Thank you to those who came to the refugee discussion in West Leeds

Thank you to all who came. I certainly learned several surprising facts. Here is a quick summary of what I heard.
refugee meeting november 2015It was first highlighted that a high proportion of refugees are been created in Afghanistan, Eritrea, Iraq, Syria and Ukraine. Generally corruption, military government and war can make life impossible for people to live. An example is Eritrea, in which military conscription is for life! Some of these are “Internally Displaced People” who will not necessarily leave the country. But other groups of refugees are forced to flee their country. The BBC graphic below shows the number of Asylum applications in the EU. However many of these applications are unsuccessful.
_86549138_eu_asylum_application_origiThe United Kingdom has accepted relatively few asylum applications.
_85333547_asylum_applications_eu_624It is possible to appeal against a refused asylum application. A “no” decision usually results in a cut in the person’s £5 a day allowance or a cut in the blue card to use at supermarkets. Asylum seekers spend an average of 18 months on the blue card scheme. And the £5 allowance is only given if you are absolutely “destitute”, as in not-a-penny-to-your-name. Any cash with the person will lead to a reduced allowance! They are also not allowed to work but usually are too scared to return to their country of origin. Sometimes the country of origin is not known or the authorities think someone is lying. This can leave them in a no-mans-land, with 11000 people in the United Kingdom waiting over 7 years for asylum claims! The authorities have no where to theoretically send them back. Sometimes refugees/asylum seekers are detained at detention centres, this can be indefinitely!

The grim graph below shows what happens when authorities stop rescuing boats:
_86549144_migrant_deaths_mediterranean_gra624_091115What is the government changing/cutting?

  • In certain cases the government will assist people in returning back to their country. Next year this will be directly operated by the government, expect it to be harsher.
  • Cuts to allowances for Asylum Seekers in the 2015 Immigration Bill
  • Government support in some instances, will be reduced to a phone line.

What should we do?

  • Campaign for factually correct media articles
  • Campaign for the United Kingdom to stop supporting alliances with Israel or Saudi Arabia
  • Support groups such as the Red Cross who support asylum seekers/refugees who are forced to be homeless
  • End the fact that homeless charities are often forced to refuse accept asylum seekers as their funding is only applicable to legal residents! “they do not (legally) have recourse to public funds”
  • End “indefinite detention”
  • Promote “grace hosting” in which asylum seekers are housed for a night or two with willing UK residents.
  • Provide full access to healthcare for asylum seekers.
  • Allow asylum seekers to work if their case has not been resolved within a specified time.

I appreciate migration is a “divisive” issue but we should at least have a fair system before we even attempt to discuss the question of “how many”. We are all human.

Useful links
Leeds Asylum Seekers Support Network
Red Cross
Still Human, Still Here

Bootham Park Hospital Dossier

Recently LYPFT lost the tender for most of the mental health services in York to Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV). At around the same time Bootham hospital, York was forced to close by the CQC. Here is a timeline of what I have found and what I plan to ask at the next LYPFT meeting.

Summary of Patient-led assessments of the care environment (PLACE)

botham summary 20131415

PLACE scores 2013 2014

Timeline

August 2007

Changed to foundation trust – LPNFT

February 2012
Acquired York services and changed to LYPFT, The LYPFT 5 year strategy was refreshed in 2012.

December 2012
Started apprentice scheme.

Late 2013
Care Quality Commission (CQC) identified problems at Bootham Park Hospital.

May 2014
Opened new women’s low-secure unit in York.

September 2014 meeting

’…the quality of the estate in York was a concern to the trust and the Care Quality Commission reinforced the Trust’s view that the inpatient wards at Bootham Park Hospital and Lime Trees are not suitable for modern-day inpatient care. However …NHS Property Services Ltd, who owns the York Estate, has agreed to refurbish Mill Lodge as a new impatient unite for those service currently at Lime Trees…… reported that the Vale of York Clinical Commissioning Group as also agreed to refurbish Cherry Tree House and Bootham Park Hospital so that better inpatient wards would be provided to adult patients on an interim basis whilst longer term plans for a new hospital to be built for the people of York are progressed. ‘

A member of York Mental Forum ‘raised a question about the future plans for Bootham Park Hospital. In response it was noted that the Trust was of the view that although it was difficult, it was not impossible to provide 21st century inpatient services out of an 18th century building…….there was two stages: the first being plans to conduct interim work associated with making further improvements to the environment in Bootham Park Hospital and noted the changes that were proposed to the locations of the individual services. ……… assured members that the Trust was working with partners in York to ensure bespoke mental health services were available to service users.’

