NHS crisis and its causes

In a few weeks time I hope to be visiting Medway Maritime and the A&E department to look at the hard work being undertaken by staff and management to improve the situation in a struggling situation.

It is true to say that the last 12 months have not been good for our local NHS. We have had the botched implementation of an ideologically driven Conservative programme to privatise key healthcare services; we have had the hospital placed under special measures; we have had maternity and mental health services cut. The merger with Darent Valley was put on ice permanently and with the botched closure of NHS Direct in Chatham it has been a pretty full year of bad news. 

The pressure is compounded locally in my mind by the Tory-led Local Authority changing its funding formula for adults in care focusing solely on those who are in the highest category of need. It is clear that people are slipping through the cracks and ending up in hospital. In addition we have a tired bunch of Tory backbenchers seemingly unable to accept public health demographics are worsening on most key measures; alcoholism, obesity, smoking etc. This is more worrying as Public Health is now a Council responsibility under the government reforms.

Our Tory MPs are simply focused on the wrong priorities. Not a week goes by without another desperate attempt to reach out to deserting Tories to UKIP. Discussions around health tourism are base and ignore the problem. If there was ever an example of a government desperate to outbid on grubby headlines on migration or Europe we have reached that point now. A government that has utterly ceded the centre ground and whose membership is evaporating. Like with foodbanks simply being photographed smiling at a hospital wont wash if the product of failure is the same policies you voted to support. Those working in the NHS are the angriest about the ideology driven by Tories.

The recent A&E admission statistics are a case in point. The Tory government has now had months to prepare for the potential for increased admissions. The warning signs were there in Medway from the leaked correspondence from medics working in Medway Maritime all the way back to Spring. Yet the stats above highlight a worrying theme. 

The Tories claim Medway A&E department has never been up to scratch hence the need for investment now; perhaps in size and capacity it hasn't been but until the Tories took over targets were never missed on admissions by the scale we have seen in the last 12 months. Even this time last year the department was in a far better shape.

The A&E admissions crisis has worsened in just over 12 months.

The botched NHS Direct privatisation; cuts to Adult Social Care budgets coupled with senior leadership focus on re-organisations is in my mind the root cause of the problem.

All of this self-induced by this government; we did not need to pursue aggressive reforms, that had no mandate, at the exact point in time when things were working and when funding and demographic pressures required stability. We did not need to sell off NHS Direct (based in Chatham) to a multitude of private providers. We could have bitten the bullet and not solely given funding to the much smaller number in the higher categories for adult care. Direct Payments policies are flawed when it comes to elderly people with early onset dementia. Perhaps not having a millionaires tax rebate whilst instead offering greater support for the elderly could have been more appropriate.

It is true that under Labour the NHS did have provisions imposed on standards and targets. With the influx of billions of pounds of money the risk was always that it would sink into a blackhole without codified outcomes on operations, cancer diagonsis, heart disease etc. A few of the original PFI agreements were not well considered; but remembering we inherited an NHS in 1997 where over half the hospitals were older than the NHS itself and were utterly unfit for purpose. Most people on polls recognised things did improve. The Labour Manifesto position in 2010 for a National Care Service still has merit. 

Despite all the health twitter accounts in Medway and the glut of Press Officers  the truth is quite clear. The service has got worse since May 2010 and no amount of flinging the odd million or so here and there will make it better. 

If you have botched the fundamental structure, undermined the principle foundations, and have done so during a period of sustained demographic and economic stress the reality is for all to behold. 

The election in 2015 will be fought over our local NHS. If the last 12 months is the record then it is truism that you simply can't trust them with our cherished service.

Food for thought from my visits to schools

One of the issues that has been raised on the doorstep and where I meet parents in Medway is the current state of our Primary Schools in Medway.

Over the last decade KS1 and KS2 results in our area have remained stubborn whilst in many other Local Authority areas with similar demographics we have seen major improvements. 

I have been spending the last six months meeting headteachers across Chatham and Aylesford and whilst I have not met them all there are a number of issues that have consistently been raised that I believe should be reviewed.

