Thursday, January 30, 2014

Health inequality should be Labour's priority

Neil Findlay, Shadow Cabinet Secretary for Health led a discussion at tonight's AGM of SHA Scotland.

Neil's focus was the appalling levels of health inequality in Scotland. This reflects other socio economic factors in disadvantaged communities. The problem has been analysed to death, in effect reinventing the Black Report several times over. We now need to take action.

This is not just about the NHS. It's about jobs, income, housing, education, and community networks. Neil drew a comparison with investment in community services in the developing world. We need better integration and local initiatives, not just hospitals. Others pointed to the need for health impact assessments of every policy decision by health boards and councils. We also have to look at how resources are targeted on those areas most in need.

He also highlighted the pressures on NHS Scotland that he had heard from a wide range of staff, patients and healthcare organisations. These include budget pressures, staffing levels, vacancy rates, bullying and harassment, A&E waits, private sector payments and many others. In hospitals, crisis management is the norm with the target culture distorting priorities and putting unbearable pressures on many staff. Neil has called for a review of NHS Scotland, recognising the contribution staff make to the NHS that is Labour's finest achievement.

Community services are also under pressure. Neil used the example of Deep End GPs who use support staff to help patients with wider issues, but need more time with patients. One practice had not had a health visitor allocated for a year, others had limited contact with social work. Other members at the meeting were highly sceptical that the latest version of care integration is going to work. On local democracy, health workers made an unfavourable contrast between the NHS and the outsourcing initiated by many councils.

Home care quality is been driven to the bottom as council budgets are slashed. This was illustrated by the example of a 17yr old who was given four days training then allocated 30 visits in her first day, including patients with complex conditions. She was paid £5.13 per hour and worked from 8am to 10.30pm. Neil argued for good national standards and where services are contracted out they should compete on quality not wage levels. We should be raising the status of care workers so there is continuity of care, slowing the growing turnover rates.

There are similar problems in private care and nursing homes, where there is one scandal after another. In Edinburgh, 100 patients are bed blocking because of the number of nursing homes under investigation or being closed. A number of members referred to the size of new homes, creating new institutional environments.

Neil has established two reviews on social care and inequalities to feed into the SLP policy process that has just started. There was a detailed look at the remit for the health inequalities review and SHA Scotland is well represented on the group. Members made a range of contributions that will be fed into that process.

Thursday, January 16, 2014

More bluster than solutions in health debate

NHS Scotland may not be a 'basket case', but it is under huge pressures that the Scottish Government would do well to recognise. Sadly, not much sign of that in yesterday's Scottish Parliament health debate.

Shadow health minister Neil Findlay opened the Labour debate, he said: "The reality is that the NHS in Scotland, the staff who work in it are under pressure like never before". He drew attention to  budget pressures with "fewer staff being asked to do more for less" as some of the problems facing the NHS, along with bed blocking, waiting times increasing and a "skeleton weekend service" in hospitals.

The Cabinet Secretary for Health's response was combative rather than constructive. He dismissed a Labour demand for a review as the "laziest, most vacuous motion" he had encountered in 15 years of the Scottish Parliament. This is of course a classic lazy and vacuous response and a bit rich from a Government that has used reviews extensively, particularly when the alternative is a difficult decision!

Neil ­Findlay cited unions and professional bodies who believed the NHS in Scotland was close to breaking point. He said, "The Cabinet Secretary has a choice - he can either ignore those informed voices or he acts now and instructs a wide-ranging review of the health and social care system. As these voices have grown louder the Cabinet Secretary's response appears to be to stick his fingers deeper into his ears. This simply is not good enough."

Staff concerns are reflected in the latest NHS Scotland workforce survey. Three of the five lowest scoring statements related to how involved in decisions staff felt they were. The statement ‘Staff are always consulted about changes at work’ received the lowest percentage positive response of all (26%).  The second lowest percentage positive response was ‘There are enough staff for me to do my job properly’, with only 31% of respondents answering positively.

While the NHS has got off relatively lightly in the huge Scottish public sector workforce cuts, 6,000 posts have still gone. This is at a time when the demands on the NHS are increasing. It is therefore not surprising that NHS workers don't believe there are enough staff to do their job properly.

The Health Secretary yesterday referred to 'Everyone Matters: 2020 Workforce Vision'. This is an important document and reflects the constructive way NHS Scotland is seeking to address workforce change. However, this is largely a process document, it doesn't set out how change will be delivered in the current financial environment. Helen Puttick, makes a similar point in her entertaining but caustic analysis in today's Herald. Seeking practical measures she asks, "Why, then, do we have a plan that does little more than describe planning structures?"

NHS finances are also under pressure as the recent Audit Scotland report highlighted. They said "In 2012/13, pressures on the NHS’ capacity became more apparent and the health service spent more on short-term measures to deal with them". That's polite auditor language for putting a sticking plaster over the cuts. And real term cuts they are, when inflation and other cost pressures, not least drugs, are added to the balance sheet. For example, recent statistics revealed that there were 149,866 emergency admissions among people over 75 in 2012/13, compared to 116,128 in 2003/4. That's 410 a day.

The NHS in Scotland does an amazing job, but we do need to recognise that all is not well and staff are working under growing pressure that will impact on patient care. Political bluster is not the solution.

Neil Findlay MSP will be expanding on these themes at the the AGM of SHA Scotland on 30 January 2014.