Annual report March 2015

-‘Work has been undertaken to review the future of Bootham Park Hospital whilst focusing on short-term environmental improvements.’
-Higher % of York population has used IAPT services and LYPFT has reduced time from referral to assessment.
-CAMHS relocated to Mill Lodge for a ‘better environment’
-York Inpatient dementia services changed into single-sex units.-One of 10 possible risks to LYPFT was “Continuing to provide services from premises of which the trust is not in direct control that have been identified as not suitable from an environmental perspective’
-Established volunteer run info and drop-in centre at Bootham Hospital.
-LYPFT hoped to have a fixed home for new York hub teams. Hoped to have a solution by working with York CCG & NHS Property Services by the end of September 2015!

‘Much work has been undertaken to review the future of Bootham Park Hospital. We understand and recognise the importance of Bootham Park to the delivery of inpatient and community care in York….We have completed work to eliminate ligature risks from the fabric of the building and have completed a review of the security of the building, meaning service users can expect to receive safe care. Our long term plan continues to be to provide inpatient services from new facilities which will be fit-for-purpose and allow delivery of modern health care.’

April 2015 Meeting

-It again noted that the estates in York were not owned by LYPFT.
-Slightly worse 7 day-follow-ups in York compared to Leeds.
-Noted vacancies unfilled across LYPFT, nationally this is also allegedly a problem. Bootham Ward 6 was experiencing higher levels of sickness.

11/05/2015

LYPFT learnt is was not the preferred bidder for York CCG mental health services.

June 2015

..an update to the Board on the latest position in relation to the timelines and delivery of the Bootham Park Hospital interim estates solution. ….advised the Board the slippage on the project noting that this has now been formally advised to the Trust by NHS Property Services Ltd and that the expected completion date was November which is beyond the timeframe agreed with the CQC in respect of the compliance action. …. Noted that the CQC had been formally advised of the slippage…. updated the Board on the conversation which had taken place with the CQC noting that they had formally requested details of the slippage, which had been supplied, and that a response was still awaited from them…… acknowledged that the matter was in the hands of NHS Property Services but asked what the trust had done to escalate this matter and ensure that the project is delivered on time, noting that XXX had suggested this be done in October 2014….noted that the matter of the risks in relation to the environment at Bootham Park Hospital was formally identified by the CQC during their initial inspection late 2013, and indicated that in their view the Trust had done all it could to ensure the environment was as safe as possible and the Trust had through its membership of the Bootham Programme Board, done all it could to influence the progress of works…….. assured the Board that everything within the power of the Trust had been done to ensure the matter is expedited and that there is a clear audit trail of the Trust’s input. XXX acknowledged all this work, but felt that the Trust’s concerns could have been better progressed through the Chair or Chief Executive and that in his view there could be insufficient evidence of the Trust raising concerns at a very senior level about the delays.   ….noted that the CQC is aware that the resolution of this matter is not in the hands of the Trust. …. Also noted that when XXX had first suggested that the matter be escalated a judgement was made that the Trust was building better relationships with NHS Property Services and the Vale of York CCD locally and that escalating the matter could be detrimental to this progress at that time.’

July 2015 Meeting

-Update on York improvements. There was a demand for extra psychological services in York. But in York services are allegedly commissioned separately by York CCG. Less money is spent nationally in York per head of population than Leeds.
-Meeting was told that LYPFT bid had been slightly higher in quality but lower on finances. But overall the LYPFT bid had been lower than TEWV
-PD services in York were improving

03/08/2015

LYPFT writes to Jeremy Hunt over concerns about Bootham Park Hospital.

