MALNUTRITION IN CORNWALL IN 2015

The Health and Social Care Information Centre (HSCIC) has published data that shows malnutrition, among other diseases we associate with Victorian times, has increased in the Devon, Cornwall, and Isles of Scilly NHS area. You can see the data in the excel file Topic of Interest-Victorian Diseases-Data here.

In the year August 2014-July 2015 the rate of malnutrition admission episodes in Devon, Cornwall, Isles of Scilly NHS team area was 2.4 per 100 000 population, the highest of the twenty five areas of England. This is nearly double the average rate for England of 1.3. There has been an increase of 34 percent over 2010/11 admissions for malnutrition in the Devon, Cornwall, and Isles of Scilly area.

The number of admissions in the area is very small but I think it is troubling that malnutrition is around and increasing in 2015. Look too at patients’ ages. Note too that the numbers are not of individuals but admissions as a patient may be admitted more than once in a year.

The Trussell Trust, which runs foodbanks, has said, “We often see parents who are going without food so that they can feed their children.” In Britain. In 2015. There is a growing food crisis for many in our country and the Tory government is floundering.

Note
The published data does not show how many of the admissions were of people separately resident in each of the three counties in the team area.

RCHT JUDGED: UPDATED

See updates of 7 and 16 October 2015 at the end of this post

ORIGINAL POST 24 September 2015
Another judgement day for our Cornwall Hospitals NHS Trust (RCHT) with three hospitals at Treliske Truro, St Michaels Hayle, and West Cornwall Penzance. The latest Care Quality Commission (CQC) report on the RCHT, published 23 September this year, is here. Incidentally, scroll down that page for the report on the inspection of January 2015, published 27 March 2015.

The trust was inspected on four days in June this year. Do read the report on that inspection and consider what you think. I believe it is a mixed picture though the grim and unsafe have been rightly emphasised by the media. It is a very great concern that the report says the safety of services is “Inadequate.”

A serious issue in the report is shortage at times of suitably qualified staff on duty. I should like to see the CQC well analyse the origins of the shortage at RCHT and other hospitals. Does it consider it is all due to administrative inadequacies by RCHT or are government policies part of the cause? The CQC should consider how far present issues are due to government decisions, especially about cut backs on nurses’ jobs and training places and harsh limits on public sector pay rises; both by the Tory/Libdem coalition. The present Tory government is continuing public sector pay restraint. Is the work load now so onerous that it is damaging nurses’ wellbeing and the NHS?

The RCHT will be inspected again. Let’s hope the managers can engender large improvements. Let’s hope the CQC takes a wider look.

The RCHT ended 2014/15 with a deficit of nearly £7 million. It plans a £5.5 million deficit for 2015/16: see report here.

Further reading
Head of Royal College of Nursing – Nurse shortages are life-threatening: Guardian 2 September 2015

Polly Toynbee on government spending cuts damaging the NHS: Guardian 22 September 2015

Deborah Hopkins, Labour candidate for St Austell and Newquay in May, has an interesting take on this issue on her facebook

End of original post
_________________________________________________

Update 7 October 2015
Read the telling report by Denis Campbell in the Guardian NHS leadership in crisis as running hospitals becomes near-impossible.

Update 16 October 2015
The Care Quality Commission has just published its latest annual report The state of health care and adult social care in England 2014/15. This is the full report.

In the section dealing with acute hospitals the Commission reports that that two thirds of hospital trusts are in deficit (page 11 full report) and 8 percent of inspected hospitals are judged overall as “inadequate” and 57 percent “require improvement” (page 69). The CQC now says that hospitals are being asked to make significant savings and at the same time deliver an excellent service as work increases in load and complexity.

MENTAL HEALTH: IT IS TIME TO GET THIS RIGHT

The new Tory MP for Plymouth Moor View, Johnny Mercer, made a moving, passionate, and dynamic maiden speech in the Commons in June Hansard 1 June 2015 column 373, 6.54 pm).

He spoke excellently about the insufficiency of mental health provision in Britain and the duty of government, the state, to care for our armed forces veterans and their families. He said he would be actively engaged with these issues. I am onside for this: his argument is civilised and liberal (and, I think, socialist).

Two passages of his speech stand out:

“I want to speak briefly about my two main missions in this Parliament. First, mental health provision in this country remains poor. There are some extremely dogged and determined characters who fight night and day to improve the services offered to those who struggle with mental health problems. Often, those who struggle with mental health problems cannot shout for themselves and suffer in silence because of the ridiculous stigma placed on mental health. That stigma ends in this Parliament. It is not good enough to have sympathy, empathy even, or simply to understand these issues when they affect someone close to us. It is time to get this right and I look forward to starting this crusade in Plymouth.” (column 374)

“I am sorry to report, however, that there remains a great stain on this nation of ours when it comes to conflict. In 2012, we reached a very unwelcome threshold when, tragically, more soldiers and veterans killed themselves than were killed on operational service in defence of the realm. It goes without saying that there are some genuine heroes in our communities and charities up and down this land who work tirelessly night and day to look after and assist those who have found returning to a peaceful life the biggest challenge of all. A great many of these veterans are not only from Afghanistan.

