In a rushed vote on a provision added to the Care Bill at the last minute, on Monday 21st October, the House of Lords has voted to extend the powers of unelected Special Administrators appointed to fix failing trusts to reconfigure services at neighbouring trusts without extensive consultation. The Care Bill will return to the House opf Commons for final approval, probably in early November. This appears to be the death knell of "no decision about me, without me". It follows the defeat of the Special Administrator's plan to reconfigure services at Lewisham Hospital by local campaigners through Judicial Review. The regulator Monitor regards separate trusts as competitors which must be absolutely forbidden from cooperating or merging, But Health Minister Lord Howe said in the parliamentary debate on these provisions, "Where severe and prolonged problems exist, it is surely the case that the special administrator must be able to propose a viable solution. This clarification on the scope of the administrator does not constitute a change of policy, it is not retrospective and it is intended only to remove any uncertainty for the future. NHS trusts, foundations trusts and other providers dont exist in isolation from each other. They are part of a complex, inter-dependent local healthcare economy. Issues of clinical and financial sustainability nearly always cross organisational boundaries."

The Care Quality Commission has made a preliminary review of all 161 NHS acute hospital trusts to determine in what order to inspect them and has placed the Royal Berkshire Hospital Foundation Trust in the first group to be inspected. RBH scored (just) in the highest risk group of 44 trusts out of 161 The CQC's rating is based on 165 separate measures. A partial version of the data obtained by The Guardian is available here and the CQC's raw data is available together with technical discussions of the risk rating here. The Royal Berkshire Hospital Foundation Trust seems to have risk indicated for

• Composite indicator: In-hospital mortality - Gastroenterological and hepatological conditions and procedures
• Composite indicator: In-hospital mortality - Respiratory conditions and procedures
• In-hospital mortality: respiratory medicine
• Healthcare Worker Flu vaccination uptake
• Hospital Standardised Mortality Ratio (Weekend)
• % Staff receiviing health and safety training over last 12 months
• Governance risk rating assessed by Monitor
• Never event incidence (1 in last 3 months)
• Neonatal readmissions
• Whistleblowing Alerts

It is reported that Government amendments tabled in Pariament today to the Care Bill - due to have its third reading in the Lords on Monday - give the Government or Monitor the right to order any hospital they like to reconfigure - in other words, close - with little consultation, to benefit neighbouring struggling hospitals. Can it be such a little time from "no decision about me without me" to this?

We will be meeting between 6pm and 7:30pm on Wednesday, 30th October at the University Health Centre, 9, Northcourt Avenue, Reading RG2 7HE. The central feature will be a debate regarding the continued aims of the Patient Voice within the context of an engagement strategy for NHS South Reading CCG, proposed by our Lay CCG Board Member, Christopher Mott.

We will be meeting between 6pm and 7:30pm on Wednesday, 30th October at the University Health Centre, 9, Northcourt Avenue, Reading RG2 7HE. There will be a discussion on the "plan on a page" for patient and public engagement for 2014/2015.

The South Reading NHS CCG Board met in public on Wednesday 18th September at the Museum of Rural Life on Redands Road. This is a chance to hear presentation of reports and monitoring of performance and of plans. At the end there is chance for members of the public to ask questions. Agenda and documents (many) are found here. It is only possible to recount certain points from a three and a half hour meeting. Lay board member for patient and pubic engagement, Christopher Mott, spoke to his paper. Engagement in the annual QIPP projects round had started. Public and patients felt distant from the work of the federation programme boards where engagement needed to be further developed. Work was proceeding on encouraging ptactice-based groups with Healthwatch. A "plan on a page" for engagement would be developed with patient input for 2014/15. Cathy Winfield reported that the Pioneer bid involving 4 CCGs, 3local authorities and 3 principal supplier trusts, a bid for Government (non-financial) support in integrating health and social care, had gone well with our consortium on a short list of 20 from which 10 would be chosen, We were the only shortlisted bidders in the Thames Valley region. Elizabeth Johnston reviewed the work of the CCG and reported steady progress against targets. Nurse Director Debbie Daly presented the Quality Scorecard for providers to date, This showed pretty clearly the pressure that RBH h ad been under in the cold spring from April to June, when incidents requiring investigation, pressure ulcers, C Diff cases and emergency admissions had been elevated. Proportion of stroke patients admitted to Stroke Unit within 4 hours was too low. Number of Caesarian sections too high, Ms Daly said that the non-elective admissions would henceforth appear in the performance report. Further, all providers would exclude "unavoidable" pressure ulcers from their figures. (These appear to be cases where the patient is uncooperative.) Janet Meek gave the performance report. There had been missed targets in tome to treatment, the 31 day cancer pathway and time to diagnostic test at local providers - in particular ar RBH one of the areas underperforming was opthalmology where there woud be changes to the patient pathway. Non-elective (emergency) admissions from South Reading CCG area were reducing on target despite the reported overall increases in non-elective admissions to Royal Berkshire Hospital overall. This is an important target for sustainability of our health care. Amendments to the CCG constitution were reviewed and approved, These seemed to be mostly related to name changes of various NHS bodies. Janet Meek also spoke to a paper on the reguations governing procurement, She suggested that in future, when commissioning new services, a checklist should be completed to demonstrate compliance. Debbie Daly then reported on the state of the risk register. Noteworthy items were the situation at a local nursing home where CQC inspection had revealed serious failings. C.Diff cases at RBH were still excessive. Further with the IT problems continuing at RBH poor data quality could conceal problems. In discussing performance the figures for outpatient attendances were queried as being incredible - was the data at fault? A small number of enhanced services at local practices were approved - of which the most significant covered training and preparation for anew approach to annual reviews for diabetics.

