Richard Holden: Access to cash. Here in County Durham, it matters to voters. Sunak should help to guarantee it.

28 Sep

Richard Holden is MP for North West Durham.

“Cash is King”. In the City of London that means liquidity, numbers on paper – but what it boils down to is freedom of action when things get tight.

For many of my constituents, it means something slightly different: it means hard currency and it means control. When I’m away in Westminster, I rarely use notes and coins. Transactions happen at the touch of a card or, more likely, at the push of a few buttons on my phone.

In the ‘real world’ of my constituency, though, cash is still very important. Recently, while I was queueing outside the Golden Fish Inn on Delves Lane to pick up fish and chip, mushy peas and some cans of pop for the team who’d been out leafleting, I remembered that the chip shop is still cash only. A quick dash across the road to get some money from the cash machine and all was well.

But for many in my community – particularly those on tight budgets, pensioners, and people trying to manage their way out of debt – cash is what they live by. It’s easy to manage because once it’s gone, it’s gone. You can take £20 to get some shopping for the next few days, or take £10 out with you to get a few pints (yes, London readers: you really can get ‘a few pints’ for £10 in Consett) and go home not having spent more than you intended to. Access to physical cash remains crucial.

There has been a big shift under Covid-19, and the Golden Fish Inn is now unusual. Shops and businesses which were ‘cash only’ are fewer and further between.

Even my Wolsingham local, the Black Lion (where during the election campaign the regulars didn’t bat an eye as the Education Secretary and I grabbed a couple of pints, picked eggs and played pool poorly one evening) a staunchly cash-only wet pub until lockdown has now got a card machine. But in North West Durham generally it’s cash-and-card, not just card. Card only is exclusive of those in the most need, as the recent transformation away from cash in Sweden has shown.

The issue of access to cash was highlighted a few weeks ago, when I got a call from a small local shop in Billy Row, a small village near Crook in the south part of my constituency. The shop is basically open from first thing until late evening, seven days a week, provides essentials and has a cash machine inside.

It also has a post office counter, open dor much more restricted hours. Post Office Ltd had got in touch with them to say that the contract with the cash machine operator had expired, and the machine would be coming out for good in a matter of months. The result, the shop keeper told me, was that it would probably end the business and the shop in the village.

Why? Because a lot of local people budget use cash, and they don’t want to only be able to withdraw it at certain times on certain days from the Post Office counter, when to check the balance means it being printed off and passed over before they know if and how much they can take out.

It also means the workers who swing by on their way by in the morning to pick up a can, paper, packet of fags and grab some cash for lunchtime wouldn’t carry on doing so. And for the pub across the green, it means a lifeline for the business (being able to deposit and do basic banking) and access to cash for customers would go too.

A short, local campaign, a bit of local media, touching base with LINK (who were superb) and a few letters to senior management all helped – and the Billy Row cash machine will stay.

But it got me talking to people about how important cash is more broadly. I discovered that in one of the least affluent parts of my constituency, the only nearby cash machine charges £2 a go. That’s a lot to get access to your own money when you’re on a tight budget, and just want to grab so cash to pay to top up your electric meter, pay your hairdresser or grab some bits and pieces from the local shop or sandwich shop. So I’m now campaigning to get a free-to-use machine there to replace it and reduce what has been called in some quarters the ‘poverty premium.’

In the months since I was elected, it’s often these day-to-day issues: cash machines, speeding, unadopted roads, street-lighting, potholes, low-level crime and anti-social behaviour that I’ve noticed my Labour predecessors didn’t try (or at least not very hard) to do anything about.

Either they felt it was beneath them (and too many Labour councillors think these issues are beneath them still), or they were too busy concentrating on planning the revolution to deal with the issues that mean so much in people’s everyday lives.

Throughout the global pandemic, the Government has stood up in an unprecedented way to support jobs and businesses across the country. My constituents know that nothing comes for free, and that the colossal short-term support that has been provided to save jobs and businesses cannot be provided in the long-term.

The broader levelling-up agenda – the defining mission of this Government – needs to be the focus, and delivering on key manifesto promised on hospitals, police numbers, nurses and doctors must be the overarching focus post-Coronavirus.