My key point is this: there has been a fundamental misunderstanding by governments of all colours over the years that veterans’ care is a third sector responsibility and that the great British public, in all their wonderful generosity, support our troops well enough, and any new initiative is met with the response, “Well, there must be a charity for that.” That is fundamentally and unequivocally wrong, and I make no apologies for pointing it out to anyone of any rank or position who may be offended by my candour.

I am not a charity and neither were my men. We gave the best years of our lives in defending the privileges, traditions and freedoms that this House and all Members enjoy. It is therefore the duty of this House to look after them and, crucially, their families when they return.” (columns 374-5)

He goes on to talk baldly but movingly about the deaths of two of his soldiers, one from suicide, one in a terrible combat, lance-sergeant Dan Collins and lance-bombadier Mark Chandler. I urge you to read their stories told by Mercer in Hansard, and google them.

Mercer is right. Mental health provision in England, including Cornwall, is poor and must be improved. Mentally ill people in Cornwall, as elsewhere, can end up in a police cell because of poor provision of acute psychiatric beds in mental health places of safety for them. Indeed, my understanding is that such is the lack of suitable psychiatric beds here that some mentally ill people from Cornwall are sent to Manchester for treatment, away from their family and friends and familiar environment. In these circumstances the psychiatrist treating them has to visit them in Manchester. I am with Mercer all the way: “It is not good enough to have sympathy, empathy even, or simply to understand these issues when they affect someone close to us. It is time to get this right”.

CORNWALL GETS MORE

---

The NHS has many components. In this post I am writing about the funding of the clinical commissioning groups of the NHS.

The National Audit Office (NAO) has published the allocation of funding to clinical commissioning groups (CCGs) and local healthcare groups for 2014/15. You can read the NAO full report and allocations here.

Broadly, the CCGs are GP-led replacements for the primary care trusts. There are 211 CCGs in England who from April 2013 commission services for the patients in their area from other parts of the NHS such as hospitals and mental health services – and indeed from any competent health provider outside the NHS.

Off target
As I have explained in earlier posts, the finite NHS funding is allocated to the various component geography-based NHS organisations in England based on their different healthcare needs and the size of their populations. Each primary care trust/CCG has a target funding, that is, what it should receive to deliver a standard level of healthcare for its population in their particular circumstances. The allocation of the funding is cursed by historical anomalies. By and large the health authorities do not receive their target funding: some get more; and some less, including in the past Cornwall. In the jargon, measuring the distance from target, some are above target, others below. This was so for the primary care trusts and is now so for the CCGs. The moves to bring all up to their target are slow in order that no overfunded component suffers instability from sudden financial loss.

I looked at the make up of the allocation system and why some healthcare groups did not receive their target funding in the 2010 post Funding health in Cornwall.

Cornwall health funding in the past
There have been repeated complaints in the near past that Cornwall has not received its fair NHS funding, that is, its target funding. In 2011-2012, for example, Cornwall and Isles of Scilly primary care trust was funded 2.2 percent under target. However, 45 trusts were further below their targets in percentage terms than Cornwall. Cornwall was not singled out for below-target funding, was not uniquely unfairly funded. It was not a victim, or at least not a singular victim, though nationalism seldom acknowledges and campaigns for the many others funded below their target or below average in health or any other public field.

2014/15 funding
In 2014/15 Kernow CCG, which covers Cornwall, is to receive more than its target funding. Its allocation of funds is 6.2 percent above target and in these terms it is better funded than 179 of the 211 CCGs.

109 CCGs receive funding below their target funding in 2014/15, 101 receive more than their target, and one is on target.

And nationalism says …
Anyway, Cornwall is now above target, over funded. What will nationalism say about the 109 underfunded CCGs? Does fair funding in public spending apply only to Cornwall? I think a weakness of nationalism is that it deals only with the parochial and does not lift up its eyes beyond its tribe: it works to parochial not universal principles.

Presenting Cornwall as a victim, short changed, picked on, singled out for unfair treatment by central government, on the wrong side of comparisons with others – the whole train of the piranist grievance agenda – is unconvincing though a staple of Cornish nationalism. The evidence tells against it, life beyond the Tamar shows it to be nonsense, and I shall go on explaining this as long as the nonsense is expressed.

Notes
The NAO figures cover not only CCGs but also funding to local area teams for primary care and to local authorities for public health. The CCGs take about 4/5 of the budget for these three local commissioner components.

The Devon, Cornwall, and Isles of Scilly local team is funded above target and the Cornwall local authority for public health is funded below the target.

In part 3 of the NAO full report you can read how the allocations are made.

Previous primary care trust allocations
Recurrent revenue allocations for 151 England primary care trusts 2011/12
Recurrent revenue allocations for 151 England primary care trusts 2012/13

OVERWEIGHT CORNWALL

Public Health England has published the results of a survey of adults and their weight. In Cornwall 69.8 percent are overweight or obese (a BMI of 25 and over). Only 41 local authorities out of 326 have a higher proportion.

