Written evidence from Mary E Hoult (COM
05)
I am submitting this from a patient/carer perspective
and welcome this new commissioning enquiry.
I do not belong to any organisation involved
in the delivery of health care. I have done so in the past and
still show a keen interest in health policy. I have been a regular
attender at many local health economy board meetings. I feel that
this experience has given me the ability to make some relevant
observations and to ask some pertinent questions.
Taken from your list of where you want the main
focus of enquiry to be, re commissioning, I aim to address these
themes:
— clinical engagement in commissioning;
— accountability for commissioning decisions;
— integration of health and social care;
and
Overarching all of these themes is, I believe
the patient's voice. Governments pay lip service to this initiative,
but true patient involvement remains light years away. Vulnerable
groups, such as the ones discussed in my submission below often
find it even harder to have a voice. The NHS must be the best
example of how not to listen to its customers, users, clients
or whatever is today's preferred collective noun.
I have many concerns over the future of health
care delivery. Most of these concerns are as a result of how it
has been delivered historically here in Leeds. I am in broad agreement
that good commissioning is the key to good health care, both from
the patient and state perspective. The trick will be to ensure
confidence in the commissioning ability of whatever structure
is in place. To illustrate my concerns I have chosen to concentrate
on eye care in its various forms. Age related health problems
such as cataracts and macular degeneration are just two examples.
How can we bring alive the NHS Constitution
for blind and partially sighted patients? We are an aging population
and this is a growth area that we all might have to use sometime
during our lifetime. It is therefore essential that there is transparency
in the Commissioning process and that relevant information is
available to those that need it, when they need it.
World Class commissioning has now been scrapped.
It was complicated by Practice Based commissioning. It's like
being on a merry go round for patients. I know it is still early
days but it is very unclear who will commission services for this
group of patients. Will it be the NHS Board local authority/GP
consortia? Are these patients being left behind in the rush to
introduce savings? Significant gaps in the provision of eye care
services have been identified in our deprived area.
The last eye care strategy published, appeared
to quote figures that had already been exceeded, giving the impression
services were being reduced. Yet we are told the NHS budget is
ring fenced.
East Leeds faces major challenges in terms of
addressing the historic balance between community and hospital
services. During 2009-10 our Strategic Health Authority received
£1.9 million innovation funds in support of Health Ambitions
and QUIPP. 254 applications were received and 15 successful.
I have chosen two that relate to this group
of patients as examples.
1. Bradford and Airedale established a
pilot service in the community for newly diagnosed people with
visual impairment, counselling these patients and accessing the
infrastructures that currently exist within the community to make
the transition to living with a visual impairment.
2. RNIB was also successful and is developing
integrated eye care pathways for people with learning difficulties
called Bridge to Vision. This bridges the gap between Health &
Social Care.
These are first good steps for a very small
outlay but are they enough to protect/ support these vulnerable
patients who may continue to need both secondary and community/social
care?
Previously social workers were allocated to
this group to provide advice and support and worked under an accountability
protocol.
Rapid access to low vision aids & support
is a huge concern as is the lack of rehabilitation officers.
Access is another area that presents
difficulties. The Choose & Book system is a good example.
Providers have to make slot availability in advance(slot plotting).
Prior to C&B hospitals were able to react to demand by flexing
their capacity in response to that demand to ensure fair play.
Now it's down to individual commissioners and robust contract
management which has resulted in large follow up backlogs especially
for ophthalmology outpatients. Has the detailed understanding
of the needs of this group of patients, to avoid unwarranted variations
in practice and outcomes, been addressed? Leeds City Council have
recently been quoted as saying that "we only issue the documents,
it is not our job to provide large print, videos or Braille".
And this to produce tender documents for services for blind/partially
sighted users.
The consortia for my area of East Leeds was
established in 2007 and is led by the Ex Chief Executive of the
previously disbanded Leeds West PCT. They were responsible for
the redesign of hospital services. He was also seconded as Chief
Executive for the Lift Co until 2006. So is very experienced in
the local health community. How has this consortia faired during
the last three years? How will they fair if the support of the
local Leeds PCT is withdrawn? Following their progress to date
might just answer some of the questions the enquiry board want
answers for.
To conclude, there has been so much change since
2006. We've seen four Chief Executives at a Strategic Health Authority
level and at least three at PCT level with a lot of interplay
between. It is very hard to tell just who has been in control
and patients are confused. IT informatics systems are poor so
it is hoped the infrastructure is there to support further change.
Were the health inequalities targets met for ophthalmology patients
for 2010?
I hope this new enquiry will go some way to
answer at least some of these questions.
August 2010
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