Supporting our NHS
Jeremy is totally committed to supporting our National Health Service and ensuring we continue to enjoy excellent healthcare, free at the point of delivery. He fully supports the massive expansion in resources the Government has got underway (the largest in the NHS’ history) to provide the resources the NHS needs to expand its services to meet the welcome challenge of us living longer. He is fully engaged locally in promoting the expansion of the NHS and the evolution of its services to meet the needs of our area and its expanding population. On many measures of healthcare the Horsham area significantly outperforms the national picture but constituents can face problems and parts of the local NHS inevitably perform better than others: Jeremy is always keen to hear feedback (both positive and negative) and help where he can. One area on which he is keen to see progress is better working together of all local agencies – where this has been piloted the results in terms of enhanced and effective patient care have been impressive.
A Great Place to Live
In terms of quality of life the Horsham Constituency is a great place to live. Aside from generally extremely good public services and leisure opportunities we are on the edge of the South Downs National Park and benefit from beautiful countryside – much of it nationally recognised as Areas of Outstanding Natural Beauty. The area boasts a huge array of sports and community groups, faith communities and village and town activities. These are all great in their own right – but as is becoming more apparent these elements of a “good life” are also good for our physical and mental health. This, the demography of the area (including significantly above average employment) and the hard work, commitment and dedication of our local NHS form an overall backdrop which is reflected in our local health results.
Come to Horsham and Live Longer!
Clearly no one can promise it! However life expectancy in the Horsham area (82.3 for men and 84.7 for women) is higher than the County Average and the average for the UK as a whole (3 years more for men and 2 years for women).
Fitter Population – and happier
NHS Statistics suggest that the incidence of Obesity in our area is significantly (25 per cent) lower than the national average. There are many different causes of Diabetes but this too is significantly lower locally than in the County as a whole or nationally. Recorded cases of depression and serious mental illness are also lower locally.
Ensuring our Health Care Meets our Needs
A relatively good picture on many measures of local health is positive but it remains absolutely essential that we have the right NHS resources to support these results and match our changing needs. As is well known the major challenge to the NHS (and social care) is the significant increase in the 65 years+ population. This extremely welcome increase in longevity effects demand on services and increases the complexity of many cases. The population of England over 65 (already far higher than it was) is expected to grow by nearly 50 per cent in the next 20 years. Horsham already has a higher proportion of over 65s and this is projected to increase faster than the national average.
Our local GP Services
We need to ensure that our healthcare resources are fully equipped to provide excellent care and to meet increasing demand. Jeremy routinely meets the local Doctors Commissioning Group (the “CCG”) and individual GP practices: in particular to discuss how the services are evolving to meet the needs of our growing and ageing population.
CQC Reports for GP surgeries across the Horsham constituency are largely positive: an outlook reflected in most of the comments Jeremy receives from residents: however comments do vary between practices and Jeremy is always keen to receive feedback.
One tool used by the NHS to track the performance of GP services is the Patient Survey which provides consistently collated results from the across England and was last conducted in August 2018.
Horsham and Mid Sussex CCG (“HMS”) covers the substantial majority of the constituency (with Billingshurst falling under Coastal West Sussex CCG).
The Results for HMS were:
Very Good or Good experience of Local GPs
88% of Horsham and Mid Sussex patients had a ‘good’ or ‘very good’ experience of their GP practice, compared to 84% nationally.
Better Access locally than nationally
75% of Horsham and Mid Sussex patients found it ‘very easy’ or ‘fairly easy’ to get through to someone at their practice, compared to 70% nationally
Availability of Appointments
66% of Horsham and Mid Sussex patients were offered a choice of appointment when they last tried to book one, compared to 62% nationally. Overall, 69% were ‘satisfied’ with GP appointment availability, compared to the national average of 66%.
Improving Access to GP Services
The Government has embarked on the biggest ever expansion of resources to the NHS: annual spending on the NHS will increase by over £20billion over the next few years. Jeremy believes that this expansion is a necessary and welcome step to meet the increase in demand.
General Practice lies at the heart of the NHS but over decades has been relatively underinvested. The Government has reversed this trend. In 2018 Health Education England recruited the highest number of GP trainees ever. It takes a decade to fully train a GP but the NHS England International GP Recruitment programme is also recruiting suitably qualified doctors to work in English General Practice.
This expansion is absolutely necessary and is vital to the local area in particular where a significant proportion of our highly regarded local GPs are approaching retirement and the higher cost of living locally can be off-putting to new recruits.
Although there is some dispute as to the completeness and differential approach to collation of the statistics used and whether they provide an effective measure on access to services because of factors not included, a BBC report (Q1 2019) highlighted the simple ratio of patients to (full time) GPs per area. On these statistics, notwithstanding our generally good health outcomes and above-average patient positive feedback on accessibility, the Horsham and Mid Sussex CCG comes out as having a relatively low number of full time (non-locum) GPs per patient.
As the Health Minister commented in a Parliamentary Debate held on an area with a lower GP to Patient ratio than HMS (on 20th March 2019) Jeremy has been assiduous in pushing the case with Ministers for greater resources for Primary Care and the special needs for our area in particular. He will continue to do so while recognising that what matters is the access appropriate care and the health outcomes achieved for constituents.
The vital necessity of ensuring accessibility for patients to the right healthcare is very much recognised locally. The CCG are actively working with GP practices to identify staff shortages where these occur and though the Locally Commissioned Services (LCS), GP practices are able to plan creatively to solve challenges, including by working between practices.