---

REASON RIFE IN CORNWALL

Back from a break I came across two small items about Cornwall that warmed me.

Deprivation in Cornwall
On the blog I have argued repeatedly against the simplistic Victim Cornwall agenda. I have said that Cornwall is not one place and the circumstances of life vary across the county. It is inaccurate and unhelpful to talk as though all Cornwall was seriously deprived; the indexes of deprivation show vast variation in Cornwall.

Consider this comment:

“Cornwall as a whole is not deprived but there are areas where there are very high levels of deprivation”.

Exactly what I have been saying, sounds like me, but it is not me. This comes from Cornwall Council, page 5 of the introduction to the equality impact assessment guidance version 7 here.

Complex
In response to nationalist/Libdem simplism about the unfair funding of the NHS (and other public services) in Cornwall, I have argued that the allocation of health funds among health authorities is “extremely complex”. It is important to keep moving towards giving every NHS its target funding by carefully reducing the overfunding in some areas and increasing it in underfunded others but “no government can withdraw overfunding from an area all in one go because it would cause chaos in the NHS in that area”.

Yes, that sounds like me and is exactly what I have been saying. But these cited words are not mine; they come from Andrew George, Libdem MP for St Ives, making a somewhat quiet argument for more NHS funding for Cornwall (Cornishman 26 September 2013).

Here are some posts on Cornwall and NHS funding and deprivation
Cornwall, one of eighty eight 17 December 2012
Poverty by parish in Cornwall 21 May 2012
Mirror, mirror, on the wall, where’s the poorest of us all 21 March 2013

---

THE POOR DIE SOONER

This follows my post the other day on the Public health England (PHE) study of premature death in England.

The Office for national statistics (ONS) publishes life expectancy data for the UK and you can read them in the excel file at Trends in life expectancy by National Statistics Socio-economic Classification (NS-SEC ),1982-2006. The tables there show that men and women from different socioeconomic classes have different average life expectancies at birth and at age sixty five.

The evidence is clear. Now what? Well, the PHE and ONS data raise questions about how we tackle inequalities in health and income and whether we look afresh at age-related support (such as the state pension) which in current form benefits richer, longer-living pensioners more those who are poorer and die sooner. Labour has made a tentative start on this latter politically problematic issue.

---

HOW WELL IS CORNWALL ?

Public health England (PHE), an executive agency of the Department of Health concerned with health inequalities, has published some comparisons of health and mortality between local authorities in England. The data is called Longer lives and you can access it here. Begin by putting Cornwall in the search box on the home page. From there you can explore the data. Note the dates of the data.

In terms of overall premature mortality Cornwall is 47th out of 150 local authorities (where 1st is best); Cornwall is on the 69th percentile, that is, has better outcomes than 69 percent of the authorities. Cornwall is in the 6th socioeconomic decile (where 1st is most deprived) based on the index of multiple deprivation.

Cornwall is concerningly among the worse-than-England-average in the suicide statistics: see item 4.10 here or here (put Cornwall in the top box).

ADDENDUM 12 June 2013 Sky has published a map of the variation in premature deaths which this PHE report reveals: here.

---

UNEVEN BRITAIN

Today prescription charges go up to £7.85 an item for those who pay.

Whoa, not quite.

They go up in England, including Cornwall. Prescriptions are free in Scotland, Wales, and Northern Ireland. That’s down to the generous share of per capita funds for public spending those countries get from UK taxpayers under the Barnett redistribution scheme and the parliaments/assemblies they have. I think that basically England taxpayers with no parliament of their own are enabling the free prescriptions elsewhere.

It’s called the National Health Service. It’s called the United Kingdom; and we’re all in it together.

Will Cornish nationalism, fretting about 1337 and all that, question this uneven imposition on sick people in Cornwall? Prescription charges are the real world …

---

NHS STEALTH PRIVATISATION

UPDATE 14 March 2013 In response to the opposition to the present regulations the government said on 5 March 2013 it will rewrite parts of them regulations. The revised procurement regulations of 6 March 2013 are here. In response MPs wrote EDM 1188 of 14 March 2013 calling for the revised regulations to be “annulled”. Andrew George, Libdem MP for St Ives, is among the signatories to the EDM.

ORIGINAL POST 5 March 2013
When the NHS bill was going through parliament there were concerns that it would require the opening up of all local doctor-commissioned services to the private providers. The Tory Libdem government solemnly promised it did not and won over MPs and doctors on those promises.

Time passed and on 11 February this year the government quietly put out statutory instrument 2013-257 (SI 257) which does exactly what the government said it wouldn’t do. 38 degrees, the public online lobby, has persuaded 240 000 and rising people to sign a petition against this and has published a legal analysis of those promises from the Tory Libdem government about services for NHS patients and what SI 257 means: the SI does indeed require doctors to open up their local health services to private companies even if local people and doctors do not want that. It is stealth privatisation; it is a broken promise.

Read the 38 degrees document here.

EDM 1104 calls for the annulment of SI 257. It has been signed by only one of the six Cornwall MPs, Andrew George. The government are mulling over whether to go ahead or back down.

---