"Hopeless": how senior doctor described NHS maternity unit"s testing regime

A senior figure in an NHS trust’s maternity unit under investigation over avoidable baby deaths has admitted that some practices in the unit were “hopeless”.

Andrew Tapp, medical director of women and children’s services at Shrewsbury and Telford hospital NHS trust, said in an email to a GP: “I think there are real problems here.” The GP had raised concerns about the maternity’s unit’s communication of test results.

The emails, seen by the Guardian, were sent in May 2016. The GP says his concerns about the safety of patients persist, citing a recent incident he was involved in that could have risked the life of an unborn baby.

The renewed concerns about the unit come as it has emerged that NHS chiefs are now investigating the deaths of 15 babies and three mothers. Several deaths have already been judged to have been avoidable; some were allegedly caused by a failure to correctly monitor babies’ heartbeats or spot infections early.

A team is also reviewing 10 further cases where patients survived but suffered harm.

The GP’s emails express alarm about the maternity unit’s procedures for communicating medical test results, accusing some departments of having a “fax and forget” attitude.

He said that without explanation or context, it was difficult for GPs to understand why particular tests had been ordered, how to interpret the results and how follow up appropriately.

The GP, who has expertise in patient safety, said: “At best these issues are an irritation; at worst, it’s dangerous. There seems to be an inability to change and to learn from mistakes. The safety culture isn’t responsive.

“It has always been thus during the years I’ve been a GP here. The reason why I’m speaking out is because as a GMC-registered doctor I have a duty to speak up about this kind of thing. I believe that patients are at risk and that there’s a lack of effective learning about safety at the trust. My motivation is to protect patients and I’m frustrated that there has been little change over the years.”

A second GP working with the hospital trust shared his fears.“When we have concerns we have to keep asking about them again and again,” he said. “There’s a genuine concern about patients and staff. There are lessons to be learned here.”

The case cited by the first GP was of a vulnerable young pregnant woman who was tested for a group B streptococcus infection. He said there was a significant delay in the maternity unit communicating the positive result to her GP, and that some of the information had been “scribbled” and was unclear.

Any woman with this infection is at risk of passing it to her baby – with potentially life-threatening consequences – unless antibiotics are promptly administered.

Last week an inquest into the death of one-day-old Pippa Griffiths, who contracted the same infection at the same hospital trust, found that she could have survived if she had received better medical care.

A Care Quality Commission report in January 2015 found that the trust required improvement and that while staff were caring, they needed more feedback about incidents to learn from their mistakes.

Maternity services at Shrewsbury and Telford hospital NHS trust were strongly criticised by an inquiry commissioned by NHS England into the death in 2009 of a baby, Kate Stanton-Davies.

In the email exchanges with the GP, Tapp, writes: “I have just finished a clinic at the Ludlow community hospital and have found another raft of tests that are simply cc’d to GPs without information going to GPs. I was informed by the senior sec[retary] that the process of cc results to GPs as they arrive in the community hospitals has been in place for 30 years. Does this need to be unpicked as well!! I suspect so.”

Another email states: “([name redacted] can you check on this and ensure that we are informing patients of abnormal results). The place for you to contact for any discussion was not ticked ([name redacted] can you look into this matter).”

In response to an example given by the GP of a test result inadequately dealt with by the trust, Tapp said: “Hopeless. [name redacted] can you look into this matter. I am fairly stunned that any one would have just popped this result into the post without context. I am not sure where a result sent to Ms M Midwife would go but can you ensure an effective educational program for colleagues.”

He goes on to say: “There does seem to be a bit of disconnect of brain here … The previous context does not seem to have been taken into consideration.”

He also adds: “I think there are some real problems here but there are opportunities to improve.”

Dr Edwin Borman, medical director at the Shrewsbury and Telford hospital NHS trust, said: “Effective and high quality communication between medical colleagues in primary and secondary care is extremely important for safe patient care.”

