A group demonstration outside the Conquest Hospital next Thursday (1 October) will demand that the NHS terminate their data processing contract with US tech company Palantir.

The demo is part of a National Day of Action led by the BDS (Boycott, Divestment, Sanctions) Movement, which seeks to combat Israeli oppression of Palestinians. Upwards of 30 similar events are being co-ordinated on that day across the country, supported by Amnesty International as well as the Palestine Solidarity Campaign and other pro-Palestine groups.

Local campaigners, styling themselves as Palantir Out Of East Sussex, describe Palantir as “a US spyware company that provides the AI tech to militaries, police and security agencies to commit gross human rights abuses”. Palantir’s clients include ICE in America and the Israel military.

In July this year the UK parliament’s Health and Social Care Committee raised serious concerns about Palantir’s ‘Federated Data Platform’ (FDP) contract with the NHS: they highlighted a lack of data sovereignty, criticised the efficacy of Palantir’s software, claiming that up to a third of NHS Trusts using the company’s software, are now doing fewer operations, and pointed out the availability of alternative UK tech solutions. The existing contract contains a break clause allowing the NHS to terminate it from February next year.

‘REMOVE NOW’

However, according to the campaigners, Palantir “is being rolled out right now in East Sussex, giving it unlimited access to our data without the consent of NHS patients… we need to remove Palantir now to safeguard patient data, remove the danger of ‘vendor lock in’, and restore trust in public services.”

They have circulated online a letter for signature by individually named patients of East Sussex Healthcare NHS Trust (ESHT) denying consent for their private medical data to be accessed by Palantir. They say that hundreds have signed.

Hastings & Districts Trades Union Council and Hastings Jews for Justice have endorsed the campaign, as has Hastings Green Party. Cllr Becca Horn, Community Safety Lead at Hastings Borough Council and also East Sussex County Councillor, says: “I was sickened when I learnt that East Sussex NHS Trust is already using Palantir’s systems. I absolutely do not trust them with our data. This goes right to the very root of our integrity as a country – do we want our Government to uphold human rights? Or are we happy for them to get into bed with this genocide-backing, migrant-terrorising spy-tech firm? Our NHS should not be for sale, to anyone – and certainly not to the likes of Palantir.”

TRUST RESPONSE

In July, Jayne Black, Chief Executive of ESHT, responded in a letter to the campaign group that she “recognise[s] the strength of feeling expressed and the importance of providing clear, factual information about how the Trust is approaching [the FDP] programme…[It] brings together data already held within NHS systems to provide clinicians and operational teams with a more complete, near real-time view of patient pathways, capacity and demand. In practical terms, this supports improvements in areas such as waiting list management, theatre scheduling, discharge planning and the overall flow of patients through hospital services.

“It does not introduce new categories of data collection, and it does not change who controls patient information. The Trust remains the data controller for all patient data used within the platform. All use of data is governed by UK data protection legislation and established NHS information governance standards. Palantir provides the underlying software under a national NHS England contract but acts strictly as a data processor under robust contractual and regulatory controls. Patient data remains within NHS control and is used to support direct care and the effective running of services, not for commercial purposes.”

An exclusive investigation by the Hastings Independent has revealed sustained improvements in figures for the local NHS trust. These enhancements in service delivery are spread across a broad range of measures.

The NHS is generally considered to be facing fundamental problems. Some even argue it’s an acute crisis. Since the Covid pandemic, the performance of all NHS trusts has declined, with most targets being missed according to the BMJ. Yet, despite a tough winter with a virulent new strain of the flu virus (in early December, the number of flu patients in English hospitals hit a record high for the time of year), the Sussex NHS trust has reported considerably better figures.

GP SURGERIES

A long source of concern by NHS users has been the inability to see a GP within a reasonable time. But GPs have been able to improve the proportion of patients seen within seven days despite conducting, on average, more monthly appointments. Comparing 2023 to 2025, the proportion of appointments being held on the day a patient contacted their surgery increased by 10% (37% to 47%). Further, the proportion of appointments being conducted within one working day of a surgery being contacted has increased 5% in the same period.

Time taken to see a GP upon a request
All appointments

In contrast, the proportion of appointments being held more than a week from a requested appointment decreased 9% (13% to 4%). Vitally, this would indicate that despite the additional pressures GP surgeries have experienced this winter, they have managed to see more patients within a respectable timeframe.

AMBULANCE RESPONSE TIMES

Perhaps the most alarming trend many people witnessed over recent years was the worsening response times in ambulance callouts. Previous analysis in 2023 found that response times for the most urgent category callouts had worsened. Worryingly, these cases cover Category 1: life-threatening illness, such as cardiac arrest and Category 2: serious emergencies, such as heart attacks, sepsis and major burns. This means that patient outcomes are likely to have worsened due to decreasing performance. Yet, throughout 2025 these response times improved dramatically. Category 2 responses shortened by 19 minutes compared to the June 2022 peak of 43 minutes. The average response time for Hastings and St Leonards is now 24 minutes, which brings the town much closer to the national target of 18 minutes. Impressively, these improvements have extended during the late autumn and early winter months, suggesting that services have improved sufficiently to withstand the severe pressures of a winter season.

HOSPITAL PROVISION

The handling of ambulance services by hospitals has also improved, with reductions in the time taken to hand patients over to hospital care. Ambulance handover times have improved by 4.5 minutes throughout 2025, reducing from an average of 21 minutes to 16.5, much closer to the 15 minute national target. This means that patients needing urgent care are being admitted to hospital more quickly. Importantly, this can improve patient outcomes and indicates an enhancement of hospitals’ provision.

Hospitals have also lowered patient backlogs by improving waiting times. From being referred to a hospital service, the NHS sets a target of 92% of patients being treated within 18 weeks. At the peak of the backlogs in May 2023, on average 54% of patients had to wait 18 weeks for treatment. Yet at the end of 2025, this average waiting time had gone down to 13 weeks. Importantly, this reduction has increased the proportion of patients being seen within the 18-week target time.

In the same period, there was an 8% increase in patients being seen within the 18-week deadline (54.3% to 62.5%). At the end of 2025, 92% of patients were being seen within 38 weeks – a decided improvement from the 48 weeks in May 2023. Whilst this still falls below the target, it does reflect East Sussex NHS Hospital Trust improvements within a difficult winter period. Such improvements will mean fewer people remain in pain and discomfort whilst waiting for surgery.

A&E DELAYS

For those who have used A&E, their waiting times, on average, have also been reduced. In 2022, only 63% of patients were seen within the four hour target. In the final four months of 2025, 73% were cared for within that time – an improvement of 10%. Interestingly, the proportion seen within the target time was higher this winter than for last winter, indicating that these improvements are being sustained even during times of intense health pressures. Further, with these winter pressures being overcome, this indicates a long-term trend where response times will continue to improve as pressures ease in the warmer months.

Average SEACAMB ambulance response times, Hastings & St Leonards only, 2022 to 2025

HOW THIS IS ACHIEVED

These findings indicate that this has primarily been enabled through better recruitment and retention of staff. In particular, GP surgeries have been suffering from a high workload combined with limited staff to meet the rising demand. Indeed, the Hastings Old Town surgery was found to have one of the highest patient to GP ratios in the country, greatly explaining the worsening appointment waiting times in the town.

Number of patients per Full-Time GP in East Sussex

Yet, within the last two years, the number of patients per full time GP has greatly improved in Hastings & St Leonards surgeries. For instance, in March 2023, there were 238 full time GPs within the East Sussex NHS trust, with this having risen to 276 by December 2025, a 16% increase. This development has resulted in a drop of 297 (1,988 to 1,691) patients per GP, a 15% decrease in the patient to GP ratio.

The surgeries with the largest patient numbers, Hastings Old Town surgery (26,000), Hill surgery (20,000) and High Glades (18,000) saw the biggest increase in GP numbers. As these represent over 50% of the population and historically have had the biggest challenges in finding enough GPs, this indicates improvements have been made by directing new GPs to where shortfalls are greatest. This may have occurred because the new government has enabled GP surgeries to hire more staff, with resources being directed to deprived areas, thus favouring towns like Hastings.

Greater capacity has allowed GP surgeries in East Sussex to deliver more appointments. In 2023, monthly appointments were 13,240, increasing to 16,611 by the end of 2025. Therefore, as local surgeries have the staff to deliver more appointments, more people have naturally found themselves being able to see a GP on the same day they make an appointment.

Further, NHS England data confirms that the number of vacancies within South East trusts has reduced by 4,550 (18,247 to 13,705), a decrease of 25%. Vitally, the data available indicates that greater staff numbers have enabled the Sussex NHS Trust to reduce delays, provide greater capacity to deliver services and increase efficiency. As this greater capacity has reduced backlogs, future cases should have earlier intervention and better outcomes. If the trust can keep the positive momentum going, there is no reason why 2026 can’t be a year of further NHS improvements.

James Prentice is a data analyst with the Hastings Independent Press

A Freedom of Information request by the Hastings Independent reveals some statistical signs of improvement in local NHS health care.

Waiting times and the backlog are coming down. Patient to GP ratios are better, and the number of appointments for GPs has increased.

Ambulance waiting and handover times are generally better than last year. There are also fewer NHS vacancies. Although some targets are still being missed.

But what is your experience? What do you think about waiting times and access to GPs?

Please let us know in the Comment box below, and read the full story in issue 296 of the Hastings Independent out on 26 February.

Christmas and New Year can be a difficult time for many people, so it’s good to know that new resources to help people get the right mental health support have been developed by the NHS, local authority, voluntary sector organisations and people with lived experience.  

They aim to ensure that every person in Sussex knows how to find the right mental health information and support, and when to get help, with a focus on people who are neurodivergent, digitally excluded or may feel less confident using English. The mental health signposting resour es have been translated into five languages: Arabic, Farsi, Polish, Bengali and Ukrainian.  

The resources, which ask the question “How Are You Really Feeling?” include guidance on when to seek help and where to find free and confidential mental health support for adults aged 18 and over living across Sussex. It brings together information from local NHS services, local authorities, community groups and voluntary organisations, helping people understand what support is available and how to access it. 

This includes the Staying Well services, which offer same or next-day mental health support for people experiencing a mental health crisis, and Talking Therapies, a self-referral service which supports people with common mental health problems like feelings of depression, excessive worry or social anxiety.  

People can also find information about how to access help with issues that can have a negative impact on a person’s mental health, including housing or financial worries.  

Dr Claire Tanner, Deputy Chief Medical Officer for Sussex Partnership NHS Foundation Trust, says: “We know that navigating mental health support can feel particularly difficult if you are digitally excluded, neurodivergent, or living in Sussex and feel less confident using English. The ‘How Are You Really Feeling?’ mental health resources are designed to meet people where they are, making it simpler and more accessible for anyone to find the help they need, when they need it. 

We hope these new resources will help to break down some of the cultural, language and societal barriers that can prevent people from accessing help with their mental health.” 

Find out more and access resources at:  how-are-you-really-feeling-sussex.nhs.uk.  

In HIP 263 we reported on the withdrawal of NHS funding from the Eggtooth Project, which provides mental health services to children and youths. It has now emerged that the adult and youth (16+) mental health agency Counselling Plus Community (CPC), which has been offering a wide range of therapeutic interventions to residents of Hastings and Rother over the past 32 years, faces a similar funding cut.

CPC is the largest counselling service in the area, receiving around 800 referrals for individual clients in 2023. It is currently staffed by three administrators, four clinical team members, 12 employed counsellors (all part-time) and 18 volunteers. It receives referrals from GPs, from Health in Mind (the NHS Talking Therapies service), from CAMHS (Child and Adolescent Mental Health Service) and many local support services, as well as taking direct cases (word of mouth). 

CEO, Verra Papaspyrou, says that the ethos of CPC since 1992 has been to provide its counselling therapies on the basis of need “regardless of the client’s ability to pay for the service they receive”. Clients have always paid what they feel they could afford which “can be as low as zero where required”.

INCOME SOURCES

In the current year 2024-25 the service received a grant of just under £65,000 from the Sussex ICB (Integrated Care Board), which now administers NHS funding throughout Sussex. Short-term grants from the Police & Crime Commissioner, Children in Need, the Big Lottery, The People’s Postcode Society, the Henry Smith Charity and other sources for particular projects have regularly boosted the service’s budget in recent years by more than 200%. However, many of these are dependent on showing evidence of continued funding from the ICB and are directed to specific problem areas – for instance, survivors of suicide and those who are feeling suicidal, survivors of rape, sexual and/or domestic abuse, and those bereaved by suicide. For those afflicted with more general traumas that don’t fit into these categories, the ICB funds are crucial. 

In July this year Ms Papaspyrou says she received an email, “out of the blue” from the Head of Strategic Commissioning (Mental Health) at NHS Sussex. He informed her that the ICB was “exploring what the impact would be” if it discontinued its current level of annual funding. 

“No decisions have yet been taken,” he wrote, though he suggested that, as the service has low infrastructure costs (cheaply rented premises in Cambridge Gardens) that “hopefully Counselling Plus would be in a position to continue operating, albeit with lower levels of capacity to deliver activity than before”. He pointed out that there had been no formal funding contract between the ICB and the charity, hence no stipulated notice period for making changes. However, he warned that any anticipated change of budget might have “an effective date of 1 October 2024”.

RESPONSE TO ICB

Ms Papaspyrou arranged an immediate meeting and responded within 11 days with her own impact assessment. She pointed out that, in the short term, many clients were already on their course of therapeutic treatment or on waiting lists expecting to proceed via ICB funding. Furthermore, as soon as ICB core funding was lost, further external support based on this funding may be put at risk.

In the longer term, all clients whose problems did not fall within a specific area covered by project funding would have to pay the full cost. Obviously, many would simply be unable to afford it and would be unable to access professional therapy.

She also pointed out that 18 voluntary counsellors would lose their current placements, thus (at best) delaying their qualification timetable. “Counsellors are able to progress within the profession due to CPC placements which provide exceptional diversity and client presentation which is unachievable elsewhere.”

None of these arguments seem to have held sway with the ICB, save that it was accepted that existing funding should only be withdrawn on six months notice. Then there will be no phased reduction, but a total cut-off. And that seems to be that. Whilst there are ongoing consultations in the county for savings proposals related to Adult Social Care, there has been none of any substance for cuts to mental health funding, despite well-publicised rises in demand across the country.

APPEAL TO MP 

Getting no positive response from the ICB, Ms Papaspyrou wrote last month to Hastings & Rye MP Helena Dollimore. She pointed out not only the breadth of services offered by CPC but also its comparative cost effectiveness. Use of ICB funds in 2023 enabled a block of ten sessions for individual clients to be charged at an average of £118 all in. By comparison, she wrote, one session of private counselling locally has an average charge of £50-70.

Ms Dollimore has not as yet made any response, and indeed it’s difficult to see what influence she can bring to bear as an individual MP. The Sussex ICB covers constituencies across Sussex, and all areas are facing apparently unprecedented financial strain. Two weeks ago, Ms Papaspyrou received final confirmation that NHS funding will be terminated at the end of the financial year next March.

Ms Papaspyrou says that CPC is determined to survive the funding cuts, and that changes have already been implemented to ensure its continuation. It will be looking in the future for private donations as well as larger grants from existing sources. 

Recently an ex-client came in to hand over a cheque for a substantial amount.  He had had four or five counselling sessions in 2019 and wanted to offer thanks. “If I hadn’t had those sessions with you,” he told Ms Papaspyrou, “I wouldn’t be here any more.”

GPs have been the gatekeepers of the British medical system since the advent of the NHS 75 years ago. Access to medical help should come initially, save in an emergency, from your local GP.

