NHS shakeup has produced confusion, chaos and suffering, says Labour

Shadow care minister Liz Kendall has revealed major failings in Greater East Midlands commissioning support unit. Photograph: Dominic Lipinski/PA

The government’s reorganisation of the NHS has led to major failings by “unaccountable bureaucrats” in the commissioning of care for highly vulnerable people, the shadow care minister Liz Kendall has said.

A new tier of commissioning groups, which were created under Andrew Lansley’s NHS reforms, employ 9,000 people and spend more than £700m, were commissioning complex care with little monitoring of quality, she claimed.

Kendall spoke out about the 18 NHS Commissioning Support Units (CSUs) in England after uncovering major failings in her own area of the east Midlands. The CSUs were created as a result of Lansley’s Health and Social Care Act because the GP-led clinical commissioning groups – the centrepiece of the reforms – were considered too small and inexperienced to commission all the healthcare.

The shadow care minister, who is MP for Leicester West, uncovered a catalogue of failings by the Greater East Midlands CSU (GEM), which has one part-time person monitoring quality standards in their domiciliary care providers even though they procure care from 84 providers.

The failings identified by Kendall included:

• An 89-year-old bed-bound man with Alzheimer’s in need of care throughout the night whose family were not told that the company appointed by the commissioning group initially did not have enough staff. When the carers did come in they failed to change the man’s incontinence pads overnight.

• A 21-year-old terminally ill man who was discharged after 10 weeks in hospital without the correct support. When Kendall spoke to the man’s caseworker she said she was not aware he had been discharged from hospital.

• A 74-year-old man with dementia who was given four days’ notice to leave his care home after his funding for NHS Continuing Care – available for those who need support in their own home or a care home – was withdrawn as part of an annual review on the grounds that he was no longer taking medication. The man’s daughter said he had stopped taking medication to assist his condition, which has worsened.

Kendall said: “The real culprit here is the government and their massive backroom NHS reorganisation. This has put unaccountable bureaucrats in charge of commissioning care for some of the most vulnerable people in this area. Labour warned the reorganisation would cause chaos and confusion and that patients would suffer – and that’s precisely what has happened.

“Ministers must apologise to families and get a grip of the mess they have created. GEM should be stripped of its role in commissioning NHS Continuing Healthcare and a single, accountable person with the right skills and experience put in charge so that these unacceptable failures can be prevented from happening again.”

NHS shakeup has produced confusion, chaos and suffering, says Labour

NHS shakeup has created confusion, chaos and struggling, says Labour

Shadow care minister Liz Kendall has revealed major failings in Greater East Midlands commissioning support unit. Photograph: Dominic Lipinski/PA

The government’s reorganisation of the NHS has led to major failings by “unaccountable bureaucrats” in the commissioning of care for highly vulnerable people, the shadow care minister Liz Kendall has said.

A new tier of commissioning groups, which were created under Andrew Lansley’s NHS reforms, employ 9,000 people and spend more than £700m, were commissioning complex care with little monitoring of quality, she claimed.

Kendall spoke out about the 18 NHS Commissioning Support Units (CSUs) in England after uncovering major failings in her own area of the east Midlands. The CSUs were created as a result of Lansley’s Health and Social Care Act because the GP-led clinical commissioning groups – the centrepiece of the reforms – were considered too small and inexperienced to commission all the healthcare.

The shadow care minister, who is MP for Leicester West, uncovered a catalogue of failings by the Greater East Midlands CSU (GEM), which has one part-time person monitoring quality standards in their domiciliary care providers even though they procure care from 84 providers.

The failings identified by Kendall included:

• An 89-year-old bed-bound man with Alzheimer’s in need of care throughout the night whose family were not told that the company appointed by the commissioning group initially did not have enough staff. When the carers did come in they failed to change the man’s incontinence pads overnight.

• A 21-year-old terminally ill man who was discharged after 10 weeks in hospital without the correct support. When Kendall spoke to the man’s caseworker she said she was not aware he had been discharged from hospital.

• A 74-year-old man with dementia who was given four days’ notice to leave his care home after his funding for NHS Continuing Care – available for those who need support in their own home or a care home – was withdrawn as part of an annual review on the grounds that he was no longer taking medication. The man’s daughter said he had stopped taking medication to assist his condition, which has worsened.