He said the trust – which handles 4,700 deliveries a year – had created a working group of consultants and GPs to review standards of communication following a patient’s discharge and would “continue to monitor and evaluate process to ensure continual improvement”.

Medics employed by the trust are the focus of both internal and external inquiries and at least four midwives are being investigated by the Nursing & Midwifery Council, according to a report in the Mirror.

The trust’s chief executive has apologised to the families of babies who died and said the trust was cooperating fully with the NHS review. But he added that it was his “firm belief” that the trust provided safe care for mothers and babies.

The health secretary, Jeremy Hunt, ordered an investigation into the deaths of a number of babies at the trust after seven deaths were judged to have been avoidable and bereaved families and the local coroner criticised the quality and safety of maternity care.

Five of the deaths involved apparent failures by staff to correctly monitor a baby’s heartbeat. Borman said the rate of baby deaths was no worse than anywhere else in the NHS.

"Hopeless": how senior doctor described NHS maternity unit"s testing regime

A&E, cancer and maternity units to close in major NHS overhaul

Thousands of hospital beds are set to disappear, pregnant women will face long trips to give birth and a string of A&E units will be downgraded or even closed altogether as part of controversial NHS plans to reorganise healthcare in England.

A Guardian analysis of the 24 NHS regional plans that have now been published – more than half the total of 44 – has found that health service chiefs plan to push through an unprecedented centralisation of key hospital services across England.

Opposition to the plans is growing among campaign groups, councillors and a growing number of MPs, including Conservatives, in areas where major changes are planned amid fears that patients will be unable to access urgent care quickly enough.

Dozens of England’s 163 acute hospitals look likely to have services, including cancer, trauma and stroke care, removed as a result of the plans, which are at the heart of the new funding package for the NHS. The thinking behind the changes is that some NHS services can be rationalised and managed more efficiently, helping improve patient care, tackling understaffing and helping the NHS save £22bn by 2020 as part of the wider financial settlement agreed for the current parliament.

Prof Sir Bruce Keogh, the NHS’s medical director, and clinical leaders involved in drawing up the plans argue that centralising some types of medical care benefits patients and improves their chances of a good outcome because doctors deal with more cases of certain ailments.

Many of the plans make clear that widespread staff shortages are another key driver. They hope that by concentrating sometimes scarce medical personnel in fewer places they can ensure consultant presence more often than otherwise and so help realise Hunt’s ambition of a more 24/7 NHS.

However, local resistance is building up as details emerge. Campaigners in Cumbria, for example, are warning that patients will die, including mothers and babies, if they have to travel 40 miles from Whitehaven to Carlisle for care – a journey that can take up to two hours depending on the time of day, weather and traffic levels, they say.

“Centralisation of services won’t work in Cumbria,” said Annette Robson, a campaigner from the We Need West Cumberland Hospital Group. The hospital’s A&E unit is set to be downgraded, with more serious urgent and emergency cases having to go to Carlisle for treatment.

“We are not asking for specialist services. We are asking for basic provision of a 24/7 A&E and a consultant-led maternity unit in Whitehaven,” she said. “If they go, there is no doubt that lives, including those of mothers and babies, will be lost on the 40-plus mile journey to Carlisle from Whitehaven.”

Many of the published plans give few details of their exact implications. But those that do make clear that several thousand beds in acute district general hospitals are likely to be cut. They include 535 in Derbyshire and 400 each in Devon and West Yorkshire and 30% of all beds in hospitals in Bristol, North Somerset and South Gloucestershire.

South-west London will also see its bed capacity shrink considerably when one of St George’s (1,038 beds), Kingston (520 beds), Croydon (443 beds), Epsom (374 beds) or St Helier (525 beds) hospitals lose all their acute services, because the plans for that area say that five acute hospitals cannot be sustained.

The plans are the vehicles for implementing locally the NHS Five Year Forward View, NHS England chief executive Simon Stevens’s blueprint for transforming services to cope with the growing demand for care while also delivering the £22bn of savings he has pledged to find by 2020.

