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£29MILLION SET UP COSTS FOR NEW SALFORD INTEGRATED CARE ORGANISATION
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Star date: 29th April 2016 SALFORD TOGETHER HEALTH AND SOCIAL CARE TAKEOVER COSTING £29M – PLUS 2% CUTS EVERY YEAR This week, Salford City Council gave the go-ahead for Salford Together, a new `integrated care organisation' run by Salford Royal NHS Foundation Trust, which will amalgamate the health and social care work of the Council, Greater Manchester West Mental Health NHS Foundation Trust and the NHS Trust. It's costing £29million to set up, with 2% cuts to its budget every year after that; with targets to reduce hospital and care home admissions by up to 26%. The idea is that "people take greater charge of, and responsibility for, their own health and wellbeing". Full details here...
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This week, Salford City Council approved plans to create Salford Together, a single, new organisation to `integrate' adult health and social care services in the city. Led by Salford Royal NHS Foundation Trust (SRFT), it aims to "improve population health for the people of Salford". While the prospect of a proper joined up health and social care service can only be seen as positive, the rationale behind the change is massive cuts, targets to get people out of hospitals and residential homes, and an increase in do-it-yourself health care. The official set-up report for Salford Together states quite simply that "a new deal must be reached with our populations – where public services provide support, assistance and facilities, and people take greater charge of, and responsibility for, their own health and wellbeing". Basically, the case for the change is that people are living longer, they are going to get ill and use hospital and care homes more, putting financial pressure on the system... "Our triple challenge of poor health outcomes, demographic pressures and financial constraints mean we cannot leave the system as it is", the report states, arguing that the combined deficit of health and social care for Salford City Council, Salford Royal NHS Foundation Trust and Greater Manchester West Mental Health NHS Foundation Trust will reach £157million by 2020/21. The figures are somewhat over-estimated as Salford Royal Trust is stated to have a £39million deficit this year in the report's statistics, while it's actually forecasting a deficit of £14.9million. Indeed, 25 documents related to the business case for setting up Salford Together have been `redacted', plus other figures and risks set out in the report. Meanwhile, Health devolution to Greater Manchester was supposed to bring more resources into the area, rather than huge deficits. Salford Together itself is costing £29.1million to set up, but, the report states, "is expected to enable a savings contribution of £35.8million". Built into the business plan is an annual cut, or `savings efficiency' of 2% every year until 2021. The new organisation has a massive balancing act, with declared aims being "improving outcomes for people alongside delivering efficiencies". These include a 16.2% reduction in `non-elective' Salford Royal Hospital admissions, a 17.6% reduction in emergency attendances, over 11% reductions in outpatient and planned admissions, a £2.5million saving in `medicines optimisation' and a 26% reduction in permanent care home admissions. How it is actually going to do this is incredibly unclear, apart from a general statement that there will be "new models of care, and a focus on prevention and reducing population demand", that will "Provide alternatives to A and E when crises occur"; "Support effective discharge from hospital" and "Help people return home and stay well"... It also states that it will be "promoting personal independence and community resilience and delivering person centred care which will radically shift care and services away from hospital settings to communities and home...The benefits will come with the shift of care from institutional settings towards the empowerment of citizens and communities to be independent, for longer..." ...This includes the increased use of volunteers, from which people might assume that the system is moving towards almost a Dickensian do-it-yourself health and care service. The Rand Europe organisation co-led, with the Department of Health and others, an evaluation of 16 varied `integrated care' pilot projects, and found that patients were not very happy with the new arrangements... "Patients felt they were less likely to see the GP or nurse of their choice, or to be involved in decisions about their care" states the Rand report "There was also a drop in those who felt listened to by social services." The report also found that, while `elective admissions' to hospital were down by 4% per cent and outpatient visits down by 20%, A and E admissions actually rose by 2%. Meanwhile Salford City UNISON, which will see its current Salford Council social care employees transferred to the Salford Royal NHS Foundation Trust, is totally unhappy with the arrangement, stating that, while it supports the principle of integrated health and social care, the "vast majority of our members are opposed to the transfer of their employment to SRFT". UNISON argued that there was a "potential conflict of interest that arises when a social care worker has to challenge NHS decisions around the best course of action for a client/patient"; that "the NHS was not democratically accountable to the people of Salford and therefore carers and user groups" and that there would be changes to members terms and conditions, adding "Throughout this whole process, staff concerns about terms and conditions issues have been secondary to their concerns around their roles and the people they support." With the new organisation now approved by the Council, UNISON states it will be "arranging meetings with our members to discuss the next steps". While Salford Council has approved the formation of Salford Together, the three other organisations involved also have to approve the plans before the system changes on July 1st this year. The report states that it is a "unique opportunity for Salford Together to put in place conditions to meet our shared vision, and improve outcomes and experience at lower cost..." Only time will tell...
