Casebook February 2023

Casebook February 2023

Posted: February 13th 2023


In casebook this time, better news on ambulance waits, malnutrition in the UK??? Vaccine stats and two workforce stories revealing the challenges we currently face. Some useful stuff in other stuff as well I hope!!

Ambulance waits down by nearly an hour in a month

This is some good and unexpected news….

Ambulance crews reached emergencies such as heart attacks and strokes one hour quicker in January than December in England, figures show.

They took 32 minutes on average, compared with more than 90 the month before.

The target is 18 minutes but January's average was the quickest for 19 months.

A&E waiting times also improved, with just over a quarter of patients waiting longer than four hours - down from more than a third in December.

One of the key factors in the easing of the pressures was the falling rates of hospital admission for flu and Covid in January after they both peaked at the turn of the year.

Cost of living: GP concerns over rise in signs of malnutrition

The Deep End agenda profiled here, which has its origins in part at least in Australia is really insightful and fits deprived rural communities really well – let me know if you would like more information.

More cases of malnutrition are being seen in Scotland, according to doctors working in some of the most deprived communities.

A group called GPs at the Deep End is concerned the cost-of-living crisis is making people more reliant on cheaper, processed foods.

Dr Jen Dooley told the BBC people were choosing the wrong foods to 'fill up'.

She said she often saw patients lacking in basic vitamins and minerals.

GPs at the Deep End is a network representing doctors working in surgeries in the 100 most deprived populations in the country.

Dr Dooley, who is based in Port Glasgow in Inverclyde, said: "We're seeing a lot of cases where people come to us feeling a whole diverse range of presentation - fatigue, tiredness - and when we're investigating, we're finding signs of malnutrition."

Covid vaccine: How many people are vaccinated in the UK?

Useful to review the stats on this, particularly in view of the way it chimes in with the reduced Ambulance times story above

So far, more than 52 million people have had a first vaccine dose - some 92% of over-12s. More than 49 million - 85% of over-12s - have had both doses.

While uptake of first and second doses dropped off late last year, there was a steep rise in people having boosters. However, booster numbers dipped over the Christmas holiday period and remain low.

More than 38 million booster doses have been administered across the UK so far.

‘They haven’t the foggiest who we are’: the watchdog fighting to protect Britain’s exploited workers

This article from the longer form story section in the Guardian is really interesting in the context of the workforce issues connected to social care it suggests significantly poor workforce practices in some rural settings…

Beels, who is the government’s director of labour market enforcement, says exploitation in the care sector and among migrant agricultural workers are at the top of her list of concerns. She is a career civil servant, well schooled in diplomacy, but admits the watchdogs she oversees are understaffed and that the system is plagued by gaps that can be exploited – whether that be the complex definitions of employment status, the supervision of umbrella companies, or holiday pay.

She says her role is a bit like being “a lightning conductor” for those who feel exploited at work. Asked if there are enough inspectors, she says with typical understatement: “We have got about a quarter of the International Labour Organization’s recommendations in terms of inspectors, and by that yardstick you can say: no, there isn’t. It is hard not to say more resources would result in more things being done.”

Beels told a recent parliamentary committee that it was “not entirely my experience” that workers’ rights were improving under the current regime.

“The government has a strong agenda about growth,” she tells the Observer. “In my view growth can only be achieved with a workforce being looked after properly.”

She believes social care is a “big, big issue”. The government has attempted to deal with worker shortages by extending international working visa schemes in this and other sectors, but Beels says such extensions have the potential to create their own sets of problems. After last year’s rapid extension of the seasonal visa scheme for people picking fruit and vegetables, for example, it emerged some workers had been forced to pay finder’s fees to brokers in their home country to secure their UK roles.

NHS consultants run private firms charging to cut waiting lists at their own hospitals

Well this article is a sign both of the times and significant workforce malaise facing the NHS. It tells us:

Some of the country’s most senior NHS clinicians are earning a lucrative sideline running private firms that offer to cut waiting lists at their own hospitals, the Observer can reveal.

Top consultants in Manchester, Sheffield and London are among directors of “insourcing” agencies that charge the health service to treat patients at weekends and evenings and have won millions of pounds of work.

Some hold leadership roles at NHS trusts that have awarded contracts to their own companies, raising concerns about potential conflicts of interest.

One deputy medical director jointly ran a firm that provided “insourcing” solutions to his own NHS trust before it was sold in a £13m deal last year. Other consultants have set up firms that they and their colleagues work shifts through themselves, often at rates above NHS price caps.

Other Stuff

In Casebook this month:

Best Practice Gazeteer – we are beginning to build a portfolio of case studies showcasing the very best practice in the delivery of primary care. If you have any leads which you think might bring us to some areas of good practice please do let us know.

New Board Members – recently we welcomed four new Board members: Nikki Silver CEO of LIVES, Professor Mark Gussy Global Professor in Rural Health and Care University of Lincoln, Mark Cooke (Regional Director of Strategy and Transformation, NHSEI South West) and Andrew Dickenson, Chief Dental Officer for Wales. You can read more about them all here

Digital Literacy – we are launching a new pilot project to look at the development of digital literacy skills amongst the population with a focus on better self care. If you would like to know more let us know.

Rural Health and Care Toolkit – our progress with the toolkit continues with one Devon based partnership to concentrate on a “Deep End” initiative linked to the same approach as set out in the malnutrition article above, another (Gloucestershire) focusing on social prescribing and a third on the interface between the VCS and statutory sector. In Northern Ireland our partners are reviewing the operation of the health care system on Rathlin Island..

House of Lords – on 21 February we will be showcasing our key themes in Health and Care agenda at a meeting hosted by the South and East Lincolnshire Council Partnership

Self Employed Social Care – we have a meeting this week coming up with Pip Cannons from Community Catalysts about their brilliant model for addressing the social care staffing challenges which really works well in rural settings – I can let you know more if you are interested.