Jeremy Hunt, the health secretary, has backed them, but stressed that potentially unpopular decisions will be taken by local NHS and council leaders, and not by ministers. Theresa May is said to have recently told Stevens to ensure that hospital closure plans did not become a big issue in newspapers.

Conservative MP Dr Daniel Poulter, who was a health minister until May 2015, said he feared the real potential of the plans to improve the quality of care could be lost because the need to make savings will become a top priority.

Mounting protests could coalesce into a political challenge for the government, he added. “Given that the NHS is often seen through the prism of hospital services changes and closures in marginal seats, the political consequences of how the plans are being forced to operate will soon be all too apparent,” Poulter said.

The exact number of bed losses will increase substantially as a result of plans in most of the 44 areas to provide a wide range of specialist medical services at many fewer sites than at present. The areas involved include parts of Somerset, Cheshire and Merseyside, Bedford, Luton and Milton Keynes. None of the 24 plans spells out who will be the winners and losers from the reorganisation.

Several hospitals face being “gutted” of key services, say critics. For example, Bedford hospital will lose its A&E and consultant-led maternity units and the ability to undertake most emergency surgery.

Similarly, plans to change utterly the role of Barnstaple hospital in Devon have already prompted a 4,000-strong protest march. Chester MP Chris Matheson has started a campaign to stop the closure of the city’s Countess of Chester hospital, which is at risk because of a mooted merger with two others.

Many hundreds of beds in community hospitals are also set to go, despite the key role they play in rehabilitating mainly elderly patients – for example, those who have had surgery or a fall. Devon plans to close four community hospitals altogether, as does Dorset (three) and Leicester, Leicestershire and Rutland (two).

All the proposals in the plans will be put out to public consultation, so may be changed as a result of opposition. But Stevens and other senior NHS bosses have made clear that a radical transformation in how the NHS functions is needed.

NHS England says that a huge increase in care outside hospitals, including in partients’ homes, and much greater efforts to keep people healthier for longer, will reduce the need for beds in hospital.

A&E units at hospitals in Macclesfield, Milton Keynes, Teesside and Hinchingbrooke in Cambridgeshire are all likely to be downgraded.

Maternity care at the Horton hospital in Banbury, Oxfordshire, is likely to be supervised in future only by midwives, not doctors. Centralisation of childbirth units is also set to lead to downgrading at Yeovil hospital in Somerset, and also at as yet unidentified hospitals in Surrey, Birmingham and Solihull and Leicester, Leicestershire and Rutland, among others.

“Despite the flannel and platitudes these STPs are NHS England’s way of forcing local health bosses to make cuts, since genuine savings on this scale cannot be delivered,” said Dr John Lister, a health policy expert and co-ordinator of the Health Campaigns Together group.

But Prof Chris Ham, chief executive of the King’s Fund, said STP-driven downgrades of certain services were in effect painful medicine that the NHS had to take to ensure it survives.

“The public may be understandably concerned about travelling further to access A&E care. But in many cases that will be a price worth paying for a higher standard of care, and the same would apply to maternity services. Overall this is a painful process that the NHS has to go through,” added Ham.

An NHS England spokesman defended the plans as necessary modernisation. “Our NHS has constantly adapted to improve services for patients, taking advantage of new opportunities and making commonsense changes in areas that really matter to patients – making it easier to see a GP, providing more specialist services in people’s homes, speeding up cancer diagnosis and offering help faster to people with mental illness.

“We are talking about steady incremental improvement, not a big bang, tackling things doctors and nurses have been telling us for years. By continuing to adapt to a changing world, the NHS will be able to secure a better service for future generations”.

A&E, cancer and maternity units to close in major NHS overhaul

Third of maternity units have shut doors to labouring women because they could not cope

More than a third of maternity units have been forced to shut their doors to labouring women because they could not cope with demand, leading midwives have warned. Figures from the Royal College of Midwives (RCM) show that 38.6% of maternity units had to temporarily shut during the last year.