But from the perspective of patients, it has become increasingly hard to consult a GP, with the chances of seeing the same doctor from one appointment to the next  ever smaller. The options for residents of Hastings and St Leonards are pithily described on the website of DRGP, a new private clinic being set up by local GP Dr Vimalendran Ratheesh, as follows:

• ring your local NHS surgery at 8.30am, wait on hold for several minutes and hope you get an appointment;
• send an Engage Consult online request to your surgery to try to get an appointment;
• ring 111 and hope to get called back within 4-12 hours;
• go to A&E at the Conquest and wait 4-8 hours to be seen;
• use Sussex Premier Health and speak to their private GP for a fee of £110;
• use Benenden Hospital and pay £100 to speak to their private GP;
• wait till the next day and try again at 8.30.

Dr Ratheesh, who trained as GP in Hastings between 2011 and 2015 and has worked as a locum GP in a number of NHS practices in the town and elsewhere over the past seven years, is offering a further option: the launch of a new private GP ‘telemedicine’ clinic which he intends to operate personally. 

Access to DRGP will be online or by telephone. It will be marketed primarily in Hastings, promoting Dr Ratheesh as “Dr Rad…local GP with local knowledge”. However, as it will not involve any face-to-face consultations, it is accessible in principle from anywhere in the country. 

Time slots of 15-20 minutes for a telephone or video consultation on the same or next day can be booked at a cost of £55 (it was planned to be £70, but some initial market research seems to have induced a £15 reduction).

LIMITATIONS OF SERVICE

It is clear that the service which Dr Ratheesh/Rad offers is severely limited. He will not have access to the enquiring patient’s NHS notes. Unlike larger private providers like Sussex Premier Health, he has no capacity to order blood tests, scans or other diagnostic aids. He won’t be seeing any patients personally, so can make no physical examinations, though he claims that video consultations can generally serve for this purpose. He can’t make any NHS referrals. All he can effectively do is provide an initial screening, provide private prescriptions for collection at a local pharmacy and sick notes for up to two weeks, and otherwise advise his consultees, if they appear to have more complex medical needs that require further examination and/or treatment, to consult further, either with an NHS GP or a private specialist.

Dr Ratheesh is not, however, defensive about this. In particular, since the onset of the Covid pandemic, doctors have become used to assessing cases remotely, and he thinks that the need for actual physical examination is rare. He admits that the lack of diagnostic test capacity is limiting, but says that he intends to provide Randox self-testing kits which will allow simple blood tests to be carried out by patients themselves.

He is also unapologetic about setting up a private clinic outside the remit of the NHS.  “I’ve worked in Hastings as a fully qualified GP for seven years but never full-time and always as a locum. Nevertheless I calculate that I’ve done more than 27,000 consultations over that time. The demands on full-time doctors within the system are overwhelming and getting worse.”

He has worked for the Clinical Commissioning Group in Hastings including as an advisor for workforce planning and recruitment. So he has been well placed to observe the shrinkage of capacities in local GP practices and the dwindling proportion of GPs employed within them. “Most of my GP training colleagues left the area after training. There are 20 fewer GPs practising across the borough compared to seven years ago,” he says, “and those that remain are increasingly overworked and burn out quicker. Hastings does not have the same access to medical services as most big cities and towns. Morale is low, people are leaving and are not going to come back. 

“My clinic is not going to eat into NHS provision. On the contrary, it will increase capacity. In the meantime, if you are concerned about privatisation of NHS GP services, look at the American corporations Centene and Babylon Health which own huge numbers of GP practices across the country. That’s a much greater threat to the public service ethos of the NHS system than I am presenting.”

For a full debate on privatisation within the NHS see page 10 – Free at the Point of Delivery

Seventy-Five Years On

The National Health Service was established in 1948 as part of major social reforms following the Second World War. The founding principles were that services should be comprehensive, universal and free at the point of delivery – a health service based on clinical need, not ability to pay. Right from the start, though, an element of private medicine was incorporated. In order to get consultants to agree to participate in a national service, Health Minister Nye Bevan had to, in his own words, “stuff their mouths with gold”, allowing them to continue to run a private practice alongside their salaried NHS job. Over the past 75 years, private health insurance groups like BUPA have proliferated. Today around 22% of UK adults have private insurance, and one fifth of all health provision in the country is from the private sector. The Thatcher government introduced competitive tendering and outsourced ancillary services such as porters, kitchens and cleaning. John Major introduced an internal market and formed NHS trusts. The Conservative initiative of funding new hospitals via private finance was continued with alacrity by Tony Blair, who also allowed routine surgery to be contracted out to private hospitals.

Arguably it’s gone steadily downhill from there, and currently there are around 7.5 million people waiting for NHS treatment; nearly five million patients each month in England wait more than a fortnight for a GP appointment.

Can Private Health Care spread the load?

The fundamental question arises: does increasing private provision help or hinder a National Health Service free at the point of delivery? For instance, would a private GP service in Hastings free up NHS doctors to see more patients more quickly?

Here are some views of people associated with the Hastings Independent on whether it would be appropriate to run an advertisement for private GP care:

“Treatable mortality was linked to an increase in outsourcing of health services to the private for-profit sector, in a study last year by Oxford Social Policy researchers, published in the Lancet Public Health. In other words more deaths occur when you increase private health care at the expense of the NHS.”

“I don’t see how a private GP practice in Hastings which very few people would be likely to use could be seen to be undermining the NHS. Do we condemn private dentistry, given that there are not enough NHS dentists around and that NHS dentistry charges are massive anyway?”

“Outsourcing has always had a cost, and the dismantling of combined, comprehensive hospital care into lucrative, atomised private provision is more costly and less efficient. Never mind the associated loss of expertise and equipment to the wider organisation. Furthermore, the Royal College of General Practitioners is currently most concerned with costly screening and diagnostic services that are often offered by doctors in these companies with little to no therapeutic benefit, which then have to be followed up, wasting still more NHS resources.”

“If someone needs elective surgery like a hip replacement, is it really detrimental to the NHS if it’s done in a private hospital within two months instead of an NHS hospital within two years – but paid for from NHS funds? Doesn’t this ‘free-up’ an NHS hospital bed, rather than reducing the capacity of public hospitals? It’s almost impossible to discover how much private providers charge the NHS for such an operation, but it’s probably comparable to their own costs. The mixture of state and private medical provision works well in France. It could work here.”

“France, like the rest of Europe, has an insurance-based system. It’s not free at the point of need. One of the great innovations, and greatest benefit, of the NHS. Ireland for example has a 40 – 65 Euro charge for a GP appointment. France is about 30 Euros. Wait times are not substantially lower either. 

“France runs a statutory health insurance (SHI) system providing universal coverage for its residents. ‘The system is financed through employee and employer contributions, and increasingly by earmarked taxes on a broad range of revenues. Pretty much like national insurance employer/employee payments in the UK. SHI covers about 90% of hospital care and those not on benefits tend to take out private insurance to cover the other 10%. But what does seem to work are the private laboratories and diagnostic centres which are generally available in most towns … and their charges are covered by SHI.”

“Yes, France does provide universal coverage. But unlike the NHS there is an expectation of payment for the provision of primary care. Which is the big difference. The UK government certainly has the same system in mind (for the time being) and we are seeing the associated increase of private laboratories and diagnostic centres. Where it is different is that France NEVER had what we had.” 

“Without considerably increased funding, the NHS will continue to decline and more and more people will vote with their feet and go private if they can possibly afford to. The problem is that the electorate in Britain has shown over and over again they are not prepared to pay higher taxes … so where’s the money going to come from?”

“I think we can all agree, the NHS,  and in particular GP services, have been intentionally run down to facilitate further incursions of private finance into UK healthcare. The use of private hospitals/clinics has been deliberately cultivated, to the detriment of NHS hospitals –  with them losing experienced staff, materials, research and development. The Royal College of General Practitioners (RCGP) have, for decades, been warning about GP numbers as well as the reliance on older GPs nearing retirement only for successive governments to do nothing. Private GPs are not an addition to UK healthcare but a REDUCTION of the available doctors for the general public. I don’t think it is the ethos of this paper to participate in a policy that is injurious to the people of Hastings by assisting in healthcare vandalism.”

A number of participants asked to remain anonymous, so we decided not to use any names. We do seek more views on this subject however. Please email your thoughts or letters to info@hastingsindependentpress.co.uk.

Healthcare can be pretty esoteric for the average patient or service user. Even in the age of the internet, hospitality and customer care, it’s fairly normal for health services to speak in their own mysterious terms, and keep a healthy professional distance from patients that can come across as robotic or lacking in empathy. That’s not to criticise all services and workers in those services, but healthcare is still treated as a separate world with its own rules, and we the public are generally ‘just visiting’.

Take social prescribing. What does that say to you, reader? What does that mean? 

To me it comes across pretty menacing, but it isn’t. Another, slightly friendlier term for it is community referral. It’s a phrase that seems to have evolved in NHS practice since the early 90s, or possibly earlier, and it just means getting community (and especially voluntary) organisations involved in non-clinical care. Like Arts on Prescription, who we’ve featured in HIP a few times now – they run art classes and workshops as a way of supporting patients with mental health issues, which might also be related to their physical health concerns. 

It’s part of a movement in the NHS to recognise the need for holistic care i.e. you can’t just take a pill and be sent on your way, you can’t just have an operation and be expected to recover on your own, you can’t just be excluded from care because you’ve had a drink. Healthcare professionals need to see and address the whole picture. Science folk will sometimes confuse the issue by calling this a biopsychosocial model of care. 

Now, with the steady collapse of the NHS under years of neglect and outright abuse, professionals, administrators and government officials, local and national, are realising they have to get communities more involved in their own healthcare. To save money, if nothing else. As reported some time ago (“Council Aims to Tackle Health Inequalities,” HIP 213), Hastings is part of national testing programme for “Universal Healthcare.” That programme was meant to run for about a year, and so is probably nearing completion. Some early suggestions from it are available on London Southbank University’s website (see article online for a direct link). 

In line with all this, back in 2019, the Hastings Community Network (HCN) held an exploratory event looking at social prescribing, which they describe as “the process by which medical professionals suggest non-clinical solutions to patients’ issues”. Just a reminder in case social prescribing still leaves you, like me, a bit nonplussed. The event considered how different groups active in the community might be better networked and better accessed by people in need, and sought to understand how this might lead to improved health outcomes. Over 80 local organisations involved said that they were keen to implement social prescribing practices. 

In my next article I’ll be having a look at HCN’s report and trying to give you an overview of how Universal Healthcare and Social Prescribing might actually play out in Hastings. 

You might also be interested to hear that HCN is revisiting their work to learn about progress made since 2019, via a new event “HCN Connecting with Primary Care,” 16 June 2023, 10.00-13.30, Hastings Centre. If you’re a local organisation and want to get involved, have a look on the Hastings Voluntary Action website for details and contacts. 

Extraordinary

Dear HIP,

Thank you for the article An extraordinary life in HIP 214. So lovely to read and keep as a record. I have known Peter D’Arcy Champney for a mere 25 years and, despite what this article says (which I am sure he thinks too), his memory is extraordinary… better than most who are much much younger. He is quite an extraordinary man and a privilege to know.

Vanessa Fowler

Slow death of the NHS

Dear HIP,

I read with weary horror your lead article Heart Surgery Stitch-up? in HIP 217 on the removal of cardiac emergency facilities from the Conquest hospital.

Since the NHS abandoned prevention in favour of its drug-peddling ‘chronic disease management’, we have the sickest old people in Europe, with the highest proportion of obesity after Turkey. Those who make it as far as 60 can generally look forward to 20 more years of drugged ill-health. Prevention is ignored – it doesn’t make any money for the drug companies – and prescribing of drugs is rewarded.

Covid (either the disease or the vaccines or both), working on our already sick population, has caused a plummeting in longevity rates (already stalled since 2011) and has produced in particular a sharp rise in cardiac emergencies – 30% higher than in 2021.

Yet the NHS responds to this by deciding to CLOSE cardiac emergency services in Hastings, just as it has closed obstetric facilities at Eastbourne.

I have observed the misery for Eastbourne mothers of locating all obstetric care in East Sussex at the superbly inaccessible Conquest. But whereas a baby delivered in a lay-by on the A259 will most likely be OK, someone suffering cardiac arrest on the same blocked roads in high summer probably won’t.

The slow death of the NHS from 30 years of mismanagement in my time as a doctor now means these ridiculous choices are being made. Obstetrics and cardiac care should be available at ALL hospitals – not Russian roulette options which ignore the realities of congested roads and erratic public transport.

I’m not clapping.

Dr Kathryn Vale

Animal abuse

Dear HIP,

Your correspondent’s article Plumpton New Year: a day at the races clearly finds the whole event very exciting, especially the prospect of picking a winner. Although if he had bet on Mystical Clouds back in May at Plumpton he would have been disappointed. The horse was seriously injured and had to be destroyed. That means a bullet through the head. Or if he had placed a bet on five-year-old Valencia Borget last March, he also would have been disappointed. She fell at a jump and died. In fact, over the last five years, 26 horses have died at Plumpton: most were destroyed, i.e. with a bullet through the head. This number includes four-year old youngsters Springar, The Grey Scholar and Glass of Bubbles. Over the last five years, more than 900 race horses have been killed at race courses throughout the UK.

Quite a few race horses don’t make the grade. That’s more bullets through the head. In fact the majority of horses that go to the slaughterhouse in Britain and Ireland are from the horse racing industry.

An increasing number of horse owners regard horse racing as animal abuse. There are so many reasons why this is, one of the main ones being the damage being done to two, three, four year olds. These young horses are still growing. A horse’s bones start maturing from the bottom of the animal up. This is known as bone fusion. The

higher up toward the animal’s back you look, the later the bones mature: the knees at about three years, the hip at about four years. The bones in the vertebral column don’t fuse until about 5½ years old. So these young horses are having intense pressure and strain forced on their bones which are a long way from full maturity. So this results in damaged horses, referred to in the racing industry as ‘wastage.’

In the equestrian world we are forever seeing the results of this abuse: horses offered by dealers that are complete wrecks. The main beneficiaries are vets who are left to deal with a whole range of physical problems.

So by all means enjoy your exciting days out at the race course, but bear in mind that you’re complicit in serious animal abuse.

Laurie Holden

Tip of the iceberg

Dear HIP,

It is understandable that many people in Hastings are concerned about the loss of some cardiology services from the Conquest. I spoke to a doctor yesterday who explained how after a heart attack it is sometimes necessary for a procedure known as an angioplasty to be performed to open up a blocked artery. Every 10 minutes that this treatment is delayed 3% of people will die. Others may be left with permanent damage to the heart muscles. If patients from Hastings have to travel to Eastbourne for this procedure, lives will be lost.

But as a population we need to look at the bigger picture. The only reason these procedures cannot be performed at both hospitals is because of a lack of funding and staffing. Hugh Sullivan wrote in HIP 217 about all the reasons these cardiology services should be based in Hastings rather than Eastbourne. But our NHS does not exist to serve only those most in need. Our NHS exists for the benefit of us all, whether we are young, old, rich, poor, working or otherwise.

East Sussex Save the NHS sees arguments about which hospital loses services as counter-productive. We all pay for our NHS through taxation, and we all should have core services available in our local hospital.

There are currently 500 people a week dying because of delays in emergency care. And every one of us has allowed this to happen. Successive governments for 40-odd years have been redesigning our NHS into a US-style system. We need to wake up to what is really going on because we will lose our NHS altogether unless we act now. This policy of merging cardiology services is a national strategy. It is a strategy designed to mitigate against drastic cuts, privatisation and staffing problems that blight our NHS today.

