Councils turn backs on care for older people

In the same week as MPs voted in favour of gifting the audit-failing European Union a massive and unjustifiable increase in funding of £7bn, it has been revealed that nearly three-quarters of local authorities in England are rationing social services to exclude tens of thousands of vulnerable people from help with the basic tasks of daily living.

The Guardian reports today that official figures obtained by the charity Mencap reveal the worsening plight of people who cannot wash, dress, prepare a meal or go to the shops unaided - a growing problem this blog has been recording now for more than a year.

It said the problem affected older people and adults with learning disabilities in areas where cash-strapped councils have decided they can no longer afford to provide services to everyone in need.

The information, from the Commission for Social Care Inspection (CSCI), found 73% of local authorities were planning to refuse care to everyone whose needs were not considered to be "substantial".

The government's definition of substantial covers people who "cannot carry out the majority of their personal care or domestic routines" and do not have anyone available to provide voluntary help.

It excludes people with "moderate" needs who may not be able to carry out several daily routines such as getting up in the morning, bathing and doing the washing up.

The CSCI found four local authorities intending to ration services even more tightly to provide care only to people whose needs are "critical".

Under this definition, people would not get support unless their life was in danger or they were at risk of serious abuse or neglect.

The four were Northumberland, Surrey, West Berkshire and Wokingham councils. They are about to be joined by the London borough of Harrow, which yesterday defended plans to tighten its eligibility criteria at a judicial review in the high court.

Dame Jo Williams, chief executive of Mencap, said: "These figures show the true extent of the crisis in social care. It is unacceptable in the UK in the 21st century that local authorities are refusing support to very vulnerable people with a learning disability who have no one else to turn to.

"Last month the government gave an increase of less than 1% for social services. Given rises in demand, we will just see more and more cash-strapped councils cutting back."

The tightening up of council funding means the number of households across England receiving local authority care fell from 528,500 in 1991 to 345,000 this year, despite growing numbers of older people.

The CSCI data showed rationing has become much tighter over the past two years. In 2005-06, 54% of authorities restricted services to people whose needs were deemed "substantial".

This increased to 62% in 2006-07 and - according to councils' official plans - would reach 73% by the end of March.

Gordon Lishman, director general of Age Concern, said: "Chronic under-funding of home care services means people are being deprived of the help they need until they reach crisis point ... We need a better system for paying for care to end the postcode lottery and the unfair way people on low and modest incomes are charged."

The Local Government Association said: "Councils want to provide the services vulnerable people need but are increasingly unable to do so because central government funding has not kept pace with the demands of an ageing population."

David Rogers, chairman of the association's community wellbeing board, added: "Ministers need to turn with urgency to the long-term overhaul of the future funding of adult care services ... It is unjust that people have to wait until their life is threatened, or suffer from a serious mental and physical illness, before they receive care.

"If society is to meet people's needs and aspirations, the social care system needs root and branch reform, giving individuals choice, independence, dignity and control over their lives."

Harrow council last night defended its decision to save £2m by withholding services from people in substantial need. Chris Mote, the leader, said it received less from the government than other London boroughs and had to concentrate support on the most vulnerable.

"We were forced to take action ... to balance the budget" he said.

MPs have a moral obligation to be far more responsible with scarce public money than gifting it to EU, which has a terrible reputation for waste, fraud and mismanagement.

They must choose to stand up for properly-funded care for vulnerable people and vote against the European Communities (Finance) Bill at its final reading in a few weeks time.

'Cost-cutting' a factor in loss of data

The Government has today been accused of putting cost-cutting ahead of security as the fall out from the HM Revenue and Customs scandal continues to escalate - reports the Daily Telegraph.

Internal HMRC emails show that officials were concerned about incurring additional costs after receiving a request by the National Audit Office for details of its child benefit database.

In an email dated 13 March, with all named blanked out, an NAO official said: "I do not need address, bank or parent details in download - are these removable to make the file smaller?"

However, a subsequent internal HMRC email stated: "I must stress we must make use of data we hold and not over burden the business by asking them to run additional data scans/filters that may incur a cost to the department."

According to the Daily Telegraph, the procedure to delete the details - which would have removed much of the threat of identity fraud - would have cost just £5,000.

When the NAO asked for further copies of the files for an audit in October, an official wrote: "Last time we had 100 zipped files on 2 CDs. Please could you ensure that the CDs are delivered to the NAO as safely as possible due to their content."