A poll conducted among senior midwives revealed that units closed their doors on 281 separate occasions. The RCM said the average unit temporarily closed eight times, but one unit was at full capacity 50 times. Eight units had to close their doors on 10 or more occasions.

The college, which is holding its annual conference in Harrogate, said the number of closures was a reflection of the rising demands on services as well as increasingly complex births and issues with staffing levels.

The poll, which was completed by 53% of the heads of midwifery from around the UK, found that nine in 10 believed their unit was dealing with more complex cases than last year. Almost two in five said that they did not have enough midwives to cope with the demands on the service, and 19% of the 85 senior midwives who responded said their budget had decreased in the previous 12 months.

One in 10 said that they had been forced to reduce services in the last year, including reductions in parent classes and breastfeeding and bereavement support. Four in five also reported that they had to redeploy staff to cover essential services, meaning that staff who were supposed to be delivering antenatal care and community care were redeployed to cover labour delivery suites.

“Yet again we are seeing senior midwives describing services that are being battered by increasing demands, inadequate resources and staffing shortages,” said Cathy Warwick, RCM chief executive. “It is very often only through the hard work, goodwill and sacrifice of maternity staff that services are able to deliver the safe and high-quality care women need.

“It is astonishing that units are temporarily closing because they can’t meet the demands of the service, staff are redeployed to the detriment of antenatal and community services, and just after Baby Loss week, we are finding that bereavement support services have been cut.

“Every week I speak to midwives who tell me they are exhausted by the pressures they are facing, and they lack the time to do their jobs as well as they would like. This situation isn’t sustainable, and the government must start to invest in NHS staff because we all know that an investment in staff is an investment in high quality, safe care.”

A separate poll from the RCM released on Wednesday revealed that inadequate staffing levels were driving midwives to leave the NHS. The study, which polled more than 2,700 people, found some were working in “dangerous” conditions, having 12-hour shifts with no break, and worried about making “tragic” mistakes, and reports of midwives looking after as many as 15 mothers and babies at a time.

Warwick criticised the government’s “disastrous” policy of pay restraint in the NHS. “Midwives and maternity support workers are working harder than ever at the same time as they have had six years of real-terms cuts to their pay. We want to see a cost of living increase for midwives, maternity support workers and other NHS staff to show them they are valued and to reward their hard work.

“There is a growing shortage of midwives, and midwives tell us because of the demands they face, they are intending to leave midwifery, making the shortage worse. However, 80% of midwives who are intending to leave say they would stay if pay improved. The government can’t afford not to invest in maternity services.”

Labour’s shadow health minister, Justin Madders, said: “This shocking poll is yet more evidence of the crisis engulfing our NHS as a result of Tory underfunding. Six years ago the Tories promised 3,000 more midwives, but they failed to deliver them. This has left maternity units across England operating without enough staff and unable to cope with rising demand.

“This situation is causing chaos for thousands of women in labour, and could pose a serious risk to patient safety. Jeremy Hunt and Theresa May are in complete denial about the extent of this issue. They need to use the Autumn statement to deliver a rescue package for the NHS before this crisis turns into a catastrophe.”

Third of maternity units have shut doors to labouring women because they could not cope

Where next for learning disabled people after discredited units close? | Saba Salman

Ben Davis, 20, was sectioned and admitted to an assessment and treatment unit (ATU) miles from his family home in south-west England. After eight months in the NHS-run unit in the south-east, Davis, who has autism and complex needs, was moved to a newly built flat near to his family following a campaign to get him out by his mother. He and his family hoped it would be a fresh start.

But, last week, after less than two months in his new one-bedroom flat, the support he was receiving broke down. The autistic young man, for whom stability and routine are vital, will now have to move again, this time into temporary accommodation while NHS and local authority care commissioners organise the next option.