Jeremy is impressed at the efforts to which local surgeries and the CCG are going to improve patient experience and access to services. One such example is the Improved Access Service that has been live since October 2018. The Improved Access Service allows patients under Horsham and Mid Sussex CCG to book weekday evening and weekend GP appointments. Appointments can be booked through a patient’s practice, in the usual way, at a practice ‘hub’ location. The CCG has commissioned to meet the national target of an additional 30 minutes of consultation capacity per week per 1,000 head of population. For Horsham and Mid Sussex, this equals an additional 119 hours of appointment capacity per week. For example, in December 2018 there were approximately an additional 1,500 appointments available during the Improved Access Service hours of operation.
Weekday evening and weekend appointments are particularly important to those who work full time, especially the many local commuters and those who struggle to attend a weekday appointment.
Getting Smarter in delivering Services
However we also need to be smarter about how we access the NHS. As resources increase we need to ensure we are seeking new ways to provide appropriate and easier ways for patients to get the right medical advice and treatment.
Going direct via self-referral
For example previously, when someone required physiotherapy eg after a sports injury, a patient was required to have a GP appointment first, for the GP to refer them for physiotherapy. This was the case even when the injury was a repeat case and the treatment path known to both physio and patient. This was frustrating for patients dealing with uncomfortable and painful symptoms and added a layer of bureaucracy which unnecessarily took up GP time.
In 2018, Jeremy met the Physiotherapy Lead at Sussex Musculoskeletal Partnership who have developed a service whereby patients can self-refer for physiotherapy, without having to see a GP first and without continued GP referrals. Self-referral is therefore freeing up valuable GP time whilst also increasing patient control of their health care journey. Trained physios are very aware of symptoms that should be directed to a GP, but in the vast majority of cases patients simply require physio support and this can be swiftly provided. For more information on who is eligible for self-referral and how to self-refer please click on the “Physiotherapy Self-Referral” link below.
Paramedic Home Support
Additionally, the local CCG have commissioned paramedic practitioners to carry out an urgent home visiting service. This is particularly important for patients who suffer with frailty issues, who do not require treatment in A&E and do not need to be seen by their GP. Vitally, this keeps Ambulance and A&E resources committed to those who urgently require them and allows GPs to focus on patients that need their expertise.
Making the Most of Our Community Hospital
Horsham Hospital was founded for the people of Horsham and has a huge well of support and commitment locally. Jeremy is keen to see it used to the maximum extent possible as a centre for our local health needs.
Jeremy is pleased that CCG are also looking at ways to integrate Horsham Hospital into becoming a vibrant primary community hub, that can provide treatment for patients with minor injuries and illnesses across seven days a week and later into the evening. Currently, Horsham Hospital provides treatment for minor injuries during Monday-Friday 9am-5pm. This means many residents have to attend either Crawley Urgent Treatment Centre or East Surrey Hospital’s A&E department outside of these times. This is not the best use of these resources and frustrating for patients. Jeremy is pleased that the CCG are looking into the potential of increasing the role of Horsham Hospital within the local community including out of hours GP services. He is very supportive of these proposals keen to see them progressed.
Getting the Right Hospital Services Locally
Like every local resident, Jeremy would love to see a new hospital built locally to address our local needs and prevent the (for the South East of England) long journey times in-patients and their relatives currently face to reach our local hospitals – including for to access A&E.
A vocal campaign for a new local Hospital (initially proposed) at Pease Pottage (a greenfield site with the required excellent transport links and room for a 450 bed hospital, A&E unity and trauma centre) was launched in 2006.
Despite huge public support the plan was shelved in 2013.
The decision as to how best our NHS funds are used to support the health needs of the community are taken by the local health professionals. They were not convinced that setting up and running a new hospital would be the best use of funds or best means of supporting the patient outcomes in the local community. At the time the CCG made clear their belief that residents would be better served if the money was spent on improving existing facilities, building a new hospital would simply divert funding away from every other hospital.
Jeremy refuses to give up on the vision of a new hospital to serve the needs of what is a growing population. However on a practical level he wants to ensure right now that all the services currently required are provided to the very highest level locally.
In saving lives in emergency situations the most critical element is the rapid response of highly trained paramedics. Our Ambulance Service has required investment and support. Jeremy has been highly critical of elements of the culture and performance of the local Ambulance trust but this performance has been improving recently and in particular in hitting targets for the most serious emergency call outs.
As is the case across developed countries it is increasingly important that to get the very best health outcomes patients are seen by specialists in the right hospital where expertise exists. An emergency operation by a surgeon who has conducted 10 of the same that week is far more likely to be effective than the same operation being conducted by a surgeon who, no matter how good, is less experienced in that procedure.
Jeremy therefore recognises the importance of ensuring we have access to the very best, and best invested, secondary care and that this in immediate term must be prioritised.
The nearest A&E does vary around the constituency. For Horsham town itself most patients are taken to East Surrey Hospital. What has changed since 2006 has been the degree of local confidence in East Surrey, which has been transformed.
Jeremy maintains regular contact with East Surrey and was delighted that from having serious difficulties as a hospital they have made a complete turnaround and are now rated “Outstanding” by the CQC. Their A&E department has also received significant extra funding. When winter pressures have caused a high level of demand for A&E (and naturally impact the staff themselves) Jeremy has made a point of visiting A&E to see for himself – and has been hugely impressed by the dedication of the team and their ability to maintain an excellent service. He has been delighted to have received emails and letters from residents praising the A&E staff and saying how well (and swiftly) they were treated.
Hospitals most frequently used by residents for a variety of procedures and healthcare needs (with their CQC ratings) include:
Crawley Hospital - Good
East Surrey - Outstanding
Princess Royal (Haywards Heath) - Good
St Richard’s (Chichester) - Outstanding
Worthing Hospital - Outstanding
Jeremy is always keen to hear from residents about their experience with the Ambulance Service or local Hospitals.