Current state of Health and Social Care in Brighton and Hove
January 2020
This report has been circulated to a number of Brighton & Hove City Councillors.
CUTS TO NHS AND SOCIAL CARE SERVICES
The Government has required the NHS to make £22 billion in savings by 2020/21 – the second tranche of savings of this magnitude. Across the board cuts for several years in the City have resulted in severe and growing staff and bed shortages, cuts in provision. cancellations of operations etc. growing waiting lists for treatment. In 2018/19 the CCG made budget cuts of £14 million with Community / Social and Primary Care suffering the biggest cut of £2,431,000.
The Government sponsored Bettercare Fund has masked budget deficits and cuts to social care services over the last few years. There are serious questions as to what happens when the Fund is wound up as will undoubtedly happen under the proposed new Integrated Care arrangements.
PUBLIC HEALTH
The Council has already contracted out many services including Substance Misuse, Community Equipment, Weight Control. Stop Smoking etc. In 2019/20 the Council cut £2.9 million from the social care budget. Council cuts from the Public Health budget included - £1,140,000 from General health improvement, £648K from the Substance misuse service, £712K from Sexual Health, £884K per year for 3 years up to April 2020 in Children's and Young People's services. These cuts have contributed to serious staff shortages and greatly pressurised (and reduced) provision.
GP TO PATIENT RATIO -
1 GP: 2526 patients in B&H, compared to national average 1:1780 - (CCG response in June 2019).
The situation is far worse in some areas of the city which have experienced the brunt of practice closures. 12 (?) GP SURGERIES CLOSED and patient lists transferred to other surgeries. Several GP surgeries are working under-complement with more GPs coming up for retirement. A number of GP practices have closed lists to new patients.
Concerns were expressed in the October 19th report to HOSC on Primary Care regarding the “uneven distribution of practices” across the city with “some communities with significantly worse access to primary care than others. This problem may be exacerbated if these communities also experience worse health outcomes – e.g. due to high levels of deprivation”. Growing numbers of city residents (particularly those with less mobility) are being isolated from GP and primary care provision.
PRIMARY CARE NETWORKS
The introduction of Primary Care Networks as part of the Long-Term Plan will increase the problems outlined above and create even larger primary care deserts by centralising provision and the closure of smaller GP practices. There will be Increased dangers of privatised Super-Practices and the more general incursion of the private sector.
CUTS TO COMMUNITY AND SOCIAL CARE
Fewer people deemed eligible for community care services. Closures of privately-run homes, putting pressure on the system. Figures from BSUHT showed increasing rates of DTOCs - Delayed transfers of care/LLOS (Long Length of Stay) patients. The bed occupancy figure for November 2019 amounted to 14 % of Sussex County capacity (113 beds) as opposed to 98 in the same period in 2018. Furthermore those found placements are being placed further afield in Newhaven, Cuckfield etc (greater isolation, difficult for families to visit). The collapse in social care across the country is a scandal of tragic proportions.
SUMMARY COMPARISONS OF KEY LOCAL STATS -
https://www.bbc.co.uk/news/health-41483322
A&E waits less than four hours (April 2019 figures)
Target: 95% BSUH 80.8% ENGLAND 85.1%
Brighton & Sussex University Hospitals NHS Trust ranked 81 of 129 trusts
Cancer care within 62 days (March 2019 figures)
Target: 85% BSUH 72.9% ENGLAND 79.7%
Brighton & Sussex University Hospitals NHS Trust ranked 110 of 131 trusts
Planned Ops and care within 18 weeks (March 2019 figures)
Target: 92% BSUH 71.1% ENGLAND 86.7%
Brighton & Sussex University Hospitals NHS Trust ranked 129 of 129 trusts
Patients starting mental health therapy within 6 weeks of referral (Jan-Mar 2019 figures).
Target 75% Brighton and Hove 74% England 88.9%
Brighton and Hove ranked 176 of 195 CCG areas.
MENTAL HEALTH – Long waiting lists for treatment of adults and young people (in some cases as long as 18 months). In 2018/19 £12 million in “efficiency savings” made by SPFT. Brighton and Hove CCG cut £890,000 from the Children's Mental Health budget in 2017/18. Inappropriate out of area placements because of bed shortages in the Partnership trust area amounted to 375 in 2018/19. The closest Substance misuse detox beds for the city are in Islington.
NHS STAFFING VACANCIES
Nursing vacancies up from 365 in Sep 2018 to 512 in Sep 2019 (figures from BSUHT). At the same time the number of volunteers working for BSUHT across a range of services is over 800 and increasing. The Long-Term Plan includes proposals for greater de-skilling and de-professionalisation, lower paid staff and higher levels of voluntarism.
BRIGHTON GENERAL HOSPITAL – a long -running campaign is still fighting the sell-off of this site for private, unaffordable housing and an NHS hub housing reduced NHS provision.
In sum – inequalities and gaping gaps and inadequacies in NHS and social care provision across the city are. More key services are under private control but paid for from NHS budgets. The Long-Term plan and Integrated Care plans are being imposed on the city's failing health and social care systems but reveal no strategy to address that other than further budget cutting and increasing access for the private sector. The consequences for residents in general and the vulnerable with less mobility in particular, do not bear thinking about.
