Tag Archives: Care

I’m reinventing mental health care by putting patients in charge

A feeling of powerlessness dominated my experience of mental health services. And this feeling was at its worst when I was sectioned. Sectioning replicated aspects of the traumatic experience that initially caused my suicidal crisis. I felt trapped, captive and utterly out of control. I couldn’t escape. .

The limited control I had over my interactions with mental health professionals also had a negative impact on me. In the psychiatrist-patient relationship, the power lies with the psychiatrist. And in the community, mental health teams decided how often I would be seen, what kind of care I would receive and when the care would end. Each of these things made me feel vulnerable.

In the summer of 2012 I started to speak of my plans to set up Suicide Crisis, a centre to provide an alternative type of mental health care. However, many people were sceptical because I was a recently discharged psychiatric patient.

The traumatic experience I went through was profoundly damaging and distressing. Remarkably, though, I think it changed me into the kind of person who was able to overcome the many barriers to setting up the crisis service. I developed a determination and a tenacity, which I didn’t have before.

It’s entirely possible that someone can be both a psychiatric patient and a competent professional. But sometimes I’ve felt that people find this difficult to understand. In the four-and-a-half years we’ve been providing services, we’ve never had a suicide of a client under our care.

Our work has received national attention in the last 18 months. We have given oral evidence about our crisis centre to the health select committee and presented to the National Suicide Prevention Strategy Advisory Group, which is run by the government adviser on suicide. We are approached regularly by NHS professionals and commissioners, who refer to our centre as an example of best practice.

Perhaps society can start to think of people with experience of mental illness as having valuable knowledge of what works and what doesn’t, which helps them succeed in this field. There are times when my lived experience is as important as my formal training. I have a deep understanding of what it is like to be in crisis.

My experience has even helped when assessing clients’ suicide risks, as in the case of Aidan*, a patient at the centre. Aidan had been very depressed, then one day he came to his appointment with us and seemed very happy, almost euphoric. I recognised that sense of exhilaration, which a person may feel when they have made a decision to end their life, because I experienced that same euphoria myself in 2012. I recall it as a very intense experience, where all my senses were heightened. I was sure I would soon be leaving this world and could appreciate every aspect of it in what I thought were my remaining hours.

Aidan’s risk was clearly high, and we provided intensive support to ensure his survival. I immediately contacted NHS services so they could assess whether he needed to be sectioned. He wasn’t sectioned, but the NHS crisis team kept in contact with him that night.

After that, he asked us to support him and we saw him on a daily basis. We kept in regular contact with his mental health team and he continued to see them every week.

My experience of feeling disempowered when using mental health services is the reason we ensure our clients have a greater degree of control. They decide how often they see us, what kind of care they receive and when they are ready to leave us. Our male clients say they find this particularly helpful. They can feel especially vulnerable when they seek help; putting them in control helps to counteract this.

Early on we took the decision to employ an advising psychiatrist and other advising clinicians. They have expertise that we don’t. They advise us on individual client cases, which can be complex. And they helped us create links with the local mental health service.

However, the ethos of the charity and the way our service is set up and run are all from a lived experience perspective.

We are in regular contact with local mental health services because we are often helping the same people. Clients often feel able to tell us things they may not feel able to disclose to their mental health team. In such cases, we are keen to share that information, with the client’s permission.

The power balance between patients and mental health professionals has effectively been reinvented in our organisation. “You’re my boss,” our advising psychiatrist tells me. However, I prefer to see it as a levelling of power, a greater equality. We all have huge respect for each other’s different strengths and abilities. We all learn from each other.

*Identifying details have been changed

Joy Hibbins is founder and chief executive of Suicide Crisis

  • In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

I’m reinventing mental health care by putting patients in charge

A feeling of powerlessness dominated my experience of mental health services. And this feeling was at its worst when I was sectioned. Sectioning replicated aspects of the traumatic experience that initially caused my suicidal crisis. I felt trapped, captive and utterly out of control. I couldn’t escape. .

The limited control I had over my interactions with mental health professionals also had a negative impact on me. In the psychiatrist-patient relationship, the power lies with the psychiatrist. And in the community, mental health teams decided how often I would be seen, what kind of care I would receive and when the care would end. Each of these things made me feel vulnerable.

In the summer of 2012 I started to speak of my plans to set up Suicide Crisis, a centre to provide an alternative type of mental health care. However, many people were sceptical because I was a recently discharged psychiatric patient.

