WILTS PCT INTERVIEW ON BBC WILTSHIRE RADIO

BBC NEWS
Q&A: Jeff James of the Wiltshire PCT

A recently published government white paper has announced a major restructuring of the NHS in England.

The move will lead to the abolition of all 10 strategic health authorities and the 152 management bodies known as primary care trusts.

Chief executive of Wiltshire Primary Care Trust (PCT), Jeff James, spoke to BBC Wiltshire recently to put the changes in perspective, and clarify matters.

Read the Q&A below.

What are the changes to the Primary Care Trust?

The changes that the Government is making have got three components as far as the Primary Care Trust is concerned. During the course of this year, the staff that we employ that provide services direct to patients will be transferring to other organisations. During the year that follows, we'll be working with GPs who will be the new commissioners of services - the people who plan and pay for them. They'll be working in shadow form with us as part of a phased handover. We'll also, during the course of that year, be transferring our public health work to the local authority. So by April 1, 2013, the PCT will be no more.

How will patients going to their GP see a difference?

Directly it shouldn't affect the individual patient. Although as the idea of choice and how we exercise choice grows, we may see people being more selective about the grounds on which they visit one practice over another. In terms of when your GP acts as a commissioner, what your GP is doing is making a decision with you about when you need hospital care. There will be a conversation about what hospital care might make sense and which hospital would be the best place to go to. The idea at the heart of this is that the GPs will hold budgets, but the way in which they exercise the decisions will be in partnership with you as a patient.

How real is the choice that will be offered to patients?

We collect a variety of data to look at how general practices work. One of the things we look at is how often people move from one practice to another. By and large that isn't happening an awful lot. The evidence seems to be that when people make that initial choice they tend to stay with it. The government white paper is signalling a desire to want to have more information about how well general practices do, so that when you want to make a decision about which practice to register with, you can do it based on the services they offer and the results they get rather than their geographical location.

Will these changes be empowering for patients?

The whole concept of empowerment is quite a tricky one, because apart from the desire to be in charge of your own health, not everybody feels that. Some people are quite happy to trust doctors and nurses, as they feel they are the professionals and have their best interests at heart. There are also a lot of other folk who have long-term illnesses who become experts in their own care.

What is the government trying to do over all?

There's a tendency in British health care since the early 1970s to move between two poles. On the one side there are people who emphasise health care as a system and national standard and things being the same everywhere. There's another tendency which says it ought to be local because places are different, and people are different, and more of the choices should be made by individuals and their family doctors because they're the starting point for most people's health journey. This set of changes is edging away from the NHS as a national system with most things determined at the centre, to one where there's more space for diversity and more choices being made at a local level. You still have to make difficult choices but they're locally made choices rather than nationally determined choices.

Will this improve healthcare for people?

One of the hopes that the government have is that choice, and the conversations that happen between individual patients and GPs, will mean that they'll start to think about answers that we don't have in the current system. There are good parallels for this in social care. In the social care world we've started to think about what would happen if, instead of having the services that were routinely available, we've said to a person, OK here's the budget that's available for your condition, what would be the right package of things for you? And giving more choice that way.

Could tax-payers money be spent on non-scientific treatments such as homeopathy?

The hard scientific evidence, typically the controlled trial model, is a relatively modern phenomenon and tends to be applied very much in the pharmaceutical sphere, so it's important for us to recognise that it's not as though everything we currently do is empirically verifiable in that way. What we're rubbing up against here is two sorts of ideas, one is that we should think about people in machine terms, and therefore the language of science is entirely appropriate. The other is that we should think about people holistically, and therefore their sense and their feelings are as important as what you can measure in hard scientific terms. Now often is the case in terms of things like homeopathy that when you hear the conversation about it, the person's experience is as much as how they're treated as an individual is as much a part of the homeopathic package as is the homeopathic remedy itself. So we need to be careful to tease out whether what we're hearing is something important about the context in which complementary therapies are made available, as distinct from the active therapy itself. We might be learning something important about the social setting for care that matters in terms of how well people feel.

Do you believe the model will deliver a better healthcare system?

I think it's a model that can deliver, because if you look beneath the surface, underneath all of this are ideas that look quite like models that work elsewhere. There are models of health maintenance organisations that work in the United States, where you have a combination or primary care and secondary care being run through a single system. They have similar ideas about wanting to ensure that you have active partnership with patients at the core of it. You do as much treatment away from hospital as possible and you encourage people to take as much responsibility for their care as possible. Many of the HMO's that operate on that model in the States are very successful.
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/local/wiltshire/hi/people_and_places/newsid_8878000/8878376.stm

Published: 2010/08/03 12:23:55 GMT

© BBC MMX

Carers In Wiltshire :: Home

So we now have in Wiltshire a single web site for carer support , this to me is a fundamental step forward to the concept of a single carers support organisation for the county .