01/09/2015

Civil servant replies on Behalf of Jeremy Hunt:

‘I share your concerns about the facilities for the delivery of mental healthservices in York and asked officials from my department to contact NHS Property Services (NHSPS) for an update. I can tell you that the company is actively working with NHS Vale of York CCG to put in place both interim and long-term solutions to improve the mental health estate in York… NHSPS has agreed a detailed programme of work with the CCG, LYPFT and the CQC to improve the clinical environment….. Phase Two works on the wards are due to commence on 7 September, with completion at the end of January 2016 for this and all works…. To address the ligature risks, work is being undertaken to, for example, install anto-ligature windows, replace doors, box in other ligature points and ensure the ceilings are anti-ligature. The work is subject to the constraints of the listed building and management arrangements that been put in place to address oustanding risks…Any changes required by tthe new provider may therefore have an impact on the above strategy and timetable, outside the control of NHSPS…. The company has just been instructed to pause new works for two weeks while the new provider reviews potentially available options for the above programme’

09-10/09/2015

CQC inspection of Bootham Park hospital

25/09/2015

Press article stating that
CQC inspection closes Bootham Park after part of the ceiling falls on their head. 30 patients are moved out.

01/10/2015

Mental health contracts transfer to TEWV as planned

LYPFT as a whole?

Here is the CQC rating for the whole LYPFT trust for 2014/15:

CQC 20142015 lypft

The CQC rated 70% of LYPFT services as ‘good’ and one as ‘outstanding’. 25% of services required improvement and 5% were “inadequate”. Overall the trust was rated as ‘requiring improvement’. One of 5 areas requiring improvement by CQC was ‘Safety and suitability of premises’. LYPFT was only just below the national average. Other notable changes in 2014/15 included:

-New ways of receiving feedback from patients and clinicians. Improved complaints process (PALS).
-Worked with York St. John University and jointly won an award for providing classes/courses to service users.
-Staffing levels now available to see in each ward
-Worsley Court in York was closed from October 2014-January 2015 to retrain staff.
-Audits identified several areas for improvement. A recurring issue appeared to be up to date paperwork/records.
-Bootham hospital was identified as requiring improvement on admission clerking.
-York Triage service started.
-1700 staff and patients participated in clinical research.
-Planned to work with other health services in York over Eating Disorders.
-Changed internal inspection regime
– More work with 3rd and voluntary sector.
-97% of students reported a favourable experience during their placement.
-LYPFT pay at least the ‘living wage’ to their staff.

There is examples of hard effort by LYPFT, and every complaint always has an action listed to improve it. New services and collaborations are constantly launched. And you will note it was LYPFT who informed the CQC of delays to the improvement to Bootham Hospital.

My main concern is that there may have been a disfunctional ‘company culture’ in York and hope this does not exist in Leeds. Ideally I need staff members to tell me anonymously of any concerns. I would also suggest that York residents try contacting the TEWV governors.

 

Questions I plan to ask the board:

In 2014/15 were there proportionally more vacancies in York compared to Leeds? If so did this reflect worse job prospects?
Which CQUIN targets did LYPFT make and which did it not?
What was the average number of applicants for York or Leeds for each vacancy for 2012/13/14?
What is the % target for staff who do not feel secure in asking questions about unsafe practices?
From 2012-2015 how many external groups inspected Bootham hospital?
How many of the CQC ‘must do’ and ‘should do’ actions referred to York or Leeds?
Is there any student placement feedback for Bootham?
How many ‘serious’ incidents happened in Bootham hospital in 2012/13/14?
How much was the Bootham Park Hospital estate valued at in 2012/13/14?
One of the 10 potential risks listed in the Annual report was ‘Continuing to provide services from premises of which the trust is not in direct control that have been identified as not suitable from an environmental perspective’. Can we be confident there are no ongoing complications with the other 9 potential risks?