The CDs were then sent by a 23-year-old junior official from HMRC through courier TNT, neither recorded nor registered.

Following the release of the emails, Liberal Democrat acting leader Vince Cable accused the Government of putting "minor cost-cutting" ahead of security.

"IT experts point out it is possible to strip out data for a modest sum but the Government's short-sightedness has led to millions of personal details getting lost in the post. This is simply unacceptable," he said.

The news that this administrative disaster rested on a desperation by the Customs & Revenue service to save a matter of £5,000 puts the decision of MPs to lavish an extra £7bn of public funds on the audit-failing European Union in stark context.

MPs simply cannot justify giving such vast sums to an organisation - the "majority" of whose annual spending remains unverifiable by auditors - while witnessing these catastophic results of drastic cost-cutting at home.

Each MP who now exhibits such misplaced priorities and votes to approve the European Communities (Finance) Bill at its final reading in Parliament in a few weeks time will have to shoulder the blame for the consequences of public money running out, like those we've seen this week.

Norfolk: Bed crisis sparks hospitals alert

Hospitals across the east of England have been placed on "black alert" as staff and wards are overwhelmed by high patient numbers - reports the BBC.

Non-urgent cases have been sent home after up to 10 ambulances were left queuing outside one hospital.

Few or no beds are free at Queen Elizabeth Hospital, King's Lynn, and the James Paget Hospital in Gorleston, both in Norfolk.

People with minor injuries have been urged not to attend A&E.

The alert status means plans designed to enable staff to cope with major incidents, such as terrorist attacks and train crashes, are put into action.

At the Norfolk and Norwich University Hospital (NNUH), which announced it had reached the emergency status on Wednesday afternoon, managers worked with other agencies to discharge non-urgent patients from the 1,000-bed hospital to create space.

However, the hospital said that between 60 and 70 beds were still being blocked because patients who were medically fit to leave had no where to go.

Paramedics treated patients in ambulances outside the NNUH on Wednesday evening.

A spokesman for the East of England Ambulance Service said: "Most things we can manage - it only becomes critical to get someone out of the ambulance and into the hospital if someone is bleeding to death or in full cardiac arrest needing resuscitation.

"There were serious condition patients but they were being treated at the NNUH by hospital staff."

NNUH spokesman Andrew Stronach said there was no single incident that brought on the beds crisis.

"It's just general run of the mill problems, like chest pains, collapses, diarrhoea and vomiting."
The James Paget hospital and the Queen Elizabeth in Kings Lynn said there were sufficient beds, but a sudden change in the weather was putting extra pressure on them.

Norman Lamb, MP for North Norfolk, said the hospital was regularly well above the safe occupancy level of 85%.

He said: "If there was to be a flu epidemic this winter then we've got a major crisis.

"Across the country we're seeing occupancy rates increasing. There's also evidence that you run an increased risk of hospital acquired infections if you've got a hospital that's literally full.

"This is a serious problem and yet there appears to be nothing being done to increase the capacity to ensure that there's enough beds to treat patients."

Milton Keynes and Hertfordshire health officials have said they are not on alert, but Bedford Hospital has been on red alert since Friday.

In Suffolk, Ipswich Hospital said it had very few beds but was managing the situation and a spokesman for the West Suffolk Hospital said its alert had been caused by sickness bugs.

Norfolk MPs Norman Lamb and Henry Bellingham can fairly claim to be doing their best to ensure local hospital services have the facilities and resources they need to avoid situations like this developing - by opposing the payment of an extra £7bn to the audit-failing European Union.

However, Tony Wright MP for Great Yarmouth and Ian Gibson MP for Norwich North both voted on Monday to approve this unjustifiable extra multi-billion-pound spending on the wasteful EU, so can hardly claim to be doing their best for essential local services.

Local voters need only wait a likely 18 months for the next general election, to let them know what they think of such irresponsible decision-making.

'Inadequate care' in half of A&E trauma cases

Less than half the patients admitted to accident and emergency departments with severe injuries get adequate care - according to the Daily Telegraph.

A Government-funded report has found that 20% of hospitals have no dedicated trauma team and that care standards drop significantly at night, adding that trauma patients are being treated by inexperienced staff who display little urgency and make incorrect clinical decisions.