The traumatic experience I went through was profoundly damaging and distressing. Remarkably, though, I think it changed me into the kind of person who was able to overcome the many barriers to setting up the crisis service. I developed a determination and a tenacity, which I didn’t have before.

It’s entirely possible that someone can be both a psychiatric patient and a competent professional. But sometimes I’ve felt that people find this difficult to understand. In the four-and-a-half years we’ve been providing services, we’ve never had a suicide of a client under our care.

Our work has received national attention in the last 18 months. We have given oral evidence about our crisis centre to the health select committee and presented to the National Suicide Prevention Strategy Advisory Group, which is run by the government adviser on suicide. We are approached regularly by NHS professionals and commissioners, who refer to our centre as an example of best practice.

Perhaps society can start to think of people with experience of mental illness as having valuable knowledge of what works and what doesn’t, which helps them succeed in this field. There are times when my lived experience is as important as my formal training. I have a deep understanding of what it is like to be in crisis.

My experience has even helped when assessing clients’ suicide risks, as in the case of Aidan*, a patient at the centre. Aidan had been very depressed, then one day he came to his appointment with us and seemed very happy, almost euphoric. I recognised that sense of exhilaration, which a person may feel when they have made a decision to end their life, because I experienced that same euphoria myself in 2012. I recall it as a very intense experience, where all my senses were heightened. I was sure I would soon be leaving this world and could appreciate every aspect of it in what I thought were my remaining hours.

Aidan’s risk was clearly high, and we provided intensive support to ensure his survival. I immediately contacted NHS services so they could assess whether he needed to be sectioned. He wasn’t sectioned, but the NHS crisis team kept in contact with him that night.

After that, he asked us to support him and we saw him on a daily basis. We kept in regular contact with his mental health team and he continued to see them every week.

My experience of feeling disempowered when using mental health services is the reason we ensure our clients have a greater degree of control. They decide how often they see us, what kind of care they receive and when they are ready to leave us. Our male clients say they find this particularly helpful. They can feel especially vulnerable when they seek help; putting them in control helps to counteract this.

Early on we took the decision to employ an advising psychiatrist and other advising clinicians. They have expertise that we don’t. They advise us on individual client cases, which can be complex. And they helped us create links with the local mental health service.

However, the ethos of the charity and the way our service is set up and run are all from a lived experience perspective.

We are in regular contact with local mental health services because we are often helping the same people. Clients often feel able to tell us things they may not feel able to disclose to their mental health team. In such cases, we are keen to share that information, with the client’s permission.

The power balance between patients and mental health professionals has effectively been reinvented in our organisation. “You’re my boss,” our advising psychiatrist tells me. However, I prefer to see it as a levelling of power, a greater equality. We all have huge respect for each other’s different strengths and abilities. We all learn from each other.

*Identifying details have been changed

Joy Hibbins is founder and chief executive of Suicide Crisis

  • In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

I’m reinventing mental health care by putting patients in charge

A feeling of powerlessness dominated my experience of mental health services. And this feeling was at its worst when I was sectioned. Sectioning replicated aspects of the traumatic experience that initially caused my suicidal crisis. I felt trapped, captive and utterly out of control. I couldn’t escape. .

The limited control I had over my interactions with mental health professionals also had a negative impact on me. In the psychiatrist-patient relationship, the power lies with the psychiatrist. And in the community, mental health teams decided how often I would be seen, what kind of care I would receive and when the care would end. Each of these things made me feel vulnerable.

In the summer of 2012 I started to speak of my plans to set up Suicide Crisis, a centre to provide an alternative type of mental health care. However, many people were sceptical because I was a recently discharged psychiatric patient.

The traumatic experience I went through was profoundly damaging and distressing. Remarkably, though, I think it changed me into the kind of person who was able to overcome the many barriers to setting up the crisis service. I developed a determination and a tenacity, which I didn’t have before.

It’s entirely possible that someone can be both a psychiatric patient and a competent professional. But sometimes I’ve felt that people find this difficult to understand. In the four-and-a-half years we’ve been providing services, we’ve never had a suicide of a client under our care.

Our work has received national attention in the last 18 months. We have given oral evidence about our crisis centre to the health select committee and presented to the National Suicide Prevention Strategy Advisory Group, which is run by the government adviser on suicide. We are approached regularly by NHS professionals and commissioners, who refer to our centre as an example of best practice.