Kendall said: “The real culprit here is the government and their massive backroom NHS reorganisation. This has put unaccountable bureaucrats in charge of commissioning care for some of the most vulnerable people in this area. Labour warned the reorganisation would cause chaos and confusion and that patients would suffer – and that’s precisely what has happened.

“Ministers must apologise to families and get a grip of the mess they have created. GEM should be stripped of its role in commissioning NHS Continuing Healthcare and a single, accountable person with the right skills and experience put in charge so that these unacceptable failures can be prevented from happening again.”

NHS shakeup has created confusion, chaos and struggling, says Labour

Overall health thinktank urges further shakeup of GPs | Denis Campbell

The report suggests GP practices join collectively to be ready to give individuals a wider selection of experience. Photograph: Alamy

GP practices need to begin working with each other in federations and delivering far much more providers in a restructuring of healthcare that is vital to hold the NHS sustainable, the King’s Fund urges today in a report that has attracted high-level government curiosity.

Key adjustments are needed in how major care and the two hospital and local community-based solutions are funded, delivered and co-ordinated so that the health support can cope with the large pressures caused by ageing and long-phrase conditions, the thinktank argues.

Its report on the potential of basic practice comes much less than a yr right after the coalition’s unpopular and far-reaching overhaul of the overall health services in England. It accepts that it would involve “a radical departure for the NHS” and nevertheless more upheaval, especially for GPs. But it contends that without having household medical doctors hugely expanding their roles – such as a controversial resumption of obligation for out-of-hours care – the NHS will fail to cope with rising demand, years of expected tight budgets and a expanding shortage of GPs.

If implemented, the suggestions could make the prolonged-sought integration in between health and social care that ministers agree is essential to extended-term sustainability, reverse basic practice’s diminishing share of the service’s £110bn spending budget and see many providers delivered outdoors hospitals – an additional big shift that, despite the fact that widely supported, has not but took place.

“We argue that GPs should take the lead in establishing care out of hospital by taking responsibility not only for their own solutions but for a lot of other providers used by sufferers in the local community”, say co-authors Professor Chris Ham, the thinktank’s chief executive, and Rachael Addicott, a senior fellow.

Ham says: “There needs to be a radically diverse model of common practice in the potential simply because of the ageing population and shifting burden of ailment, particularly the truth that more men and women have a lot more complex demands. And this kind of people are not getting effectively served by the current model of general practice, since what they require is not what their practice can show. What they need to have is accessibility to other skills and employees in the local community, such as community nurses, physiotherapists and occupational therapists, and also social care – and at times they require access to these services 24/7 rather than throughout surgical procedure opening hours. At the second, common practice is not sustainable.”

The essential to the report is the suggestion that in between 4 and 25 GP practices join up to turn into a federation, every of which covers amongst 25,000 and 100,000 individuals. They are the bodies that would be the hub of “loved ones care networks” (FCNs). Each and every would get a population-primarily based spending budget, but from a single of NHS England’s nearby area teams and not from the 211 neighborhood clinical commissioning groups (CCGs)designed by last year’s reorganisation. This raises significant questions more than the purpose and viability of CCGs, which had been meant to symbolise GPs currently being put in the driving seat of healthcare.

Even though patients would stay registered with their personal GP, Ham says FCNs would give them access to a a lot wider selection of experience than any practice can at present provide alone.

“I feel that above time CCGs would no longer be essential to commission care as they do these days, and would wither on the vine,” Ham admits.

In her foreword to the report, Dr Maureen Baker, chair of the Royal College of Basic Practitioners, factors out that it very first floated the thought of federations a decade in the past and that some currently exist, and operate efficiently. Nevertheless, Dr Chaand Nagpaul, chair of the British Health care Association’s GPs’ committee, says basic practice does not need yet another reorganisation: “As an alternative, we must be focusing on tackling the significant workload and economic problems dealing with GP practices, and supporting them … rather than wasting sources rearranging the NHS’s presently challenging bureaucracy.”

GP Michael Dixon, president of NHS Clinical Commissioners, which represents most CCGs, says their neighborhood and clinical understanding will be critical to support and handle long term NHS changes. “I can’t see why CCGs would be redundant,” he says.

Overall health thinktank urges further shakeup of GPs | Denis Campbell