Issue: 15
July 2014
This occasional newsletter is researched, written and edited by a group of concerned residents in Ealing, West London who want to preserve our NHS. We view the wholesale engagement of private, for-profit healthcare service suppliers as unnecessary, profligate and dangerous. Process improvement is what is needed in our NHS – not revolution.
NHS is the Cheapest Healthcare System in the World – Offering the Best Health Outcomes
The New York-based Commonwealth Fund ranks Britain top of 11 advanced countries’ healthcare systems for cost and health outcomes. Britain spends $3,404 per head compared with $8,508 in the US with the other nine countries in between. On ‘effectiveness, safety, patient-centredness, co-ordination, quality and access’ Britain’s NHS rates number one.
Who Cares for the Carers?
In 1983 Crossroads was founded in Brent. It’s a charity which provides respite breaks and information for unpaid carers of adults and children which grew to provide these services throughout Brent, Hounslow and Ealing. Well it did until 11 June 2014 when it closed down. Around 300 family carers who support disabled, elderly and vulnerable people in Hounslow, Brent and Ealing will lose the help of 60 support workers.
Block grants from Local Authorities have over time been replaced by competitive bidding processes, which led to financial uncertainty and now to closure. The closure of Crossroads is cruelly ironic given the increasing size of the aging local population and the financial cuts in welfare payments, in the NHS and social care budgets throughout Local Government.
Accident and Emergency in Crisis – Yet Again
The week ending 15 June 2014 saw 297,527 attendances at major A&Es in England. This is the highest weekly figure ever recorded, and this is the summer not the winter. 97% of patients were seen in less than four hours.
As ever the Government after taking money out of A&E services is now throwing ‘crisis’ money back into it. No doubt ad hoc emergency beds are sourced from somewhere. Expensive Agency staff are hired in haste. And no doubt tired and harassed staff are coerced into working too many extended shifts.
What a way to run a national health service….
West London Mental Health Trust (WLMHT) Boss Opens Up to Ealing Carers
On 10 June 2014 Steve Shrubb, Chief Executive of WLMHT spent 75 minutes talking with 50 volunteer Ealing mental health carers at NHS Avenue House in Acton. WLMHT is the major supplier of NHS mental health services to the 780,000+ people who live in Ealing, Hounslow and Hammersmith & Fulham. It also manages the Broadmoor high security psychiatric hospital in Berkshire.
Steve joined the NHS as a ‘domestic’ in 1976, trained and practised as a Cognitive Therapist and rose to a number of mental health Chief Executive positions. He took charge of WLMHT two years ago and is likely to do another three years and then retire. His appreciation of the carer role has been sharpened recently with the onset of dementia in one of his parents.
He says that WLMHT could not function without the contribution of volunteer carers.
Although he has 3,500 staff he admits it’s not enough. In 2012 he had 4,000 staff and in 2013 3,750. In 2012 the Trust’s annual budget was £250 million – this year it’s £230 million. He thinks the Trust is ‘holding its own’ in helping those with anxiety and depression, but he feels the Trust is failing the seriously mentally ill – especially those with Schizophrenia. He then said that if he’d been talking to cancer carers and told them the NHS was providing an inadequate service they would have torn him apart limb by limb. This is because awareness and visibility of cancer suffering is much, much greater than with mental illness. We must all work much harder to raise awareness and visibility of mental illness.
That all being said, one carer whose son is a serious long term Schizophrenia sufferer said she is devastated by her poor son getting only 15 minutes face to face with a specialist and it was such a short time as to be completely useless. I piped up to point out that my troubled mentally ill son has had five different diagnoses over the last 20 years and, even if his treatment had been first class, it really counted for little if it was treating the ‘wrong’ illness.
With inadequate resources, Steve has to be quite creative in making sure the budget is used cost effectively. Hence WLMHT ‘partners’/employs/outsources with charities, volunteer groups and private suppliers. In effect in Ealing, the Trust is outsourcing mental health Primary Care (via the Ealing Clinical Commissioning Group) to 39 of the 79 Ealing GP surgeries. Of course some of the troubles and risks associated with outsourcing include:
– losing control. Atos’ broken promises, delays and huge backlogs in assessing claimants eligibility for Personal Independence Payments (PIPs) is a recent dramatic example of this.
– the risk of losing the ‘spirit’ or even the content of the original intent of the task, especially in, a ‘daisy chain’ of outsourcing deals.
– those providing the service are not accountable to the commissioning stakeholders (e.g. citizens if it’s the NHS) but are accountable to some other group who could be commercial shareholders
– if outsourced to a commercial for-profit company that company will structure its business and its resourcing so that its priority is to make a profit for its shareholders as opposed to providing a superior product or service. The Department of Education recently ‘pulled back’ from privatising child protection services after considerable negative feedback on profit taking degrading the private service supplier offering.