Perhaps society can start to think of people with experience of mental illness as having valuable knowledge of what works and what doesn’t, which helps them succeed in this field. There are times when my lived experience is as important as my formal training. I have a deep understanding of what it is like to be in crisis.

My experience has even helped when assessing clients’ suicide risks, as in the case of Aidan*, a patient at the centre. Aidan had been very depressed, then one day he came to his appointment with us and seemed very happy, almost euphoric. I recognised that sense of exhilaration, which a person may feel when they have made a decision to end their life, because I experienced that same euphoria myself in 2012. I recall it as a very intense experience, where all my senses were heightened. I was sure I would soon be leaving this world and could appreciate every aspect of it in what I thought were my remaining hours.

Aidan’s risk was clearly high, and we provided intensive support to ensure his survival. I immediately contacted NHS services so they could assess whether he needed to be sectioned. He wasn’t sectioned, but the NHS crisis team kept in contact with him that night.

After that, he asked us to support him and we saw him on a daily basis. We kept in regular contact with his mental health team and he continued to see them every week.

My experience of feeling disempowered when using mental health services is the reason we ensure our clients have a greater degree of control. They decide how often they see us, what kind of care they receive and when they are ready to leave us. Our male clients say they find this particularly helpful. They can feel especially vulnerable when they seek help; putting them in control helps to counteract this.

Early on we took the decision to employ an advising psychiatrist and other advising clinicians. They have expertise that we don’t. They advise us on individual client cases, which can be complex. And they helped us create links with the local mental health service.

However, the ethos of the charity and the way our service is set up and run are all from a lived experience perspective.

We are in regular contact with local mental health services because we are often helping the same people. Clients often feel able to tell us things they may not feel able to disclose to their mental health team. In such cases, we are keen to share that information, with the client’s permission.

The power balance between patients and mental health professionals has effectively been reinvented in our organisation. “You’re my boss,” our advising psychiatrist tells me. However, I prefer to see it as a levelling of power, a greater equality. We all have huge respect for each other’s different strengths and abilities. We all learn from each other.

*Identifying details have been changed

Joy Hibbins is founder and chief executive of Suicide Crisis

  • In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

Hospital to home: people’s needs must be central to transfers of care | Paul Burstow

When moving between hospitals, home and care homes, it can be harmful to those receiving care if the process is poorly managed. Quite simply, time is muscle. In as little as 12 hours, an older person admitted to hospital can lose the ability and confidence to stand unaided. Once lost, that muscle and confidence is hard to recover.

Following a 2015 review by NHS Providers into transfers of care, which I chaired, it was concluded that “there is no simple solution to delays in transfers of care: no one individual to blame nor a magic bullet that will solve everything”.

Getting these moves – these transfers of care – right can make a huge difference. When it comes to moving someone between a hospital and home, especially a care home, their needs should be paramount. That might sound daunting but often it’s the small details that make a difference.

One solution is intermediate care and there is good evidence that it could play a bigger part in helping people regain their strength. After it was identified that delayed transfers of care were causing older people to stay in a hospital bed longer than necessary, a “stabilise and make safe” scheme in Trafford, Greater Manchester, has seen 70% of people achieving full independence and a £7.78 return on investment for every £1 spent.

Andrea Sutcliffe, chief inspector for social care at the Care Quality Commission, says that small, practical solutions can be important. She suggests matching people with members of staff who share a common interest, giving the example of attending a pub quiz together. This can make life more interesting for everyone, rather than merely concentrating on individual tasks.

But small things can be complex to get right; registered managers of care homes and homecare services play a key role and can be the difference between a good or poor transfer.

So much has been written on transfers of care that it is sometimes hard to see the wood for the trees. This is why the Social Care Institute for Excellence (Scie) has produced a quick guide for registered managers, based on detailed guidelines from the National Institute for Health and Care Excellence.

The guide offers a practical overview of what registered managers and their teams need to do before, during and after a hospital stay. When someone has to go to hospital, managers and their teams can make sure the hospital has their care plans, details of any preferred routines or communication and accessibility needs, and any medication the patient is taking.

The key question they should be asking themselves is: how do we help this person get back to where they want to be?

