Monitor, the body that assesses and licences NHS hospitals has placed the Royal Berkshire Hospital on notice to improve its computer data handling, its governance and its financial plannng. In addition its progress in making the improvements demanded by the Care Quality Commission in June 2014 will continue to be monitored. In a notice issued on 12th December 2014, Monitor recorded a number of undertaking made by the Royal Berkshire Hospital in response to earlier criticism. Royal Berkshire Hospital had suspended reporting of the key RTT (referral to treatment) figures against the 18-week target claiming problems with data quality. In this it is not alone. Barts hospital in London, which also runs the Cerner Millennium hospital software used by RBH has also suspended RTT reporting for the same reason. It seems extraordinary that there is no nationally coordinated action on such problems with systems from a common supplier. Royal Berkshire Hospital is also criticised for weaknesses in its financial planning - in particular concerning the costs of correcting failures to meet the 18-week referral to treatment target and concerning the costs of redundancies. This latter point must be of concern to both staff and patients as no indication is given of the nature of the redundancies in question. As a further consequence weaknesses in governance are raised, and measures demanded to improve governance. At a time when the hospital is coming under greatest pressure it must be difficult to find the spare effort to adapt and improve internal systems and attitudes. We can only wish the whole staff well with their programmes of improvement in quality, performance and governance.

At this time of year there is usually an outbreak of tinsellitis. You may notice sparkly matter on the scalp, neck or elsewhere. There may be a momentary irritation but this should not be lasting. Should you feel an urge to shout, "Bah! Humbug!", cover your mouth until it passes. Infection takes place mainly through the eye, and young people are particularly susceptible. The active element is often found on ceilings, pine trees or draped over electronic equipment. It is generally harmless and will not last long into the New Year. Don't bother your GP with it - they've probably got it themselves. We wish our readers and members a happy Xmas break and a healthy New Year!

A childrens' clinic, mainly for under-fives, will operate in Broad Street Mall from 4pm to 8pm every day except Bank Holidays through the winter up to Sunday 12th April 2015 to relieve pressure on the Royal Berkshire Hospitals A&E department. Access is by booked appointment on 07766 418 168 from 9am daily until Sunday 12th April. For full details see the South Reading CCG website.

Your GP surgery offers flu vaccination for children who were aged 2,3, or 4 on 1st September 2014. The vaccine is given by means of a nasal spray so there is no nasty needle involved. Flu spreads very rapidly among young children and can then be passed to older children and adults so this is a good means of protecting most of the population. Available NOW. Read more about it here .

 Reading Borough Council is consulating the public on the implementation of the new Care Act. The Act sets uniform, national standards for assessing need and gives new rights to those needing care and to their carers. We hope to have a talk and discussion about aspects of the Care Act at our meeting on 28th January. Details of the consultation are this Reading Borough Council web page.

A workshop primarily for users of mental health services and their carers, but also for voluntary organisations in this field will be held at Reading Town Hall between 10am and 3pm on Tuesday, 2nd December. Reading Borough, Reading's two Clinical Commissioning Groups and Berkshire Healthcare Foundation Trust are sponsoring this free event which will contribute to planning future Mental Health Services in Reading. Please see the workshop's website page for details of how to book your place.

 The governing body of South Reading NHS CCG meets in public, from 9.30am to 12.00 noon on Wednesday, 3rd December 2014, at the Museum of English Rural Life, Redlands Road, RG1 5EX If attending, or wanting to ask a question, please contact southreadingccg@nhs.net or 0118 982 2738 before 12 noon on Tuesday, 2 December. This is a chance to receive, look at and hear discussed the plans, quality and performance reports of our CCG and at the end to ask pre-notified questions of the members of the Governing Body. Questions should be notified before modday on 2nd December to lynn.casey (at) nhs.net (email address modified to avoid robot scavengers).