Related: Why did Connor Sparrowhawk die in a specialist NHS unit? | Saba Salman

His mother, Catherine Davis, says one problem with the flat was that it was more like hospital than home, as reflected in her son’s initial reaction to the property. “He said, ‘it looks just like the unit’,” she says. On social media, she offers a stark summary of the situation: “They fail him, send him miles away, drug him, send him back damaged after eight months, to a mini-institution with pretty curtains”.

Davis, whose campaign to release her son from the assessment and treatment unit included a petition of more than 15,000 signatures, warns of “a steep learning curve” for care commissioners organising support for people after discharge from such units.

In her son’s case, she says, commissioners rejected his wish for a move back to his family home, deeming it unsustainable. She describes poor transition between the unit and flat, no recognition of the trauma caused by being locked away and the presence of fire alarms in the flat that sparked unsettling memories of the secure hospital unit. New-build glitches meant the alarms sounded frequently at night, fuelling the young man’s distress and panic-stricken calls home.

The government promised four years ago to move people from treatment and assessment units following BBC Panorama’s exposure of abuse at the privately run Winterbourne View. The preventable death of 18-year-old Connor Sparrowhawk, who drowned in a Southern Health trust unit in Oxfordshire three years ago, and the subsequent Justice for LB campaign, further fuelled demands for action and accountability over the treatment of learning disabled people. In October, NHS England and council leaders set out a £45m plan to close England’s last NHS hospital for people with learning disabilities, plus up to half the 2,600 beds in the units. But according to the latest government figures, in June more than 2,500 people were still languishing in such units. Family-led research published today highlights the problems for people, like Davis, who are leaving these facilities. The report, Avoiding Crisis – A Parent Survey on Support Needed, is published by parent-led network Bringing Us Together and support charity Respond. It includes the views of 29 families whose sons or daughters are in or have recently left ATUs and is part-funded by NHS England,and also involves family-led campaigners Seven Days of Action, who raise awareness of people stuck in these institutional settings.

It acknowledges “the success stories of young people coming back into their communities and being close to home”. But it adds: “It has become increasingly apparent that this desirable outcome is often very difficult to achieve.” And it warns that the precarious state of social care funding could affect the development of new, community-based support.

An accompanying but separate survey of 88 families in 54 areas across England that accompanies the report reveals inconsistencies in advice for people during crises, such as being sectioned. Nearly half the families say they were not given advice on where to get help. This is despite the Care Act in 2014 obliging councils to provide information so people can make decisions on care.

Other problems include hostile relationships between families and the “responsible clinician” – psychiatrists authorising admission and discharge. In addition, parents feel sidelined by professionals. They worry that there is no recognition of possible post-traumatic stress disorder after time in units. One relative suggests: “They go in with autism and come out with personality changes, mental health issues, poor physical health issues, weight issues, no education and with post-traumatic stress disorder.”

The report underlines how people are often discharged without the person-centred planning designed to boost choice in support. Also, as in Davis’s case, their new accommodation feels eerily similar to the hospital. A parent comments: “Individuals returning to the community are given a flat which is often impersonal, with little thought given to their sensory needs. Bare walls, windows you can’t see out of.”

Katie Clarke, the executive director of Bringing Us Together, says: “There’s no pathway for parents and families, there’s a lack of support immediately on discharge … people are desperate for information and advice.”

Solutions in the report include ensuring that transition plans are thorough, that independent advocates are available to support the family at meetings, and that there are properly pooled health and council budgets to enable quicker discharge from health-funded units into council-funded community-based housing.

Related: People with learning disabilities are still not recognised as fully human | Sara Ryan

Mark Griffiths, who has Asperger’s, moved back to his family home in the north-east after a mental health crisis in 2010 led to several months in a unit 200 miles away. His experience, although arduous, seems like a comparative success story. Care commissioners proposed transferring Griffiths to residential care but his mother, Hazel, with the help of two specialist solicitors, won the argument that he should be moved back home. Initial support from a home-based care provider failed as staff changes undermined Griffiths’ need for routine.