But now that the budget is delayed until spring, we have a window of opportunity for the Chancellor and his team to also step back, and target support for schemes and policies that can really deliver those smaller changes that make a difference to families and communities in the ‘Blue Wall’, and also pockets in every constituency.

Not all of it needs to cost the earth – and in some cases, need not cost anything. Access to cash is one of these issues in the broader Treasury remit, and needs to be looked at. With a bit of time, we can drill down into the long-term issues that make communities feel left behind, isolated, ignored and yes, ripped off.

By listening to them, rather than talking at them, we can avoid the fate of our Labour predecessors across the newly Blue constituencies by getting things done on the ground that make an immediate difference to people’s lives, alongside our broader ‘levelling up’ agenda.

Matt Oakley: Hancock’s tech revolution is key to reducing mental ill health among NHS workers

20 Aug

Matthew Oakley is the Director of WPI Economics and a former Treasury civil servant.

The Conservative Party won the general election on a platform committed to public service reform. Alongside 20,000 new police officers and a £33.9 billion boost to the NHS, the party’s manifesto also promised the construction of 40 new hospitals and 50,000 extra nurses.

But improving public services, including the NHS, is about more than just buildings and numbers. It is about people. The team manning A&E departments 24 hours a day. The hospital porters transferring patients from wards to operating theatres. The clinicians going above and beyond to nurse us back to health.

It is the task of any government to ensure that those who commit so much time, energy, care and empathy looking after us, are allowed to get on and do their jobs. Matt Hancock recognises this; in a speech given in 2018 he stated that of his top three priorities – tech, prevention, workforce – “workforce is the most important.”

This commitment to those working in the NHS has become even more important this year, when the UK went into lockdown to suppress the spread of Covid-19. Doctors and nurses in the NHS, alongside care workers, receptionists, cleaners, and paramedics, have been saving lives day in and day out on the frontline. It has been an extraordinary effort, which will have taken an extreme physical and emotional toll on many.

In a report I have authored, published today and commissioned by the technology company VMware, we identify the scale of the mental health challenge among the NHS workforce. Using data from NHS Trusts and the Health and Safety Executive (HSE), we estimate that more than 10 million working days were lost to poor mental health among NHS staff across the UK in 2019 at a cost of £3 billion. That’s the equivalent of every single worker in the health service taking on average seven sick days off work. Unfortunately, due to the impact of Covid-19, we can expect the 2020 figures to be even worse.

There isn’t a one-size-fits-all solution to the problem of tackling mental health among NHS workers. A wide-ranging strategy is needed, which includes improved management practices and raised awareness within hospitals of what best mental health practice looks like. But there is one area which will be absolutely fundamental to any improvement: technology.

A recent survey of NHS professionals showed that six in ten thought NHS IT was not fit for purpose, and in a BMA member survey four in ten respondents stated that their stress levels were significantly affected by inefficient IT and data sharing systems.

Some of the IT issues which confront NHS staff are totally unacceptable and reform is long overdue: it takes around 10 minutes to log on to many NHS systems, for example, with multiple logins necessary throughout the day. Some NHS Trusts have as many as 110 different IT systems in place, without any connectivity between them. This means constantly moving files of patient data from system to system or, as is more likely, using apps on personal devices such as Whatsapp to share patient details. These digital silos are slowing NHS staff down, causing unnecessary stress, and creating huge inefficiencies and security issues right at the heart of the health service.

Whilst these issues currently place real pressure on the time and workload of the NHS workforce, there are clear routes through which they can be tackled by improved technology. One such example is establishing a simple principle that clinicians should have the right information on the patient in front of them, on any device that they are using and at any time, with the security you would expect to surround personal medical records. It is a simple principle, but one that would fundamentally change the experience of many clinicians today: saving time, easing workloads, reducing stress and improving patient care.

Creating a strong digital foundation in every hospital in the country won’t just relieve the pressure on staff and enable them to spend more time looking after patients. Replacing outdated IT systems will kickstart the roll out of game changing technologies in the health service. This could mean artificial intelligence predicting demand for hospital beds, cutting edge robotics technology revolutionising keyhole surgery, and pioneering machine learning approaches identifying rare diseases.