Hastings and Eastbourne both come under the newly created Sussex Integrated Care Board (ICB), who control exactly what services we have access to. As happens in America with HMOs, their job is to ‘manage demand’ so it fits the budget provided. If the demand cannot be met, the ICB can cut services, change staff pay or introduce charges for patients.

We need to stop the squabbling over which town gets the services and join forces to say we all need adequate access to core services. A good beginning would be to start demanding the ICB opens up about any proposals they may have to make cuts, introduce charges or change staff pay locally. For their budget this year is not enough to continue with our local services as they are.

Our Government may be saying they cannot afford to fully fund the NHS. But they managed to find £30bn when Liz Truss crashed the economy. They threw £37bn away with a test and trace system that didn’t work, £11bn was wasted on overpaying UK debt, and £8.7bn on useless personal protective equipment.

If you do care about the future of our NHS and would like to know more about our campaign, please visit: https://esussexsavethenhs.org.uk

Lucette Davies

By Rosie Brocklehurst

I wanted to let local people know about the extremely positive experiences I have had with members of the RMT, ASLEF and RCN nurses. I am a chronically ill and disabled woman. I have severe arthritis, several other conditions and am awaiting knee replacement. I am 73 and use a wheelchair.

In February last year I was placed on a new NHS treatment trial to address what had hitherto been an incurable urological condition. I could not be accepted on to it without the ability to self-catheterise using liquid gentamicin. Disaster struck: I failed to do it, and the doctors said it looked like this was not going to be possible for me. But a local nurse, Antonia Berelson, heard about me from a mutual Hastings friend and offered to come and train me for nothing, after 12 hour shifts, for five days in a row.

Thanks to her efforts, I got the hang of it despite my physical disability, and was accepted onto the trial. Almost a year later, on 12 January, I embarked on a 95 minute off peak journey from St Leonards Warrior Square to London’s Guys Hospital, feeling very apprehensive about a further uncomfortable urological procedure scheduled for 12 noon. I travelled in my wheelchair, with my retired teacher husband Paul.

We were helped into the disabled carriage by a charming guard called Ray, only to discover that the lifts serving my destination platform were out of use. Escalators and stairs at London Bridge are incredibly steep and there was no way I could navigate or walk. I would have missed my urology operation if I had had to go into Charing Cross and come back out again. However another guard, RMT member George, rapidly arranged with staff at London Bridge and the train driver to divert the train in that incredibly busy station, to a different platform with a functioning lift, so I could get to hospital on time.

I was so amazed and pleased I chatted with George further. I asked him what he did to earn money, as he gets no money at all on strike days. He told me he plays the bagpipes and has occasionally been known to do a gig or two. George plays so well in fact, that despite not being a Scot, he was invited to welcome Prince Charles (before he became King) into Edinburgh’s Waverley Station. I asked how that went down with the Scots. “Fine until I opened my mouth to speak,” said George.

This catalogue of human kindnesses was completed by superlative hospital staff in a very busy Urology Department at Guys. So, a day of anxiety was soothed by nurses, doctors and railway staff. I was therefore so overwhelmed with admiration to see my friend and helper, RCN nurse Antonia Berelson being interviewed this week on Sky News, the BBC, Talk TV and Meridien arguing the nurses’ case.

Unions are simply groups of working people trying to maintain a decent life for their families. As I have experienced: the public sector teachers, nurses, doctors, train drivers, fire brigade and ambulance service and so on, will often rise above deep and justified grievances to reveal immense generosity of spirit. They are the best of us.

The Government decision to slash the funding of its Energy Bill Relief Scheme (ERBS), designed to help businesses with spiralling energy costs, is going to cause severe problems for many of our local businesses and charities in the coming months.

The current £18 billion scheme comes to an end in March and will be replaced with a new, much less generous,

£5 billion programme. The new ERBS is targeted primarily at helping “energy and trade-intensive industries”, particularly those involved in manufacturing. Other energy intensive sectors, such as museums, libraries and even “botanical and zoological gardens and nature reserve activities” will also continue to benefit.

One of the sectors that will miss out on extra support under the new arrangements will be local swimming pools and leisure centres, including the Summerfields Leisure Centre in Bohemia Road, the Helenswood Sports Centre on The Ridge and the Falaise Fitness Centre on Cambridge Road. All three centres are owned and operated by Freedom Leisure (FL), one of the leading charitable and not-for-profit leisure trusts in the UK. CEO Ivan Horsfall Turner said he was left “frustrated and very disappointed” at the Government’s announcement. Sports centres and swimming pools are very intensive energy users. To illustrate this point, he said, FL’s annual energy bill has increased from £8 million to £20 million even with the temporary cap. Such rising costs cannot be sustained without a “real risk of having to take difficult decisions to close facilities and services”.

Impact of closure

The swimming pool at Rye Leisure Centre, managed by FL, has been closed since 1 November. The potential closure of other local sports centres and swimming pools would have a huge impact on schools and on the wider community. As recently as 2018, public pools were encouraged to work with schools to provide swimming lessons, with ministers extolling the great benefits of swimming in helping children to stay fit and healthy, with swimming also teaching children vital skills in how to stay safe in and around water. This is especially important in a seaside town like Hastings. Swim England estimates that in areas across the country where public pools have closed there has been a direct correlation with the numbers of children who leave primary school unable to swim 25 metres.

The impact of pool closures on adults and seniors is equally dramatic. Local pools are central to the wellbeing of local communities with organised swims for women and toddlers, disabled and older people. They also help against isolation and loneliness.

The recent wave of public sector strikes has focused attention on the funding of front-line public services, and in particular, the NHS. There has been little scrutiny of deeper problems relating to wider public health, however, and the seemingly intractable questions of how lifestyle and diet can impact on disease prevention. Various Government initiatives to encourage healthy eating or participation in sport invariably fall by the wayside when confronted with the financial reality of Treasury cut-backs. The NHS is then l eft to pick up the tab, with doctors having the grim experience of seeing the same patients in the same impoverished areas with the same conditions year after year.

In an ideal world with joined-up government working for the long-term good of the country, local sports centres and swimming pools would be an essential part of a solution to improving public health and not the easy option for short-term savings.

Nurses from the Conquest Hospital in Hastings joined with their colleagues in 55 NHS trusts across England last Wednesday (18 January) to strike as part of the Royal College of Nursing’s on-going dispute over their pay and conditions.

A large and lively group of nurses formed a picket line outside the hospital on The Ridge. Despite the bitterly cold day the public warmth towards the nursing staff was apparent. Conversations were hard to hear because of the regular and noisy honking of horns by passing motorists in support of their cause.

Antonia Berelson, a Specialist Nurse at the hospital and RCN organiser, said she, like all nurses, regretted having to take industrial action but said it was “necessary to force the UK government to open formal negotiations on the below-inflation NHS pay award” for this financial year. She said responsibility for the disruption lay firmly at the feet of ministers and the Health Secretary, Steve Barclay, who has “so far refused to take part in serious talks, choosing strikes instead”. His inaction was nothing short of “political negligence” which was threatening the very future of the NHS.

Annemarie Powell, a Stroke Rehabilitation Sister, was equally scornful of the government’s response to the unfolding crisis. She said she felt “betrayed” by ministers who had been quick to praise her and her colleagues during the Covid-19 pandemic, leading the weekly round of applause for key workers, but then quickly turned their backs when things returned to normal. She said it was a “political choice” to under-fund the NHS and not to pay nursing staff fairly. Visibly angry, she said: “people aren’t dying because nurses are striking. Nurses are striking because people are dying. That is how severe things are in the NHS, and it is time the Prime Minister led a fight for its future.”

Vicky Payne, a Critical Care Nurse said she and her colleagues were fully committed to the strike action, adding that a “significant pay rise was the only way to help tackle chronic staff shortages and enable the NHS to recruit and retain the nursing staff it desperately needs.”

This sentiment was shared by Jess Austen, who said the record number of unfilled nursing jobs meant more work and stress for those nurses who stayed on the wards. “Things cannot afford to get any worse. We need to pay nursing staff fairly to turn this around and give the public the care they deserve, otherwise things will continue to get worse. More nurses will burn out, and many more will simply leave the profession, putting even more stress on those of us who remain.”

A posse of government ministers took to the airwaves to express “regret” at the strike action, but none offered any solutions for its resolution. In response, the RCN General Secretary, Pat Cullen, warned: “if progress isn’t made by the end of January to resolve the dispute, we’ve said our strike action will be escalated on 6 and 7 February to include members at 73 NHS trusts in England and all but one NHS employer in Wales.”

Monday 6 February is shaping up to be a decisive day in the on-going dispute and for NHS a day of massive disruption, with strike action not just by nurses but ambulance staff, also in an unprecedented coordinated walkout. NHS leaders are warning that hospitals will grind to a halt as doctors and nurses from other departments are redeployed to provide emergency cover in strike-hit A&E units.

In addition to the unrest within the NHS, further strikes are promised by train drivers, Border Force workers, driving examiners, baggage handlers at airports and senior civil servants. The National Education Union representing teachers has become the latest group to vote for industrial action, with the promise of seven days of strike action in February and March. They and other unions have also declared Wednesday 1 February as a National Day of Action. As part of this campaign, Hastings and District TUC will hold a march from the Pier to the town centre in Hastings.

This winter of discontent shows no signs of easing.

When multi-millionaire Nadhim Zahawi, Tory Party national chair, attacks striking nurses for being dupes of Putin, you know he’s desperate. The Conservative Party have accepted millions in donations from Russian oligarchs. Zahawi, who claimed parliamentary expenses to heat his horses’ stables, is the last person to be lecturing anyone about “responsibility”.

Retail Price Index inflation has jumped from 4% to over 14% in a single year – heating and food increases are even higher. Since the banking crash of 2008, workers have faced the longest sustained squeeze on living standards for 200 years. Average real wages have fallen by 7%, and in the public sector real wages have fallen by about 20%. Food banks, which hardly existed before 2008, are now more common than McDonalds.

Workers in Hastings have had enough. Rail workers have taken 19 days of strike action, and low-paid train cleaners have been part of the first national cleaners’ strike. Postal workers at the Hastings delivery offices are locked in a war to save jobs and their service. BT engineers based at Sedlescombe Rd North won a £1,500 pay rise after strikes. The crisis in the NHS has reached a new low, with services crumbling. Ambulance workers based at Bohemia Road went on strike on December 21 and January 11, with emergency cover provided direct from the picket line. For the first time ever, nurses in the RCN will strike on January 18 at the Conquest and elsewhere.

Billionaire Profiteers

Britain is in the grip of a profiteering crisis. There are now a record 177 billionaires worth a combined £567 billion. Research by Unite has shown that profit margins for the top 350 FTSE companies rose by 73% during the pandemic years of 2019-2021. Tory peer Lady Michelle Mone’s company, awarded ‘VIP’ status, made a cool £100 million in profit from PPE contracts during the pandemic, of which £70 million has been taken off-shore and at least £29 million stashed in private family trusts. The rich are getting richer at our expense.

The big surprise is not that strikes are happening now – it’s that a fightback has been so long coming. So, what has changed?

The cost-of-living-emergency has created a common experience across the whole working class; everyone knows that we are all in it together. This helps to explain why nearly two million workers have voted for strike action and why the strikes are so popular.

Heroes or Zeroes?

This is the revolt of essential workers. During the Covid lockdowns, ‘key workers’ continued to work despite the risks, with utterly inadequate PPE. They accepted pay freezes. Covid fatalities were disproportionately high (which also explains why BAME workers were hit harder). Clapped as heroes but now treated as zeros – insulted and vilified by Tory politicians and their craven media. “But now we know what we are worth,” said the GMB union representative of Hastings refuse collectors at a trade union rally earlier this year.

The revolt is about more than pay. “We cannot do our jobs properly” is a common refrain, the public sector has been cut to the bone, ‘line managed’ with ridiculous targets and subject to unsustainable ‘efficiency measures’. The recent King’s Fund report confirms that the NHS is close to collapse because of years of cuts and marketisation.

To deflect blame, the Tories want us to join in the scapegoating of refugees. But the crises in health and housing are not caused by an “invasion” of people arriving in small boats. It’s the Etonians and the people using executive jets and limousines we should worry about.

Paying for Pay Rises

It would cost £1.6 billion for an above-inflation pay rise for nurses. But the cost of Rishi Sunak’s tax handouts was £7.3 billion. Last year the government removed the cap on bankers’ bonuses and loosened the banking regulations brought in after the 2008 crash. These are the conditions for more speculative bubbles and another crash. Guess who will be expected to pick up the pieces?

Instead of stuffing the pockets of the super-rich, the government could be investing in green jobs – a massive programme of housing insulation; rapid expansion in renewable energy sources like wind, tidal and solar; cheap, or even free, public transport.

‘Enough is enough’ is the slogan of the day. Strikes are escalating, with many workers discovering their collective power for the first time.

Where Are We?

At the time of writing, none of the disputes have been resolved. The government are not even prepared to negotiate with RCN nurses’ union leaders. Their pay claim of RPI inflation plus 5% is utterly reasonable if the historic pay squeeze is to be reversed and the chronic understaffing addressed. Physiotherapists and midwives also voted for strike action. Junior doctors are balloting. Ambulance workers took national strike action for the first time in over 30 years. It is shocking that Labour’s shadow health spokesperson, Wes Streeting, has sabotaged the nurses’ claim by saying that it is unaffordable and that a future Labour government would not pay up.

In exchange for a paltry pay offer the government expects the rail workers to accept thousands of job losses, the closure of all ticket offices, driver only trains and a 50% cut in track maintenance inspections. The RMT are fighting for a safe railway, for secure jobs and a pay rise after three years of pay cuts. Train cleaners on the minimum wage and outsourced to cost-cutting contractors are fighting for £15 an hour and to be treated like all other rail workers. Renationalisation without compensation cannot come soon enough.

Postal workers are up against a Royal Mail management who want to create gig-economy jobs – they want to rip up terms and conditions using only owner/drivers and new starters on 20% less. This is an existential crisis for the Communication Workers Union and they have the full support the entire trade union movement.

With civil servants, teachers and firefighters balloting for national strike action a showdown is looming.

Government on the Attack

The government is threatening new anti-strike legislation, the use of troops and emergency powers. These threats are real, but the Tories are chronically divided and widely despised. Their political base is fragile and disintegrating, which is why they are so vicious.

Our power is in our strikes and in our numbers. Now is the time to unify the strikes so that everyone is out together. A national coordinated strike would create a political crisis for the government.

Hastings & District Trades Union Council will do everything we can to build solidarity for the strikes. At last there is light at the end of the long dark tunnel of austerity and Tory rule. Together we can win!

Despite an outcry by Hastings Borough councillors and more muted objections from within the local medical community, the Conquest Hospital is to lose its in-patient cardiac facilities including the capacity to treat emergency cases. Within the domain of the East Sussex Healthcare NHS Trust (ESHT), stretching along the South Coast from Camber to Seaford, anyone who in future suffers an acute heart attack and needs immediate life-saving surgery in the form of an angioplasty will have to be brought by ambulance (or otherwise) to Eastbourne District General Hospital (EDGH). Under plans approved last month at a meeting of the East Sussex Health Overview and Scrutiny Committee (HOSC), cardiology consultations and non-emergency out-patient treatments will still be offered at the Conquest, and a Cardiac Response Team will remain there primed to carry out urgent assessments. But they will no longer have the facilities – in particular a catheterisation laboratory (cath lab) where angiograms, angioplasties and pacemaker operations can be carried out – to undertake surgery where needed. The surgery team would be concentrated solely at EDGH, likewise beds for cardiac in-patients.