Steve is a big believer in the positive impact of good physical health for mental health patients. He’s also a big fan of Lord Layard’s proposals to train 10,000 mental health therapists and set up 250 mental health centres in England. In fact in a previous role he was a lobbyist for this cause.
He wants us all to get involved with ‘Time to Change’ – the organisation dedicated to challenging mental health stigma and discrimination. I have, and you can too at www.time-to-change.org.uk
The initiative to convert the NHS Lammas Centre in Mattock Lane, W5 into a 12 bedded residential mental health Recovery House is his. When he arrived at WLMHT he was surprised to find no residential Recovery Houses – half way houses between long term admission wards and going back home. Two more are planned in Hounslow and Hammersmith & Fulham. The mental health charity Rethink will run the Lammas Recovery House. WLHMT prides itself on rarely having to send service users outside Ealing, Hounslow and Hammersmith & Fulham for treatment.
Steve seems to be re-thinking the Trust’s approach to volunteer carers’ groups and has commissioned an internal report on a way forward. Spending so much quality listening time with the Carers Support Group – probably the largest and best run volunteer mental health carers group in Ealing – is a very good start to his own personal research on support for carers.
Jean-Claude Juncker will Scupper TTIP/ISDS – Which Would Be Good News for Our NHS
Without going into mind bending details, the proposed Transatlantic Trade and Investment Partnership along with its Investor-State Dispute Settlement adjunct (TTIP/ISDS) aims to give greater powers to big international businesses and undermine democracy. Under ISDS large global corporates will challenge national regulations and go straight to Industrial Tribunals (ITs). Theses tribunals will consist of just three arbitrators – one chosen by the company, one by the State and a third agreed by both. These tribunals are not answerable to any British or European courts.
So if UnitedHealth of Minneapolis was not invited to bid to run NHS Ealing Hospital under an open tender, it could immediately go to an IT with no doubt its own world expert barrister as one of the three decision makers.
If TTIP/ISDS gets sadopted it will make the privatisation of our public services permanent.
No wonder Prime Minister Cameron is so agitated. Mr Juncker is courting European Greens and socialists who want to kick out TTIP/ISDS. With Juncker now elected lets hope TTIP/ISDS does not get signed!!!!
Future NHS Cash ‘Crisis’
The Conservative, Labour and LibDem political parties have all recently tried to ‘out doom’ each other by variously saying ‘no more cash for the NHS’ and ‘£30 billion 2020 deficit in the NHS budget’. But Labour is also talking about ‘re-setting the NHS’ by, in effect, suggesting it will roll back much of what is contained in the Health and Social Care Act 2012.
Labour’s pronouncements come out of the mouth of Andy Burnham MP, but not from Labour Top Trumps Ed Milliband MP or Ed Balls MP. Also some of Burnham’s statements are not really credible. He said on 5 June 2014 that patients can expect a single point of contact to co-ordinate their NHS care. So every one of 250,000 adults in Ealing would have a single point of contact? So one person would deal with my arthrytis, blepharitis, psoriasis, back problems and no doubt possible future dementia – never mind a one in five chance of mental health problems. This is just not credible for the 47 million adults in England.
NHS Hammersmith Hospital A&E and NHS Central Middlesex Hospital A&E (Harlesden) to Close on 10 September 2014
NHS St Mary’s Hospital in Paddington will in just few weeks time become very crowded in its A&E department as many people in pain in Hammersmith, Harlesden and Acton will have to travel there. Charing Cross A&E in Hammersmith will also get very busy, but it may well also close this year with a formal announcement scheduled for July/August 2014. We know the future of NHS Charing Cross A&E. It will close, even though Prime Minister David Cameron shamefully lied about this in Hammersmith on 15 May 2014.
The future of Ealing Hospital’s A&E in Southall is well known. It will also close. What we don’t know is when. Dr Mohini Parmar Chair of NHS Ealing CCG and David McVittie, NHS Ealing Hospital Chief Executive, both tell us that its closure will only take place when adequate replacement, accessible A&E facilities are available. Trouble is ….we just don’t believe them.
After 10 September 2014 a large GP surgery staffed only by GPs and nurses will provide a 24 hour service on the site of Hammersmith Hosppital. In NHS jargon it’s called an Urgent Care Centre (UCC). Flashing blue light ambulances do not travel to UCCs. UCCs have no Intensive Care beds, consultants or equipment. You will not find an Intensive Care Unit in a UCC and there are 44 defined medical conditions not treated in a UCC.