Hazel Griffiths is now her 31-year-old son’s full-time carer, with a charity offering four hours support a week. She says: “We managed to find professionals who were sincere – it took a long time to trust again.” Griffiths works with her local NHS trust, Tees, Esk and Wear Valleys, encouraging people, families and professionals to collaborate in care. She acknowledges this is unusual. “The system seems so disintegrated,” she says.

Closer working between health and councils is vital, says Gary Bourlet, founder of self-advocacy group Learning Disability England. “It’s not just health and social care but also social housing, [and money should go] into one pot.” He adds of professionals: “They’re not listening to people and not giving them choices.” Bourlet suggests that funding from closed units be spent on specialist learning disability nurses.

An advocacy-led approach would create emotional and practical support for people leaving units, says Respond chief executive Noelle Blackman, who worked on the research.

Bringing us Together and Respond run Justice Together, a project uniting parents and professionals wanting decent support for families in crisis. Blackman suggests a helpline where specialist advisers offer advice on discharge and transfer and offer counselling sessions. Advisers can suggest human rights solicitors, local advocates or independent specialists to create person-centred plans for an active life in people’s home areas. Families can, says Blackman, dip in and out of this “justice circle” as needed: “We’d give them a path to follow when everything feels so overwhelming.”

While Blackman welcomes the national plan to close assessment and treatment facilities, she warns: “There’s good stuff being written … but the reality – translating it on to the ground – is miles away.”

Dominic Slowie, NHS England’s national clinical director for learning disability, says the momentum on transfer is growing. He anticipates change “over the coming months and years” as areas implement plans for community-based housing, care and advocacy. Slowie adds: “It is crucial that the views of patients and families with lived experience of services are central to the continued development of these plans by councils and local NHS bodies, and of course we will continue to engage nationally with organisations like Bringing Us Together to ensure this is the case.”

Back in the south-west, Ben Davis is in limbo. Such words offer little reassurance for Catherine Davis, who desperately worries about her son’s future. As she says, “just getting someone out of an assessment and treatment unit is not where it ends”.

Some names and details have been changed

Where next for learning disabled people after discredited units close? | Saba Salman

Call for GPs to operate at A&E units

Staff in the A&ampE department at Bradford Royal Infirmary in West Yorkshire. Photograph: Christopher Thomond for the Guardian

GPs must perform at each and every A&ampE unit so that patient numbers do not overwhelm emergency departments, an alliance of senior medical doctors has urged.

Hospital medical doctors, surgeons, A&ampE and children’s wellness experts want every unit to contain a principal care facility staffed by family doctors that is open overnight and at weekends.

This would ease the strain on A&ampE units brought on by present GP out-of-hrs solutions not offering the care individuals need, they say.

The phone has come from the School of Emergency Medicine, to which A&ampE doctors belong, and also been backed in a joint statement by the healthcare royal colleges representing Britain’s surgeons, doctors and paediatricians.

They want all A&ampE units to have a “main care out-of-hrs facility” to allow individuals with small or significant illnesses to be triaged quickly and then treated according to medical want.

But the British Health care Association (BMA), the doctors’ union, said shortages of GPs in a lot of areas may suggest that there are as well handful of to workers this kind of services and that care of their normal sufferers could suffer as a result.

“We previously have an inadequate amount of GPs that has left GP providers struggling to meet patient demand. This is currently being exacerbated by falls in GP recruitment and the truth several GPs are thinking about early retirement,” said Dr Chaand Nagpaul, chair of the BMA’s GP committee. “If important numbers of GPs were to work in A&ampE rather than GP surgeries, this would contribute to these troubles and could lead to patients not getting the care they need to have in the local community,” he stated.

The instant priority must be to make sure there are adequate GPs to look soon after the growing variety of individuals coming to surgeries, especially older sufferers, Nagpaul added.

The 4 bodies are also in search of a rest of the politically essential 4-hour target for treating A&ampE sufferers, which they say is “unfit for function”.