The Government is expect to seize on the findings to support a White Paper published last year advocating centralising trauma care in specialist regional centres, at the price of local A&E departments.

Critics suspect the proposals are more about cost-cutting than patient care and say the move could see 29 hospitals closed. They argue this will jeopardise the survival of patients, who will be put at risk by travelling the extra distance to a trauma centre.

Their fears are backed by recent research which suggested that mortality rates increase by 1% for every extra six miles travelled.

Commenting on the report, Dr Jonathan Fielden, of the British Medical Association, said: "It must not be taken to support closing local units, it should be used to improve patient care. There need to be more consultants employed in the NHS to lead trauma teams."

The report, "Trauma: Who Cares?", published today by the National Confidential Enquiry into Patient Outcome and Death, says hospital trusts must ensure a trauma team is available 24 hours a day with an experienced consultant as leader.

Sadly this is unlikely to be affordable while MPs splash so much public cash on the audit-failing European Union.

On Monday, MPs voted to approve a massive £7bn increase in funds, taking our annual EU payments to an astonishing £10.5bn gross every year.

But while the "majority" of the EU's spending remains unverifiable by auditors, and reports of EU waste and fraud continue, there is absolutely no justification for rewarding the EU with such a huge increase in payments.

No wonder the government is having to consider centralising trauma care in regional centres, instead of properly equipping local A&E departments. Where are our MPs' priorities?

Cash crunch will stop Forces doing their job, says ex-Army chief

The former head of the Army has warned that the Armed Forces are facing a cash "crisis" - reports the Daily Telegraph.

The news comes as, just two days ago, MPs voted to approve the government's pledge of an extra £7bn to the EU's budget, despite last week's revelation that the EU Court of Auditors has been unable to verify the "majority" of the EU's spending for the 13th year in a row.

Gen Sir Mike Jackson said recent spending commitments by the Chancellor were likely to prove insufficient to ensure the country's "national insurance policy", raising doubts over whether the military will be able to pay for future operations or major equipment projects.

Speaking to BBC Radio 4's Today programme, he said: "I detect, I fear, some crisis ahead in defence spending, if things go on as they are in terms of what we do, what we might have to do and the money allocated"

He hinted that there might be bad news ahead for one of the military's main procurement projects, such as new destroyers or submarines.

Since resigning, Sir Mike has also criticised the MoD's treatment of soldiers, particularly the standards of pay and living accommodation.

The MoD is currently battling with the Treasury over funding of equipment projects and "urgent operational requirements" of kit needed in Iraq and Afghanistan.

There are also worries that without proper funding the military is going to continue to lose substantial numbers of troops who are fed up with poor pay, accommodation and constant operations.

MPs need to think again about whether gifting the EU billions of pounds extra is either affordable or justifiable while a "majority" of its spending cannot be verified, in advance of the Third Reading of the European Communities (Finance) Bill.

Those who vote for such large-scale waste of public funds will then have to bear personal responsibility for the consequences of shortfalls of funds elsewhere, many examples of which are already in evidence.

London: Health summit paves way for abolition of traditional hospitals

A major health summit is taking place today will change the face of the NHS in London, reports the Evening Standard.

Senior managers and doctors are meeting to draw up plans that will abolish traditional hospitals.

They are finalising a major consultation document that asks every Londoner to decide if GPs should move into big polyclinics.

Patients will be asked a series of crucial questions - signed off at today's meeting - that will lead to the massive changes next year.

They will be asked about the centralisation of services such as trauma care, treatment of children and the care of stroke victims should be centralised away from local hospitals into so-called "specialist" centres.

And whether more maternity departments should be run by midwives instead of doctors.

The consultation will be launched at the end of the month and is likely to trigger battles to
save local services.

Bosses have refused to name the hospitals and surgeries that should close and are consulting on "ideas" first.

Robert Creighton, chief executive of Ealing primary care trust, and one of the leaders of the consultation, said: "We want to get people's views about the proposals and we intend genuinely to listen to what the public have to say."

But doctors have warned that the plan is being driven through. Dr Stewart Drage, head of Londonwide Local Medical Committees, said: "We have reservations about this whole process. We are concerned that the local input is going to be very limited."

It comes as campaigners find out the results of a consultation to downgrade Chase Farm hospital in north Enfield.