One good answer to that question is NHS Sutton’s Red Bag Scheme; a simple innovation that makes sure someone takes and brings back everything they need when admitted to hospital, from their medication to details of current care. Developed by Sutton Homes of Care Vanguard in Surrey, the scheme allows ambulance and hospital staff to determine the treatment a resident needs more effectively. When patients are ready to go home, a copy of their discharge summary is placed in the red bag so that care home staff have access to this important and updated information when their residents return.

Moving to and from hospitals and the community is one of a series of quick guides to meet the needs of busy frontline health and social care professionals, while others address such issues as recognising and preventing delirium, and planning for children and young people transitioning to adult services.

It’s easy to assume that hospital transfers are solely about avoiding unnecessary admissions. This is an important component, but it’s crucial to remember the whole journey – from a community setting, to hospital, and back again. Registered managers and their teams have an important role to play and if time is muscle, much can be done in an efficient manner to make sure people’s experiences and outcomes are improved.

Join the Social Care Network for comment, analysis and job opportunities, direct to your inbox. Follow us on Twitter (@GdnSocialCare) and like us on Facebook. If you have an idea for a blog, read our guidelines and email your pitch to us at socialcare@theguardian.com.

If you’re looking for a social care job or need to recruit staff, visit Guardian Jobs.

Exposed: ‘secretive’ NHS cost-cutting plans include children’s care

Cancer diagnostics and treatment for children with complex needs are among services earmarked for cost-cutting plans considered by the NHS to plug a funding gap, according to documents seen by campaigners.

The plans, by South Gloucestershire clinical commissioning group and released under a freedom of information request, show that waiting targets for non-urgent operations are also due to be relaxed under the “capped expenditure process” (CEP) as the health service seeks to balance its books in the current financial year.

The proposals are the latest example of what critics have condemned as “draconian” measures that NHS care providers in 13 large areas of England are being told to push through, said the campaign group 38 Degrees, which obtained the documents.

They detail £5m of additional cuts to local services in South Gloucestershire as part of CEP, which is run by national NHS regulators and aims to find £250m of savings by rationing services.

Cancer diagnostics, neurological rehabilitation and children’s continuing care policy for those with complex needs arising from disability, accident or illness, are listed for proposed savings by the South Gloucestershire CCG. It aims to make a total of £4,839,000 in extra savings under CEP. The bulk could be made by “reduction in RTT [referral to treatment] performance”, which would lead to longer waiting times, and reduction in independent sector treatment centre activity.

The crowdfunded group 38 Degrees said the proposals were the first to be revealed under FOI. The doctors’ union, the British Medical Association, which has been frustrated in its attempts to gain information about the CEP through FOI requests, has previously accused NHS bosses of shrouding the process in “totally unacceptable secrecy”.

Leaked proposals from three other areas have already revealed plans including downgrading or closing A&Es and extending waiting time for operations.

Holly Maltby, a campaigner at 38 Degrees, said: “These plans shed light on just how seriously patient care in South Gloucestershire could be affected. They also begin to paint a picture for how services in other areas of England are likely to be hit too – with cancer treatment and children in need affected.”

More than 245,000 people have signed a 38 Degrees petition calling for full public disclosure on each of the 13 regions being forced to make deeper cuts. “The NHS belongs to all of us, so all of us should get a say in any changes to our local services,” said Maltby.

The 13 regions, which are among those expected to record some of the service’s biggest deficits, have been instructed by NHS England and NHS Improvement to “think the unthinkable” to balance the books. Originally they were told to make £500m of savings by March 2018, later reduced to £250m.

The South Gloucestershire CCG is part of the Bristol, North Somerset and South Gloucestershire sustainability and transformation partnership (STP). The South Gloucestershire savings amount to £4.8m, which is roughly a quarter of the £17.2m savings required from the whole STP.

The Guardian revealed in June the threat of closures and increased waiting times under proposals to save £183m across five London boroughs under the CEP programme. There is also concern that cancer treatment may be delayed if the NHS in Cheshire reduces the number of diagnostic endoscopies it undertakes by 25%, and that patients in east Surrey and Sussex may be denied angiograms and angioplasty surgery as part of the CEP savings drive.

The president of the Royal College of Paediatrics and Child Health, Prof Neena Modi, said: “The UK has previously been a champion of fair and equitable cost-containment, so secretive decisions on which services to stop providing are both surprising and unacceptable.