The plans are intended to be put into effect as soon as government funds are made available to develop additional space at Eastbourne for transfer of the existing Hastings cath lab and establishment of additional in-patient wards there.

Hastings versus Eastbourne

The idea of combining acute cardiology services in a single hospital within the Trust’s domain has been floated for many years. Senior clinicians have agreed that the specialised nature of emergency heart surgery requires the establishment of a team of quality and experience, equipped with the best technological support. A national NHS improvement programme recommended in 2020 that trusts across the country should consolidate these services at a single location. After some delay caused by the onset of the Covid-19 pandemic, lengthy consultation was undertaken up to March last year which endorsed this principle. But choice of the location remained to be decided – should it be Hastings or Eastbourne?

Medical practitioners in Hastings, both in the cardiology department and in primary care, seem to have assumed that the geography of East Sussex and its socio-economic demographics would be seen as overwhelming factors in preferring the Conquest to the EDGH.

There is common acceptance that in cases of heart attacks there is a critical time between the onset of chest pain and the implementation of angioplasty procedures (“call to balloon”) which should not exceed a maximum of two and a half hours. But this includes the time the ambulance team takes to arrive and the immediate assessment process they need to undertake on arrival. The further travel time that the ambulance team must then incur to deliver the patient to the doors of the hospital should clearly be minimised.

If ESHT chose the Conquest as their single emergency site, patients suffering a heart attack at a location west of Eastbourne could be taken in emergency to Brighton, where full angioplasty facilities are also available. But if Eastbourne were the chosen site, patients from Rye or other locations east or north of Hastings would have little choice but to endure the additional drive, ironically with the ambulance passing the entrance to the Conquest on its route west.

Historically, moreover, while EDGH has run a slightly bigger cardiology department and, for instance, fits more pacemakers than the Conquest (there is also rather more opportunity to augment salaries with fees from private patients in Eastbourne), Hastings has generated a higher proportion of angioplasty cases. That’s the result of almost double rates of cigarette smoking, present or past, amongst its population, associated in turn with other indices of social deprivation. Preference for the Conquest in these circumstances would seem to accord with the government’s claimed ‘levelling up’ policy.

How the decision was made

However, it was apparent from early in the decision-making process that both senior clinicians and others involved in the provision of cardiology services might have their own personal reasons for preferring one site rather than the other. The Trust engaged an external consultancy – an “independently facilitated site panel” – to review the arguments on either side in an effort to arrive at an objective decision. But HIP has learnt that the crucial meeting conducted by this external panel, held on 12 September last year, was attended by seven cardiologists either currently or formerly based at EDGH, led by the Trust’s Deputy Chief of Medicine Professor Nik Patel, compared to only one based at the Conquest. Two other senior consultants from the Conquest were not invited because they are locums, even though both have been working there for several years.

When the meeting was convened, some financial projections were presented on screen, without any supporting documentation, apparently showing that transfer of facilities from Eastbourne to Hastings would be more expensive than vice versa; there were also calculations suggesting that ongoing maintenance costs would be higher, again unexplained. Problems of relative patient accessibility were downplayed from a Hastings perspective.

The process was in due course determined by a series of votes of the attendees, recorded confidentially, on parameters measuring projected outcomes for either location, including financial implications. The panel announced that on all counts Eastbourne was the favoured site.

The decision has subsequently been ratified by an ESHT Board meeting held on 11 October and approved by the East Sussex HOSC on 15 December. At the latter meeting Cllr Sorrell Marlow-Eastwood, who is the ward councilor for St Helens and Silverhill on East Sussex County Council, and Cllr Mike Turner, representing Hastings Borough Council, raised pertinent questions concerning the extent of travel times from Hastings to Eastbourne and the comparatively greater neediness of the Hastings population. But these were batted away by Professor Patel, to whom the committee deferred as the clinician in charge. He maintained that, while prompt delivery to hospital was important, “door to balloon” times (measured from when patients arrive at the door of the hospital) were best minimised by having a top quality response team assembled in readiness.

Political intervention

Hastings councillors are far from satisfied at the result. Labour party leader Cllr Paul Barnett has written an open letter to the Health Minister Steve Barclay, co-signed by Cllrs Andy Patmore for the Conservatives and Julia Hilton for the Greens, describing Hastings as having “the worst health and highest deprivation in the south of England” and claiming that removal of heart surgery facilities would be “very harmful” for patients.

“1,500 residents a year will be forced to travel 20 miles (and public transport makes this a long and very difficult journey for early morning surgery appointments), and many will as a result not follow through on this critical treatment.

“This comes after other services have been moved, such as stroke services, and capital investment here is scheduled to be far below Eastbourne. It feels as if our hospital is being downgraded.”

He referred to the potential for legal action in the form of a judicial review. “However, I would much prefer for you to help us ask the new Trust to review and change this proposal”, he wrote. “Hastings needs a first-class hospital or our residents’ health will continue to lag well behind where it should be.” No response is yet known to have been received from Mr Barclay.

By Paul McLaughlin

Nurses employed by East Sussex Healthcare NHS Trust last week backed their leaders across the country in voting to take industrial action after rejecting a below-inflation pay offer (5% with some add-ons). It is the first time in its 106-year history that the Royal College of Nursing (RCN) has instigated a statutory ballot across all the countries of the UK and recommended strike action to its members.

Any strike will impact all local hospitals including the Conquest Hospital, the Bexhill Hospital, the Uckfield Community Hospital, the Rye, Winchelsea and District Memorial Hospital, and the Eastbourne and District General Hospital.

Nurses in Sheffield pose in support of pay claim
CREDIT: Tim Dennell/Flickr

The RCN is required to give 14 days notice before embarking on any strike action. But, whilst no dates have yet been confirmed, it appears likely that nurses will be manning picket lines before Christmas. This phase of the dispute could last until next spring, unless staff are awarded a bigger pay rise.

Helen Wigginton, the RCN Communications Manager for the South East Region, said the vote reflected widespread anger at the government’s refusal to support the nursing profession over many years. She said nurses have seen their real-time pay cut by over 20% since 2010 and they had also borne the brunt of an understaffed and under-resourced health service leading to an increase in levels of stress, depression and burn-out. The pandemic, she added, has worsened these underlying problems, and led many thousands of nurses to quit their jobs leaving those who remained with even more to do. “It is clear from the results of the ballot that our members have had enough. Our anger has become action. We will no longer tolerate a raw deal at work.”

The RCN and NHS bosses agree that their priority is to keep patients safe during any strike action, and they both stress that the NHS has tried and tested plans in place to minimise disruption and ensure that emergency services, including A&E and cancer care, continue to operate. 

However, with 47,000 existing nursing vacancies across the country and 62% of all hospitals reporting a nurse vacancy rate higher than 7.5%, it seems inevitable that any action will result in massive disruption.

At the Conquest Hospital, 50% of wards are already what the NHS terms ‘risk- managed’. 

This involves a complex set of clinical and administrative systems, processes, procedures, and reporting structures designed to detect, monitor, assess and prevent any risk to patient safety whilst keeping within available finances. Risk-managed wards are the pinch points, often requiring more specialist nurses; the numbers of very ill patients are hard to predict, so finances and staff levels fluctuate. This delicate balance is likely to be upset in the event of any industrial action, and will almost certainly lead to a block on new patient admissions in other areas.

Any action will also have an impact on waiting times in A&E departments. The latest data covering NHS England shows that 43,792 people waited longer than 12 hours in October, up 34% from 32,776 in September and the highest number in records going back to August 2010.

Whilst talks are planned between the Secretary of State for Health and Social Care, Steve Barclay – the fifth in four years – and Pat Cullen, President of the RCN, to avert a strike, other health workers are queuing up to take their own industrial action.

Ambulance crews across Hastings have already voted to take industrial action after rejecting the latest pay offer from their local South East Coast Ambulance Service NHS Foundation Trust, and the NHS is braced for similar action from junior doctors, hospital porters and cleaners – all before Christmas.

The discontent of health workers is shared by others employed within the public sector and it may not be too long before their anger leads them to take similar action. A new winter of discontent beckons.

Just last week, Kay Green and Lorraine Murphy started a petition titled – plain and simple – We need help using our NHS. It was addressed to East Sussex County Council and Hastings Borough Council (HBC), asking for practical aid with the day-to-day flaws in the local NHS that many of us have experienced.

Have you rung your GP lately and had to wait about two and a half minutes before the call actually starts, and then found yourself number 21 in the queue? Maybe you’ve heard your anger and exhaustion mirrored in the beleaguered receptionist who finally greets you. Or had to get a late night taxi home from A&E because your GP couldn’t see you all day and sent you up to Conquest instead? And when you are at last seen by a specialist – what was your name again? No I can’t find your notes – something about the whole experience leaves you… unsatisfied?  

Kay and Lorraine write, “We appreciate the excellent work that our NHS medical staff do, and the value of their expertise, but we constantly see signs that contractors and government policy-makers do not need those services, and do not understand or care about the needs of less well-off citizens.”

If you answered yes to any of those questions above – sign the petition www.change.org/p/we-need-help-using-our-nhs. 

CREDIT: National Cancer Institute

Its authors also ask what local government is doing to protect and improve existing services. Well, as it happens, I have a spare report I wrote on an HBC cabinet meeting back on August 1 just gathering dust. And it might help to explain some of what’s going on.

Doom and Despair

To quote the HBC motion from back in August, “Hastings is the most deprived lower tier local authority in Sussex and one of the most deprived in the country. The experiences of deprivation contribute to higher rates of long-term illness, disabilities, cancer, lung disease and heart problems compared with the rest of England. Men in the most deprived areas of Hastings are expected to live 11.5 years less than those in other areas of the town – the biggest gap in the southeast of England. Life expectancy for both men and women is lower here than the England average.” As I understand it those deprived areas are especially represented by Ore, Hollington and Central St Leonards. 

The motion talks about, “the benefits of exercise, healthy eating, and access to quality outside spaces… vital for physical health and mental well-being”. 

Hastings residents generally have minimal access to quality outside spaces and nutrition. The parks and beaches are there, sure, and the foodbanks too, but you try and tell us that that equates to “access” and “quality”.

The NHS is Changing

Our failed system of Clinical Commissioning Groups (CCGs) was dissolved in July. They’re being replaced by brand new Integrated Care Systems (ICSs). Acronym central. Where the CCGs were almost hegemonic, looking at populations as best as they could and then making decisions on behalf of everyone, the ICSs plan to involve service users – read “people” – and community organisations in their own healthcare. At long last, right? But the ICSs are currently more hierarchical than their inefficient and problematic predecessors. 

The plan is to have ICSs replace CCGs in one fell swoop (still rolling out now), so apparently they need to be centrally-organised, monolithic organisations, just for the moment, while the coup d’etat is underway. Steadily they are being partitioned into localised systems and partnerships that’ll finally “integrate” with the people using NHS services.

I’m pessimistic about this whole process. I think we’re going to see the NHS privatised within a decade, and it’s disgusting that horrific and deadly mismanage-ment will be rewarded with a kind of equally horrific mismanagement (privatisation). Something that’s even more profitable for the so-called ‘managers’. But enough of that…

Universal Healthcare 

Over the past year HBC’s informal action group, the Hastings and St Leonards Local Strategic Partnership (LSP), has been making recommendations in line with the ICS rollout. It says a ‘whole system’ approach is needed and, “key to success will be collaboration, peer support… scaling up community-centred approaches to tackling inequality and poverty”.

The LSP held a workshop of healthcare aficionados on 14 September, which featured a speech from Professor Chris Witty (I recommend looking up his report on ill health in coastal communities). But, “as ever, the issue of resources and capacity to achieve the objectives set out by the group was identified.” In other words, will there be the people and money to actually get anything done? 

Before our local CCG departed, Cllr Mike Turner (Hasting’s man in East Sussex County Council) secured £3.4m of funding, most of which is going to be used for a Universal Healthcare Programme: a year-long initiative working with Bradford local authority and Southbank University. This, it is hoped, will start the kind of good work that ICSs are supposed to be bringing to us in the near future. It’s an experiment that will get national attention. 

A local design team is supposed to start things off. Cllr Hilton (recently thrown out of the HBC leadership coalition on orders from national Labour) wondered whether service users themselves might be included on this team, to help design their own services – isn’t that what all these reports are saying should happen, after all? Possibly, the answer was.

In fairness to the council, gathering information from service users is no simple task. How do you even begin to understand and average out what thousands of people are thinking and saying about a service, or a platform? HBC might consider questionnaires and focus groups – practical measures, but ones that won’t really satisfy the Borough’s itch for action. There doesn’t seem to be any quick solution for that.

Regenerating Like Nature

The Hastings Health Equity, Wellbeing and Prosperity Group, establised in June 2021, has some interesting comments to make, maybe clarifying a little of what this Universal Healthcare thing might mean for us. It’s another LSP initiative. They’re about “solution-focussed” (maybe read preventatve) and “whole system” (i.e. holistic) change. Their scope is “Community Wealth Building”, “Regenerative Economy”, and creating “Healthy Places”. What does any of that mean? Even if this latest sub group is too young to be a driver of it, the buzzphrases are referring to a lot of the good progress we’ve already seen in the town. 

I’m talking about housing co-operatives and community associations, about HBC committing to build more council houses, even if the numbers are currently destined to be small. I’m thinking of the Hastings Commons community-led development area, which people ran themselves and didn’t need to be created by the council. I’m even talking about Transition Town Hastings greening up our stations and streets to make them nicer places to be, at Warrior Square, and in the Town Centre by the Trinity Triangle, say. 

We have an extensive web of local community organisations that are by now experienced enough to make most of the changes HBC want to encourage on the ground. A lot of these organisations haven’t lost their ambition yet, despite sometimes fierce opposition.

Universal Healthcare is about stretching our understanding of what affects health. It assumes we already have universal healthcare in terms of getting care to people (debatable I know). Instead it’s saying healthcare doesn’t start and end in the surgery, in the hospital. It also happens in peoples’ homes, meeting places from cafes to parks, in schools and workplaces. Everything affects how healthy you are. 

But when they say, “£2.4m will… be used to support a new innovative Hastings-focused programme which starts with the recognition that access to healthcare is currently unequal, and poverty is a key driver of poor health,” I struggle to see how this disparate web of community activity can work with NHS bureaucracy. 

You can’t quantify how a garden in the town centre, clean beaches or warm community spaces reduce hospital admissions by, X% annually. The survey necessary to work it out might be possible, but it would be too complicated and cost too much. Yet there’s ample evidence not involving percentages that shows it to be true.

So will the NHS management ever be able to acknowledge what’s going on right in front of them? We’ll just have to wait and see. 

But back to the petition mentioned above: I’ll be asking Cllr Andy Batsford – who’s rather appropriately gone from Housing to Health – and anyone else who wants to be involved to give us at HIP a proper briefing on plans for local healthcare, in the vain hope that we might be able to translate it for you. Watch this space. 

Now ambulance call-out statistics for Hastings and Rye, obtained under a Freedom of Information request, have revealed a desperately stretched service. 

CREDIT: Dave Young

For Category 2 emergency call-outs, which include suspected strokes and heart attacks and represent approximately 60% of 999 calls, NHS guidelines state that patients should wait on average 18 minutes. But in the period from April 2021 to March 2022, people in Hastings and Rother were frequently left waiting for almost an hour
by SECAmb. In postcodes TN34 (central Hastings) and TN35 (Ore, Pett and surrounding villages) the average wait was over 52 minutes. In TN31, covering the Rye area, it was 56 minutes. 