Thousands have been fighting plans to move A&E and maternity services to Barnet and North Middlesex and make Chase Farm a community hospital.

The summit meeting into changes across the capital - taking place at the Sofitel hotel near St James's Park - could mean the plans for Barnet and Chase Farm change again.

The proposals are based on plans drawn up in the summer by junior health minister Lord Darzi, who is now leading a nationwide review of the NHS.

Questions must be asked as to whether these changes are being driven more by attempts at cost-cutting than to enhance patient care.

With MPs voting an extra £7bn to the European Union completely without justification on Monday of this week, public funds for essential services are becoming increasingly tight.

It's time MPs looked again at the real priorities of those they represent, before they give final approval to this multi-billion-pound funding increase to an organisation that has failed its annual audit for 13 years and is beset by reports of needless extravagance, waste and fraud.

Come next year, it'll be no good MPs posturing in protest against hospital closures in their constituencies if they've voted to waste such vast sums of public money on the EU. They will be personally responsible for the money running out, and themselves can expect to pay the price at the ballot box.

State borrowing to rise as Treasury left with little 'wiggle room'

The Government is on course to exceed its borrowing targets by as much as £4bn this year, as public finance data came in much worse than had been expected - reports The Times.

Analysts said that the public sector net surplus was £993 million in October, compared with expectations of £3 billion, putting a dampener on the health of Alistair Darling's forecasts as the economy enters the second half of the fiscal year.

The Chancellor forecast in his Pre-Budget Report that public borrowing over the year as a whole would reach £38 billion. But the Institute for Fiscal Studies (IFS) said yesterday that the figure could reach £42 billion if present trends continued.

PriceWaterhouseCoopers predicted that the State would borrow £40 billion this year and next.

The IFS said that the overshoot in borrowing was because capital spending was growing twice as quickly as the Treasury forecast.

John Hawksworth, head of macroeconomics at PriceWaterhouseCoopers, said: "At this point in the economic cycle, the public finances should be improving in order to provide some 'wiggle room' in the event of a future cyclical downturn."

"The fact that they are getting worse will be of concern to the Treasury, since it suggests possible structural weakness and a potential need for further tax increases or greater spending restraint looking ahead."

In this context, the apparent enthusiasm of the government and many MPs to spend an extra £7bn on paying the European Union's extravagant and largely unverified bills looks particularly ill-advised.

Those MPs who vote approve these extra payments when the final vote in Parliament on the European Communities (Finance) Bill comes will consequently have to bear major responsibility for the tax increases or other public spending restraints impacting on their constituencies that analysts are now saying will have to come if the public finances continue to worsen.

Such irresponsible decisions to throw billions more pounds every year into such a black hole of waste, extravagance and fraud cannot possibly come without a price.

Norfolk: Third of crimes not investigated

Police chiefs have defended their screening policy after it emerged that a third of crimes reported in Norfolk are not investigated by officers - reports the Eastern Daily Press.

Figures released by Norfolk Constabulary show thousands of crime reports get no further than civilian call-handlers, under the supervision of an officer, who are trained to decide whether or not an incident is serious or solvable enough to warrant further investigation.

Opponents of the policy claimed the figures proved the force was under-resourced and under too much pressure to chase government targets.

However, senior officers defended the system, saying it helped it to make the most of limited resources, and that no category of crime was risk-free for the culprits.

During 2006-07, 20,739 crimes were screened out from a total of 62,626 reported - a rate of 33%, which is just below the national average of 39%. Of those, 9,375 thefts and 8,819 cases of criminal damage were not investigated.

Other crimes not probed included burglaries, violent crimes and drug offences.

Det Supt Julian Gregory, of Norfolk police, said: "As with any public sector body we have a budget and finite resources and it is vitally important to target those resources to where we get the best benefit for the community. It is common sense."

Norwich North MP Ian Gibson said 33% seemed to be a very high number and called for an explanation.

"The police force needs to explain in more detail about why these crimes are not being investigated, because I think members of the public really need to know," he said.

Norman Brennan, chairman of the Victims of Crime Trust and a serving police officer, said: "The sad reality is that police numbers have not kept pace with the huge rise in crime across the spectrum.

"The public are our masters and have a right to know why we don't turn up to every call and investigate every crime."

Screened out offences are still counted in official crime figures, and victims are issued with reference numbers for insurance purposes.