The Health Secretary understands the pressing need for this reform. The government and NHS England have committed to providing a core level of digitisation in all hospitals by 2024. Many trailblazing hospitals have stepped up to the challenge and are leading from the front. Other hospitals, however, need help in the form of technological expertise and funding. We should provide them with the tools to allow them to update their IT backbone and enable their staff to carry out their jobs more easily.

The UK is a leader in healthcare and technology. If we can combine our expertise in both, then it will go a long way in improving the mental and indeed physical health of our dedicated NHS workers, which in turn will help all of us.

Chandra Kanneganti: The Coronavirus challenges I’ve seen as a doctor and a councillor

31 Jul

Dr Chandra Kanneganti is the Chair of North Staffordshire’s GP Federation, and is a Stoke-on-Trent City Councillor.

It’s been almost six months since we have been dealing with Covid-19 pandemic. With the benefit of hindsight, it can be said that we could have handled the health crisis better.

We should have imposed the lockdown much earlier, and made sure we had enough PPE to support and protect our health care workers. We could have communicated better the precautionary measures that should be taken. As we move forward, it is critical that we evaluate our Covid-19 response. However, such assessments should be defined by empathy and humility.

I am a GP of 14 years’ experience. As medical professionals, we were never trained to handle a health crisis of this magnitude. Like military exercises during peacetime, the healthcare professionals never conducted nation-wide pandemic-response exercises during normal times. Much less, many health care professionals never even attended a single workshop on pandemic response during their careers.

This is not surprising, since we have never seen something like this in our country or for that matter, no country has ever anticipated a crisis of this magnitude. Our health care infrastructure was tested and stretched by this once in a generation health crisis. Our people and the health care professional community have demonstrated remarkable resilience in the combat against the deadly pandemic.

Over the past few months, my colleagues and I worked every weekday and many weekends in GP practices, in Covid Hot clinics and extended access clinics. Many of us had at least 40-50 contacts of patients every day as a GP. During the breaks, which were always few, we would ruminate on the experiences narrated by the pandemic infected patients, and we would think of the safety of our loved ones at home.

But there was always extraordinarily little time to pause, and we had to get back to patients to work with clinical precision. In the midst of all this, I had to respond as Chair of British International Doctors Association (BIDA), and have led campaigns to scrap the NHS Immigration Health Surcharge for NHS workforce and for research with actions into disproportionate BAME Covid deaths and infections.

As a Conservative councillor, being there with the residents in my ward provided me with the opportunity of experiencing the remarkable ‘British resilience’ up and close. I had the privilege of working with the local church to start a voluntary group that helped in distributing medicines as well as food and shielding patients. It was heartwarming to see people supporting each other in the communities. A resident in my ward collected food and kept it outside every week for anyone to come and collect it.

I am sure there are many such good Samaritans in all communities. The lockdown also provided us with an opportunity to get potholes fixed in my ward by the council. Keeping up the local business in lockdown was also an important priority. I worked with the local authorities to deliver grants to businesses quickly and offered help to vulnerable people.

While there were PPE problems in some parts of the country, Stoke On Trent and North Staffordshire never faced such issues. This was largely due to innovative solutions created by people working collaboratively to supply PPE to general practices and care homes. Indeed, one of our administrators made visors for doctors working in Covid hot clinics. Further, these clinics to see Covid-suspected patients were opened in record time. We must note with some pride that Stoke had one such clinic, which was first of its kind in the entire country.

It is essential to recognise the achievements in our pandemic response, as it will help us to build a more robust health care infrastructure. Based on my work as a medical professional and as a councillor, let me share with you four important accomplishments.

First, in terms of infrastructure, hospitals have come up with Covid wards in record time with well-trained staff ready to serve. Our health care staff was trained quickly to shield vulnerable people and protect them. Today, there are thousands of intensive care beds, ventilators ready to be used along with Nightingale Hospitals across the country. There was no problem in accessing an intensive care bed and ventilators during the pandemic in our country. Thankfully, we will be spared the experience of Italy, where doctors, unfortunately, had to choose patient’s for ventilation and treat the patients in corridors.