In contrast, residents of Ashford and Brighton had average waiting times for similar call-outs of around 26 minutes.

Call-outs doubled

These figures were obtained by Helena Dollimore, who is on the shortlist of candidates to represent the Labour party in the Hastings & Rye constituency at the next parliamentary election, and are set in a context of hugely expanding patient demand. According to analysis of NHS data by the GMB union, ambulance calls in the south-east region are running at 14 million per year, nearly double the number in 2010. 

This in turn would seem to reflect the proportionate increase of older people in the population, particularly in Hastings and Rother (see census report on page 3). Rates of cardiovascular disease, COPD, stroke and high blood pressure conditions are also higher in Hastings & Rye than in the rest of the region as well as in comparison with England nationally.

Ms Dollimore had a personal reason to make her enquiry. ““Last summer we had a long wait for an ambulance for my dad. While he was OK, this data shows that we were not alone and people across Hastings and Rye are waiting too long. Why should people in Hastings, St Leonards and Rye wait longer than those in Ashford or Brighton? 

“Residents in Hastings and Rye deserve better than what they’ve got under the Tories. Our NHS has been under-funded and under-resourced for over 12 years, leaving staff in impossible situations and people waiting too long for treatment. Our NHS workers deserve more than just clapping, they deserve a fair pay rise and enough resources to provide the best service to NHS patients.”

Unfilled vacancies

She ascribes the length of local waits to short-staffing at SECAmb – not just for reasons of Covid absences but because vacancies are left unfilled. In particular, she points out that the South East region has a vacancy rate for ambulance staff that is much higher than in other regions.

A SECAmb spokesperson admitted last week that the Trust is “focussed on recruiting additional staff across a variety of both frontline and support roles while supporting its staff in their roles to improve retention. 

“As we continue to face periods of high demand, we would like to thank our staff and volunteers for their hard work and commitment. We are sorry that some patients are waiting longer than they should for a response and we are doing everything we can to reach those who need our assistance as quickly as possible, while prioritising our response to our most seriously ill and injured patients.”

The spokesperson maintained that all ambulance services are facing significant pressure and that none are achieving the response time performance expected. But he claimed: “While it is clear that there remains a lot to do to improve our response times and also reduce variation within our own region, it is worth noting that for May this year, SECAmb remains ahead of the national average in the highest three categories of call-out and has among the shortest response times for Category 2 calls.

“The public can help us manage demand by only calling 999 in an emergency. We also urge everyone to make use of alternatives to 999 for help and advice including speaking to their GP, a pharmacist, by visiting 111.nhs.uk or calling 111.”

No surprise

Jason Dicker, GMB SECAmb Branch Secretary said: “The data Helena has collected is not a surprise to GMB.  Our members have seen the impact of national government funding cuts to the ambulance service in Hastings and Rye and have continued to argue for more funding from the government to ensure a more consistent service delivery for all, regardless of where in the region someone lives.

“GMB members working in the service see day in, day out, the impact of these funding cuts, and despite their best efforts know there will be an impact on service users. We continue to call for more government funding for the ambulance service across the board so that our members can provide the level of support they joined the service to deliver.”

A survey undertaken this year in East Sussex amongst NHS hospital patients shows an almost 50% dissatisfaction rating in respect of their discharge experience. The survey was carried out between February and April this year by Healthwatch East Sussex, a community interest company which reports patient feedback to the NHS. It charted the views of 36 patients, most of whom were discharged from the Conquest Hospital in Hastings or Eastbourne District General Hospital. 

Among the reported findings

• Nearly half (47%) felt insufficiently informed about their health condition and treatment whilst in hospital; 

• Only 44% had received a hospital discharge letter, and nearly a quarter (22%) stated that they had received no documents or any other information at the point of discharge;

• 42% say they received no information on how to access non-medical support and information;

• 36% say they received no advice on how to manage symptoms or physical conditions;

• Over 20% indicated that their expectations had not been met in receiving a follow-up hospital appointment, follow-up GP appointment, or a diagnosis or test;

• 53% felt ready to leave hospital at the point they were discharged, but 25% did not.

It may be instructive to compare these ratings with the average of over 90% satisfaction expressed by a different sample of East Sussex patients when asked whether their needs had been met at their most recent appointment at a local GP surgery (see HIP 183: GP Appointments in Hastings: A Survey).

Recommendations 

Healthwatch have made four main recommendations based on their findings: 

• all patients should receive a hard copy of their discharge letter, written in compre-hensible English, including details of hospital treatment, post-discharge requirements and any next steps; 

• written guidance on medication (including self-medicating), pain management and appropriate self-care advice (do’s and don’ts) should be given;

• the same core set of information should be provided to all patients on discharge, including clear guidance as to who the first port-of-call should be for any issues that arise linked to their hospitalisation.

• They should be provided with details of any community or voluntary sector support for which they are eligible. 

Hastings hearing aid users can look forward to a relaunched service this summer from local charity East Sussex Hearing. The pop-in NHS hearing aid maintenance and battery replacement sessions will start
on Tuesday 29th June and continue (subject to government lockdown regulations) every last Tuesday of the month until the end of November 2021.

The service is free to all NHS Conquest Hospital Audiology department patients and takes place at the Central Hall, Bank Buildings, Station Road, Hastings TN34 1NG, between 10.30-11.30 am without an appointment. It
has always been well used, with up to 50 people attending each
month. Users to the Hearing Aid Maintenance service (HAM) also access our Hard of Hearing groups, along with the lipreading and sign language classes delivered by the charity.

The HAM sessions provide a service for NHS patients who traditionally have had difficulty getting to the NHS drop-in session at the Conquest Hospital. This service has been disrupted with the drop-in session at the Conquest cancelled for the foreseeable future.

The HAM service was suspended during the national lockdown causing real concern for hearing aid users.

According to a spokesperson, the equipment requires cleaning every six months, but this can be difficult for anyone with dexterity problems. Their only alternative is to post the aids to NHS audiology, which leaves them without any hearing equipment for several days. Without the service, many people simply stop wearing the equipment. 

Commenting on the relaunch, charity CEO, David Rowan, said: “Our Hastings area volunteers team can’t wait to get back and help the townspeople maintain their hearing aids. The pop-in sessions will also give wearers the opportunity to discover the other services East Sussex Hearing offers to the deaf, deafened and those with hearing difficulties.”

Covid-19 numbers – for positive tests, for hospitalisations and for deaths – have all been reported on a sharply downward trend for several weeks in both Hastings and Rother. Local vaccination roll out has at the same time kept pace with national timetables. In Hastings at least, the target of offering the top four priority groups a first dose of either Pfizer or Astra Zeneca vaccines appears to have been met. Last week the GP-led programme here was already reaching the 65-69 age group.

Catching the current mood this poster, by graphic artist Luke Smile,
recently appeared in Upper Park Road, Bohemia. Instagram

Government statistics for positive tests in both Hastings and Rother show a top peak – of over 1,000 per seven day period in Hastings, over 700 in Rother – as having occurred around 23rd December and again on 4th January (the dip presumably accounted for a slackening of efforts to get people tested during the period between Christmas and New Year), Since then, these figures have reduced steadily.

In Hastings there were 124 new positive tests showing Covid infection in the week between 7th and 13th February; this contrasts with 172 for the previous seven days.  Over the same period there were nine deaths within 28 days of a positive test compared to 16 the previous week. 

The improvement is equally apparent in Rother: positive tests down from 134 to 54; deaths down from 21 to 17.

As to hospitalisations, East Sussex Health Care Trust, which manages the Conquest and Eastbourne District General Hospital, disclosed on Sunday that they have an aggregate of 226 in-patients currently being treated for Covid, with just 18 on ventilation. There were 97 admissions in the week up to 7th February, a drop from 117 the previous week.

Hastings & Rye MP Sally Ann Hart has kept silent publicly in recent weeks as to how she believes that the government should respond to these clearly ameliorating health figures. However her Conservative colleague Huw Merriman, MP for Bexhill and Battle, who voted against the government’s tier restrictions on 1st December and is believed to be one of the 63 MPs in a self-styled Covid Research Group of his party calling for a rapidly phased easing of lockdown restrictions, has been more vocal. As chairman of the Transport Select Committee in parliament, he challenged the Health Secretary Matt Hancock last week to confirm that the new restrictions imposed on international travel and arrivals would be “a temporary measure which would not impact summer travel”; he says he was left “bemused” when Mr Hancock suggested that they could last until autumn, while Transport Secretary Grant Shapps advised against making holiday plans for the summer even within the UK.

“One of the reasons I was willing to support the lockdowns of this year was because I was assured that once the vaccination had been delivered, lockdowns would be over,” Mr Merriman observed in a statement issued last Friday. “If ever we’ve deserved or needed a holiday, this is the year. In our part of the country, it’s not just a leisurely pursuit but, for many in the tourism and hospitality business, a job and a livelihood.

“I am determined to ensure that we get our travel industry, and our leisure time, back to some form of normality once the UK is vaccinated.”

The Conquest Hospital started its Covid vaccination programme at the end of December. Eastbourne DGH followed suit from 4th January. In each case, first doses were of the Pfizer/BioNTech vaccine, code-named “Courageous”. Initial recipients were frontline health and care staff at East Sussex Healthcare NHS Trust (ESHT), local care home workers, and staff from other local NHS organisations.

The alternative Oxford Astra-Zeneca vaccine, code-named “Talent”, was also approved for use from the beginning of this month. However, so far, at least in East Sussex, initial “Talent” doses have been reserved for residents of care homes and house-bound patients because of the comparative ease of transportation. The “Courageous” vaccine needs to be carefully stored at a temperature of  -70ºC and can only be moved a certain number of times ahead of use.

A third vaccine, developed by Moderna, has also been approved, and will be made available shortly.

Each of these vaccines is typically delivered by a simple injection in the upper arm.

The government has indicated that the NHS aims to offer jabs nationally to 15 million people – the over-70s, healthcare workers and those required to shield – by mid-February and millions more by “spring”. The UK’s chief medical adviser, Prof Chris Whitty, has described such a timetable as “realistic but not easy”. The ultimate target is to reach all adults who want the vaccine by September.

17 mass vaccination centres have been set up nationwide. However, the nearest to Hastings is over 60 miles away at Epsom Downs racecourse. The vast majority of vaccinations in Hastings will be delivered at Kings Church on The Ridge to which patients of all GP surgeries within the borough will be directed. Patients of Bexhill surgeries will attend the Sidley Medical Practice.

All patients will be contacted, in strict priority order.

GPs and local vaccination centres have been asked to ensure that every care home resident in their area is offered vaccination by the end of January. 

Order of Priority for Vaccination Offers

1 Residents in a care home for older adults and their carers;

2 All those 80 years of age and over and frontline health and social care workers;

3 All those 75 years of age and over;

4 All those 70 years of age and over and clinically extremely vulnerable individuals;

5 All those 65 years of age and over;

6 All individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality;

7 All those 60 years of age and over;

8 All those 55 years of age and over;

9 All those 50 years of age and over.

As part of their evolving activities, Arts on Prescription (AoP) has just launched a lockdown project to engage the whole community and is looking for participants. As Tara Reddy, project team coordinator says: “We are living in an unprecedented time, a time that will one day be read about in history books.”  

The Arts on Prescription Lockdown History Project 2020 is designed to enable people to write their own page in history, local families documenting their everyday life through lockdown in a fun and interactive way using the activity book that can be downloaded using the link below. Completed work can then be submitted to AoP to display as a collective community and as a lasting peoples’ living history project.

When AoP approached Sir Quentin Blake, he thought it was a great idea and agreed to do some of the illustrations for the activity book. He also designed an illustration for Arts on Prescription as a whole, so as Tara says: “We now have the honour of using this unique design to head our service.”

•  To download the booklet go to www.artsonprescription.org/aop-meets-quentin-blake

• For information on other AoP activities visit artsonprescription.org/current-project-time-table

St John Ambulance has just been awarded a grant of £6,200 to provide much-needed medical help for people living on the streets. The funds, provided by the Morrisons Foundation, have supported the charity’s mobile treatment centre where volunteer nurses can provide immediate emergency care to homeless people.

Nurse Coordinator for Hastings Homeless Service, Roger Nuttall, explains that the money is being used to take a twice-weekly, nurse-led, mobile clinic to where people are, treating their conditions and successfully re-engaging them with the services they need. “We are very grateful to The Morrisons Foundation for their grant, enabling us to continue this vital work.”

According to Roger Nuttall, the service has received a growing number of referrals from A&E and community agencies during the Covid-19 restrictions.  Homeless and vulnerably housed individuals have “found it increasingly difficult to access essential primary care and have been suffering with conditions requiring direct physical care such as leg ulcers and abscesses”.

St John Ambulance continue to run four clinics a week at Seaview Project in Hatherley Road.

• Mondays, 12pm-2pm: nurse consultations and specialist foot care 
• Tuesdays, 12pm-2pm: nurse consultations
• Thursdays, 10am-1pm: nurse consultations and specialist foot care
• Fridays, 12pm-2pm: nurse consultations 

The Morrisons Foundation was set up by Morrisons Supermarket in 2015 and has donated £29 million to hundreds of charities across England, Scotland and Wales.

David Scott, Morrisons Foundation Trustee, is delighted that the Morrisons Foundation has been able to help fund St John Ambulance’s vital work in Hastings.

• Local charities are encouraged to visit www.morrisonsfoundation.com to find out how to apply for a grant.

Alternative sites for the ‘occasional’ mobile testing unit, which appeared in the heart of Hastings Old Town, are now being investigated after it caused a nearby café to close and provoked a wave of opposition from residents and traders in the area.

The army-operated unit arrived at The Stade Open Space on the busy Saturday of 18th July to test keyworkers and other members of the public with pre-booked appointments only. 

The view from Eat@stade 
PICTURE: Stephen Kelleher

Those with symptoms had been instructed to visit in cars while asymptomatic patients were able to walk in. 

The unit was originally intended to remain for three days, but did not return on the Monday, and had been organised by the Sussex Resilience Forum (SRF), a group involving Hastings Borough Council, Public Health at East Sussex County Council, NHS and emergency services, formed to respond to the Covid-19 pandemic.

Mixed messages

Stephen and Louise Kelleher, who rent their café Eat@thestade from the council, say that while they’d been informed about the unit a few weeks previously, they’d not known when it would appear.

“We were told there would be some testing, of some kind, at some point but that it would be small and discreet and tucked away near the lifeboats,” said Louise Kelleher. “The implication was that it would not affect business. We were given no dates, no details and no consultation.”

The couple, who are directors of Eat@ours Ltd, had arrived that morning to find the space taped off and were told by military personnel they could not open their doors or put out chairs and tables because the area was ‘a no footfall zone’.

Posting on their Facebook page they announced: “We do not feel it is safe to operate inside dining so close to this area and are pretty convinced that the view of soldiers in face masks in a hazard-taped no-go zone would put off all but those with the most dystopian appetites.

“We cannot tell you how sad, angry and scared we are about this. Our staff, some of whom are already anxious due to health conditions, have gone home, one in tears. 

 “The Old Town is filling up with the first visitors of the school holidays and we are shut, with no opportunity to make back some of our losses from the last quarter.” 

The unit was moved further away on the Sunday, but their
staff members, one of whom has asthma, were reluctant to return to work while it was there.

“The public perception of a Covid testing site is anxiety-inducing, not just for my staff and my customers but also for me and my family,” Louise Kelleher told HIP.