“Transparency is essential around what each service costs the taxpayer, what proportion of public monies go to frontline care and what proportion is wasted on the profit margins of non-NHS providers. The public has a right to know the basis on which decisions are made. These should demonstrably be based on principles of equity, efficiency and should include consultation with healthcare staff and the families of children that will be affected.

“Without such transparency there will inevitably be even greater disquiet at the erosion of children’s services at a time when metrics of children’s healthcare in the UK is a recognised cause of national concern.”

NHS England was approached for comment.

Exposed: ‘secretive’ NHS cost-cutting plans include children’s care

Cancer diagnostics and treatment for children with complex needs are among services earmarked for cost-cutting plans considered by the NHS to plug a funding gap, according to documents seen by campaigners.

The plans, by South Gloucestershire clinical commissioning group and released under a freedom of information request, show that waiting targets for non-urgent operations are also due to be relaxed under the “capped expenditure process” (CEP) as the health service seeks to balance its books in the current financial year.

The proposals are the latest example of what critics have condemned as “draconian” measures that NHS care providers in 13 large areas of England are being told to push through, said the campaign group 38 Degrees, which obtained the documents.

They detail £5m of additional cuts to local services in South Gloucestershire as part of CEP, which is run by national NHS regulators and aims to find £250m of savings by rationing services.

Cancer diagnostics, neurological rehabilitation and children’s continuing care policy for those with complex needs arising from disability, accident or illness, are listed for proposed savings by the South Gloucestershire CCG. It aims to make a total of £4,839,000 in extra savings under CEP. The bulk could be made by “reduction in RTT [referral to treatment] performance”, which would lead to longer waiting times, and reduction in independent sector treatment centre activity.

The crowdfunded group 38 Degrees said the proposals were the first to be revealed under FOI. The doctors’ union, the British Medical Association, which has been frustrated in its attempts to gain information about the CEP through FOI requests, has previously accused NHS bosses of shrouding the process in “totally unacceptable secrecy”.

Leaked proposals from three other areas have already revealed plans including downgrading or closing A&Es and extending waiting time for operations.

Holly Maltby, a campaigner at 38 Degrees, said: “These plans shed light on just how seriously patient care in South Gloucestershire could be affected. They also begin to paint a picture for how services in other areas of England are likely to be hit too – with cancer treatment and children in need affected.”

More than 245,000 people have signed a 38 Degrees petition calling for full public disclosure on each of the 13 regions being forced to make deeper cuts. “The NHS belongs to all of us, so all of us should get a say in any changes to our local services,” said Maltby.

The 13 regions, which are among those expected to record some of the service’s biggest deficits, have been instructed by NHS England and NHS Improvement to “think the unthinkable” to balance the books. Originally they were told to make £500m of savings by March 2018, later reduced to £250m.

The South Gloucestershire CCG is part of the Bristol, North Somerset and South Gloucestershire sustainability and transformation partnership (STP). The South Gloucestershire savings amount to £4.8m, which is roughly a quarter of the £17.2m savings required from the whole STP.

The Guardian revealed in June the threat of closures and increased waiting times under proposals to save £183m across five London boroughs under the CEP programme. There is also concern that cancer treatment may be delayed if the NHS in Cheshire reduces the number of diagnostic endoscopies it undertakes by 25%, and that patients in east Surrey and Sussex may be denied angiograms and angioplasty surgery as part of the CEP savings drive.

The president of the Royal College of Paediatrics and Child Health, Prof Neena Modi, said: “The UK has previously been a champion of fair and equitable cost-containment, so secretive decisions on which services to stop providing are both surprising and unacceptable.

“Transparency is essential around what each service costs the taxpayer, what proportion of public monies go to frontline care and what proportion is wasted on the profit margins of non-NHS providers. The public has a right to know the basis on which decisions are made. These should demonstrably be based on principles of equity, efficiency and should include consultation with healthcare staff and the families of children that will be affected.

“Without such transparency there will inevitably be even greater disquiet at the erosion of children’s services at a time when metrics of children’s healthcare in the UK is a recognised cause of national concern.”

NHS England was approached for comment.

Exposed: ‘secretive’ NHS cost-cutting plans include children’s care

Cancer diagnostics and treatment for children with complex needs are among services earmarked for cost-cutting plans considered by the NHS to plug a funding gap, according to documents seen by campaigners.