Second, with regards to processes, general practices have been trying to digitalize for ages. Within one week of Covid pandemic, GPs across the country shifted to remote consultations, using various digital tools and continued to be there every day for their patients. Whenever there was a perception that the decision-making process was erring in its policies, there were quick corrective measures. For instance, all doctors’ associations have united in one voice to support BAME NHS Staff who are disproportionately affected. Eight GP colleagues and a Practice Manager in Greater Manchester prepared a risk assessment tool called SAAD tool in memory of a GP colleague who unfortunately died of Covid.

Our democratic political process and the elected, as well as accountable leadership, are important assets that we have. We are one of those few countries in the world that reported Covid deaths with complete openness and transparency.

In fact, the fatality rate may have been over-reported. I have seen a number of reports of deaths, particularly in care homes that were reported as Covid deaths, based on care staff and paramedics observations without any valid medical test results. Our democratic ethos and administrative frameworks do not permit us to push inconvenient numbers under the carpet.

Third, the response of our political leadership has been brilliant throughout the pandemic. Boris Johnson has been in ICU with high flow oxygen and has recovered. The Prime Minister gave us hope and showed considerable fortitude in crisis. Rishi Sunak was fantastic, and all my constituents have nothing but praise for him. Matt Hancock’s knowledge of the issues and his engagement with scientific and medical advisors showed a mature health secretary with a reassuring presence in the hour of crisis.

We are at the forefront of vaccine development with contracts of millions of vaccines in place, which is marked contrast to some of the developed economies which are yet to sign a contract with vaccine producers.

Fourth, there was a robust societal response. The British public has demonstrated remarkable generosity with the wonderful campaign of Sir Tom Moore. His campaign collected £32.79 million. I had the first-hand experience of the British kindness, as I was able to collect 17,000 in a short time through British International Doctors Association (BIDA), and distributed this to number of stranded doctors for their living expenses. Through various symbolic measures, such as clapping, our society has shown immense appreciation to all the key workers for the work that they are doing.

Despite these achievements, we must never forget the fatalities that we registered due to the pandemic. Death is not a statistical data point, and the loss of life of a mother, a father, a child, and a key worker can never be filled. There are concerns that there may be a second wave of coronavirus in the winter. There is no time to rest. We must continue to help each other and support the government. We are in this together – and will come out of this much stronger as a country.

Paul Bristow: The biggest challenge for our NHS may still lie ahead, but it’s also an opportunity

30 Jun

Paul Bristow is the MP for Peterborough and a member of the Commons’ Health and Social Care Select Committee.

Our NHS has done an excellent job looking after us during the Covid-19 crisis. But the biggest challenge for our NHS may be about to begin as the service deals with the backlog of delayed operations and treatments.

The lockdown began in order to protect our NHS. This was the early central message. The Government was concerned that hospitals would be overwhelmed as we saw in Italy and elsewhere at the start of the pandemic. This didn’t happen. Our NHS ramped up capacity as former NHS workers came back to serve, new hospitals were built, and a deal was struck with the independent sector. This push for increasing capacity within the system needs to continue.

We need a national effort backed by the Government PR machine – supported by the charisma and optimism of the Prime Minister – to back our NHS and clear the backlog. I have heard personal harrowing stories from NHS patients through my role on the Health and Social Care Select Committee.

Rob Martinez from Bracknell, who needed a double knee replacement, had his operation due in April cancelled. He told our committee that he had taken early retirement. I asked him if he would have continued to work if his operation had taken place – he confirmed he felt he could have worked for another 5 years. What was the most bitter blow is that he has been told there is ‘zero chance’ of his procedure taking place this year.

Another patient from Sevenoaks had her chemotherapy stopped. And while it has restarted, there remains huge concern that the number of patients receiving chemotherapy is far fewer than would be expected. Cancer Research UK estimates more than 20,000 patients did not get treatment because of the virus crisis.