Health commissioning groups in the Reading area will be holding a town meeting on Tuesday, 12th November from 7pm to 9pm at the Kennet Room (Reading Civic Centre). To book a place please phone 0118 982 2709 or send an email specifying the Reading Call to Action meeting on 12th November to nhs.calltoaction@nhs.net This is a local initiative under NHS England's Call To Action. The Call To Action describes the future increased demands and costs for healthcare and poses the challenge of how the NHS will go forward. The Call To Action assumes little increase in funding in real terms and continuing adherence to the principles of a national health service free at the point of delivery.. It suggests a shortfall in funding of 30 billions by 2020/21 despite efficiency changes worth 20 billions in the first NHS challenge. The review of the NHS future covers avoidable deaths due to unhealthy lifestyles, the increase numbers of people living to great age, and the effects of health inequalities which are especially pronounced in the number of years of impaired health which people suffer.The contribution of technology is also considered.

South Reading Patient Voice was a motive force in arranging the Dementia and Elderly Care Conference held by South Reading NHS CCG earlier this year. The CCG have now published their account of changes and innovations brought about as a result of that conference. You can read it here.

The Friends and Family Test is to be extended to more NHS and Government services. It currently covers NHS funded acute services for inpatients (including independent sector organisations that provide acute NHS services) and patients discharged from A&E (type 1 & 2). The test is to be extended to maternity services this year. For GP practices, community health services and mental health services FFT, NHS England will expect all service providers to be collecting FFT from January 2015 at the latest,. For other areas of acute care - such as outpatient and day case services - and other areas of primary care - such as pharmacists, dentists and opticians - the latest start date will be April 2015. The question asked is How likely are you to recommend our ward/A&E department/maternity service/etc to friends and family if they needed similar care or treatment?. The answer can be "Extremely Likely", "Likely", "Neither Likely nor Unlikely", "Unlikely", "Extremely Unlikely" or "Don't Know". A score is then calculated monthly or quarterly for the service. The scores can be accessed on the NHS Choices web page for the trust or service or at this NHS England web site. The scoring prescribed works (see here ) as follows: The total number of respondents N_respond is given by: N_{extremely likely} + N_likely + N_neither/nor + N_unlikely + N_{extremely unlikely} The score is then given by: 100 * (N_{extremely likely} - N_neither/nor - N_unlikely - N_{extremely unlikely}) / N_respond This scoring has a number of peculiar properties.

1. It makes no difference whether you answer "neither/nor", "unlikely" or "extremely unlikely" - the resulting score will be the same.
2. If you answer "likely" it is more negative than if you answer "don't know" but answering "neither/nor" is even more negative.

Extraordinarily, two GP practices locally advertised only 0844 (5p or 7p a minute) telephone numbers until this Summer. These were London Street Surgery and the Russell Street and Coley Park practices. South Reading Patient Voice raised this with the GP Consortium (pre CCG) nearly two years ago. This summer those practices advertised 0118 numbers as alternatives. A reasonable way to treat hard-pressed patients. But why, oh why is the 0844 number still advertised at the top of their practice web page when the 0118 number is right at the bottom? What are they like? Doesn't treating patients fairly mean putting the 0118 number prominently on the web page? And informing NHS Choices web site of the 0118 number too?