Here are a some links to interesting videos and a very clear report about integrated care for frail, elderly patients. Professor David Oliver, consultant at Royal Berkshire Hospital comments on a patient's experiences where very common failings in care took place - see the video - produced under an initiative of Health Service Journal and Serco. And here is the King's Fund's picture of how joined up care should work -Sam's story Key to better care is determined cooperation by the local authorities and the CCGs - which has been notable in Reading where the Better Care Fund (health and social care integration) plans have been fast-tracked as a planning pilot for other areas. Also key is effective access to records between providers. At this moment community nurses in Reading are having to enter data separately into two or three databases. In order to speed discharge in Wexham Park hospital in East Berkshire a special team had to be established by Berkshire Healthcare Trust who had access to both the communithy and the hospital record systems so that they could manually read, compare and update. It has been effective - but we can do much better. Five key points from the report attached below are:

1. There is a myth that providing more and better care for frail older people in the community, increasing integration between health and social care services and pooling health and social care budgets will lead to significant, cashable financial savings in the acute hospital sector and across health economies. The commission found no evidence that these assumptions are true.
2. The commonly made assertion that better community and social care will lead to less need for acute hospital beds is probably wrong. A short-term reduction in acute sector demand may follow as a consequence of community-based demand reduction initiatives, although this is unproven.
3. We need more realism in the debate about the quality and quantity of care that can be provided in an environment of funding that is declining relative to demand. The pursuit of current NHS funding policies looks likely to lead to a funding gap. No major political partys current health policy commitment will meet this funding gap.
4. Hospitals should not be used to provide care that should more appropriately be provided elsewhere. Commissioners must improve community care to meet future demand, but the required investment must be based on evidence
5. While acute hospital admission is often the right thing to do for frail older people, being in hospital also creates risks for older people.

Circuit Lane surgery in Southcote lies outside the South Reading CCG area but developments there could be an indicator of future changes here. When the GP partners were unable to recruit a replacement for a partner who had announced their resignation, they found themselves unable to guarantee the safe continuation of the service and all resigned together. NHS England (Thames Valley) was left with the problem of how to push forward the GP service for around 11,000 patients from Southcote and areas further afield. NHS England and the Berkshire West CCG Federation resolved to replace the GP service in two steps. Firstly, a 12-month interim service, from February 2015 to hold the fort at Circuit Lane. A more permanent replacement would be appointed to start from February 2016. The reasons for this are not altogether clear, but at public meetings it was explained that from April 2015, NHS England and the Berkshire West CCGs will be co-commissioning GP services rather than NHS England having sole responsibility. It was suggested that this will allow an innovative replacement service in 2016. Although the details have not been made clear it has been suggested that a centre integrating GP services with full community care could be under consideration. Alternatively, mention has been made of the use of "Physician's Assistants" alongside traditionally trained GPs and nurses at the new centre. It has now been announced that the interim 12-month service contract will go to Berkshire NHS Healthcare Trust which already operates the Berkshire West out-of-hours GP service through its Westcall organisation. This allays immediate fears for patients of having to deal with a very different "business-oriented/profit-seeking" organisation - as was strongly expressed at the public meetings about the change of service. The contract award to Berkshire Healthcare Foundation Trust is an interesting development which should provide interim assurance to the patients at Circuit Lane. They will now want to know more about the long-term solution for 2016 and onwards. Ths underlying problem at Circuit Lane - the difficulty of finding replacement GP partners at a practice - is likely to be widespread, particularly in areas of relatively less prosperity where workloads can be somewhat higher and income opportunities somewhat less. There is a firstly a shortage of new GPs. Half the training places in the Thames Valley are empty although there are 5 applicants for every GP training place in the North West. Then, since a large majoriity of newly qualifying GPs are female and in their late twenties or thereabouts, part-time salaried work can be a more attractive option than the demands of partnership. Further, the attractive but relatively familiar conditions in countries like Australia and Canada induce a certain number to seek work abroad. Some think that this is all leading to the demise of the GP partner model. It is certain that there will be a big role for salaried GPs in the near future. South Reading has quite a few small practices and quite a few GPs approaching retirement and a measurable shortage of GPs. It has been said that North and West Reading CCG has 69.8 whole time equivalent GPs per 100,000 population, while South Reading had 53.9 per 100,000. How will all of these developments come to affect us in the South Reading CCG area?

South Reading CCG has received winter pressures funding which can be used for GP services. It will be used to open a 7-evening a week childrens' urgent care centre at a location still to be determined over the winter months. The sum of 129,000 awarded to the South Reading NHS CCG will provide 20 20-miinute appointments between 5:30pm and 8pm every evening until April 2015. It is hoped that as well as aiding the children of South Reading this arrangement will lessen the pressure on the A&E department at the Royal Berks Hospital.