Although it is beneficial, it does not assist hospitals steer clear of “exit block”, when hospital beds turn into complete and it is challenging to admit any a lot more sufferers who arrive by means of A&ampE. The requirement to treat 95% of A&ampE instances inside 4 hours need to be revisited so that it far better supports “clinically related outcomes”, they say.

Essential neighborhood health and social care solutions based mostly outdoors hospitals also need to have to operate seven days a week so individuals can be far more simply discharged to cost-free up beds, they say.

Call for GPs to operate at A&E units

Five top guidelines for commissioning assistance units

CSUs need to emphasis on efficient connection management and co-ordinating assets to improve overall health and healthcare, writes Leigh Griffin. Photograph: Alamy

This week marks the initial anniversary of the introduction of radically changed commissioning arrangements in the NHS.

These arrangements, which, through the creation of clinical commissioning groups (CCGs), placed clinicians in a position to lead choice-generating for neighborhood health solutions, also noticed the creation of commissioning help units (CSUs) to assistance CCGs and NHS England.

As managing director of the CSU serving Better Manchester, it truly is a helpful time to reflect on the 1st yr of operations. Here are my leading 5 reflections:

one Drop the ‘C’
We have a pivotal part in enabling the commissioners of a support to access expertise and skills at scale. As a provider of such companies, we can and need to also assistance NHS trusts, main care and the broader public sector, as we improve service co-ordination and good quality, whilst living within our implies.

As such, we are not basically ‘commissioning’ assistance units, but public sector support units.

two Integrate our efforts
In an era of resource constraint, it is critical that NHS organisations work together. We need to concentrate on effective partnership management, co-style and co-delivery to co-ordinate our use of sources and our collective commitment to enhance overall health and healthcare. Immature organisations revert to dysfunctional master-servant relationships, which we need to resist.

3 Our customer’s consumer is our customer
In searching for to strengthen our support to our clientele, primarily based on sturdy connection and account management, we must make our function clear. This is to allow our customers to enhance the wellness and healthcare of the communities they serve.

While we need to have to show worth to our having to pay clientele, it is crucial that both our employees and customers are ready to see how we are jointly improving well being and healthcare across Better Manchester.

four Flexibility and adaptability
It is evident that our clientele – CCGs, NHS England and neighborhood authorities – are seeking for consultancy and undertaking management or delivery-kind assistance to tackle both foreseen and unforeseen short-term issues.

This demands CSUs to be in a position to flex and adapt to these needs, as properly as operating closely with our consumers to foresee and speedily respond.

We aim to strengthen our capabilities and techniques of working to be a lot more responsive, constructing a powerful public sector consultancy skill base and, hopefully, minimizing the public sector’s demand for commercial sector support.

5 Efficiency
We must and will try to be much more productive to demonstrate greatest value to our consumers. Recognising the two the considerable monetary challenges dealing with the public sector and the steady emergence of a market place for commissioning help, we have to be reasonable and aggressive if we are to grow sustainable assistance to the public sector.

Locally, our programs to merge with Cheshire and Merseyside CSU reflect this need, as nicely as the opportunity to strengthen our service and ability base, and entice potential partners.

In summary, it truly is been a tough but productive initial 12 months. CSUs have discovered to be companies, recognising the imperatives of value and relationships. We now need to embed ourselves as providers of decision in a potential market for assistance solutions, demonstrating the actual skills, skills and expertise that the NHS can offer.

Leigh Griffin is managing director of Better Manchester CSU

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Five top guidelines for commissioning assistance units

Psychological well being units "are heading for a Mid Staffs scandal", warns senior psychiatrist

Sue Bailey said mental overall health providers are approaching tipping stage. Photograph: Anna Gordon

Britain’s senior psychiatrist has warned that the mental overall health sector is heading towards its personal Mid Staffs scandal, as it emerged that NHS patients are currently being handled in a hospital in which workers have been lately accused of utilizing injections and seclusion as threats.