Norfolk was one of 12 English and Scottish forces which released the figures under Freedom of Information laws. Suffolk Constabulary does not operate a screening policy.

Blackpool: Campaign to save post offices

Campaigners were out in force in the Fylde at the weekend amid fears rural post offices in the borough could be shut down, according to the Blackpool Citizen.

Government plans could see up to 2,500 rural post offices closed across the country, with the full list due to be announced in January.

Fylde borough currently has 24 post offices open, but eight have been closed since 1999.

Campaigners took to the streets of St Annes over the weekend, and were collecting signatures to fight any proposed closures.

Post office campaigner, Coun Cheryl Little, who represents the Fairhaven ward, said: "We had a remarkable day with much support from the people of St Annes and the sub post master at Wood Street.

"I strongly feel that post offices are a vital lifeline in many people's day to day lives and shutting them does not make sense."

Post Office Ltd managing director, Alan Cook, said: "Taking the decision to close any post office branch is always very difficult and we know will cause concern to many of our customers.

Wales: Councils warn on funding figures

Local councils in Wales have criticised their £3.8bn budget settlement for next year from the assembly government.

The assembly, which receives its funding from the UK government and Europe, last week set out its spending plans.

Ministers admitted funding was "tight", saying local government funding would rise by 2.3% next year and by 2.6% and 2.8% in the following two years.

Local Government Minister Brian Gibbons called it a "realistic" deal and said councils must make efficiency savings.

But the Welsh Local Government Association (WLGA), which represents council leaders, called this year's settlement "appalling" and warned of public services cuts, jobs losses and rising council taxes.

Derek Vaughan, leader of the WLGA, said: "The assembly government seems to think that council tax payers are the solution to their budgetary problems - they can't balance the books, so the people of Wales are expected to cough up."

WLGA education spokesman John Davies, a Pembrokeshire councillor, said education authorities faced "cuts in service, redundancies and school closures" without extra cash or council tax rises.

Liberal Democrat Jenny Randerson said AMs had passed on a "very tight budget" to local authorities "knowing that with local elections next year, people are going to blame their local council, not blame the assembly government".

"I can assure you, they [AMs] wouldn't have been doing this to themselves if it had been an election year in the assembly."

Manchester: Long wait for a dentist

People suffering toothache in Greater Manchester are still being forced to join long queues for treatment - three years after a government minister pledged to improve NHS dental treatment in the region - according to the Manchester Evening News.

Many are being forced to wait in hospital after failing to find an NHS dentist who can give them an appointment.

In September 2004, health minister Rosie Winterton promised dental care would improve after we showed her the queues of desperate patients outside the dental hospital.

But the lines of desperate patients are still there, and an exclusive survey conducted by the MEN this month has revealed that only a quarter of NHS dentists in Greater Manchester are offering NHS treatment to patients who say they have a painful dental problem.

Despite the freezing weather yesterday morning, patients had chosen to queue at the hospital on Oxford Road rather than face the expensive fees of their dentists who have converted to private practice.

Terrible toothache Alani Mosharaf, 31, a student from Chorlton upon Medlock, was first in the queue, he said: "I've got terrible tooth ache, I don't know what is wrong, I've had problems for the last four months and I've been here several times.

"I've tried to get a dentist near my home since I arrived in the city three years ago but they are all private, they are not interested in NHS patients - it seems like there is no NHS any more where I live."

Ben Cousins, 21, a restaurant manager, from Hulme, was also in agony but he queued for more than an hour because his last visit to his - now private - dentist cost him more than £100.

He said: "I can't afford it in November with Christmas coming up, I'm not looking forward to having a tooth removed and I don't want to pay that much to have it done.

"They say it costs £14.50 here for an appointment and depending on what you have it can go up to £48, which is a lot better value."

Last year we reported how two new full-time dentists had been recruited to work at the hospital enabling the clinic to see up to 80 extra patients a day but it still hasn't reduced the queues.

Patients are supposed to be able to get dental treatment on the NHS without being registered with a dentist. But when an MEN reporter rang 50 dental surgeons complaining about a chipped tooth just 13 said they would offer an NHS appointment within a month.

Our reporter was told by 21 of the dentists that he could have treatment privately.

The remaining 16 dentists could not offer an appointment at all, either privately or on the NHS.

The dentists were registered in the "find a dentist" section on the government's NHS Choices website.