Public opposition

By Monday 20th July a petition, started by resident Becky Smith on behalf of local businesses, had gained over 1,600 signatures; this had increased to over 1900 a week later. It demanded that the unit be relocated “to a less populated site” arguing that placing the testing station on The Stade  “could completely jeopardise the area’s recovery, in all senses, as well as increasing the risk to the local population”.  

“Our attention has been drawn to the fact that this is on a ‘walk-in’ basis, meaning that individuals (potentially with COVID) are drawn to our very small, narrow and BUSY streets,” it declared. 

Meanwhile, a joint statement was hastily issued by Hastings Borough Council, Sussex Resilience Forum and the Director of Public Health for East Sussex County Council explaining that The Stade had been chosen above other sites which had been ‘looked at with military advisers’ because it ‘met the strict criteria and faced with the alternative of not having a testing station at all, we agreed it could then be used on an occasional basis.’

“I want to reassure the local community that they were not exposed to greater risk by the temporary Covid-19 testing centre,” said Darrell Gale, Director of Public Health for ESCC.

“These mobile testing units are a vital component of our effort to manage the pandemic in East Sussex. They provide quick and easy access for the local community to a testing facility, reducing the need for people to travel long distances to a testing station. 

“Symptomatic people will only be accepted if they are in a car. Those on foot are likely to be asymptomatic essential workers, who pose no more risk there than if they went shopping or anywhere else.” 

But the Chair of Sussex Resilience Forum, Superintendent Marc Clothier of Sussex Police said: 

“The council, with partners, will continue to look for alternative suitable sites for the pop-up testing unit to be hosted in the town. However, in the interest of public health, paramount importance will be that the town can host mobile testing sites when they are needed.”

Alternative sites

In the joint statement, Leader of HBC Kim Forward said The Stade had not been the council’s preferred choice, but that it was an ‘accessible location’, while HBC’s Marketing and Major Projects Manager, Kevin Boorman, later told HIP that Summerfields Leisure Centre and The Oval had both been considered as sites but were rejected because they didn’t fulfil criteria laid down which were ‘access, layout and provision of toilets’. 

 “Verging on cruel”

But this was not enough to assuage opposition to the site being selected in the first place and re-used in the future.

A furious letter to MP Sally-Ann Hart written by Bianca Eichler on behalf of residents and Old Town traders demanded to know why residents and business owners had not been told that the testing unit would be appearing “in an area where it is virtually impossible to enforce social distancing”.

“As a resident and a trader this is simply mind boggling,” she wrote. 

The implication was that it would not affect business

“Hastings Old Town is a unique community that has weathered many many storms. This year we have lost the following events: Jack in the Green, Pirate Day, Hastings Old Town Week and possibly more later this year. The damage to our local independent traders has been massive.

“To then place a Covid testing station in the middle of this area on a day when traders are desperate to make up for lost income is verging on cruel. 

“We understand the need for testing centres, we understand that these testing centres have very specific parameters that they have to meet in order to be used. However, this may be the worst possible placement the council, government and powers that be could have made. 

“We would like a clear explanation as to why this cannot be somewhere else in the town (this is not nimbyism it is common sense) and why we as traders and residents were not informed.” 

Ms. Hart had yet to respond to the letter at the time of going to press. However, HBC has since revealed that over the two days the testing unit was there, 124 people were tested with 2 testing positive for Covid-19.

The ‘clause 17’ amendment to the Trade Bill, proposed by Green Party MP Caroline Lucas and supported by Labour, demanded legal protection for the NHS in any future trade deals ensuring the UK retains control over the pricing of medicines and that the NHS remains ‘a comprehensive and publicly funded health service, free at the point of delivery’. The amendment also sought to bar any future deal which compromised the quality of health and care services as well as protect NHS staff wages. The amendment was defeated by 340 to 251 on Monday 20th July. Ms Hart also voted against amendments demanding legal protection for food standards and the environment, as well as one giving parliament the right to ratify any future deals negotiated.

A petition calling on the House of Lords to amend the Trade Bill to protect the NHS gained over 40,000 signatures in a day. Without cast-iron protection, campaigners fear it will pave the way for further privatisation, leaving it vulnerable to overseas asset strippers and venture capitalists.

East Sussex Save the NHS Campaign, which is backed by Labour and Green parties, Trades Councils and People’s Assemblies across Hastings, Rother and Eastbourne, accuses the Government of using the Covid-19 pandemic as a smokescreen behind which our NHS is being further dismantled.  One move that threatens its future in particular is the UK Trade Bill that is progressing through Parliament right now.

The Trade Bill is claimed to be simply a technical instrument, designed to govern how the UK forms trade agreements now we have left the EU, and only concerned with transferring the trade agreements that existed between the EU and other countries into UK law.  But its provisions will also allow our Government to negotiate changes to existing trade deals and form new ones. 

Conquest Hospital staff applauding a Covid-19 recovery
PICTURE: East Sussex Healthcare Trust

Clauses that were in the bill before the election last December giving parliament a say in trade deals have been ditched.  This is fundamentally undemocratic: negotiations on trade deals should be transparent and open to scrutiny by parliament.

Low regulations

The purpose of trade deals is to allow private business to trade freely across borders by reducing import and export tariffs, levelling out regulations between the two countries, and preventing any preferential treatment towards businesses from either country.  But they have the effect of forcing a government’s hand, preventing it from increasing regulations, which are largely about protecting people and may limit the capacity of a private business to make profits.  Any move by a government to change regulations and therefore reduce that capacity to profit could result in those businesses suing.  

So why be concerned about our NHS in a trade deal?  It has been fractured into many disjointed pieces by this Tory Government and previous governments.  It can no longer be considered a publicly owned and provided service; it is now a marketised economy, open for profit. 

The deal that worries us most is between the USA and UK, currently being negotiated. Although our Government has promised that the NHS is “off the table”, Donald Trump has said that everything is on the table. There are already US corporations operating within our NHS, and a trade deal would grant them access to so many more aspects of our healthcare. 

Access for US corporations

Access to the UK’s unique data base of 55 million patient records would be worth £5bn per year to private companies.  Access to the control of intellectual property could result in the Americans increasing the length of patents on drugs.  The UK would then lose the right to make cheaper generic drugs.

Granting the US access to public procurement, so that US corporations could start providing the things our NHS has to buy, would risk a lowering of our safety standards on those items. It could also mean a lowering of public health regulations, those that govern the sale of tobacco and alcohol, food safety rules, or the minimum wage.

Furthermore, if we ever attempted to renationalise our NHS preventing US healthcare corporations from operating in our healthcare service, they could sue our Government.  If our Government ended the trade deal, then the right to sue would still exist for another 20 years.

Exclude the NHS

On the other hand, if the Trade Bill carried a clause that our NHS has to be excluded from any trade deals, then our Government would be forced to list specific services which are included in the deal as opposed to services that are excluded.  This would give greater protection. 

We also need a general clause in the bill giving parliament the right to scrutinise trade agreements as they are formed.    

We do not want to emerge from this pandemic only to discover that, while we were distracted, our Government has destroyed the healthcare service that has helped us survive it.  East Sussex Save the NHS Campaign has sent direct emails to each of the MPs in East Sussex.  We urge you to contact yours and express your concerns about how this Trade Bill could lead to trade agreements that have this effect. Our elected representatives must hear the strength of feeling in our communities that their NHS is treasured and must be protected. 

Bank holiday sunshine lights up the back streets of Hastings – silent, empty and lined with parked cars. The majority of windows have blinds down, I suppose they help to keep the digital screens brighter within. But many windows, too, display posters, official or homemade, with rainbow colours adorning the ubiquitous message: ‘Stay at Home, Protect the NHS, Save Lives’. The images are redolent of those local shrines in rural regions of Southern Europe where Catholic faith remains strong. And that comparison is apt: for belief in the National Health Service has become a religion more widely and tenaciously held than any form of Christianity in modern Britain.

The Church was once the haven for the faithful in times of plague. Although mediaeval populations might rationally have come to doubt either the goodness of the Almighty in inflicting the cruelties of disease upon them or His omnipotence in failing to halt its ravages, but history tends to relate the contrary: the higher the casualties, the more fervently they joined their priests in praying to Him for salvation. Belief in Him, moreover, might be the state of grace necessary at the moment of death to avoid a hereafter of everlasting hellfire.

Covid-19 – season of veneration

The NHS seems to occupy an equivalent popular veneration during this Covid-19 season. Rational observers might highlight its failure to prepare, despite apparent years of warning. There have been insufficient beds, lack of equipment and apparel; an economic and social lockdown has had to be imposed across the whole of society in order that it could avoid being “overwhelmed”; the death count in Britain is now the highest in Europe, even while almost all other medical priorities have been abandoned. Politicians and bureaucrats have come under fire for failing to provide resources over a long period, and for mismanaging the logistics of providing protective equipment and rolling out a testing programme. But they are like mediaeval priests found guilty of venial sins unworthy of their offices. Belief in the sanctity of the NHS as an institution remains apparently undimmed, its frontline staff lauded as saintly heroes (even if not remunerated or protected as such); criticism is treated as blasphemy. 

Failure to observe its current sacred rituals, from frequent hand-washing to minimising time and social contact outside the home, not only invites criminal sanctions but moral obloquy – the guilt of putting other people’s lives at risk. There’s also the uncomfortable sense that we are all going to end up, sooner or later in our lives, dependent on the comforts of modern medical science, as people once sought the comforts of religion. Lack of faith in its practitioners may come to seem not just ungrateful but impious.

Government Dogma

At all events, no evidence that challenges ‘the science’ is allowable. Suggestions that the numbers of dead and seriously ill from Covid-19 might be exaggerated in comparison with other medical eventualities, or that alternative health models might produce a better balance between the direct risks of the disease and the collateral effects of lockdown, are dismissed as ‘fake news’.

This goes not just for mainstream media coverage on the BBC and in national newspapers, both of which explicitly support government dogma. Even pan-global social media like Google and Facebook have brought themselves into line, reckoning that their brands are better protected by going with the orthodoxy than opening themselves to heretical alternatives. From  16th April Facebook contrived a programme that “users who have read, watched or shared false coronavirus content will receive a pop-up alert urging them to go the World Health Organisation’s website”, where the “true” facts are supposed to be relied upon. On April 22nd YouTube, which is owned by Google, issued a statement that “any content that disputes the existence or transmission of Covid-19, as described by the WHO [World Health Organization] and local health authorities is in violation of YouTube policies” – and will be taken down.

Politicians and bureaucrats have come under fire… like mediaeval priests found guilty of venial sins unworthy of their offices

British political leaders, many of whom regard the political process as a game of brand-protection, have learnt to coat themselves in NHS orthodoxy. Former Prime Minister, David Cameron, speaking at his first Tory party conference as leader in 2006 declared: “Tony Blair explained his priorities in three words: education, education, education. I can do it in three letters: NHS. We will serve and support the National Health Service. We will never jeopardise the NHS by cutting its funding.” And he used, as proof of commitment, his personal role as parent of a child with cerebral palsy. “For me, it’s not just a question of saying the NHS is safe in my hands. My family is so often in the hands of the NHS, so I want them to be safe there.”

The NHS Flag

Current PM Boris Johnson’s most prominent rhetorical flourish prior to getting himself elected leader was his highly dubious claim, made during the Brexit referendum campaign in 2016, that £350 million pounds per week could be re-directed from the EU to the NHS once Britain had left. Perhaps not many people believed him – but so what, he was showing he understood and endorsed the popular belief system.

Wrapping the NHS flag even tighter around himself, his recent unscheduled personal hospitalisation as a Covid-19 victim ended as he miraculously rose from the hospital bed on Easter Sunday. Describing his narrow escape from death by virtue of the “amazing” care and attention he received, Boris has literally lived out a religious paradigm of suffering and redemption. 

In his first address to the nation on 12th April, after being released from hospital earlier that day, he said, “We are making progress in this national battle because the British public formed a human shield around this country’s greatest national asset: our national health service. We will win because our NHS is the beating heart of this country, it is the best of this country. It is unconquerable. It is powered by love.”

Church of England Website

What, in the meantime, happened to Christianity – the religion that was supposed to be powered by love? Its churches are closed, its ceremonies stalled. Church buildings cannot be used for weddings nor for funerals. A message on the Church of England website instructs its priests that it is “still vital that the necessary hygiene and social distancing precautions are kept in place in order to protect the NHS and save lives”. 

Saving souls? Reminding us that we are all mortal, and that there may be limits to the value of preserving lives at the expense of all else? That’s old time religion, as apparently irrelevant as incense and hellfire. And who needs church services? The good news gospel is celebrated in these times by an enthusiastically devout, if socially distanced, congregation down your street every Thursday night, clapping for the carers.
Zenos Metevsky is a Hastings resident

HIP SAYS…

I am aware that this piece somewhat ‘goes against the grain’ of the current consensus on the NHS and is likely to provoke various reactions and debate. I remind readers of my column on this page in HIP145, where I stated, “We wanted to create an open space in which people are free to set out their views on what they consider to be the pressing political issues of the moment, and also to react and respond to views expressed by others”. If you have an opinion that is different to this and feel moved to respond, then I would very much welcome hearing from you as per the contact details above. 
Juliet Harris
Editor, Thoughts and Voices

But before everyone takes to balconies and doorsteps to applaud again perhaps we might consider why? Because beyond the undoubted morale-boosting affect of participation what is arguably taking place is an act of political dissonance, a collective self-delusion.

When the Covid-19 emergency began, the NHS was already on its knees, weakened by 10 years of austerity and underinvestment, a catalogue of horrors including: 

• The creation of a ludicrous internal market in a not-for-profit, ‘free at the point of delivery’ public service 
• A hostile environment for overseas workers
• Piecemeal privatisation
• Increasing tiers of ‘management’
• Removal of nursing bursaries
• The PFI hospital building programme… 

Not accidentally but as ideologically-motivated political decisions based on free-market extremism, leading me to question how those waving banners and shouting support on recent Thursdays voted in the last few elections?

I’m not suggesting anyone goes to the ballot box to deliberately damage our health system. However it seems – at a charitable interpretation – much of the electorate didn’t bother to read the small print regarding policy. Wittingly or otherwise, anyone voting either Tory or Lib Dem (no, the coalition hasn’t yet been forgotten) indirectly supported funding cuts. As a matter of historical record, the Conservative party voted against the National Health bill in the Commons in 1946 and renewed their attack on the post-war consensus during the Thatcher years. After cynically blaming post-2008 austerity on public spending rather than bankers’ irresponsibility and tax avoidance, the NHS was never going to be safe in Tory hands.

When the pandemic is finally over we can fully investigate the lack of protective equipment, insufficient hospital beds, dearth of ventilators, testing failures and unnecessary deaths of NHS workers. Then perhaps rather than waving and hanging banners people might think harder and take some personal responsibility for political outcomes before voting?

Dave Young is HIP’s Health and Environment Co-Editor

To emphasise the point, according to the Office of National Statistics the numbers of deaths in England and Wales where coronavirus was recorded as a causal factor were just 7% of the total over the month of March. The normal mill of fatalities – heart disease, cancer, dementia etc – has’t receded. 

Local GPs have nevertheless resorted largely to physically distanced consultations, screened by reception staff trained to divide off patients between those reporting symptoms which are potentially related to Covid-19 and those which are not. Little Ridge Surgery in St Leonards has been dedicated to host assessments of the former only, referred by a combination of several of the town’s practices and staffed in rotation by their GPs. A separate set of practices, headed by Dr Craig Namvar and combining Old Town Surgery, Warrior Square Surgery (based at Marlborough House) and Churchwood Medical Practice, has adapted its services into a ‘primary care hub’ under the name of Hastings and Rother Healthcare. From last week all its non-Covid patients have been directed to Churchwood; potential Covid patients are being seen at a ‘drive-through’ clinic at Warrior Square, waiting outside in their cars for examination by doctors who are fully kitted up with masks, gloves and other protective equipment. A marquee has been installed in the carpark of Marlborough House for examination of such patients, when needed.