HMP Leeds and mental health in prisons

England & Wales has one of the highest prison populations in Europe. There has been a 90% rise in the prison population in the last 20 years(1). There are approximately 85000 people in prison in England & Wales , with 82000 identified as male (2). It is predicted to rise to 90200 by 2020, a 10% increase (3). For comparison, the population of England and Wales will go up around 4% between 2015 and 2020. It is estimated to cost around £36000 per prisoner per year. 21000 prisoners are from an ethnic minority, nearly 25%, compared to around 10% in the general population(4). (vulnerability and poorer job prospects?)

Government predictions

Government predictions

It is possible that rising inequality or government policy has increased the prison population. Especially when environmental factors such as leaded fuel have reduced (5). See https://www.equalitytrust.org.uk/ for the problems with income inequality. The UK sometimes mirrors the USA. Like our health system we are starting to copy the USA. Private companies are starting to run our prisons.

Amongst prisoners there is higher prevalence of anxiety, depression and psychosis, than the general population. Approximately 7% of prisoners meet the criteria for having a learning disability. There is stigma within prisons and prisoners considered ‘difficult’ may actually have mental health problems. Drug use in prisons is a problem and the staff:prisoner ratio has been reduced over the years. The government wrongly attempted to reduce book access to prisoners, however illiteracy can be an issue. Prisoners spend approximately 22hr a day in their cell. Sometimes they are transferred to other prisons or are in on short sentences. In extreme cases they can be removed under the Mental Health Act but this is not taken lightly. HMP Leeds in Armley is the 2nd most overcrowded prison in the country (6). It is designed for 669 people but currently has 1176. This means prisoners have to share cells, this is not ideal for certain prisoners with mental health difficulties.

HMP Leeds

HMP Leeds

Mental health services in prisons have to overcome these complications. Further cuts to health and social care, risk affecting these service users. This is just one service that the Leeds and York Partnership NHS Foundation Trust provides.

By a governor on the Leeds & York NHS Partnership Trust.

(1) http://prisonwatchuk.com/2015/06/11/uk-prison-population-stats/

(2) https://www.gov.uk/government/statistics/prison-population-figures

(3) Prison Population Projections 2014 – 2020, England and Wales

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/380586/prison-population-projections-2014-2020.pdf

(4)http://www.prisonreformtrust.org.uk/projectsresearch/race

(5) http://www.bbc.co.uk/news/magazine-27067615

(6) http://www.howardleague.org/weekly-prison-watch/

 

 

Farnley & Wortley Green councillor passes council motion asking for better housing

In July, Chancellor George Osborne announced that he would withdraw a commitment to improve the energy efficiency standards of new homes by cancelling an improvement of the building regulations scheduled for 2016. The announcement received widespread condemnation from several hundred businesses who have asked the Chancellor to reverse the decision (1). Cllr Ann Blackburn’s motion stated:

  • The negative impact this will have on householders at risk of fuel poverty in new housing.
  • The missed opportunity to reduce carbon emissions in new developments.
  • The loss of income to the local economy as a result of these lower energy efficiency standards, as householders’ income is spent paying energy bills rather than in local shops and on local services.’

In July, the Green Party called for a cross party campaign by local Councils to specify ‘Passivhaus’ standards on all new homes and buildings constructed on Council land or as a condition of sale on Council land sold for development (2). Passivhaus is an internationally recognised standard that typically means that an average household can have heating bills of less than £100/year due to the highly efficient thermal performance (3)

A Passivhaus in Denby Dale, West Yorkshire

                                         A Passivhaus in Denby Dale, West Yorkshire

At a recent (Wed 16th ) council meeting Cllr. Ann Blackburn initially submitted a motion which stated:

‘…This Council, therefore, requests that an early report is brought to the Executive Board to specify Passivhaus Standards on all new buildings on council-owned land and as a condition of sale on any council land.’

However the motion was amended by Labour to say:

‘…..This Council also notes that the Leeds Standard for Housing aims to improve the quality of building, with energy efficiency as a central component of these changes. This approach has emphasised the needs for all housing -whether on Council land or not- to meet high quality energy efficiency standards.

