Director of Strategy and Director of Primary Care Services and Redesign – even their respective titles fill one with gloom.

The first choice for local residents would be a full service hospital in what is the most populous district in Hertfordshire.  That was taken away and we were promised a super-hospital at Hatfield instead as a second best.  Then we were told we couldn’t have that, so we were promised an Urgent Care Centre – third best.  Now it turns out we cannot even have that.

I asked the two PCT men whether they could state plain and simple whether services to St Albans residents would be better or worse as a result of the decision.  “That’s the wrong question,” they said.  Well not to me and local residents it isn’t.

There were some good questions tonight about whether an Urgent Care Centre is what we need.  There is clearly great confusion as to what services it would provide in the spectrum between minor injuries and blue light stuff.  But its cancellation becomes a metaphor for the endless down escalator in really local health service delivery.  The decision looks like it was made on the back of an envelope.  No wonder local people think the NHS has left them.

All we got from the two PCT representatives was evasive management speak.  St Albans is owed better given the sad history of let-down and betrayal.

The number of managers in the NHS increased by 4,748 in the last year – an increase of 12% – while the number of nurses only increased by 2%.

That’s an extra £230m on the NHS pay bill.

There are now 44,661 managers in the NHS – an 84% increase over the last ten years. The average annual increase in managers over the last ten years has been 4.6% – the average annual increase in overall nurse numbers has been only 2.4%.

Ho hum.

It was only a few days ago that I blogged about the closure of A&E at Hemel Hempstead and then blogged again about a young resident writing to me about how he just did not know what services were provided any longer at the St Albans site.

Yesterday’s communication is just another sad chapter in the long and sorry history of broken promises and betrayal over health service provision in our city and district by successive Conservative and Labour governments.

So much for all the consultation by the PCT on its Developing Quality Healthcare programme for Hertfordshire, the fancy slideshows and glossy brochures.  For the residents of St Albans, the fancy promises have turned out not to be worth the paper they were printed on.

Following our recent public meeting in the city with Norman Lamb MP to discuss local health service delivery and accountability, we are already delivering a survey to local households asking for people’s personal experiences  – from the new arrangements for A&E to out of hours services, transport and parking.

We decided to do this before we knew of this latest blow, and we are receiving a huge number of responses, which we will collate into a powerful dossier.  Many people have agreed with the sad comment of one elderly local resident quoted in the survey’s cover letter that “the NHS had left her”.

This latest blow provides yet more graphic evidence of the way that the historic city of St Albans is still being treated as an afterthought by health planners.  With less than six weeks to go to a General Election, the NHS must now be at the forefront of the local campaign.

Here are two e-mails received within an hour of each other:

I personally have had no problems at all accessing local health services.  I think the service provided by my GP surgery is very good and I am  happy with the out of hours service.  If I phone them I get to speak to a doctor much quicker than if I call NHS direct and can actually get a face-to-face appt with a doctor if necessary.  Sometimes when I have needed to access the out of hours service I have seen a GP from my own practice anyway.

I don’t personally find it a great hardship to have to travel to Welwyn or Stevenage to go to hospital – I haven’t had to go to Watford yet but none of these places are so very far away or take very long to get to.

I have been able to find a dentist in St Albans who does  NHS treatment and have been impressed by how quickly I was seen when referred for physiotherapy and when my daughter had to be seen by an audiologist and speech therapist – MUCH  quicker than friends living in other parts of the country.

We are well served in St Albans with health care in my opinion.

Two local residents living in reasonably close proximity, two entirely different stories.  And I am daily receiving more comments, both e-mail and hard copy.  From them we are able to build a powerful picture of our local NHS.  I am most grateful to so many people for taking the trouble to write in.

Hick Hollinghurst spoke first on the local picture, positive and negative. Then Norman spoke passionately about the need to improve particularly in mental health provision, about reducing some of the more rigid NHS targets (negative) and replacing them with guarantees of standards (positive), about the need to streamline the multitude of supervisory bodies all doing similar jobs and to bring greater efficiency into the NHS by re-designing processes and service delivery.

