Moving Grantham Hospital medical services into the “local enhanced neighbourhood team” – aka Care Closer To Home

This blog post focusses on proposals for “care closer to home”, to be provided by 12 neighbourhood teams across Lincolnshire. You can find an overview of the Sustainability and Transformation Partnership proposals and public engagement here. There’s information about the hospital cuts and centralisation proposals here. And info here about how Lincolnshire Health Scrutiny Committee is failing in its vital role.

Resistance is fertile!

The preferred option for the Lincolnshire Sustainability and Partnership public engagement on huge changes to the county’s NHS services is to maintain inpatient medical services at Grantham Hospital and join them up with local Out of Hours, GP and community health services.

These would be managed as part of the local enhanced neighbourhood team (see below) with hospital doctors and the hospital services being part of an integrated service with GP services, community health and other local services.

This would be led by Community Health Services (not ULHT) .The video claims that the Community Health Services Trust will be able to staff the hospital more effectively.

How? John Turner’s “Healthy Conversation Opening Statement” admits,

“…in many services we struggle to recruit and retain staff across our GP, community and hospital services. Currently over 800 posts are either vacant, or filled by temporary agency or locum staff.”

This “closer integration” is supposed to bring big advantages as medical patients will be treated at home or closer to home.

It relies on the so-called “left shift” in health care that makes patients increasingly responsible for their own care

An example of this shift of care from the NHS to patients themselves is the newly privatised Lincolnshire Community Pain Management Service. This is now provided by Connect Health. Patients who are waiting for a pain management appointment have been told that they can’t have appointment until they’ve been to a “workshop” in 2 months time which comprises a lecture on how the Service works, alternatives of treatment and small group discussions of what they can do to help each other or other rubbish. This also means travelling a long distance to the workshop which is difficult for people on low incomes and those who rely on public transport.

That workshop nonsense is all part of ” empowering” patients to “self manage” their health – in other words, restricting access to health services and telling patients to get on with it. This is how Connect Health justifies this nonsense:

“The commissioned model supports innovation and a revolutionary way of supporting the community to manage and understand persistent pain enabling people to live a life of quality and value. If people are able to manage their pain better, they will be in employment more of the time, they will feel physically fitter, their mental health and wellbeing will be improved and they are less likely to need medical interventions…

Working together with the NHS, we are committed to delivering…care, which empowers patients to understand and manage their pain in the best way possible.”

Neighbourhood Teams – trying to deal with “significant GP workforce and capacity challenges”

There is info about Care Closer to Home on the Lincs Sustainability and Transformation Partnership website.

It says Lincolnshire already has 12 Neighbourhood Teams, that include GPs, community and mental health services, social care and the third and independent sector.

Neighbourhood Teams are part of primary care networks delivering “new models of care” that involve GP practices working in partnership with community services, care services and other providers of health and care services, as a way of dealing with “significant [GP] workforce and capacity challenges”

When was there any consultation about this this major change to primary, community and mental health services and social care? Lincs Sustainability and Transformation Partnership say they want people’s feedback in the “engagement” process – but it’s a bit late now, isn’t it?

Digital apps are key to the whole shebang

At lot of this “left shift” to self care and primary and community health services relies on digital apps to support ‘digital first’ primary care, and particularly for people with frailty. And skype consultations with doctors.

This is a bit bonkers when you consider the poor broadband coverage in rural areas and the numbers of people without internet access – particularly the frail elderly, who will most need to rely on this “digital first” primary care. That’s before you take into account many GPs’ dissatisfaction with video consultations.

And alarms bells are ringing about Digital Care /Telehealth Hub staff. A job description and person spec for Digital Call Handlers at Airedale hospital in Yorkshire shows that these vital points of contact for poorly people at home and for care home staff are Band 3 healthcare support workers, whose only qualification is a Care Certificate. But they are expected to carry out skilled and responsible tasks that include:

  • Receiving and actioning clinical calls from Care Home staff under the direction of the Senior Clinical Assessors.
  • Supporting patient centred care of care home residents
  • Supporting self-management and education as necessary in conjunction with the home requirements
  • Assisting the care home team to support and train their staff in a range of delegated duties assigned by the registered practitioner such as virtual supervision of vital signs measurement and recording, clinical skills including phlebotomy, cannulation and ECG recording, education support and virtual care activities as required

The informed opinion of an Advanced Nurse Practitioner is,

“What the actual chuff – support and training to care home staff on a range of clinical skills such as ECG, phlebotomy etc on a band 3?? Bonkers! Question is, will people fall for taking on that role for that pay? That’s the problem. I’ve seen nurse practitioner jobs at band 6 in hospitals with job specs wanting at least a band 8 level. If less qualified people take on these roles then it allows downgrading & it’s not until they are doing the job they fully realise the risks and responsibility. It also leads to bad practice where folk cover up rather than acknowledge their lack of skill, fearing losing their position.”

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