MD/Sussex Defend the NHS/January 2020
January 2020
This report has been circulated to a number of Brighton & Hove City Councillors.
CUTS TO NHS AND SOCIAL CARE SERVICES
The Government has required the NHS to make £22 billion in savings by 2020/21 – the second tranche of savings of this magnitude. Across the board cuts for several years in the City have resulted in severe and growing staff and bed shortages, cuts in provision. cancellations of operations etc. growing waiting lists for treatment. In 2018/19 the CCG made budget cuts of £14 million with Community / Social and Primary Care suffering the biggest cut of £2,431,000.
The Government sponsored Bettercare Fund has masked budget deficits and cuts to social care services over the last few years. There are serious questions as to what happens when the Fund is wound up as will undoubtedly happen under the proposed new Integrated Care arrangements.
PUBLIC HEALTH
The Council has already contracted out many services including Substance Misuse, Community Equipment, Weight Control. Stop Smoking etc. In 2019/20 the Council cut £2.9 million from the social care budget. Council cuts from the Public Health budget included - £1,140,000 from General health improvement, £648K from the Substance misuse service, £712K from Sexual Health, £884K per year for 3 years up to April 2020 in Children's and Young People's services. These cuts have contributed to serious staff shortages and greatly pressurised (and reduced) provision.
GP TO PATIENT RATIO -
1 GP: 2526 patients in B&H, compared to national average 1:1780 - (CCG response in June 2019).
The situation is far worse in some areas of the city which have experienced the brunt of practice closures. 12 (?) GP SURGERIES CLOSED and patient lists transferred to other surgeries. Several GP surgeries are working under-complement with more GPs coming up for retirement. A number of GP practices have closed lists to new patients.
Concerns were expressed in the October 19th report to HOSC on Primary Care regarding the “uneven distribution of practices” across the city with “some communities with significantly worse access to primary care than others. This problem may be exacerbated if these communities also experience worse health outcomes – e.g. due to high levels of deprivation”. Growing numbers of city residents (particularly those with less mobility) are being isolated from GP and primary care provision.
PRIMARY CARE NETWORKS
The introduction of Primary Care Networks as part of the Long-Term Plan will increase the problems outlined above and create even larger primary care deserts by centralising provision and the closure of smaller GP practices. There will be Increased dangers of privatised Super-Practices and the more general incursion of the private sector.
CUTS TO COMMUNITY AND SOCIAL CARE
Fewer people deemed eligible for community care services. Closures of privately-run homes, putting pressure on the system. Figures from BSUHT showed increasing rates of DTOCs - Delayed transfers of care/LLOS (Long Length of Stay) patients. The bed occupancy figure for November 2019 amounted to 14 % of Sussex County capacity (113 beds) as opposed to 98 in the same period in 2018. Furthermore those found placements are being placed further afield in Newhaven, Cuckfield etc (greater isolation, difficult for families to visit). The collapse in social care across the country is a scandal of tragic proportions.
SUMMARY COMPARISONS OF KEY LOCAL STATS -
https://www.bbc.co.uk/news/health-41483322
A&E waits less than four hours (April 2019 figures)
Target: 95% BSUH 80.8% ENGLAND 85.1%
Brighton & Sussex University Hospitals NHS Trust ranked 81 of 129 trusts
Cancer care within 62 days (March 2019 figures)
Target: 85% BSUH 72.9% ENGLAND 79.7%
Brighton & Sussex University Hospitals NHS Trust ranked 110 of 131 trusts
Planned Ops and care within 18 weeks (March 2019 figures)
Target: 92% BSUH 71.1% ENGLAND 86.7%
Brighton & Sussex University Hospitals NHS Trust ranked 129 of 129 trusts
Patients starting mental health therapy within 6 weeks of referral (Jan-Mar 2019 figures).
Target 75% Brighton and Hove 74% England 88.9%
Brighton and Hove ranked 176 of 195 CCG areas.
MENTAL HEALTH – Long waiting lists for treatment of adults and young people (in some cases as long as 18 months). In 2018/19 £12 million in “efficiency savings” made by SPFT. Brighton and Hove CCG cut £890,000 from the Children's Mental Health budget in 2017/18. Inappropriate out of area placements because of bed shortages in the Partnership trust area amounted to 375 in 2018/19. The closest Substance misuse detox beds for the city are in Islington.
NHS STAFFING VACANCIES
Nursing vacancies up from 365 in Sep 2018 to 512 in Sep 2019 (figures from BSUHT). At the same time the number of volunteers working for BSUHT across a range of services is over 800 and increasing. The Long-Term Plan includes proposals for greater de-skilling and de-professionalisation, lower paid staff and higher levels of voluntarism.
BRIGHTON GENERAL HOSPITAL – a long -running campaign is still fighting the sell-off of this site for private, unaffordable housing and an NHS hub housing reduced NHS provision.
In sum – inequalities and gaping gaps and inadequacies in NHS and social care provision across the city are. More key services are under private control but paid for from NHS budgets. The Long-Term plan and Integrated Care plans are being imposed on the city's failing health and social care systems but reveal no strategy to address that other than further budget cutting and increasing access for the private sector. The consequences for residents in general and the vulnerable with less mobility in particular, do not bear thinking about.
MD/Sussex Defend the NHS/January 2020