NHS Ealing Hospital and NHS Northwick Park Hospital are Clearly ‘In Love’ and are Desperate to Get ‘Hitched’
In the middle of all the carnage wreaked by the ground breaking (could be career breaking) ‘Shaping a Healthier Future’ blitzkrieg, Ealing and Northwick Park Hospitals are desperately trying to ‘live together’ in order to save money. ‘Two can live as cheaply as one’ is the guiding maxim no doubt. £Millions have been spent on this shot gun wedding with full colour brochures being distributed like confetti.
The ‘marriage’ target date keeps changing and now it’s October 2014. We even know who the designated non-executive directors are (four months before the nuptials). It’s interesting that NHS bosses have plumped for folks with experience in Southern Cross Healthcare, Barclays Bank, the Probation service, the Magistrate service, the Employment Tribunals service and Housing Associations. To be fair there is some medical experience in there too.
Will Charities and Volunteers Have to ‘Rescue’ Huge Swathes of NHS Services?
‘The Guardian’ of 6 June 2014 featured the impressive set of services provided by the 30 staff at the charity Integrated Neurological Services (INS) of Twickenham, West London. INS is funded by the NHS and by the Big Lottery and provides creative and wide ranging support for sufferers with MS, Parkinson’s, strokes and many other neurological complaints.
With local staff cuts and budget cuts will local volunteer groups and charities have to fill in gaps with carer services, carer recruitment and carer training?
NHS Midwives Could Go On Strike
The Royal College of Midwives (RCM) is recommending industrial action if the 1% pay rise for NHS staff is killed off. On 9 June 2014 RCM began consulting its 30,000 midwives and maternity support staff about industrial action. The Royal College of Nursing (RCN) and Unite have variously described the 1% pay rise climb down by the Government as ‘shameful’ and ‘insulting’.
Ealing Hospital midwives have been, in effect, been given their marching orders but they don’t know where they are marching to or when.
‘care.dot’ Makes a Re-appearance
‘care.data’ is the name of the Atos software driven personal medical records /Atos managed personal medical records data extraction and data sharing service. ‘care.data’ was revealed to the public in January 2014. It caused a furore. Citizens had to write to their GPs to stop their data being used. And then it was revealed that our personal health medical records had already been sold to pharma companies, insurance companies and goodness knows who else. On 19 February 2014 NHS England retreated from instantly implementing care.data and announced a six month delay in implementation.
Well, barely four months on, NHS top brass is banging the jungle drums about care.data. Tim Kelsey, NHS England National Director for Patients and Information said at a conference on 6 June 2014 ‘…the true scandal in our health service is ignorance’. He went on to say that plans for a giant GP database (i.e. care.data) were ‘the biggest data revolution any public service had embarked upon’.
Oh dear….
Firstly citizens no longer trust the Government /NHS bosses with our personal data. Don’t trust it to collect it accurately, anonymise it consistently and effectively and don’t trust that it will not give it /sell it to Tom, Dick or Harry.
Secondly, citizens (and IT folks specifically) have zero confidence in the Government/NHS successfully designing, building, implementing, managing and maintaining such a giant database. Aren’t we all still paying for the abortive fiasco hatched by Bill Gates and Tony Blair in 2002 to computerise all English medical records and make them accessible 24/7 anywhere in the world? The initial budget for the project named NPfIT was £11.4 billion. The project was abandoned in 2011 with no usable value created. We are all still paying for it and the current losses are £10 billion and rising.
BMA Accuses Government of ‘Economic Illiteracy’, Being ‘Bonkers’ About Seven-Day Working and Driving GP Surgeries Out of Business
The British Medical Association (BMA) – the doctors’ trade union and professional body – is demanding a £2 billion cash injection into the NHS in order to head off a crisis in patient care. The BMA is also saying that seven-day working can’t be done without the investment of more state money. It says seven-day working is unfeasible without cuts during the week or hospital closures.
The BMA claims that there has been a reduction of £450 million in funding GP practices in real terms allied to a 40 million increase in annual demands for appointments. These changes are driving GP surgeries out of business. An ominous forecast by the BMA is that a 6% reduction in GPs seeing patients will double the number of patients at hospital A&E units. Apparently the Department of Health (DoH) is in complete denial about the BMA’s accusations and predictions. The DoH describes it all as ‘scaremongering’. Yet again….oh dear….
CORRECTION
In June’s issue we publicised England’s first mental health eclinic. Sadly we were given the wrong URL for this useful resource. www.ealingeclinic.com is a useful online facility for service users and for carers.