Whilst official statistics have been paused, it is estimated almost two-thirds of Britons with common life-threatening conditions have had care cancelled. The NHS Confederation is saying that NHS waiting lists could rise to 10 million in the autumn, and take up to two years to clear. The Royal College of Surgery has called for a five-year strategy to tackle the waiting list situation.

This is now one of the Government’s central challenges.

We can do this. The NHS has shown its remarkable ability to cope, and yet again the British people have shown great resilience through this emergency. But it needs to be framed as a national effort with the Prime Minister and the Secretary of State personally leading this.

Those who have re-joined the NHS to help with the Covid-19 crisis need to be persuaded to stay. I appreciate staff will be tired, and those that have returned will need to be properly motivated. The appreciation that the public has shown to our NHS staff should help, but efforts will need to be made to make the NHS a better place to work and should be prioritised.

The Prime Minister had it right with the simple message about workforce at the General Election, promising to recruit and retain 50,000 nurses. We need to look with urgency at long-term recruitment issues. The NHS needs staff in almost every setting, as many begin to reach retirement age. According to the latest annual census from the UK Royal College of Radiologists, in 2020 approximately 200 doctors will qualify as radiology consultants – not enough to fill even half of the estimated 466 vacancies.

The Government needs to be alive to the challenges associated with the safety of NHS staff and patients. The need for PPE and new designed layouts will affect theatre capacity. Diagnostics, which underpin clinical activity in hospitals, and a backlog in MRI/CT scans, endoscopy and laboratory tests are also limiting factors.

Back in March, Matt Hancock was right to sign a deal with the independent sector. In peace time this would have been an incredibly courageous thing to do with those on the left gleefully pointing to proof of Tory privatisation. I hope that the Covid-19 emergency has dismissed the lazy assumption that the independent sector and the NHS cannot work in partnership.

A similar long-term deal agreement with independent providers to retain capacity will be crucial in the years ahead. They can help ramp up elective capacity, power through knee, hip and cataract procedures, and improve lives – and in the case of Mr Martinez may even allow him to return to work and generate more tax revenue to fund public services. It will also allow for cancer treatment and cardiology procedures to resume at pace and scale. With appropriate testing arrangements, these could quickly become a significant proportion of the ‘Covid-light’ units that are being regularly discussed as the means to reduce the elective backlog.

The NHS does so many things well. But few would claim – especially staff – it cannot become more productive. We have seen the NHS conduct GP appointments and other consultations through digital challenges. This has worked. It is also worth noting that much of this would have been impossible if it wasn’t for the visible presence of the NHS on our streets in the form of community pharmacies offering that face-to-face reassurance for many routine issues.

This obviously needs to continue, but it is only the beginning. Let’s start a conversation about how the NHS can change many care pathways to become more productive. We can accelerate the uptake of already established treatments, which can keep patients out of a secondary care setting or at least not in expensive hospital beds for days at a time, by the adoption of less invasive procedures.

Changing pathways to enable the adoption of technology has often meant local evidence needed to be established – this could take years and was often completely unnecessary. We can expediate the move to integrated care working, especially with regarded to initiatives such as shared waiting lists and flexibility in payment mechanisms. This is a chance to improve existing practice.

We can be optimistic and ambitious for the future of our NHS. So much goodwill has been garnered and our staff are more valued than ever. But it is also an opportunity for change. A national effort led by a transparent and upfront Government is what is required.

Paul Bristow: The biggest challenge for our NHS may still lie ahead, but it’s also an opportunity

30 Jun

Paul Bristow is the MP for Peterborough and a member of the Commons’ Health and Social Care Select Committee.

Our NHS has done an excellent job looking after us during the Covid-19 crisis. But the biggest challenge for our NHS may be about to begin as the service deals with the backlog of delayed operations and treatments.

The lockdown began in order to protect our NHS. This was the early central message. The Government was concerned that hospitals would be overwhelmed as we saw in Italy and elsewhere at the start of the pandemic. This didn’t happen. Our NHS ramped up capacity as former NHS workers came back to serve, new hospitals were built, and a deal was struck with the independent sector. This push for increasing capacity within the system needs to continue.

