Hinterland - 11 November 2019

In Hinterland this week - we have a strong health theme with the first rumblings of critical health incidents, climate change emergencies, a lack of key workers in health and care, the unkind and greedy face of some private sector health providers and then the bright sunlit uplands of a great approach to those supporting vulnerable children in our largest rural county and some wonderful dialect words to bring a final smile to our faces. Read on...

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A&E pressure causes 'critical incident' in Nottingham

Just to prove this is more than a rural phenomenon and to indicate that I am sure there are many more of these announcements to follow over the winter…. The big issue in rural places is that chronic underfunding of, for example the 7 most rural hospitals in England, means it is impossible to escape from these structural challenges. The long term solution lies in a different approach to the supply and management of clinicians within acute trusts and more and focused investment in primary care. This story tells us:

A hospital trust has declared a "critical incident" because of the "exceptional" pressure on A&E.

Nottingham University Hospitals Trust (NUH) runs the Queen's Medical Centre (QMC) and City Hospital and has been on OPEL 4 - previously known as black alert - since Monday morning.

On Wednesday it raised the level further.

Some routine operations have been cancelled as the trust prioritises those who need emergency care.

Health bosses do not want to operate on patients who cannot be guaranteed a bed in which to recover.

Lisa Kelly, NUH chief operating officer, said: "This is following a number of days seeing exceptional pressure across the system, with high numbers of very poorly patients arriving at our emergency department."

She added they were working closely with health and social care partners and trying to discharge patients in a "timely" manner to free up beds.


Charities say next UK government must bring forward climate targets

I thought, with many small authorities, which are potentially in all truth relatively toothless in the face of our global challenge, declaring climate emergencies, Hinterland readers might find this article interesting. It tells us:

The next government must bring forward the target for reaching net-zero carbon emissions by five years to 2045, phase out diesel and petrol cars by 2030 instead of 2040, and start devoting at least 5% of all government spending to the climate and the restoration of the UK’s natural environment, a broad coalition of civil society groups has demanded.

They have written to the leaders of all the UK’s main political parties, citing the UK’s hosting of next year’s UN conference on the climate, known as COP26, as the catalyst for strengthening existing goals in line with scientific advice.

“[Next year] will be crucial for the future of our planet and presents opportunities for the UK to enhance its reputation as a global leader on these issues,” they wrote, on 17 October, before the general election was called. “Global leadership will depend on strong evidence of domestic delivery.”

Alongside green groups such as Greenpeace, WWF and Friends of the Earth, the signatories include the Women’s Institute, the UK Health Alliance on Climate Change, development charities including Oxfam and Tearfund, and religious organisations such as Islamic Relief, Quakers, GreenChristian and Cafod, the Catholic Agency for Overseas Development.


Does UK lag behind other rich nations on health and care?

I think the answer to the above question, as witnessed by this article, is a resounding “YES”….

The UK has fewer doctors and nurses and poorer access to elderly long-term care than other rich nations, a study shows.

The OECD review also warned that many Brits were living unhealthy lives with high rates of drinking and obesity.

But it praised the "strong access" to health care delivered by the NHS, saying there were low levels of inequality compared to other countries.

Spending at 9.8% of GDP - a measure of the size of the economy - was above the 8.8% average for the 36 nations.

The review - carried out every two years - looks at the performance and characteristics of the wealthiest nations across all continents.


Care sector 'leaks' £1.5bn every year

I have long thought that if you work out how much it costs to pay for adult social care and reduce it by the wages paid to those receiving it and the cost of the accommodation at a reasonable price a lot of excess cash seems to be evaporating! I begin to wonder whether there might not be an argument in favour of the nationalisation of an adult care service?? This article tells us:

Hundreds of millions of pounds of care home fees paid by residents and local authorities are never reaching frontline services, claims a report.

The Centre for Health and Public Interest has revealed £1.5bn a year "leaks out" through rental payments, interest on loans, and profits.

The figure is 10% of the total annual income of the UK care home industry.

The think tank says some of this money could be used for frontline care if the industry were restructured.

The centre's study - which is part funded by Unison - analysed the accounts of 830 adult care home companies across the UK.

