the accountability of NHS
organisations to local people has become a significant policy
issue within the NHS. Until
now, primarycare trusts(PCTs) which
spend
the bulk of the NHS budget, have been largely accountable
to the centre. There have been calls to review this as PCTs
become more autonomous. This paper discusses a range of options
for reforming the relationships between PCTs and their public.
It explores the question of whether more responsive local
services should be the
main goal of better accountability or
whether
local accountability should be an end in itself.
click here
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Camden Council's proposed charge of £10,000 to
monitor the HOST contract.
Camden Council propose to charge the cLINk
£8,500 to monitor the HOST contract. This would buy 40 sessions
of speech to text operators for Deaf members or 20 quarter page
adverts in the CNJ/Ham & High. Whilst Camden Council are perfectly
entitled to make this charge according to the LINks legislation
we would ask them to reconsider it for Year 1 in order to be
able to buy maximum promotional media space and ensure the LINk
has enough funds to provide for members with additional access
needs. |
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Camden demography
2001 UK population 60,000,000
People with a hearing loss 8,979,00 (ca 15%
of whole of UK)
People who are Deaf/BSL users 50,000
(ca 0.56% of all deaf
people)
People who are deafened i.e. severe or
profound hearing loss but
using English not
BSL 123,000 (ca 1.4% of all deaf people)
In Camden
Total Population = 217,100
People with a hearing loss (15%) = 32,565
Deaf BSL users (0.56% of deaf) = 183
Deafened (1.4% of deaf) = 455
From RNID INFORMATION
From Camden Council statistics website
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Alcohol abuse
Using evidence from the North West Public
Health Observatory.
Data shows that Camdenhas a higher percentage of people
drinking
above the maximum recommended limits compared with the
rest of London. It is estimated that Camden has approximately:
• 45,000 hazardous or harmful drinkers
• 11,500 dependent drinkers.
In general Camden has:
• A high level of alcohol attributable and
specific morbidity
and mortality, resulting in
many months of life being lost.
• A high and increasing rate of alcohol
attributable ambulance
call outs.
• A high and increasing rate of alcohol related
and specific
hospital admissions.
• A high level of alcohol related crime and violence.
• A significant problem with the direct and
indirect impact of
alcohol misuse on children
and young people
• A large homeless population with substance misuse (including
alcohol) problems.
• A high need for mental health services as many people have
psychiatric co-morbidities
with alcohol.
The Camden Alcohol Harm Reduction S
trategy 2007/10 also reports
that “In 2005/06 1555 detoxifications took place in hospital
and
1467 in 2006/07. There is insufficient provision for medically
managed withdrawal, whether in-patient or community based in the
borough, particularly when provision is
mapped against current
indicators of need.
There is an overall lack of aftercare provision or liaison with
generic aftercare services – particularly structured aftercare
such as
Education, Training and Employment. Service users are
unclear about entry points into the treatment system and the
differences between services in terms of intervention offered.
click here ·
Extracts from
a meeting of the ALCOHOL SERVICES LIAISON
GROUP held on THURSDAY 1st FEBRUARY 2007.
The key focus for screening for problem
drinkers should be GPs surgeries. Tony Carrick said that one in
five of GPs patients had an alcohol-related problem. He
recommended the use by GPs of the 20 point screening tool
produced by Alcoholics Anonymous.
Gilles Bergeron confirmed that the scope of the Strategy covered
the whole spectrum of
alcohol misuse.
Tony Carrick pointed to research indicating that 50% of
criminals were intoxicated while offending and asked what could
be done to help problem drinkers who were criminals, along the
lines of methadone treatment offered to drug users in prison.
Gilles Bergeron said that the Strategy would allow for any
intervention to be considered provided the evidence base showed
it was effective.
The high incidence of alcohol-related crime (+34%) suggested the
possibility of an increased level of reporting as well as a
growth in this type of crime. Councillor Williams asked whether
longer pub/club opening hours were affecting the crime rate.
Alison OGrady said that it was unclear how far more widespread
reporting of drink-related crime was
responsible as opposed to
changes in the way Police were recording reported crime. The
consultation on the draft Strategy would seek views on the
reliability of these statistics.
