Sunday, 26 January 2020

CCG's, CQC and the true result of UK care.

Image result for how many CCGs are there?ATR picked up this recently online from the UK's largest hearing loss charity (Who failed to mention it is selling off all their own care homes for the deaf).  It also fails to clarify devolved areas use differing health options too, so we should not read this as an 'UK-wide' thing.

"Vital hearing aid services across England could be at risk because an overwhelming majority of Clinical Commissioning Groups (CCGs), the local bodies responsible for commissioning and paying for NHS services, do not have the “bare minimum” information needed to be effective, according to new research conducted by charity Action on Hearing Loss. The report also highlights the vast disparities in hearing aid provision across England.

The report, launched today and entitled Valuing Audiology: NHS Hearing Aid Services in England, was compiled using data from Freedom of Information (FOI) requests the charity sent to all 195 CCGs in England. Of those who responded in full, just 1 in 20 (5%) knew how much they are spending on audiology, how many hearing aids they are fitting, and whether patients are satisfied with what they are receiving.

Dr. Roger Wicks said: “These results demonstrate an alarming lack of oversight and accountability on the part of CCGs, which are entrusted with providing healthcare local populations across England need.

“Without what seems to be the very fundamentals of evidence-based healthcare commissioning – the most obvious of which is rigorous data collection – 94.6% of CCGs are displaying a grave failure in basic budgetary and service management. Without data on how many people are being treated for hearing loss or on the quality of services, commissioning for audiology in many parts of England is being done through apparent guesswork, and we fear that under pressure CCGs may well continue to see hearing aid services as a soft target for cuts.”

The charity actively campaigns against cuts to NHS hearing aid provision, and has successfully persuaded 14 out of 15 CCGs not to go ahead with proposed restrictions. The new report, however, has identified three CCGs that are currently deliberately choosing to restrict access to hearing aids. North Staffordshire CCG, Dorset CCG and Cambridgeshire & Peterborough CCG all require a high threshold of hearing loss before hearing aids are provided, which means that hearing aids are not provided to all those who would benefit from them. This is contrary to NICE guidance which states that provision of hearing aids should be based on need, not threshold alone.

Roger continued: “Such a systemic lack of oversight on hearing aid services sadly seems to demonstrate that CCGs are still not taking hearing loss and its wider health implications seriously. Hearing loss is linked to a significantly increased risk of dementia, isolation and other mental health problems.

“Hearing aids are a lifeline for people who use them and are prohibitively expensive for the vast majority of people when bought privately. NHS hearing aids enable people with hearing loss to remain engaged with their families and their work-life, and it’s vital that they remain available. Until CCGs take steps to collect fundamentally important data on the services they are commissioning, these services remain exposed to the risk of cuts and rationing.”  The charity’s report lists a number of recommendations for CCGs, including at minimum collecting accurate data on audiology spend, access rates, number of hearing aid fittings, waiting times and outcome measures. It also calls on NHS England to stipulate that this data should be consistently collected and centrally published."

ATR:  England has nearly 200 CCG's all vying for the cheapest form of care they can get away with, Wales has 11, all attempting to provide localised provision for a national issue and acute shortage of funding. of the 12m alleged to have hearing loss e.g, 3 million who need hearing aids won't even wear them. 

The article is an emphasis on Hearing Aids because this charity is focused on hearing aids advice and the ultimate cure of hearing loss via research funding, but there are alternative monitoring bodies e.g. in Wales and other devolved regions provision varies there too.  Staffordshire has 3 times attempted to cease provision of TWO hearing aids insisting on just one, and even then only if the db readings were pretty dire, regardless if clinical advice suggests two are needed, and a lot earlier, in essence they were trying to focus provision to those too late to benefit from them and leaving others with loss to get worse before acting.   In part, it was attempting to persevere hearing in one ear by sacrificing the other also.

Reading recently of the scandals in Bury where deaf and HoH Mental Health patients were treated in appalling neglect and manner, it was explained that in fact, the CCG's/CQC had no authority to insist on the level of trained help mental health patients with hearing loss were entitled to, it was left to LA's struggling to find people, maximise cost-saving priorities, or simply left to private care providers themselves to sort out what they could find.  

E.G. no sign language interpreters in Bury could be used without Level 4 BSL but there was no such requirement to sign at all for their daily care help. Daycare welfare ignores sign use.  When the CQC and CCG's were asked about sufficiently trained deaf support they said it wasn't their area of concern. No BSL terp needed any skill IN mental Health support, primarily because no such specialist training exists, any skills picked up by terps were quickly lost via huge turnovers of interpreters and changes, continuity didn't exist, specialism is lost.  There are few if any specialist trained health communicators in the NHS as we can see just those with BSL skills alone whom everyone insists can do anything regardless of any special skills required, the random nature of BSL provision just adds to the issue, its a part-time and free-lance mess.

We found the CQC  and CCG's frustrating in that they mostly they have no real authority.desire or back up to monitor 70% of what they provide, [very much mirroring recent huge issues of prisoners released into the community without supervision, no staff to monitor], more cuts just take away more means of ensuring people's safety.  They are only seen to act AFTER situations get so bad someone else informs them.  

With regards to hearing loss, it is time those with it stopped assuming a CI or hearing aid or even a text or a bit of sign, addresses the real effects of it, PTSD applies to those with hearing loss too, their war is 24/7 every day of their lives.  The system of LA monitoring or care provision is a huge reliance on whoever runs that provision to keep records themselves, and then send them regularly to the relative SS depts but, little or NO checkups that is sent is true or even accurate, mostly because clamping down on poor care with those would mean they have to seek out more staff they cannot afford, and better care provision that costs more, so there is a 'blind eye' turned to most of it, the system moving to cover themselves.

It is one thing allocating provision but quite another it seems in ensuring it is fit for purpose or even monitored after.  Mostly they never bother or check-up to find out because they have cut social workers, also to limit criticism when the brown stuff hits the fan.   Apart from LINK (HearingLink) few services really exist for those with hearing loss problems and charity is moving away from care because they are now getting criticised. 

Provision is sketchy and of course expensive, so LA's are avoiding recommending more monitoring of their bad decision-making.  Areas see huge cuts to social services and it is not unusual those needing one can see 3 or 4 different every year as they go on 'leave' and never return.  Curiously my area has seen half a dozen heading for Canada?  Apart from wanting to follow Harry why are they heading there?