As chairman for the night, I found the Q&A session particularly interesting from an audience which was a mixture of general public and healthcare professionals.

•    The first question picked up on the appalling case where a German doctor with no GP experience came over to work in an out of hours on-call service and killed a patient through a massive overdose of the wrong drug.  Current freedom of movement rules in the EU meant he faced no requirement to pass language and competency tests.  As it happened Norman Lamb has been working closely with the family of the deceased man and he was robust in his approach to this issue – the prime responsibility is to ensure patient safety and that means there must be confidence in the language and medical skills of people coming over to work as doctors, period.  Not all EU member states’ medical regulatory bodies are of the same standard.  It’s not like someone coming to drive a crane.  Patient safety must be paramount.

•    A member of the audience spoke movingly of her mentally handicapped son – now grown-up – and how he is given little or no dignity or respect when it comes to NHS treatment.  There is clearly a particular issue which I will be following up with her but Norman spoke with feeling of how mental health is generally the poor relation in the NHS.

•    A local pharmacist asked about competition versus collaboration in the NHS.  At the moment NHS workers are often forced to compete against other branches for finance/equipment etc.  Would it not be better to focus on collaboration between the different branches instead.  Norman Lamb said that competition had introduced fresh thinking and improved NHS services in certain areas but it could not be the be-all-and-end-all.  It was important to ensure that there is integrated care – he instanced a very interesting healthcare provider on the west coast of the USA – so there is a need for both competition and collaboration.

•    Another question was about the effect of the European Working Time Directive on doctors’ training.  Norman Lamb said that currently only 9-18% of specialists are complying with the 48 hours rule, all the others were working beyond these hours (mainly without reporting it).  The new rules also mean that there need to be more handovers between doctors which could compromise patient care.  There should be greater flexibility to these rules, and the ability to work up to 56 hours a week.

•    NICE was raised – whether it is effective, whether it makes good judgements, whether it is fair.  Norman Lamb said that the principle of NICE was good, however the criteria with which it judges value for money should be known in the public domain – currently they aren’t.  Also there is the problem that NICE doesn’t take into account the impact of particular drugs on the lives of carers, or the economic impact if a particular drug would enable someone to continue to work and pay taxes.  It also doesn’t measure what is lost by paying for new drugs – what services have to be cut to enable the funds for the new drug to be available.

•    There was a very interesting question about whether the National Dementia Strategy is viable in the current economic climate.  Norman Lamb said that the strategy was welcomed as an aspiration but there wasn’t enough money at the moment to make it work.  However the issue of the funding of social care is of vital importance.  Many people fail to qualify for means tested free care, but do not have much money and so are spending everything they have on care.  There is a need to get all 3 parties to work together to find a solution to this.  We need to accept that more money is urgently required in social care, the parties should commit, before the general election, to work together to find a solution to this, since it will have to be paid for.

•   Finally there was a question about Link and how well current systems of public involvement in the health service are working.  Norman was very critical of the chopping and changing since the abolition of community health councils, and also of the way that over-bureaucratic demands for CRB checks and similar work to put people off getting involved.

I wish there had been time for more questions but Norman had to get away for a train to get him home to Norfolk at a reasonable hour travelling from Chelmsford so not risking FCC!).  From the e-mails I have received following the meeting, it is clear that people find events like these really informative.  When I was a young candidate, public meetings were much more common.  I have a hunch they may make a comeback  as people look for more than soundbite politics.

And giving his reaction to the meeting, Nick Hollinghurst sent me a most insightful note yesterday:

The big prob with all this stuff is to balance out the
(a) anecdotes (nearly always negative),
(b) NHS improvement plans (nearly always over-optimistic),
(c) excuses (always self-serving),
(d) BMA propaganda,
(e) local politics (often simplistic, populist and willfully ill-informed),
(f)  national politics (often simplistic and populist),
(g) drug company promotion (often venal and self-serving),
(h) pressure group campaigns (sometimes populist, often ill-informed, occasionally obsessive, but also sometimes quite excellent)

And to do so while finding one’s way around the NHS structures (getting simpler, but still somewhat Byzantine) and understanding the science (often challenging and often, especially the statistics, downright challenging).