The findings of the MEN's study are to be presented to a committee of MPs later this week by Dr Anthony Halperin, the chairman of the Patients' Association who is also a dentist.

He believes lack of funding for NHS dentistry from Primary Care Trusts is at the root of the problem and said: "It does show there are problems gaining access to NHS dentists.

"That is not necessarily because dentists are choosing to treat private patients before NHS patients, but because they are not getting funding from the PCT to take on new NHS patients.

"Under the old system, dentists could take on as many NHS patients as they liked and then fill out forms for funding. But now the funding must already be in place from the PCT and that is causing problems.

"That is what has come across to the Patients' Association. It is the lack of funding, rather than a lack of space or capability.

"These are interesting findings and I'll mention the survey when I speak to MPs next week at a select committee."

All dentists now work on a self-employed basis, and receive funding from the Manchester PCT for treating NHS patients. As more dentists turn from treating NHS patients to private work, many are now branching out into cosmetic dentistry.

When our reporter rang the same 50 dentists and asked whether they could do teeth whitening - a private cosmetic service costing between £190 and £550 - more than two thirds (34) of them said they did and offered an appointment.

A spokesman for the Manchester Health Watchdog said it was a concern that most NHS dental practices are still running a registration system despite the new guidance from the Department of Health. The watchdog was also aware practices were asking patients to sign up to monthly direct debits to receive treatment.

Martin Rathfelder, member of the Manchester Health Watchdog, said: "It is a difficult situation because dentists are self-employed and there isn't any way of preventing them doing cosmetic work, but I think questions should be asked of Manchester PCT about the level of capacity of NHS dentistry in the city.

"Based on the information collected by the MEN, the PCT should be ensuring that all NHS dentists in the city are meeting their dental unit targets and if they are not, why not?

"Is capacity the issue or is it about the money.

"Most of the dental practices in Manchester seem to be running a practice list system. Is that lawful?"

Graham Stringer, Labour MP for Blackley, said: "It seems since the new system was introduced more dentists are choosing to take on more private work.

"The current system isn't delivering what it promised to in many parts of the country, although the situation in my constituency isn't as bad as in other parts of Greater Manchester and elsewhere.

"It needs to be looked at again because the tax paying public is not getting value for money and there are real flaws in the new arrangements.

"The balance is not there. Dentists are choosing to take on more private work and this is limiting the number of NHS patients they can treat."

Norfolk: Warning over the cost of care

Old people face having to pay more for their care and some will miss out completely as Norfolk social services prepares to make millions of pounds of cuts - reports the Eastern Daily Press.

The department is trying to make £13m of savings from the adult social services budget next year alone, a figure which rises to £37m over the next three years.

It is part of what County Hall chiefs described as a “difficult” picture for all the council's services. Although the county council will not hear about its government funding settlement until next month, it is expecting to receive an extra £16m from Whitehall - but faces paying an extra £38.7m in inflation costs and to meet rising demand for services, leaving it to make £22.7m of savings next year.

Paul Brittain, the council's head of finance, said: “There are savings right across the board in adult services, children's services, planning and transport and so on. It is a very difficult financial situation.”

Harold Bodmer, director of adult social services, said: “It is a tough situation. We have to set this on the context of a very difficult budget.”

The most severe cutbacks proposed are reducing the number of people who receive care by 1,084 over the next three years, saving £3m next year and more than £19m in all.

Hilary Macdonald, chief executive of Age Concern Norfolk, said that some people might choose to do without services if they were faced with having to pay more.

She said: “Inevitably the burden is going to fall on family and other carers.

“We are very concerned that with the need for cuts - and this is across the board, in health services as well as social services - preventative services will fall off the agenda. It is vitally important that older people receive the support they need”.

Chris Mowle, cabinet member for adult social services, said: “Quite clearly the government is underfunding social care by a massive amount, therefore if county councillors hold to their pledge and keep council tax down, services for vulnerable adults are at extreme risk.”

Swindon: Hospital's £600k cuts to cleaning

The Great Western Hospital in Swindon is to make £600,000 of cuts to its cleaning and catering service, reports the BBC.

Health workers' union Unison said the cuts would reduce standards and could lead to higher rates of hospital infections such as MRSA.

Joanne Kaye-Smith, of Unison, said: "These cuts cannot be justified."