The logic is very very simple the number of carers in Wiltshire does not justify in these harsh economic times the added cost of the Tax payer funding indirectly four separate organisations infrastructures in the county , the money just is not in the pot .

Carers In Wiltshire :: Home

Depression really does make everything look grey - Health News, Health & Families - The Independent

Depression really does make everything look grey - Health News, Health & Families - The Independent

CONDEMS-NHS

So Mr Andrew Lansley, the health secretary, raises the spectre of job losses in the NHS as he pledges to cut £1bn a pa in "central bureaucracy".

Rising demand for health services, means that major savings must be found in the NHS's "ring-fenced" budget.

In reality tens of thousands of jobs could go.

Are we seeing the beginning of the end of the NHS as we know it ?

Mental illness will rise as millions struggle with debt

Depression and mental illness will increase as millions struggle to cope with debts and money problems during the economic downturn, according to a study.

People who owe money are more likely to suffer from psychological problems, the study from the Nottingham School of Economics found.

Researchers examined information from the Families and Children Survey, which questions about 8,000 people a year on issues including their financial situation and health.

In 2007 13% of respondents who reported debt problems and 17% of those reporting financial stress also reported mental health and psychological concerns.

At the same time less than 3% of those who did not report debt or financial stress said they were suffering from psychological problems.

With the new governments tight fiscal controls the personal debt problem will only increase in the short term so we have a ticking time bomb

Mental illness research warning

The following article comes from the BBC news web page it is very thought provoking and well worth a read

Mental illness research warning

VIEWPOINT
Professor Til Wykes
Institute of Psychiatry, King's College London
Poor mental health affects 16.7 million people in the UK today.

In this week's Scrubbing Up, clinical psychologist Professor Til Wykes says strategies for funding research into mental health need to be overhauled.

Patients and their families deserve better, she says.

When it comes to thinking about mental health, I'd like to believe we've come a long way from the Victorian stereotypes of hysterical women and crazed madmen languishing in Bedlam.

But while physical diseases like cancer are managing to throw off the stigma they carried in previous centuries, mental illnesses are still too often ignored or misunderstood.

Not only does this lead to prejudice and discrimination, it also seems to make it harder to find funding for research into the causes of, and treatments for, mental ill health.

Improving care and treatment for people with mental health problems requires the same rigorous research as demanded for tackling physical illness.

However, despite the huge burden that poor mental health represents to society - from the disabling effects on individuals and their families, to the financial costs of dealing with mental illness - mental health research is incredibly underfunded.

“ In these austere times, it is worth bearing in mind that in England alone mental health issues cost us £77bn a year ”
Only 5% of medical research in the UK is into mental health, despite 15% of disability resulting from disease being due to mental illness.

It's estimated that one in four of us - 15 million people of all ages in the UK - will experience a mental health problem this year.

That's substantially more people than will have a heart attack or a stroke, and yet twice as much research goes into heart disease and stroke than is carried out in mental health.

It's more people than will be diagnosed with cancer this year, and yet cancer gets more than 25% of medical research funding - five times as much as mental health.

In these austere times, it is also worth bearing in mind that in England alone mental health issues cost us £77bn a year.

If we had a better understanding of mental health and better treatments for specific conditions, it would go a significant way to easing the nation's financial situation, as well as our states of mind.

Last week, one of the major research funders, the Medical Research Council, published one of the most up to date reviews of the strengths and challenges of mental health research in the UK.

It not only showed that the research that does get funded is world-class but that the UK is well-placed to lead the way in this area.

The review concludes that there are several opportunities to fund more research in the UK that would help accelerate progress in developing new treatments, or lead to better ways of preventing mental illness in the first place.

It means we have to set priorities. We have to direct the funding that is available into the research most likely to help.

But (and there always is a but) it sets the bar high in terms of funding decisions over the next few years and challenges the UK to really pull its weight in this much needed research arena.

Mental health problems frequently start in childhood and persist throughout the rest of a person's life. Finding better ways to treat - or preferably prevent - poor mental health as early as possible will bring enormous benefits to individuals, their families and society as a whole.

We simply can't afford to ignore this problem any longer.

Provocative thoughts from experts in the worlds of health and medicine