Given Central Government’s clear movement away from policies designed to improve energy efficiency, the Council resolves to ensure practical action takes place at a local level to secure a sustainable future.

Council therefore requests that officers investigate the need for even more challenging, locally set building standards, whilst also promoting and supporting self-builders, community-builders and developers who will seek to build to Passivhaus or similar standards. Council requests that Executive Board receive a report on this within the current municipal year.’

Unfortunately the amount of motions a party can submit is approximately proportional to the number of party councillors on council. The Greens are not yet big enough to change this and the bigger parties do not want this to change.

Full motion here or here

(1)http://www.ukgbc.org/press-centre/press-releases/over-200-businesses-urge-chancellor-reconsider-scrapping-zero-carbon

(2)https://www.greenparty.org.uk/news/2015/07/23/greens-call-for-%E2%80%98passivhaus%E2%80%99-revolt-by-local-councils/

(3)http://www.passivhaus.org.uk/standard.jsp?id=122

The tragedy of a market based NHS

The 2012 Health & Social Act created a new NHS framework. Clinical Commissioning Groups have been set up to commission health services to any bidder (“any qualified provider”). I remember campaigning against the 2012 bill with the relentless Leeds Keep Our NHS Public. The bill encourages privatisation of the NHS. Yet bizarrely, Conservatives (and the odd Lib-Dem) claim that paying the private sector to run a service is not privatisation!! In fact nearly any NHS service can now be privatised, even services involved with the commissioning itself. We all knew that introducing a ‘market’ into the NHS would add extra costs.

Leeds & York Partnership Foundation Trust (LYPFT) runs mental health services in Leeds, North Yorkshire and York. It recently lost the majority of its contracts in York to another public sector Foundation Trust called Tees, Esk and Wear Valleys NHS Trust (TEWV). LYPFT still runs a few services in York and North Yorkshire via an NHS England contract. The decision to award the existing contract to TEWV over LYPFT was decided by the Vale of York Clinical Commissioning Group (CCG).

CCGs are made up of groups of General Practices and commission the following:
• Planned hospital care
• Urgent and emergency care
• Rehabilitation care
• Community health services
• Mental health and learning disability services

A CCG board is made up of GPs and a few other specialists. Currently we have a shortage of GPs and many are working long hours. From a laymans view it appears the government wants the GPs to run the accounting and the Accountants the NHS!

On the 11th May LYPFT learned they had not been selected as the “preferred provider” by the Vale of York CCG. LYPFT was surprised, since they believed the contract would be awarded on quality not cost. LYPFT were also in the middle of doing-up an important medical centre in York. It then turned out there was a conflict of interest. A Doctor on the judging panel for the Vale of York contract had a partner who worked in TEWV (1).

LYPFT then asked Monitor (the NHS regulator) to investigate these issues. Monitor refused….. yet another watchdog which is not fit for purpose. The 2012 Health & Social Act created more bureaucracy than prior to 2010. Tellingly the government has plans to merge Monitor and the NHS Development Authority into “NHS Improvement”. But no amount of ‘creative’ renaming can hide the cuts in money and staff shortages within the NHS. This grim graph shows the amount of Foundation Trusts now in deficit. Do we want our NHS to rack up debt and even go ‘bust’?

Source: http://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/trusts-deficit

Source: http://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/trusts-deficit

The tendering cost for LYPFT for the Vale of York contract cost at least £250000. The combined costs to both LYPFT & TEWV from tendering and any transfer costs could be over £1m. This money would better spent on patient care, not expensive, wasteful tendering processes. Yet the government will continue with their empty double-speak. I can only assume many MPs will eventually be rewarded by positions on private health company boards (2).

(1)http://www.yorkshirepost.co.uk/news/main-topics/general-news/nhs-investigation-trust-didn-t-know-of-role-played-by-doctor-with-conflict-of-interests-1-7376641#ixzz3lSUKOpyw

(2)https://leedskeepournhspublic.wordpress.com/2014/08/08/press-release-mp-connections-to-private-healthcare-in-yorkshire/