* For further details on Salford Together see its website - click here
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Winston Smith wrote
at 06:22:05 on 01 May 2016 |
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| Yet again, the theory sounds great, but in practice it will be no better than what we had previously and £millions will have been blown, again, on restructuring. An integrated system needs a holistic approach to management, infrastructure, everything and believe me, this doesn't exist in the CCGs, SRFT or Salford Council and never will |
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shirley jones wrote
at 16:15:39 on 29 April 2016 |
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| As regards the elderly, you get little choice of where you go or what they do with you. I suppose this has come about because they can't see them off quite so easily by putting them on the Liverpool Care Pathway or it's follow on. Strange how this has come about since it was made public that all hospitals were paid a fee for every patient they placed on the LCP. When this was made public the Government quickly stopped it but strange how death rates of things like Sepsis/septicaemia, etc., rose sharply during this period. This is not just kept for the elderly either. The numbers are truly shocking but then so are those dying or suffering neglect in Britain's care homes. Google it check it out for yourself. Many are being put on LCP or it's predecessor without families realising what's going on. It is a shocking scandal currently being ignored. Many are wrongly put on it, hospital doctors just see a number and assume they have no quality of life. No one has the right to choose when someone has to die by administering high amounts of strong painkillers such as morphine so patients look more ill than they are to worried family, then deny IV fluids, and IV nutrition. This is not a kind peaceful death!! Would anyone starve and dehydrate a dying dog... no! It's rife in all hospitals (not just in Liverpool) even though it was supposed to have been stopped it still seems to be happening. Some do survive when families have intervened and stopped it, as we did with our mum. As Steve will confirm she's alive and kicking and goes on foreign holidays, runs rings around us all at 83. Just over 3 years ago after she was admitted with a mild asthma attack to A&E. The hospital didn't phone to tell us until the morning. When I got there she seemed fine, was sat up, sat forward, chatting away. So improved they put her on a general ward within a few minutes of me arriving. They didn't want me to stay but as I'd just got there I insisted that I did. She was still sat up, chatting, very alert, sorting out what she was keeping out of her bag, etc. Giving me her orders on what she needed from home, what plants to water, etc. She was fine when we left her, just a bit weary from being up all night in A&E. They made me move away when my sister arrived, we refused to leave so they put us in a tiny room with the door open. Within minutes different doctors, nurses, kept coming one after the other. Each described her as having no quality of life, couldn't get from chair to chair, was very ill, had been for some months, had been on steroids so must have been ill. ALL WRONG! They tried to imply none of us knew my mum..??? We cared very much but she's very independent always has been. They wouldn't listen when we tried to tell them this wasn't our mum they were describing. We had video footage, they wouldn't watch it. Within 20 mins she was taken past the door still sat forward. In the lift something happened. They said she was so ill they had to put her in a drug induced coma on ICU but couldn't tell us what or why exactly. When we saw her we were shocked, she was on a ventilator. They still kept insisting she'd had medication we knew she hadn't, had no quality of life, had been ill for months. All wrong. Several family members all gathered to be told she was going to die, had COPD (said in both lungs when asked) had pneumonia, would never come off the ventilator. They still wouldn't listen to any of us when we said this was very wrong, totally incorrect, almost as if they were talking about anther person, not our mum. They got 2 Doctors to tell us she had all these things wrong, was going to die. I couldn't accept it. I went in with a mum & was leaving with a bag of clothes try said she wouldn't need. Following morning rang our GP, he was very shocked, said that wasn't my mum, described her as amazing for her age (she was 79 going on 21!) was very active. He confirmed no medication. He phoned to try and stop them but de to the Data Protection Act the hospital Doctor said he couldn't discuss her with Him I later found out. GP told them to listen not discuss. I arrived at hospital just after to find they had brought her round (looking very ashamed & flustered) & them trying to get her off the ventilator, but they said she'd fought them so hard they'd had to put her back onto the ventilator, joked how strong she was for such a little lady. Yet still a doctor took me in a room told me she was going to die, had COP, pneumonia, etc. I told them if they didn't listen I would take legal action. Told them they were wrong, told them I'd checked with our GP. Told them they must not put her on LCP. To cut a long story short she was taken off the ventilator within a week as she kept telling them she didn't need it, could breath fine when at times they had to take her off it. She was offering to run around the ward when physiotherapists first called to see her. Was taken off there to HDU (who were shocked by how well she was) onto a general ward within the same day! Where a Doctor said she was fine, her chest was clear.... you don't recover from all that they said you had wrong within a week. Since then she's been fine, is still fiercely independent, lives life to the full, goes on foreign holidays with friends & family & is bloody marvellous for her age!! No one believes she is 83. Doctors should not be allowed to play God to decide when any patient should die. My mum would not be here if I hadn't intervened. They would have just upped the morphine (she was not in pain) kept her sedated, stopped the fluids, stopped the IV nutrition until she passed away, suffering a long horrifically slow death starved and dehydrated. Most people just accept what Doctors say. Why were the Government paying hospitals incentives to put patients on the LCP? Because it saves on cost of care in hospital, cost of care home fees, cost of pensions & benefits....Why are patients sedated on morphine when they're not in pain as has happened. Why are they sedated at all? They sedate them then tell families see how ill they look, they're refusing food implying they are more ill, to justify what they are doing... anyone who's had strong painkillers or sedation would understand that it's not that they are refusing food, its because they're not able to due to the effects of sedation. I urge anyone with elderly or sick relatives in hospitals, hospice or care homes to be very vigilant, very observant, to ask questions, get answers, don't be fobbed off. Take great care of your loved ones, no matter where they are even in care homes. |
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Michael J Felse wrote
at 16:15:29 on 29 April 2016 |
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| Interesting. There are many things local people can do to help others. I would like Salford school to include sign language for all children to help combat isolation. Want more local food coops, an increase in cycle clubs for all ages and for Salford to invest in the Mind charity to expand healthy mind assets, like a £9million new technology live music stage to be managed by Salford's youths. The Salford Together plan will fit into a holistic better health plan if it opens up to new ideas, safeguards jobs and put our Salford people in need before politics. I await in high hopes. |
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