Heads in the clouds...

Do you remember bed-blocking? That’s when people in hospital cannot leave because no-one will pay for their care. You haven’t heard about it lately? No surprise – they’ve changed the name. Twice.

Across England, 17% of NHS capital is tied up looking after these vulnerable people. Salisbury District Hospital has a ward-full. They have made progress. Six months ago it was two wards-full. Down from 60 to 30 is good, but it is still a waste of NHS resources in people and money, and it is undignified for patients and embarrassing for the rest of all of us.

Recently I met the Chairman and Chief Executive of the South West Strategic Health Authority to discuss three local issues. When I mentioned bed-blocking I was told it had been re-branded. Bed-blocking didn’t sound nice. So they called it delayed discharge. But this implied someone might be responsible for the nasty ‘delaying’ bit. So now it has become an accountancy exercise and they call it cost-shunting.

I raised this at Health Questions in The House. The Health Minister responsible said everyone should be nice to each other – in other words he is in denial. This problem will grow and it will not be solved until Ministers in the Departments of Health, Communities and Local Government and the Treasury decide to take ownership and agree who pays up.

Action this day?
The second issue was the growing concern for how we care for people with dementia. We are so fortunate to have our excellent Salisbury Branch of the Alzheimer’s Society which provides a lifeline for scores of local patients, their families and carers. They help alleviate real fear by explaining how things work – and why it is not always necessary to sell your home to fund care.

I was told the NHS must be ‘rebalanced’ so that out-of-hospital services are as well financed and well-organised as hospital acute services. “But when?” I asked. The problem is now, not lurking on the right-hand margin of some spreadsheet. I know our Wiltshire Primary Care Trust really is working on this, so watch this space.

Thirdly I raised the crisis in NHS dentistry. I was told that we, the taxpayers, have given the Wiltshire PCT extra money for this. I’m checking this out. Meanwhile, buy painkillers!

Off the rails?
Recently I received a glossy First Year Review from First Great Western, the company that operates our services from Bristol to Portsmouth via Southampton. It is a very good, very attractive Review. It says their vision is to provide travel that is safe, reliable and enjoyable. I am sure that is what their passengers want, too. But it is not quite what many of them get, as they regularly tell me. So I went along to a meeting with FGW senior management and represented those views. The bad news is that there will be no significant changes to FGW timetables and no additional carriages and no new rolling stock.

The good news is that in 2008, South West Trains will be running more trains between Salisbury and Southampton. But their fares will rise on all routes. Why? Because at present taxpayers (most of whom do not travel by train) subsidize every train journey by an average of 22%. The Government is not only reducing that subsidy to zero, in a few years they will be taking a hefty premium payment from the operating companies under the new franchises.

At least we can look forward to the 1000 new carriages the Government has promised. Or can we? FGW told me no-one in the industry knew how these would be paid for or distributed within the train companies. Down went a Parliamentary Question – and then came the answer.

“It is too early to say where precisely the additional rolling stock will be used. The deployment of new rolling stock will be agreed with the industry following the publication of the High Level Output Specification and the long term rail strategy this summer, in accordance with the Periodic Review timetable set out in the Office of Rail Regulation’s advice to Ministers published in February 2007”.

Or, to put it another way, “you didn’t literally believe what we said, did you, silly”.

I also asked whether the new carriages will be constructed to carry bicycles. I was told, “It is too early to comment on the design of the additional rolling stock. Regrettably, there will always be constraints on the ability to accommodate non-folding bicycles at peak times, with the competing pressures on space from increasing passenger numbers”. In other words, “No, and don’t believe a word we say about integrated transport”.

And finally
Sometimes we all have to get back to basics. Did you know that there is no legal requirement for operating companies to provide and maintain lavatories on trains – except for wheelchair users? And if they stop working, those loos are allowed to be unserviceable for six days with no penalty. Most companies offer better than that – but they can still legally provide nineteenth century pedestals that empty directly on to the track below. One of the few things no-one has ever complained to me about is loos on trains. Yet how often do we find train toilets that are smelly, dirty, lack soap and water – or are locked? Meanwhile, we are offered continuous trolley service (usually), selling lots of drinks. It makes you think!

Robert Key MP
May 2007