It is worth stating at the outset I am not an education specialist and I do not sit on any of the Education Committee's on the Council; in reality my interest areas lie in finance and capital spending but it is important to try and get a holistic grasp of the challenges I will face. Education failiure is one Labour will inherit from the Tories whether you are an MP representing the area or a Labour Council trying to clear up the mess. 

It is for that reason that I have a very good working dialogue with Peter Read - the Independent Education specialist - and have been assidiously reading his position papers on Medway schools.

The first thing to state is that despite the change in Political leadership in Gun Wharf from Cllr Les Wicks to Cllr Mike O'Brien we have actually witnessed a worsening of overall results in Primary School OFSTED reports over the first period that I believe there is validity to assess (see above). This period being from September 2013 onwards highlights that fact still too many schools sit below the national average and 2 have worsened. 

This was reinforced in my mind by the publication of the Key Stage 2 performance league tables that once again has Medway close to the bottom of the league tables. Whilst these are for the previous year the same people in charge now offered unqualified support at the time for the political decisions made then. It is the reason we need a whole new policy agenda not just a new suit with a handerkerchief.

Worryingly still we have a clear narrative coming out of Gun Wharf that needs to be squashed. Namely that the schools becoming Academies need not warrant the same level of attention or scrutiny when compared with those in LEA control because that is what the government has done. I back Academy schools but the move by Tories to relinquish any LEA oversight is utterly flawed.  As a Council all those young people under our review need to be assessed and if needs be we need to be robust on this. 

When meeting with headteachers and governors several points ensue.  I summarise those:

i) Medway Governors - Whilst the Council has focused investment in training and development there is still not enough cross-school working and the Council needs to proactively do more to advertise and promote governerships. I believe Medway needs to be more proactive in this regard and schemes that give those that serve the community a Medway Council Tax reduction should be actively considered for those that have offered services over a certain timeframe (perhaps 2/3 years). The Council should proactively speak to local accountancy firms and private sector employers (those with an ability to scrutinise finances imperative) to secure committment. Many private sector firms have Corporate Social Responsibility statements and may be open to engagement. 

ii) Logistical Support - Many of the schools feel the Council has lost the plot when it comes to service provision including hiring + support. Hence why so many have been happy to walk away to become Academies. When problems are identified schools should not have to hit heads against brick walls. If we have a block in the officer population in the Council this needs to be reviewed. This should be done in consultation with governors and headteachers

This also relates to issues around school spending on key projects around infrastructure. At present the Audit Committee has significant concerns around procurement in schools; this needs to be robustly resolved. The Council should offer to headteachers checks and balances on any third-party engagement on any school project over a specific size as matter of recourse on key projects.  

iii) Specialist Headteachers - The Council should consider hiring specialist headteachers on a permanent 12 month contract basis to advise failing schools. These should not solely be used to fill a headteaching gap when one arises but be genuine partners with schools to ensure staff have access to experienced professionals who can advise. They would be on the Council payroll and may have two/three schools at any one point in time and would focus on the issues identified from OFSTED only; not the wider issues of school management required from those in the ground. They would partner not order schools.

Medway MPs have been right to highlight the lack of leadership in some schools but the focus has always been on hiring a new teacher after a failure had been identified which takes months. Once an OFSTED report highlights concern we need excellence to intervene immediately - excellence with experience is the only credible recourse.  

iv) Education O&S - Any school that sees a reduction in OFSTED performance should have a report to Councillors as to why and what will be done in an indivdual report. Headteachers should be invited to address the Committee to discuss efforts and management to improve and be held to account. Too many times Councillors have had to proactively approach school management teams to get a meeting. Schools are of course arms length but when it comes to public money accountability is key. A more broader committee with similar powers to the Health & Wellbeing Board involving more headteachers and professionals should be considered and lobbied for. 