Tony Carrick asked what could be done to assist problem street
drinkers who were having to wait weeks to access detox services.
Councillor Fraser asked whether there were reliable baseline
statistics on problem drinking to enable the effectiveness of
the Strategy to be assessed. Gilles Bergeron said that the
statistics were robust and the Strategy would establish clear
numerical targets for each outcome based on these statistics.
Mike Sanderson queried the lack of funding for tackling alcohol
abuse compared with high levels of funding for interventions
relating to drug abuse. Alison OGrady said that £1.25m was being
made available for alcohol abuse in Camden, funded from PCT and
the Social Services budgets. Funding for tackling drug abuse was
being increased as a result of action by the National Treatment
Agency, whereas the Government were not proposing any increase in resources for alcohol abuse.
Councillor Hoque said that a strong, focused public education
message was needed to alert people to the problems of misusing
alcohol. Preventative work was made more difficult when problem
drinking was a feature of offenders behaviour.
In response to a question from Councillor Fraser, Gilles
Bergeron said that the £76m annual expenditure in Camden
resulting from alcohol-related crime (quoted in a Metropolitan
Police report in late 2006) represented the total costs across
all agencies, excluding health-related costs. Alison OGrady
added that the amount which agencies in Camden spent on
prevention work was small, equating to approximately one member
of staff.
John Anderson asked whether any initiatives were planned to
raise awareness about alcohol abuse among young people. Gilles
Bergeron said that there was a programme for publicity and
awareness-raising in schools. Alison OGrady added that although
schools were being engaged there was a gap in targeting the 18
to 25 age group; GPs would be key to accessing this age group.
Mark Flynn asked whether more specialist workers were likely to
be made available.
Alison OGrady replied that these resources were expensive so much would depend on funding levels. The
Council was looking into the possibility of training less
expensive staff to do more in this area. Gilles Bergeron added
that there were two specialist alcohol nurses responsible for
early intervention in the A&E departments of the Royal Free and
University College Hospitals.
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Public Health:
MEN in St Pancras and Somers Town have
the lowest life
expectancy in any ward in London, a study into the state of the
health ofthe population of Camden reveals. Death rates for
Kentish Town, Kilburn, St Pancras and Somers Town wards are 35%
higher than national averages. St Pancras and Somers
Town is the
most deprived ward in Camden
and one of the most deprived wards
in
London.
Areas of deprivation are also characterised by high levels of smoking,
which is a significant cause of death. St Pancras and Somers Town also
has the largest Bangladeshi population and smoking rates are higher in
this community.” If you live in Kentish Town, St Pancras or Somers Town
your chances of dying of a heart attack is a third higher than the
national
average.
About 30 people commit suicide each year in
the borough, and according
to Whitehall
statistics, Camden has one of the highest needs in the UK
for mental health services – 109% above the national average. Emergency
admissions to hospital because of
schizophrenia are among the highest 10
per
cent in the country, and are around twice the national average and
yet Camden & Islington Mental Health Trust are closing the only
Mental
Health Walk In centre in the Borough without any apparent concern shown
by
Camden PCT.
Camden’s mortality rates show 600 deaths
each year are of people under
the age of 75, which is 28% above the national average.
People being
screened for breast cancer
stands at 63% of women – below a national
average of 76%.
Other lifestyle trends have been identified:
17% of people are
identified as binge drinkers, while drug use is prevalent. A third of
people arrested and tested for drugs were found to have used cocaine and
opiates, the highest of12 London boroughs for which figures are
available.
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Somalia-
background info
 George Galloway (Bethnal Green & Bow, Respect)
A Government ready to rely on those friends of liberty, the
Democratic Unionist party, to shred the liberties of our own
people are almost by definition unembarrassable, but I hope this
evening to add to the issues ventilated in a recent Channel 4
"Dispatches" programme to adumbrate the extent to which the
tragedy in Somalia, which so many people are now becoming aware
of, is another of our Government's dirty little secrets.
click here
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The CSP is designed to give our local
population, staff,
partners and other key stakeholders a clear and structured view
of our future plans, clearly linked to health
outcomes, activity
and financial forecasting.
The document also describes some of
our achievements to date
.click
here
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