The purpose is not to provide anti-viral treatment: medical science has none to offer at present. Nor are the GPs equipped with any testing facilities, so they cannot actually determine whether their patients have contracted Covid or not. If symptoms are severe, the sufferers will be directed to the Conquest for testing and, if necessary, intensive care. 

On the other hand, prior examination by GPs may identify other medical problems. And here there’s some concern that the massive diversion of hospital resources to the pandemic frontline, added to perennial shortages of senior specialist doctors at the Conquest, may result in serious non-Covid cases being undertreated or misdiagnosed. The media, and many politicians, have presented the pandemic as a foreign invasion, an attack unprecedented in modern times that we must oppose and ‘defeat’ on a comprehensive war footing. Wars, though, tend to accumulate collateral damage. 

Sue Tilley’s made an indelible mark on the local arts scene since relocating to Hastings from London in 2017.

Her eclectic litany of job titles have included: benefits supervisor; till dolly at the notoriously decadent Taboo club in London; exhibited artist; and published author…as well as being a frequent model for a certain Lucian Freud.

However there’s much more to this unique and vivacious soul – in the last couple of years she’s fought and won a battle against breast cancer, all whilst maintaining her infectious ‘can-do attitude’ and effervescent sense of humor.

I caught up with Sue for a chat, about running life modelling classes online during lockdown, gossip sessions with Lucien Freud, thoughts on austerity and more…

Sue Tilley as drawn by Tina Mansuwan from Bangkok

You used to work as a cashier at Leigh Bowery’s infamous Taboo night club in London, which quickly became notorious for its avant-garde and fringe sensibilities. What impact do you think the scene has had on mainstream art and culture today? How do you think Leigh Bowery would feel about this legacy?

I’ve always said if you went to Taboo one of two things happened – either you died or became a great success! Lots of people from ‘the scene’ went onto establish themselves in the arts… the film director John Maybury, fashion designer John Galliano and even the girl band Bananarama – if you’ve heard of them – were all regulars at the club! 

I think the club kids today are probably quite jealous of the fun we had – it was such a different time – our biggest excitement was getting our photo in magazines like The Face or i-D! 

Gender fluidity and being non-binary are considered much more mainstream now. I’m still surprised when people are shocked by it though – why does it matter what people identify with, as long as they’re happy? 

I know Leigh would be proud to be considered such a trail-blazer – he always wanted people to be different and was very interested in challenging perceptions of the human form. 

Sue Tilley as drawn by her 8-year-old nephew, Reynard

You modelled for the artist Lucian Freud on numerous occasions, can you elaborate on what it was like to sit for him? 

How important do you think the relationship between artist and human subject is in the creative process overall?

Lucian was very aware of the relationship between the artist and model – he really felt the model’s physical presence was vital to the overall composition.

I used to really enjoy sitting for him… it was very relaxing as you couldn’t do anything but pose in one position!

He was very keen on gossip and told me some great stories about celebrities such as Joan Collins, Cecil Beaton, Greta Garbo and Judy Garland!

Lucian had a wonderful sense of humour and would often make me laugh. He was a good cook too and would make me lunch or take me out somewhere fancy to eat, which I loved!

Alongside your work with Lucian Freud and colorful experiences at Taboo, you also used to work as a benefits supervisor, in Charing Cross. How did you find navigating such opposing realities and do you have any views on the recent spate of austerity cuts within the benefits sector, perhaps most notably to the arts?

I really like all the contrasting threads in my life, as I feel that they’ve given me a good, balanced view of things! 

Working at Charing Cross wasn’t too bad, however I found the last few years of my career at DWP very depressing. I’d often end up crying with the customers, as their situations seemed so hopeless. I was thrilled when I was offered redundancy, as it meant I could finally get out! 

I think the cuts to the arts have been terrible, but we also need to prioritise the NHS, charities and similar services for those who need it most – especially now with the current health crisis.

You moved to St Leonards in 2017 after many years in London and shortly after, you were diagnosed with breast cancer, from which you’ve since thankfully recovered. Did your background in the arts play any part in helping you through such dramatic life events?

I moved to St Leonards on a bit of a whim really – I had no plans to leave London, but decided to after visiting a friend here. I’d been here a few weeks when I met Tom Bartlett from The Sea Spray Gallery, who offered me an exhibition and a studio, which was amazing. 

I discovered I had breast cancer a few months after I moved here. The staff at Carisbrooke Surgery, The Conquest and Maidstone Hospital were just amazing… so supportive and kind. I’m not sure if my background in the arts helped me through, although I think a positive attitude probably did. I try not to worry about things and just focus on making the most of every day. 

I’m a huge fan of your virtual life drawing classes, which you’ve been running via Isolation Station for the duration of the current lockdown. What sort of response have you had from the community and what does it mean to you personally, to be able to help facilitate such a creative outlet for others?

I absolutely love running classes and used to hold them at The Fountain Pub, where my friend Wayne Shires is the landlord, prior to the lockdown. I was thrilled when Isolation Station, Hastings asked me to hold them online instead.

I modelled for the first one, but we’ve had other people modelling from home too – I had my friend from Lisbon this week so we’ve gone international now! Anyone can join in and we’ve had people from all over the world signing up to take part, as well as our regulars. People can send their sketches in at the end and we have a gallery on Facebook too, which is very popular.

Next week I’ve got London nightclub and fashion legend, Princess Julia modelling. We’ve been friends for over thirty years, so there should be some good chat and she’ll be brilliant to draw!

I also do a weekly online quiz via Isolation Station, which I used to run on a regular basis at The Cactus Hound. I love writing the questions and they often represent my own interest in modern culture and art.

From Sue Tilley’s art class at the Fountain Pub, Hastings

Why does it matter what people identify with, as long as they’re happy?

Having sat for one of the most highly regarded artists of the last century, which famous painting would you most like to feature in and why?

I’d have loved to have sat for any painting by Matisse – apparently he had a wardrobe of clothes for his models to dress up in! I actually told Lucian he should have one but he wasn’t too keen on the idea – he preferred his models nude! I often set up the models and backdrop for my art classes in the style of Matisse – lots of bright colours and flowers. 

You’ve worn (and modelled!) many hats throughout the years, what’s next for Sue Tilley?

Who knows… I never really plan anything… opportunities just seem to come my way!

I have got one exciting thing in the pipeline, but I can’t really talk about it at the moment! I’m sure the world will be a different place once all of this is over, so we’ll have to just wait and see what happens won’t we?

• You can find out more about Sue Tilley’s online life drawing sessions and quiz session’s @isolation.station.hastings on Facebook.

I was asked to say a little bit about what it’s been like in general practice since the Coronavirus crisis. Well I saw a brilliant little clip that sums this up perfectly: it was one of those old Donkey Kong style games with obstacles coming at you from all angles so you had to leap out of the way. 

During the first week of the lockdown everyone froze in time and kept away from the GP surgeries so it was reasonably quiet. However, this was the calm before the storm, as we had to all pick ourselves up and start to analyse what was needed in the coming weeks and months.

Now imagine all the red poles spinning

It was soon evident that we still needed to keep essential medical services going, such as the cervical smear program and childhood immunisations, amongst others. There’s no point in surviving the Coronavirus only to die of things like cervical cancer and measles. 

Another issue we face in general practice is the fear and anxiety that the pandemic has created on so many levels. One particular topic that has caused a huge amount of angst is that of the government designation of a high-risk patient category, which has been given the name ‘shielding’. These people need to stay at home as much as possible unless they have essential medical appointments and minimise their contact with the outside world for at least 12 weeks.

The problem is that initially the government had quite a broad range of conditions that were felt to be at risk – affecting some 19 million people – but they quickly narrowed this down to the much smaller number of around 1.6 million, those with conditions that come with very strict criteria, e.g. those with cancers who are undergoing chemotherapy.

For more information on this please go to the govt website https://digital.nhs.uk/coronavirus/shielded-patient-list

Unfortunately, the broad criteria were published first and this has created a lot of anxiety amongst people feeling that they should be on this list of the shielded, and it has been GPs who have had to advise them that they are no longer on the elusive list. 

Who knows when this will all end? But one thing is for sure: Coronavirus is not the only disease that needs to be considered in our nation and general practice is at the heart of ensuring we keep people healthy in many other ways. Surgeries are now implementing strict processes to ensure your visits are as safe as can be e.g. HOT sites where patients with suspected symptoms are seen and COLD sites where only people with no symptoms are seen. On the COLD site everyone’s temperature is measured on arrival and, if high, they aren’t allowed in, including staff.

By Maya Evans

In a week when the Coronavirus crisis sent millions into isolation in their homes, and the NHS was braced for an influx of patients, Planet Earth sent its loudest warning shot to date – human behaviour needs to change. COVID-19 is thought to have originated from the capturing and selling of wild animals for meat. This lack of respect towards other living creatures reflects the general lack of regard for our ecosystems such as the large-scale burning of fossil fuels, which is causing the planet to rapidly warm. What we are seeing today is a relatively small indication of what to expect in
20 to 30 years time, unless we take immediate drastic steps to change. 

In the same week UK Covid-19 lockdown was declared (23rd March), Hastings Borough Council played its part in preparing to avert catastrophic climatic change by passing its emergency climate change strategy and action plan. This follows the climate change motion of last year, pledging to go carbon neutral by 2030. Since then, HBC have been working on a strategy, with a key focus on renewable energy.  

The Covid-19 crisis has, for now, put our ambitions and action plan on hold.  But this tragic crisis has demonstrated a number of optimistic lessons for the task of tackling climate change. 

Government action

Maybe most importantly, the Government can make dramatic and radical decisions overnight and, when necessary, it can throw a LOT of money at a crisis.  Covid-19 has proven that, within a week, big money can be freed up, legislation passed, and human behaviour can dramatically change via a three-word message ‘stay at home’. 

In the same way that climate change has been a scientifically proven fact for decades, a global pandemic has been on the cards for over 10 years. Bird flu, swine flu, SARS, MERS – all triggered warnings which the government ignored, leaving the NHS without the appropriate resources and government without an adequate action plan. 

Global pandemics and climate change also share another thing in common: many people, mostly the vulnerable, are sadly going to die. The key difference between runaway climate change and Covid-19 is that a pandemic will eventually subside; sadly the same cannot be claimed for the planet post-climate tipping point: once the global temperature increases more than 1.5c, there’s no return to ‘normal’ and many more lives will be at risk.

Lessons to be learnt 

The UN’s Environment chief, Inger Andersen, said this week: “Nature is sending us a message with the coronavirus pandemic and the ongoing climate crisis: not taking care of the planet means not taking care of ourselves”. 

Incredible stories about the planet miraculously rejuvenating in just a few weeks are now appearing, everything everything from NASA images showing air pollution levels plummeting to dramatic improvement in the clarity of water in the canals of Venice. Optimistically, the planet has demonstrated an incredible ability to bounce back. However, the current dramatic energy scale-down has been hurting people and is unsustainable, which is why now is exactly the time to lay the foundations for a just and sustainable transition – a less chaotic scale-down which will benefit people and the planet.

Transition has now proven to be relatively easy and fast – within a week leading arms companies BAE Systems and Airbus re-skilled their workforce and tools into making desperately needed ventilators. It has been a longstanding demand of climate change activists for the multi-billion-pound arms industry to transition into making cutting edge renewable energy technology. Only a few months ago Jeremy Corbyn was ridiculed for suggesting that the British Forces should become a global emergency climate crisis response service. Today we see the British military mobilised to build the Nightingale Hospital in East London and distribute food parcels to the elderly. 

No temporary fix

Inspiringly, we’ve seen 700,000 step up to help the NHS, while in Hastings HEART volunteers have signed up for activities such as calling vulnerable people who are self-isolating and delivering essential supplies. All of this speaks to a community spirit, mutual aid and a sense of solidarity that can be harnessed to tackle climate change. The last few weeks have seen the world participate in a mass action never witnessed before – this precedent is key for our future fight against climate change.

What we’re seeing now is the practice run for the impacts of climate change. Once this crisis is over, we cannot go back to business as usual. It cannot be a temporary fix. This is the wake-up call telling us that things need to dramatically change, and it can potentially signpost us in the right direction.

• The writer is cabinet member for Climate Change on Hastings Borough Council.

Among the online apps that have become important during the pandemic, Nexdoor is at the forefront.

Unofficial spokesperson for the Nextdoor in Hastings and St Leonards is Dave Smith, who launched the COVID-19 support group and is also moderating it.

He says: “I just wanted somewhere that local people could find friendly, local help whilst in self-isolation but without being as ‘public’ as Facebook. The response has been amazing.” 

He explained that Nextdoor has set up a ‘volunteer map’ for each district so people in need can find local help. “The last time I checked the combined map for the Hastings area, we had over 50 volunteers offering everything from dog walking to collecting shopping or simply a friendly chat on the phone.”

Commenting on the work that Hastings Emergency Action Response Team are doing, he made it clear that he didn’t see it as competition. “It’s a situation where so many need help that each group needs to be able to do its own thing.” He thinks they’re doing a great job and “if there was a situation we could not deal with, any of us would happily refer on”. 

Dave points out that Coronavirus has resulted in a massive boost in the Nextdoor membership, with well over 700 joining in recent weeks so that now over 4,000 households are registered in the Hastings area. “As sad as the COVID-19 crisis is, it has brought people together, and problems are dealt with as a community rather than alone.”

Ironically, Dave is currently in the second week of self-isolation, as his partner has had the virus. He’s therefore been restricted to admin and moderation of the group rather than getting out and helping, “but having so many volunteers, that hasn’t been an issue”. 

He feels that much of their help has been verbal, rather than physical. “On many occasions people just have questions about shopping, whether they should be phoning NHS 111, asking who to phone because their boiler has broken down, which store has loo rolls in stock or similar queries.” On the group page he has also provided links and phone numbers which may be useful during this pandemic.

“Now we are all in lockdown … we are all beginning to understand the frustrations of losing our freedom and the need to talk to somebody,” he says.

Dave would encourage every household in the town and surrounding areas to join Nextdoor, and not just to find help during this crisis: “When it comes to any issues across the town, like crime and suspicious behaviour, we spread the word before the emergency services have even turned up. Also the more volunteers we have, the better!”

When should we expect the epidemic to peak? The government suggests not for several weeks, but other evidence points to the possibility that it has already done so.

The key is when did Covid-19 arrive in Britain? The first officially recorded case was 31st January and the first documented incidence of transmission within the UK, February 28th. But we now know that one East Sussex family contracted the virus in mid-January after Maresfield father, Daren Bland, returned from skiing in Austria and transmitted it to his wife and children – probably a month before the official date. Hundreds of cases around Europe have been traced back to the Austrian ski resort. This could seriously affect epidemiologists’ assumptions about the rate of transmission throughout the country. 

The NHS is reported to be facing a ‘tsunami’ of cases in the next month, but if transmission within the UK began at the end of January and not the end of February, then it could be wrong, and the country should already have seen the peak.

Eminent epidemiologist Neil Ferguson originally predicted possibly a million deaths in the UK, but last week US media reported he had revised down those figures to 20,000 or ‘far fewer’. His new figures assume many more people probably have, or have had, Covid-19 than previously thought. Which is consistent with it being transmitted up to a month before previously thought. However Ferguson’s revised figures are predicated on continued lockdown and social isolation.