The plans, by South Gloucestershire clinical commissioning group and released under a freedom of information request, show that waiting targets for non-urgent operations are also due to be relaxed under the “capped expenditure process” (CEP) as the health service seeks to balance its books in the current financial year.

The proposals are the latest example of what critics have condemned as “draconian” measures that NHS care providers in 13 large areas of England are being told to push through, said the campaign group 38 Degrees, which obtained the documents.

They detail £5m of additional cuts to local services in South Gloucestershire as part of CEP, which is run by national NHS regulators and aims to find £250m of savings by rationing services.

Cancer diagnostics, neurological rehabilitation and children’s continuing care policy for those with complex needs arising from disability, accident or illness, are listed for proposed savings by the South Gloucestershire CCG. It aims to make a total of £4,839,000 in extra savings under CEP. The bulk could be made by “reduction in RTT [referral to treatment] performance”, which would lead to longer waiting times, and reduction in independent sector treatment centre activity.

The crowdfunded group 38 Degrees said the proposals were the first to be revealed under FOI. The doctors’ union, the British Medical Association, which has been frustrated in its attempts to gain information about the CEP through FOI requests, has previously accused NHS bosses of shrouding the process in “totally unacceptable secrecy”.

Leaked proposals from three other areas have already revealed plans including downgrading or closing A&Es and extending waiting time for operations.

Holly Maltby, a campaigner at 38 Degrees, said: “These plans shed light on just how seriously patient care in South Gloucestershire could be affected. They also begin to paint a picture for how services in other areas of England are likely to be hit too – with cancer treatment and children in need affected.”

More than 245,000 people have signed a 38 Degrees petition calling for full public disclosure on each of the 13 regions being forced to make deeper cuts. “The NHS belongs to all of us, so all of us should get a say in any changes to our local services,” said Maltby.

The 13 regions, which are among those expected to record some of the service’s biggest deficits, have been instructed by NHS England and NHS Improvement to “think the unthinkable” to balance the books. Originally they were told to make £500m of savings by March 2018, later reduced to £250m.

The South Gloucestershire CCG is part of the Bristol, North Somerset and South Gloucestershire sustainability and transformation partnership (STP). The South Gloucestershire savings amount to £4.8m, which is roughly a quarter of the £17.2m savings required from the whole STP.

The Guardian revealed in June the threat of closures and increased waiting times under proposals to save £183m across five London boroughs under the CEP programme. There is also concern that cancer treatment may be delayed if the NHS in Cheshire reduces the number of diagnostic endoscopies it undertakes by 25%, and that patients in east Surrey and Sussex may be denied angiograms and angioplasty surgery as part of the CEP savings drive.

The president of the Royal College of Paediatrics and Child Health, Prof Neena Modi, said: “The UK has previously been a champion of fair and equitable cost-containment, so secretive decisions on which services to stop providing are both surprising and unacceptable.

“Transparency is essential around what each service costs the taxpayer, what proportion of public monies go to frontline care and what proportion is wasted on the profit margins of non-NHS providers. The public has a right to know the basis on which decisions are made. These should demonstrably be based on principles of equity, efficiency and should include consultation with healthcare staff and the families of children that will be affected.

“Without such transparency there will inevitably be even greater disquiet at the erosion of children’s services at a time when metrics of children’s healthcare in the UK is a recognised cause of national concern.”

NHS England was approached for comment.

Exposed: ‘secretive’ NHS cost-cutting plans include children’s care

Cancer diagnostics and treatment for children with complex needs are among services earmarked for cost-cutting plans considered by the NHS to plug a funding gap, according to documents seen by campaigners.

The plans, by South Gloucestershire clinical commissioning group and released under a freedom of information request, show that waiting targets for non-urgent operations are also due to be relaxed under the “capped expenditure process” (CEP) as the health service seeks to balance its books in the current financial year.

The proposals are the latest example of what critics have condemned as “draconian” measures that NHS care providers in 13 large areas of England are being told to push through, said the campaign group 38 Degrees, which obtained the documents.

They detail £5m of additional cuts to local services in South Gloucestershire as part of CEP, which is run by national NHS regulators and aims to find £250m of savings by rationing services.

Cancer diagnostics, neurological rehabilitation and children’s continuing care policy for those with complex needs arising from disability, accident or illness, are listed for proposed savings by the South Gloucestershire CCG. It aims to make a total of £4,839,000 in extra savings under CEP. The bulk could be made by “reduction in RTT [referral to treatment] performance”, which would lead to longer waiting times, and reduction in independent sector treatment centre activity.