Professor Sue Bailey, president of the Royal School of Psychiatrists, mentioned she was increasingly concerned that psychological services were approaching a “tipping stage” with funding becoming lower regardless of a record 50,000 uses of the Mental Overall health Act to detain individuals in hospital for assessment or therapy in 2012-13.

Regardless of the government’s claims that mental health would be offered parity with bodily health, Bailey stated money that it was due to be given had been redirected to deal with the repercussions of the Francis inquiry into the scandal of the needless suffering, and attainable needless deaths, of hundreds of men and women at Stafford hospital.

Bailey warned that the mental overall health sector could only “cut its cloth” so far. She mentioned: “I do truly feel really strongly that if we keep constantly becoming the last in the line there will come a tipping stage and we will end up with our very own [scandal and subsequent inquiry]. We are under increasing stress. Carers will tell you that. Mental overall health practitioners who really feel it is risk-free to talk about these issues will tell you that – but whistleblowing is nonetheless not simple.”

Bailey spoke out as it emerged that a juvenile patient at a private mental overall health secure unit in Woking, Surrey, which has a chequered historical past of overall performance, had told Care Top quality Commission (CQC) inspectors in December that seclusion and intramuscular injections were regularly employed as threats by personnel. During a go to to the hospital, owned by the personal Alpha Group, inspectors also identified that a younger particular person who had banged his head in seclusion was left lying on the floor for 15 minutes getting sick.

Inspectors could locate no information of healthcare assist being provided to a youthful man or woman in seclusion who was mentioned to have signs of “rolling eyes and losing balance” for at least thirty minutes.

The hospital, which was instructed in January to show proof of improvement within weeks, had already been told to urgently improve its functionality following two prior visits. In a prior report, inspectors recorded that “one particular female adolescent patient had been restrained by 9 members of staff, one particular of whom was a male” since she refused to take away her underwear.

Alpha Group, which has two even more hospitals in Bury, Higher Manchester, and Sheffield, is owned by the controversial Liberal Democrat donor Sudhir Choudhrie, who was named by India’s Central Bureau of Investigation as a single of 23 “unscrupulous persons” in 2012 and is accused of currently being an arms dealer, a claim which he denies.

Bailey said that exactly where failings were emerging they were a symptom of a program below strain. She explained: “Just like the rest of medicine, items can go wrong. We know the factors that make issues go wrong. And we know one of the things that created Mid Staffs go wrong was finance driving the complete kit and caboodle. We’re worried.”

In December a freedom of data request revealed that mental wellness trust budgets for 2013-14 shrank by two.three% in genuine terms from 2011-12. 10 out of 13 trusts that supplied forecast budgets for 2014-15 have been projecting additional cuts.

On Friday the CQC announced that Alpha hospital in Woking was now compliant with the “needed requirements” but that the regulator would proceed to keep track of the support. NHS England confirmed that NHS sufferers would proceed to be referred there. It stated that there had been no block on NHS referrals given that issues initial emerged at the hospital eight months in the past, regardless of the scathing findings above a series of CQC inspections.

Surrey has no other secure hospital in which juvenile mental well being individuals can be inpatients.

Victoria Bleazard, Associate Director of Campaigns at Rethink Psychological Illness stated she was concerned that the lack of different amenities in the region left vulnerable mentally ill children with no other alternative but the Alpha hospital.

She mentioned: “The government says that individuals must be able to decide on exactly where they get treatment for psychological illness, in the same way that folks with physical well being problems can. But when there is this kind of an acute shortage of hospital beds, the thought that they will be ready to pick where they receive therapy is completely unrealistic. For many men and women, receiving remedy at all is a struggle in itself.”

Alpha Hospitals explained: “We quite considerably value suggestions from the CQC. Following its inspection of 1 of our wards in November and December 2013, we worked closely with NHS England and CQC to create and implement an action plan. We have given that been inspected by the CQC and obtained optimistic feedback.”

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