"The government and the Department of Health say they are committed to improving the cleanliness of all our hospitals," she said.

But the Swindon and Marlborough NHS Trust, which runs the hospital, claim the changes would not reduce the quality of cleaning or catering.

In a statement, the trust said: "It is part of our responsibility as a trust to get the best value for taxpayers' money that we can alongside providing quality patient care.

The Great Western Hospital has 464 in-patient beds, 87 day-care beds, 10 operating theatres, two maternity theatres and 3,500 staff.

North West: 65 post offices to close

Post Office bosses have unveiled plans to axe 65 branches in parts of the North West - reports the Manchester Evening News.

A six-week consultation will now be held before a final decision is taken to axe the branches in Merseyside, the Wirral, Cheshire, Wigan, Leigh and Makerfield.

Some 371 post offices are set to remain open in the area and new outreach services - where post office services are operated from pubs or village shops - will be created in Malpas, Crewe and Tarporley.

Post Offices bosses insist that more than 99% of people in the affected area will see no change to their service or be within one mile of another branch.

Jane Briginshaw, Post Office Ltd's network development manager for the North West, said: "Taking the decision to close any Post Office branch is always very difficult and we know will cause concern to many of our customers.

"Post Office Ltd's aim is to continue to provide essential services and support retail businesses and the local economy in as many communities as possible, subject to the minimum access set by the Government."

Liverpool City Council leader Warren Bradley said: "It is deplorable that this government, which was elected on a devolution platform, is now sounding the death knell to local communities throughout Liverpool.

"Post offices are a crucial public service and once again Labour is forcing through cuts."

Post Office branches in the following parliamentary constituencies are included in this area plan: Altrincham and Sale West, Birkenhead, Bootle, City of Chester, Congleton, Crewe and Nantwich, Crosby, Eddisbury, Ellesmere Port and Neston, Halton, Knowsley North and Sefton East, Knowsley South, Leigh, Liverpool Garston, Liverpool Riverside, Liverpool Walton, Liverpool Wavertree, Liverpool West, Derby, Makerfield, St Helens North, St Helens South, Tatton, Wallasey, Warrington North, Warrington South, Weaver Vale, Wigan, Wirral South and Wirral West.

Norfolk: Flagship hospital at full capacity

Norfolk's flagship hospital last night reassured patients that it was open for emergency admissions and routine operations, despite reaching maximum capacity - according to the Eastern Daily Press.

The Norfolk and Norwich University Hospital was yesterday placed on the highest state of alert following a large volume of admissions over the weekend.

Three other East of England hospitals, including the West Suffolk Hospital at Bury St Edmunds were also classed as being on “black alert” following an unusually high number of patients being transferred to Accident and Emergency and Emergency Assessment Units.

Officials at the Norfolk and Norwich yesterday urged local GPs to look into alternative treatment plans for their patients and to avoid referrals as much as possible, whilst the hospital aimed to speed up discharge arrangements for those medically fit to leave in a bid to address the “critical” bed capacity issue.

However, the hospital confirmed that scheduled operations would continue as usual and there were currently no plans to turn away emergency admissions to the James Paget Hospital at Gorleston and Queen Elizabeth Hospital at King's Lynn, which are at amber and green alert levels respectively.

Hospitals at Hinchingbrooke, Cambridgeshire, and Peterborough were also placed on black alert, whilst Ipswich and Addenbrooke's, in Cambridge, were on red alert - the second highest pressure score.

Norfolk and Norwich University Hospital spokesman Andrew Stronach said it had been an “extremely busy” weekend for emergency admissions and equally busy yesterday with GP referrals, which had no link to bonfire night celebrations or any winter bugs.

“We are full. There is no more room in the inn, so we make sure that we can discharge as many patients as we can and free up beds for emergencies. If GPs can manage their patients without admitting to hospital, that would be much appreciated.

“There is no rhyme or reason to it. It was just a high volume of medical illnesses and surgery cases over the weekend and today (Monday),” he said.

Mr Stronach added that it was “not particularly unusual” for the flagship hospital to be on black alert and had been in the same situation 27 times last year.

Hospitals can be placed on black alert for a variety of reasons such as a rapid rise in emergency admissions, severe lack of beds, low staff numbers, or system failure and can be resolved in the most extreme cases by stopping new admissions, routine operations and transferring new patients elsewhere.