We need a national effort backed by the Government PR machine – supported by the charisma and optimism of the Prime Minister – to back our NHS and clear the backlog. I have heard personal harrowing stories from NHS patients through my role on the Health and Social Care Select Committee.

Rob Martinez from Bracknell, who needed a double knee replacement, had his operation due in April cancelled. He told our committee that he had taken early retirement. I asked him if he would have continued to work if his operation had taken place – he confirmed he felt he could have worked for another 5 years. What was the most bitter blow is that he has been told there is ‘zero chance’ of his procedure taking place this year.

Another patient from Sevenoaks had her chemotherapy stopped. And while it has restarted, there remains huge concern that the number of patients receiving chemotherapy is far fewer than would be expected. Cancer Research UK estimates more than 20,000 patients did not get treatment because of the virus crisis.

Whilst official statistics have been paused, it is estimated almost two-thirds of Britons with common life-threatening conditions have had care cancelled. The NHS Confederation is saying that NHS waiting lists could rise to 10 million in the autumn, and take up to two years to clear. The Royal College of Surgery has called for a five-year strategy to tackle the waiting list situation.

This is now one of the Government’s central challenges.

We can do this. The NHS has shown its remarkable ability to cope, and yet again the British people have shown great resilience through this emergency. But it needs to be framed as a national effort with the Prime Minister and the Secretary of State personally leading this.

Those who have re-joined the NHS to help with the Covid-19 crisis need to be persuaded to stay. I appreciate staff will be tired, and those that have returned will need to be properly motivated. The appreciation that the public has shown to our NHS staff should help, but efforts will need to be made to make the NHS a better place to work and should be prioritised.

The Prime Minister had it right with the simple message about workforce at the General Election, promising to recruit and retain 50,000 nurses. We need to look with urgency at long-term recruitment issues. The NHS needs staff in almost every setting, as many begin to reach retirement age. According to the latest annual census from the UK Royal College of Radiologists, in 2020 approximately 200 doctors will qualify as radiology consultants – not enough to fill even half of the estimated 466 vacancies.

The Government needs to be alive to the challenges associated with the safety of NHS staff and patients. The need for PPE and new designed layouts will affect theatre capacity. Diagnostics, which underpin clinical activity in hospitals, and a backlog in MRI/CT scans, endoscopy and laboratory tests are also limiting factors.

Back in March, Matt Hancock was right to sign a deal with the independent sector. In peace time this would have been an incredibly courageous thing to do with those on the left gleefully pointing to proof of Tory privatisation. I hope that the Covid-19 emergency has dismissed the lazy assumption that the independent sector and the NHS cannot work in partnership.

A similar long-term deal agreement with independent providers to retain capacity will be crucial in the years ahead. They can help ramp up elective capacity, power through knee, hip and cataract procedures, and improve lives – and in the case of Mr Martinez may even allow him to return to work and generate more tax revenue to fund public services. It will also allow for cancer treatment and cardiology procedures to resume at pace and scale. With appropriate testing arrangements, these could quickly become a significant proportion of the ‘Covid-light’ units that are being regularly discussed as the means to reduce the elective backlog.

The NHS does so many things well. But few would claim – especially staff – it cannot become more productive. We have seen the NHS conduct GP appointments and other consultations through digital challenges. This has worked. It is also worth noting that much of this would have been impossible if it wasn’t for the visible presence of the NHS on our streets in the form of community pharmacies offering that face-to-face reassurance for many routine issues.

This obviously needs to continue, but it is only the beginning. Let’s start a conversation about how the NHS can change many care pathways to become more productive. We can accelerate the uptake of already established treatments, which can keep patients out of a secondary care setting or at least not in expensive hospital beds for days at a time, by the adoption of less invasive procedures.

Changing pathways to enable the adoption of technology has often meant local evidence needed to be established – this could take years and was often completely unnecessary. We can expediate the move to integrated care working, especially with regarded to initiatives such as shared waiting lists and flexibility in payment mechanisms. This is a chance to improve existing practice.

We can be optimistic and ambitious for the future of our NHS. So much goodwill has been garnered and our staff are more valued than ever. But it is also an opportunity for change. A national effort led by a transparent and upfront Government is what is required.