v) Splitting Adult and Children Services - With the increasing scrutiny on Child Safety and the move towards a more complicated process of Direct Payments, with the demographic challenges of an ageing population, it is time we had a focused Director for both these two areas in the Council. Having one over arching Director for two key changing and challenging areas of policy provision is madness. If it wasnt for the fact we had concerning OFSTED's for child safety as well as KS2 it is clear the current model just isnt fit for purpose. 

vi) 11+ Test - Schools are currently focused obessively on this Medway Test. A scheme operated by Durham University has taken the wrote-learning out of testing and allows testing on ability rather than those who can simply 'learn' the test. The less politics on locations for testing the better.

vii) Peer-to-peer assessment at KS1 - Many of those headteachers I have spoken to have expressed concern about the level of pupil attainment that they inherit from other schools. Incidentally, this is also a concern for many headtachers at secondary schools as well who feel they have to play catch up on attainment for new starters. Medway needs a far more rigorous peer-to-peer assessment process through KS1 to ensure problems are identified before they reach KS2. We have assessment processes now; these need to be tighter and more robust. 

viii) Proactive engagement with TeachFirst and specialist teacher training - Council should offer excellent Teachers sponsorship through College and University with a proviso they then work in Medway Schools. Some schools at Secondary level already offer this type of training provision but this could be codified centrally and more actively. Working with excellence organisations in the private sector should be persued far more vigorously. Deputy Headteachers should be offered sponsored career-development for leadership (MBAs, MEds etc); in short we need to retain and develop individual excellent teachers within Medway.

Some of the above points are current practice that need far more rigourous persuit; and I know Labour Councillors have welcomed a focus on some of these issues in recent months. However, as an MP I would be far more active than our current crop of Tory MPs in engaging on the of failing Primary Schools. 

It is clear we are going to inherit a mess on KS2 from the current Conservative Administration, with the evidence at present not leading me to conclude things will radically improve. 

These are not manifesto points merely some of the issues that have been raised during my meetings and my conclusions from them. As an MP I would take these points forward with any incoming Medway Labour administration in Gun Wharf. 

Time to curtail FOBTs

I’ve spoken to many local people who have told me that they are fed up of seeing so many bookmakers operating as mini-casinos offering high-stakes gaming machines on our high street. 

One of the reasons for there being so many betting shops is the prevalence of Fixed Odds Betting Terminals (FOBTs). These machines can be highly immersive with players betting up to £300 a minute or £18,000 an hour. Players on these machines may enter the ‘zone’ and spend more money than they intended, causing huge damage. 

The clustering of betting shops can also have a negative impact on high streets with many people expressing concern about anti-social behaviour and the impact on other local businesses. Recent evidence shows that FOBTs machines are concentrating in areas where people are predominantly on low incomes. 

Current legislation limits these machines to four per shop but this just means that betting shops open multiple stores in one area in order to get more FOBTs in to the local neighbourhood. 

With 31 betting shops across the three Medway constituencies this means we could have upto 124 of these types of machines and their prevalence has huge consequences for families, for levels of crime and anti-social behaviour, and for the kind of communities we live in. 

Kent Messenger have also indicated that this is hurting our local economy by some £7.65m

Fixed Odds Betting Terminal machines can cause enormous harm and experts estimate that up to 23% of FOBT takings come from people with gambling problems. 

That’s why I’m backing Medway Labour’s plans to give local people and local authorities the power to decide if they want them on their high street or if they want to ban them from our communities all together. 

Medway Labour’s proposals would put betting shops in a separate class so that councils can use planning powers to control how many open. Labour would also give councils the power to change existing licenses to remove or limit the number of FOBTs in betting shops and reduce their harm by increasing the time between plays, requiring pop-ups to break up continuous cycles of gambling. 

The Conservatives across Medway are clearly split. Whilst several Tory Councillors have been working with the Press to highlight the plight of those impacted we also have several Tories (and former Tories) who are in abject denial about the impacts of FOBTs.

If evidence suggests that FOBTs and betting shops are having a detrimental effect on local people then local authorities must have the power to reclaim their high streets for the benefit of everyone.