Jonathan Cook, director of corporate services for Norfolk Primary Care Trust, said: “We are confident that we have robust procedures in place to ensure that we deal with these emergency admission problems appropriately and assist the Norfolk and Norwich by avoiding non-urgent GP referrals.

We continue to work with our colleagues at the hospital and will monitor the situation extremely closely.”

A spokeswoman from the West Suffolk Hospital added: “We are on black alert because of an unusual high volume of A&E admissions, but these things happen and we are coping with it.”

Norfolk: Cash cuts for children’s services

Key services for children and young people in Norfolk could be under threat due to painful cuts being considered in order to fill a predicted £11m black hole in funding - reports the Eastern Daily Press.

Dozens of jobs face the axe over the next three years as financial experts try to make ends meet. And Norfolk's 450 schools face having to meet the bills for numerous services that have until now been provided free.

The expected cash crisis comes at a troubled time for the county, as growing numbers of schools are being judged "not good enough" by Ofsted inspectors, the numbers of children in care continue to spiral and GCSE achievement is falling further behind the national average.

Lisa Christensen, director of children's services, pledged that these three key areas would not be touched by any cuts. But they are putting pressure on the children's services department, and senior officers are being urged to come up with ways to save money through "efficiency savings".

The flurry of activity has come amid predictions that the government's 2008/9 settlement would only amount to a 2.3% increase in funds for Norfolk. A high-profile delegation has been to London from Norfolk to put pressure on the government in a bid to secure more money before the final amount is announced.

But at the moment all heads of department are working on the basis of the 2.3% rise, which barely covers the cost of inflation in key areas like transport and the price of providing care.

Rosalie Monbiot, cabinet member for children's services, admitted she was "frustrated" at the prospect of another tight financial settlement.

She said: "We deliver some marvellous services in Norfolk. If the worst comes to the worst we will be reduced to only delivering statutory services and that will not be of benefit to the children of the county. We don't have many areas where we can make the savings."

The possible cuts are outlined in a report to Wednesday's review panel.

It includes a proposal to save more than £2m in staffing costs over three years - the equivalent of at least 60 people losing their jobs or not being replaced. Other suggestions include saving £1m on special educational needs transport by more strictly enforcing the rules.

Northampton: Funds loss threat to youth group

One of the largest youth support groups in Northamptonshire is facing closure unless it raises £75,000 to fund its activities by the end of the month - reports the BBC.

The Lowdown, based in Northampton, offers information, counselling and support to young people.

The group has been trying to raise enough money to stay open but still faces a budget shortfall.

The charity said it has been struggling financially since funding cuts to youth services in the county last year.

Blackpool: Famous seafront trams face axe

Blackpool's trams will stop running for five months on Monday - and could disappear from the seafront for good - reports the Manchester Evening News.

The 11-mile-long line will be shut until Easter for an £11m programme of essential maintenance.

But the resort's transport chief has warned that if it doesn't get another £66m in funding from the government for a complete upgrade of the tracks and trams, the famous machines could stop running for good.

The first tram appeared in the resort in 1885 and they run every day apart from December 25 and 26 and January 1.

Blackpool Transport managing director Steve Burd said: "If we fail to get the money then there is a chance that the trams could stop running in Blackpool."

The council hopes transport minister Tom Harris will make a decision by Christmas.

Lewisham: Rally against cuts to hospitals' A&E

A call has been made for South-east Londoners to join a protest against cuts and changes in hospital and health services - reports icSouthLondon.

Greenwich Unison and campaign group Keep Our NHS Public are urging people to join a national march and rally on Saturday.

Proposals for the region have provoked widespread anguish and have been slammed by MPs for being "a step too far".

In the past year the hospitals have made millions of pounds worth of savings and cut hundreds of jobs.

Last month, recommendations that emergency and critical care should be axed from two of the region's four cash-strapped hospitals were revealed.

The proposal came out of a review of health services in Greenwich, Lewisham, Bexley and Bromley led by the boroughs' primary care trusts.

In the document A Picture of Health, the trusts outlined their aim to save cash and improve services by relocating some hospital treatments to centres closer to people's homes and by concentrating specialist services in fewer hospitals.

No firm decisions have been made but a key consideration is likely to be the economic argument to keep full services at the hospitals with the biggest private finance debts - Queen Elizabeth Hospital in Woolwich and Princess Royal in Bromley.