The crowdfunded group 38 Degrees said the proposals were the first to be revealed under FOI. The doctors’ union, the British Medical Association, which has been frustrated in its attempts to gain information about the CEP through FOI requests, has previously accused NHS bosses of shrouding the process in “totally unacceptable secrecy”.

Leaked proposals from three other areas have already revealed plans including downgrading or closing A&Es and extending waiting time for operations.

Holly Maltby, a campaigner at 38 Degrees, said: “These plans shed light on just how seriously patient care in South Gloucestershire could be affected. They also begin to paint a picture for how services in other areas of England are likely to be hit too – with cancer treatment and children in need affected.”

More than 245,000 people have signed a 38 Degrees petition calling for full public disclosure on each of the 13 regions being forced to make deeper cuts. “The NHS belongs to all of us, so all of us should get a say in any changes to our local services,” said Maltby.

The 13 regions, which are among those expected to record some of the service’s biggest deficits, have been instructed by NHS England and NHS Improvement to “think the unthinkable” to balance the books. Originally they were told to make £500m of savings by March 2018, later reduced to £250m.

The South Gloucestershire CCG is part of the Bristol, North Somerset and South Gloucestershire sustainability and transformation partnership (STP). The South Gloucestershire savings amount to £4.8m, which is roughly a quarter of the £17.2m savings required from the whole STP.

The Guardian revealed in June the threat of closures and increased waiting times under proposals to save £183m across five London boroughs under the CEP programme. There is also concern that cancer treatment may be delayed if the NHS in Cheshire reduces the number of diagnostic endoscopies it undertakes by 25%, and that patients in east Surrey and Sussex may be denied angiograms and angioplasty surgery as part of the CEP savings drive.

The president of the Royal College of Paediatrics and Child Health, Prof Neena Modi, said: “The UK has previously been a champion of fair and equitable cost-containment, so secretive decisions on which services to stop providing are both surprising and unacceptable.

“Transparency is essential around what each service costs the taxpayer, what proportion of public monies go to frontline care and what proportion is wasted on the profit margins of non-NHS providers. The public has a right to know the basis on which decisions are made. These should demonstrably be based on principles of equity, efficiency and should include consultation with healthcare staff and the families of children that will be affected.

“Without such transparency there will inevitably be even greater disquiet at the erosion of children’s services at a time when metrics of children’s healthcare in the UK is a recognised cause of national concern.”

NHS England was approached for comment.

Adult social care is in crisis mode. We need a clear long-term plan | Joel Charles

This party conference season, all political parties will use their platforms to set out a post-election vision. Adult social care was one of the big general election issues, and the government has indicated that an adult social care green paper is likely next year. The next few months are critical for capturing the views of the public, the health and care sectors and charities working to support older people.

At Future Care Capital, we have launched a new policy report about the challenges facing our ageing society and the implications for every generation. Addressing three key themes – intergenerational fairness and the economics of ageing, health and care futures, and planning ahead – we invited leaders from the public, private and third sectors to contribute. They considered how policies and spending decisions that impact health and care outcomes could better reflect the challenges and opportunities we can expect in the next five, 10 and 15 years.

Our report also calls for a more concerted effort to in the short-term to adapt homes and public spaces for age and mobility, as well as recognition of the contribution of carers to the economy and measures to improve their work-life-care balance.

What’s striking is the consensus that there is no long-term plan for health and adult social care and that the result is a growing care deficit. Our health and care services are facing a perfect storm; the country’s population is getting older and the number of care workers is insufficient to meet future demand. At the same time, 10% of people already identify as unpaid carers, which has implications for their work-life-care balance and the wider economy. Tackling the problem in isolation is not an option. The government needs to collaborate with communities, service commissioners and providers, and charities and innovators to forge a way forward.

A new settlement for health and care or a “care covenant”, underpinned by our future care guarantees, could offer greater security to everyone. These guarantees call on the government to introduce a new funding formula for health and care services, to champion independent living by investing in pre-care measures and education to build a bigger care workforce.

One key issue is a general lack of understanding among the public about the scope of state-funded adult social care services and who should pay for them.