The average cost for a residential care home place in the UK is £32,084 per year, not including nursing care.

The study found that among the 26 largest care home providers, £261m of the money they receive to provide care goes towards repaying debt.

Of this, £117m goes to related companies.

"Hundreds of millions of pounds a year leak out of the care home industry in the form of rental payments to offshore landlords, in the form of profit, in the form of management fees and in the form of rental payments again to offshore companies," CHPI director David Rowlands told Newsnight.

"Lots of debt has been loaded onto large care home companies by the companies that brought them and that means in some cases that 16% of all the money that is given over to care for a resident each week disappears out of the system to pay off those high cost loans."


The new approach keeping looked-after children out of crime in North Yorkshire

Inspiring stuff by a rural group active in addressing an issue oftenequated with urban places. This article tells us:

The North Yorkshire initiative, called No Wrong Door, is based on a dedicated team of specialists including a police officer, a clinical psychologist and a speech and language therapist who are based at each of the region’s two council-run children’s homes, in Scarborough and Harrogate. There are no uniforms, no suits and no appointments – the professionals have a mentor-like relationship with the children based on informal chats over breakfast, in the car, or at the gym.

And the scheme is having impressive results: an independent report by Loughborough University found a 38% drop in arrests, a 68% reduction in children going missing, a 33% fall in drug use, and hospital admissions reduced by 92% in its first 18 months from 2015 to 2017.

The programme is being rolled out to six other children’s services and has attracted interest from more than 100 councils across Britain, as well as further afield in Australia, the US and the Caribbean. It has won praise from Ofsted, the chief social worker for England, Isabelle Trowler, and Sir Martin Narey, the former director general of prisons.

The key to its success is having a specialist team all under one roof. “Kids fall out of bed and they need to speak to Ian [the clinical psychologist], they knock on his door,” said Cerena Butterworth, the team manager at the Scarborough home. Each child has a dedicated support worker, who is their consistent point of contact, while the police, council, psychologist and speech therapist – who ordinarily would have little contact with each other – work closely in the interests of the child.

Although a police officer is based at the children’s home every day, there are no handcuffs or helmets. “If uniform turns up here, the kids are in crisis because what’s the background for the kid? They see a very negative view of the police because it’s the police turning up arresting mum or dad,” said Neil Millican, the resident police officer, dressed casually in jeans and shirt. “They go into fight or flight mode and they just fight. Then we’re having to arrest them for assault and they are in that cycle.”


And Finally

Ferntickles or murfles? Survey of England's regional dialects to be revived

I love dialect, folklore and all things local. According to this article a number of people I work closely with could be described as “gibble fists” wonderful stuff….

Are you terrified by “harvest men” or “long-legged tailors”? Do you have “ferntickles” or “brunny-spots” on your face? If someone called you “gibble-fisted” would you be affronted or amused?

The words for daddy long-legs, freckles and left-handed are all examples of English regional dialect discovered in the 1950s by a team of fieldworkers in what was the most comprehensive survey of its kind ever undertaken.

On Saturday, the University of Leeds announced plans to update the survey by recruiting volunteers to be modern-day dialect researchers, thanks to more than £500,000 of national lottery funding.

The original surveyors set out from Leeds 70 years ago, targeting “old men with good teeth” for two reasons: they were a more likely to be a bridge to the past, and they could be understood.

Fiona Douglas from Leeds School of English, who is leading the project, said the net would be cast wider this time round. “I’m not just going out looking for old men with good teeth who haven’t moved anywhere,” she said. “We will speak to people whose families haven’t stayed in one area for generations, as well as those who can trace their roots back to the same place over hundreds of years. We want to include everyone’s language.”

The lottery money will also allow the digitisation of notebooks, photographs, word maps and audio recordings from the original fieldwork. The extensive Leeds Archive of Vernacular Culture (LAVC) will be opened to the public.

Researchers are keen also to speak to descendants of people who took part in the original surveys.


About the author:
Hinterland is written for the Rural Services Network by Ivan Annibal, of rural economic practitioners Rose Regeneration.


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