PICTURE: Anshu/Unsplash

What is the death rate from Coronavirus? 

Or put another way, when is a death from Covid-19 NOT actually a death from it?

Testing for the virus is a long and complex procedure. Nasal swab RT-PCR tests carried out in hospital need laboratory analysis, so it can be days before results are known. So are all deaths attributed to
the virus actually from it and, anyway, might a number of patients have died of respiratory illness regardless? As HIP reported last year, posters promoting annual flu jabs claimed ‘10,000 die from flu infections annually in England and Wales’. But former Chief Medical Officer, Sir Liam Donaldson, revealed that influenza related deaths for England and Wales were in fact 44 in 2005 falling to 39 in 2008. This massive discrepancy seems to have begun with US policies to lump together all deaths from respiratory disease, including ‘flu-like’ illness and pneumonia. Thus the US figures for these deaths in 2001 was 62,000. The BMJ (British Medical Journal) later revealed that only 257 of the deaths were actually attributable to flu, and of those just 18 were confirmed cases of the virus.

Could the same or a similar thing be happening with the current Coronavirus epidemic? If so then the death rate – put at 3.4% of all who contract the disease – is unlikely to be accurate. In fact, because some cases of the disease are asymptomatic and others are very mild, many people don’t know they have it or don’t report it. Edinburgh University’s Professor Mark Woolhouse believes it means the overestimation of mortality rates could be 10 times too high, making it nearer 0.34% rather than 3.4%.

How complete should the lockdown be? 

The government has been criticised for sending mixed messages over who can continue to work and to travel while civil liberties campaigners argue that the police are already using unnecessarily heavy-handed techniques that are at odds with the actual law. Sunbathers in a London park were dispersed by officers who told them it was not a holiday and “you can’t just come here and sunbathe”. Quite apart from the clear health benefits from exposure to sunlight providing vital vitamin ‘D’, people travelling on public transport or shopping for essentials are at much greater risk than those observing a safe distance outdoors.  

The use of police drones to monitor visitors to national parks, and the closure of beaches or beach car parks are also seen as excessive and counterproductive. The government’s advice is to stay indoors where possible. But as we reported in the last issue, fresh air is a tried and tested method of both treating and preventing infection for many airborne diseases. Dr Jill Vines told The Guardian: “I am surprised that the intervention of fresh air and increased air flow to reduce Covid-19 infection does not appear to be mentioned in the advice to the public.”

While all sorts of other groups have sprung into action such as Isolation Station providing online entertainment and Arts on Prescription providing creative opportunities, HEART has been busy working behind the scenes, setting up a robust response that can provide a safe and comprehensive local hub for practical support with people self-isolating.

The initial face of HEART was its Facebook page, but as one of its founders, Alastair Fairley commented: “The Facebook page has served its purpose of enlisting volunteers. It’s limited in what it can do.” 

A great deal of work has been put into setting up a website and despite technical difficulties – involving calling in the help of East Sussex College – it is now up and running at www.hastings heart.com. There you can find answers to what HEART is, how it operates, who is behind it, etc. More importantly, it has a form for people to request help, and currently contains information on such things as health and wellbeing and local food suppliers. 

Now up and running, this will expand over time to include such things as proforma letters to make it easier for people to apply for what they need and deal with the inevitable bureaucracy that will emerge.

A lot of work also went into such issues as health and safety: with so many people involved it’s important not to endanger either the volunteers or the people they are seeking to help. Work is also well under way to match people up with those needing help. 

Currently there are about 40 volunteer coordinators operating area by area. These are being kept local where possible to promote cohesion, some perhaps known to volunteers. Almost 1,000 volunteers have signed up to help where they can.

A lot of what HEART will be doing is signposting people to the right place for their needs. But very importantly it aims to react to community needs as they arise, trying to ensure that nobody is left out: for example, they are producing cards that volunteers can post through letterboxes with their contact number where there has been no response.

How to manage money is another big issue. When shopping for others, it isn’t considered appropriate to use cash – OK on a small scale but not when large sums might be involved. After considerable research, they have chosen to go with Pockit prepaid cards: it’s easy to apply for with a simple form and costs just 99p per month. 

“The whole thing will develop and grow,” says Alastair. “It’s been a lot of work to set up a robust solution, but once set up it will always be there for any repeat.

“And in the end,” he says: “Lots of people just want a friendly person to talk to”.

The cure, it says, is “free, easy to take, has an immediate effect and you don’t need a GP to get some. Its name? Exercise”.

On another section of the NHS website headed “Stress Busters” readers are further advised to “connect with people”; to “take some time for socialising”; and to set themselves “goals and challenges….such as learning a new sport”.

It’s ironic, then, that, in the name of protection from a virus that seems to be striking most harmfully at people who are already in poor physical shape, the health benefits of playing sport have been so comprehensively cut off – for who knows how long.

Direct Physical Contact

Sports involving direct physical contact have been obvious casualties of directives designed to lower, if not eradicate, viral transmissions.

Suspension of not only the Premier League but most other professional football announced on 13th March seemed in some ways the trigger for wider social disengagement.  After PM Boris Johnson’s speech of the following Monday warning against, if not quite outlawing, “unnecessary social contact”, shutdown of the sport has extended to all grassroots levels – training as well as matches.

Hastings & Bexhill rugby club had their Kent Vase match against Kings College Hospital on the 14th blanked out because of the more pressing concerns of their medic visitors – but, then on the following Monday, the national RFU suspended all rugby activity at both professional and community level, including club training. Regional hockey authorities issued similar edicts.

The start of the 2020 cricket season has been postponed indefinitely, with “all forms” of recreational cricket suspended by the English Cricket Board, including “training, pre-season friendlies and any associated cricket activity”. 

Martial arts that necessarily involve close contact between contestants are another class of sport with no alternative to suspension. The Fighters Loft kickboxing gym, featured in HIP in January, is closing, though intending to offer “virtual classes via Facebook live”. West Hill Boxing Club, which managed to stay open all through the Second World War, has temporarily closed its gym, albeit with a fighting message to its members – “This doesn’t mean you can sit at home and play computer games, we expect you to keep your fitness levels up. Plenty of mirror work circuits and running. We will probably hold some outdoor sessions at some time too to keep up your fitness levels.”

Empty courts at Amherst LTC
PICTURE: Dave Young

Tennis at a distance

Tennis, a game in which, in singles at least, players are socially distanced at opposite sides of the net, might have hoped to be spared. Both clubs in town, Amherst and The Green, last week advised their members that while all external matches, tournament and formal club sessions were suspended, and social gatherings barred, their respective courts would stay open and clubhouse facilities kept usable for toilet and hygiene purposes. After Mr Johnson’s further edicts of last Friday telling pubs, restaurants and gyms to close, the Lawn Tennis Association directed affiliated clubs to shut off all “social spaces” including changing and toilet facilities. Players were advised not to change ends between games. Coaching was not banned outright if players were kept sufficiently apart, but fresh cans of balls were to be opened for each session with a recommendation that only coaches, and not their pupils, should touch the balls. (How the latter were supposed to serve was not indicated).

Amherst coaching team, 6-0 Tennis, which up to that point had continued with regular sessions for both adults and juniors, promptly announced an end to them. Then came the total lockdown imposed on Monday evening: club tennis courts were now branded as “community spaces” and barred. 

Hastings Half Marathon

All local athletics organisation has also ceased. Hastings Athletic Club has suspended all training as well as competition  “until at least the end of April”; Hastings Runners have issued a suspension notice likewise. The weekly Hastings parkrun on St Leonards seafront is off, with a plea not to arrange group gatherings at any parkrun venues whilst suspension continues.

The Hastings Half Marathon, due to be run this coming Sunday, was cancelled indefinitely. There will be no race this year; 2020 entrants are being offered free entry for next year’s race instead. Race director Eric Hardwick of the Hastings Lions Club issued a statement suggesting that those who were raising monies for needy causes and charities should “still try to run a ‘virtual’ distance at some time to obtain your precious sponsorship for those in need.” He admits, however, that the Lions will not be able to donate to local needy causes nearly £70,000 that was raised and spent last year.

“The Health of all People is what is Important at this difficult time”, Mr Hardwick concluded, “and we would encourage everyone to follow Government guidelines to protect themselves and others from this dreadful virus”.

Arguably, the health of most people would in fact be enhanced by the retention of socially distanced sport. But not even golf now survives: see below. 

Coronavirus pod at the Conquest
PICTURE: Dave Young

Vikki Carruth, the Trust’s Director of Nursing and of Infection Prevention and Control, issued a statement last month that “our staff have worked together to put in place everything that is required of us, to be prepared and respond if needed”.

National guidelines from PHE direct the Trust not to “get into a running commentary about numbers tested in our pods”. Any confirmed cases will be announced by PHE. At the time of going to press there have been none in the East Sussex healthcare area.

NHS 111 has an online coronavirus service that can tell you if you need medical help and advise you what to do.

Use this service if:
• you think you might have coronavirus;
• in the last 14 days you’ve been to a country or area with a high risk of coronavirus;
• you’ve been in close contact with someone with coronavirus.

Do not go to a GP surgery, pharmacy or hospital. Call 111 if you need to speak to someone.

Self-isolation
If there’s a chance you could have coronavirus, you may be asked to stay away from other people (self-isolate).

This means you should:
• stay at home
• not go to work, school or public places
• not use public transport or taxis
• ask friends, family members or delivery services to do errands for you
• try to avoid visitors to your home – it’s OK for friends, family or delivery drivers to drop off food

You may need to do this for up to 14 days to help reduce the possible spread of infection.

Like many people, I’m aware that all is not right with the NHS and that predatory corporations are looking to make lucrative profits through an ongoing process of privatisation. Yet even I am lulled by the constant denials from government that this is actually happening. 

So I was prompted to buy How to Dismantle the NHS in 10 Easy Steps to gain some clarity – after all, there is an election on the way. 

And what a shock to read that the total bill for PFI hospital building (a way of financing public sector projects through the private sector) is set to exceed £79 billion on capital costs of £11.4 billion. 

I could have read that in the Guardian, and perhaps have, but it’s so different when you read everything in context. The sheer waste of money is extraordinary, and much of it, apparently, with the purpose of preparing the NHS for privatisation. As quoted in a previous article in HIP Softly Killing the NHS, Issue 123: “PFI horrors can only gain their heady profits by selling us the story that our NHS is inefficient and uneconomical.”

But privatisation is still hotly denied and most people, at least at some level, believe that the NHS is still ‘safe in our hands’, the mantra bequeathed to the Conservative Party by Margaret Thatcher. Why this belief? Perhaps the main reason is that the government can point to the huge amount of money they are “ploughing into the NHS year by year”. But whether any promised increase is to make up for previous cuts is almost immaterial when much of the new money is just syphoned off into private hands. 

A kind of propaganda is drip fed to the media through ‘think tanks’ like the Kings Fund, who have this to say in answer to the question Is the NHS being privatised?

“Provided that patients receive care that it is timely and free at the point of use, our view is that the provider of a service is less important than the quality and efficiency of the care they deliver.” 

Well they would, wouldn’t they.In the words of Councillor Turner at the end of Battle Lines for the NHS: “Think very carefully who you are voting for at the ballot box.”

Things have a way of coming around with something you might mistake for vengeance or poetic justice. In this case it was my pelvis hitting the pavement in perfect edge-on alignment. There isn’t a scratch on the bicycle; It feels like it could be bad, but you fool yourself into thinking the pain will pass. 

You call a friend, the one you always call at times like this: Bob peels me off the pavement, muttering something about growing old gracefully, throws the bike in the back of his car, and squashes me, buckled with pain, through the passenger door like a soggy parcel too big for the letterbox. 

PICTURE: Bob Massa

“Straight to A&E for you, my boy,” says he. And there we are, in the Conquest carpark, my legs flopped uselessly out of the open door as he trots off for a wheelchair. We weave our way drunkenly across the tarmac and check in at a little bank-teller-style window. It’s a stock-in-trade A&E waiting-room scene: a sprinkling of patients – women, men and children and the customary nutcase giving the security crew a run for their money. 

And there you are, watching it all unfold. The place you never want to be. You’re a ball of sweat at the National Health Service coalface. And there’s the reminder of that poignant irony coming round to smack me in the chops. 

Just weeks ago, I’d written a piece on the NHS for this paper (HIP Issue 133: Battle Lines for the NHS). Not too flattering, how it’s terminally ill; death by a thousand policy cuts; great people and a great institution being hollowed out by neglect, cynicism and predatory market forces. And I’d just walked into the lion’s den.

Thank God it’s not a busy evening and we don’t have to wait long. Ivanka summons us to a cubicle for a preliminary assessment. It’s hardly a high-tech affair. “I fell off my bike and it hurts a lot,” I tell her, enough to qualify me for a trolley and admission to the inner sanctum where worlds collide. Indeed, it’s a United Nations of health care, a shimmering mélange of races and skills, from the Zimbabwean nurse who administers my first shot of morphine to the Panamanian consultant who sends me for CAT scans after concluding that the x-rays aren’t telling the whole story. 

I’m glad he did. They were about to pack me off home with paracetamol, wet-wipes and a Zimmer frame when it was decided that pain like mine can only signify a fracture. Turns out it’s the hip-joint, the socket part, and a tricky little number to fix. It’s well after midnight when I’m finally sent up to the ward – and Bob finally goes home. 

If they decide to operate, it’ll be in Brighton where the pelvis wizards live. That’s how the new NHS works, concentrated resources in ‘centres of excellence’. Not everyone’s happy about it but right then it was a relief to know that the local orthopaedic crew, masters of hip and knee replacements, freely admit they have limits.

It’s 7am the following morning and the orthopaedic consultant, retinue in tow, drops by. Early forties, crisp white shirt, perfect half-Windsor, not a hair out of place, he might have stepped straight off Holby City. Brighton are in the loop, and they agree. Send him home but put no weight on that left leg for twelve weeks. But first I’ll spend another week in the ward learning how to get in and out of bed, how to hop around on a Zimmer frame and on crutches. 

I quickly forge relations with the health crew, the lowly health care assistants, the HCAs who are the backbone, the very pulse of our hospital services, working twelve-hour shifts night and day; and the other patients, the hip-and-knee-op people on my ward. One pair are octogenarians, unsure when they’ll be allowed home – or whether they have homes anymore. No handy slot for the system to patch them into. 

I saw the consultant just once more – seven in the evening of that first day. He looked reassuringly disheveled after 12 hours.

What the NHS lacks in financial resources, it makes up for with love and dedication. But love can only go so far because from time to time it must surely flow the other way – from us, from government. Because when it works, this NHS thing of ours is a living miracle. 

The medical walk-in centre at Station Plaza in Hastings will be kept open, re-styled as a Primary Care Hub and offering from December an “advanced nurse-practitioner-led service”. That is how Jessica Britton, managing director of the Hastings & Rother Clinical Commissioning Group (CCG), described it to members of East Sussex County Council’s Health Overview and Scrutiny Committee on 26th September, confirming that the previous proposal to shut it down and move the facility to the Conquest Hospital has been reversed. 

The centre will in its new guise close at 6.30pm each evening rather than, as currently, at 8pm. It is intended to provide greater “integrated services”, directing patients on, where appropriate, to community nursing units or the county council’s social care teams rather than to GP facilities.

Ms Britton said that most patients currently attending the walk-in centre are already registered with local GPs, but many come with concerns over benefits or housing issues, which had been diverting GPs away from other patients.