Some 67% of 16 to 75-year-olds agree that people should be required to plan and prepare financially for later life, while 49% agree they should have to plan and prepare financially for adult social care services they might need, according to a survey we conducted with Ipsos Mori.

In addition, it found many people support a range of income tax rises to increase the amount of funding available for adult social care. Raising the additional rate from 45p to 50p was supported by 58% of those surveyed, increasing the higher rate from 40p to 43p by 57%, and half backed a raise in 1p of the basic rate.

What’s more, 76% of those surveyed said increasing the number of health and social care workers would ease pressure on the system, and 71% thought that providing greater support for unpaid carers would be effective.

Our ageing society represents one of the biggest human challenges of our time – every family is affected. We need political consensus on our direction of travel – a long-term plan to guide the policies of successive governments to improve health and care outcomes and enable people to plan ahead. Otherwise, we will remain in fire-fighting or crisis mode. The government’s forthcoming green paper affords it a prime opportunity to act now and build health and care provision fit for everyone in our society.

Joel Charles is deputy chief executive of Future Care Capital

Join the Social Care Network for comment, analysis and job opportunities, direct to your inbox. Follow us on Twitter (@GdnSocialCare) and like us on Facebook. If you have an idea for a blog, read our guidelines and email your pitch to us at socialcare@theguardian.com.

If you’re looking for a social care job or need to recruit staff, visit Guardian Jobs.

Adult social care is in crisis mode. We need a clear long-term plan | Joel Charles

This party conference season, all political parties will use their platforms to set out a post-election vision. Adult social care was one of the big general election issues, and the government has indicated that an adult social care green paper is likely next year. The next few months are critical for capturing the views of the public, the health and care sectors and charities working to support older people.

At Future Care Capital, we have launched a new policy report about the challenges facing our ageing society and the implications for every generation. Addressing three key themes – intergenerational fairness and the economics of ageing, health and care futures, and planning ahead – we invited leaders from the public, private and third sectors to contribute. They considered how policies and spending decisions that impact health and care outcomes could better reflect the challenges and opportunities we can expect in the next five, 10 and 15 years.

Our report also calls for a more concerted effort to in the short-term to adapt homes and public spaces for age and mobility, as well as recognition of the contribution of carers to the economy and measures to improve their work-life-care balance.

What’s striking is the consensus that there is no long-term plan for health and adult social care and that the result is a growing care deficit. Our health and care services are facing a perfect storm; the country’s population is getting older and the number of care workers is insufficient to meet future demand. At the same time, 10% of people already identify as unpaid carers, which has implications for their work-life-care balance and the wider economy. Tackling the problem in isolation is not an option. The government needs to collaborate with communities, service commissioners and providers, and charities and innovators to forge a way forward.

A new settlement for health and care or a “care covenant”, underpinned by our future care guarantees, could offer greater security to everyone. These guarantees call on the government to introduce a new funding formula for health and care services, to champion independent living by investing in pre-care measures and education to build a bigger care workforce.

One key issue is a general lack of understanding among the public about the scope of state-funded adult social care services and who should pay for them.

Some 67% of 16 to 75-year-olds agree that people should be required to plan and prepare financially for later life, while 49% agree they should have to plan and prepare financially for adult social care services they might need, according to a survey we conducted with Ipsos Mori.

In addition, it found many people support a range of income tax rises to increase the amount of funding available for adult social care. Raising the additional rate from 45p to 50p was supported by 58% of those surveyed, increasing the higher rate from 40p to 43p by 57%, and half backed a raise in 1p of the basic rate.

What’s more, 76% of those surveyed said increasing the number of health and social care workers would ease pressure on the system, and 71% thought that providing greater support for unpaid carers would be effective.

Our ageing society represents one of the biggest human challenges of our time – every family is affected. We need political consensus on our direction of travel – a long-term plan to guide the policies of successive governments to improve health and care outcomes and enable people to plan ahead. Otherwise, we will remain in fire-fighting or crisis mode. The government’s forthcoming green paper affords it a prime opportunity to act now and build health and care provision fit for everyone in our society.

Joel Charles is deputy chief executive of Future Care Capital

Join the Social Care Network for comment, analysis and job opportunities, direct to your inbox. Follow us on Twitter (@GdnSocialCare) and like us on Facebook. If you have an idea for a blog, read our guidelines and email your pitch to us at socialcare@theguardian.com.

If you’re looking for a social care job or need to recruit staff, visit Guardian Jobs.