Apart from that, it’s easy!

In our West Hertfordshire Hospital Trust area, families paid out £148,218 in 2008/9 alone to get their deceased loved ones’ bodies released for cremation.

It may be “a long established practice” but but it’s hard to justify taking money off grieving relatives when this involves nothing beyond most doctors normal working hours.  Two separate doctors have to sign forms and get paid £73-50 for each one.  Because the undertaker normally pays and then includes the fee in his overall charges,  the practice is not very visible but that does not make it any more palatable.

“Ash cash” is a Dickensian relic of past times and the Government should take action to put an end to this unjustifiable practice as soon as possible.

PS Norman Lamb is coming to St Albans this week to speak at a public meeting on the future of the NHS.  For details see my previous blog entry

There have been many disappointments for St Albans over the last few years.  The city expresses the ambition to be Hertfordshire’s premier community.  Yet our City Hospital was down-sized against the promise of a new super hospital at Hatfield, and then the Government reneged on the deal.

We have been promised a great new Urgent Care Centre, but the omens do not look good for its delivery given the state of public finances.

Maternity services have long since left St Albans, but how happy are local mothers that they will soon only have home birth, Watford or Stevenage to choose from within the county?

Just how easy is it to get to Watford General in Vicarage Road on a match day?  For people visiting in-patient loved ones, are the car park charges fair (assuming you can even find somewhere to park)?  How do the bus routes work for non-drivers?

But of course there are good news stories too with the Minor Injuries Unit and the elective surgery unit.  There are some interesting innovations with the new county council and NHS Joint Commissioning Partnership Board.  So can Hertfordshire teach things to the rest of the country?  And most importantly how can we reconnect local people with their NHS?

These are all matters which are likely to be raised at the public meeting we are organising this Thursday.  The meeting takes place at the Marlborough Road Methodist Church at 7 pm and the main speakers are Norman Lamb MP, Lib Dem Shadow Secretary of State for Health, and Nick Hollinghurst, Vice Chairman of the Hertfordshire County Council Health Scrutiny Committee.

We will hear what is happening locally from Nick and then hear from Norman Lamb on LibDem thinking on the NHS overall – not least within the context of a new age of public spending austerity.  And I hope there will be a lively question and answer session to follow.

Everyone is welcome to attend the meeting.  It will help us plan for numbers if you register your interest via the health survey link at the top of this page.  Hope to see you there!

The body was found in a toilet. Allegedly it had an out-of-order notice on the door. But it is still difficult to comprehend that a proper cleaning regime would not have exposed the tragedy much sooner

West Hertfordshire Hospital Trust is rightly holding an inquiry into the case. The results of the inquiry must be made public, in order to reassure patients and their families that processes have been changed, and to reassure the public that this could never happen again.

Sal Brinton, my fellow Liberal Democrat candidate in Watford has been campaigning for years for improvements to be made in the running of the hospital for the sake of everyone in West Herts.

Sal has posed the following questions, in light of the most recent Healthcare Commission Healthcheck report on West Herts Hospital Trust in 2008:

1. What monitoring was in place for a patient in distress, and what arrangements were made to search the hospital for him after he disappeared?
(Healthcare Commission report 2007/8:
C20a: safe, secure environment: Insufficiently Met
C20b: privacy and confidentiality: Poor
National indicator: experience of patients rated Poor)

2. What arrangements were in place for cleaning the toilets, for a body not to be discovered for this length of time?
C21: Clean, well designed environment: Compliant (but not met in 2005/6)
National indicators: C. Dif and MRSA targets: not met

Residents of West Hertfordshire deserve to know what happened as a matter of urgency.