Issue: 19
November 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.
Delays at North West London Hospital A&Es Follow September 2014 Closure of Central Middlesex and Hammersmith Hospital A&Es
Entirely predictable but lamentable increased delays are being reported at Chelsea and Westminster and Northwick Park Hospital A&Es. The reports come from CQC and the Department of Health respectively. At Northwick Park Hospital a quarter of ‘Type-1’ (highest need) patients are waiting over four hours for A&E treatment.
The obvious conclusion to be drawn from these deteriorating A&E services is that the promises of the provision of alternative A&E facilities before the two A&E units in Park Royal and East Acton were closed have not been met.
400,000 NHS Staff Strike for Four Hours on 13 October 2014
After three years with no pay rise, 400,000 NHS staff have had to strike to gain the nation’s attention. It’s the first such strike for over 30 years. For midwives it’s their first strike ever. Ealing midwives joined the picket line outside Ealing Hospital. On 20 October NHS radiographers also went on strike.
According to Unite one in five NHS staff have second jobs as this is the only way they can make ends meet.
Senior Tories Admit ‘Huge Strategic Error’ in Implementing Controversial NHS Reforms
On 13 October 2014 ‘The Times’ revealed what many of us had suspected – that senior Tories had failed to grasp the explosive content of Andrew Lansley’s NHS plans. And now they regret allowing his ‘revolution’ to take place. No doubt with a General Election just six months away, senior Tories are worried that electors’ unhappiness with NHS performance will cost them votes. Most recent polls are showing that the NHS is the leading national issue amongst electors.
The Tory led Coalition Government spent £3 billion on an unpopular and potentially unproductive re-organisation when this money, and more, was needed to treat a growing, aging population.
Nuffield Trust Report Confirms that NHS Performance is Deteriorating
The highly respected Nuffield Trust along with the Heath Foundation recently revealed the results of its research into NHS performance. Some of the findings:
+ Four hour+ ‘trolley wait’ rose by 79% from 2010/11to 2013/14
+ One in ten patients waited longer than the prescribed 18 week maximum for planned treatment
+ Mental health assessment waiting times have risen by one third.
+ The psychiatric hospital nurse workforce in mental health fell by 13%, whilst mentally ill patients detained rose by 17%.
These figures make a nonsense of the Government’s and NHS bosses’ claims that the massive changes and financial cuts in the NHS are making it more efficient. Many of us would welcome some honesty along the lines of – we know the NHS needs more money; we won’t find this money; and so service levels will inevitably deteriorate.
London Ambulance Service (LAS) Admits Patient Demand is Up and Staff Recruitment , Retention and Morale is Down
LAS reported in September 2014 that demand for its services is up 11% over last year. 238 staff left LAS in 2013/14. Only 80 staff left in 2011/12. A fully staffed LAS should have 3,000 front-line staff, but this year it is short of 320 paramedics and 130 emergency medical technicians. The results of a recent LAS staff survey are not encouraging either. 71% of respondents would not recommend LAS as a place of work. Only 46% said that they would recommend LAS care to friends and relatives.
Meanwhile NHS spending in London on private ambulances rose 1,000% between 2011 and 2013. In 2011 the spend was £795,000 and in 2013 that had ballooned to £8.84 million.
Campaign of the NHS Reinstatement Bill 2015
Launched on 4 October 2015, the campaign aims to reverse the failings of the Health and Social Care Act 2012 and fully restore the NHS in England as an acceptable public service. More information at www.nhsbill2015.org
care.data Rears its Head Again – But This Time it’s as the Accredited Safe Havens (ASH) Scheme
care.data is/was a national Government scheme for collecting, storing and using confidential NHS patient information. It stalled earlier this year when GPs and patients expressed concerns about privacy and the requirement for patients to actively opt out if they didn’t want their personal medical records involved.
The scheme has seemingly risen from the dead under a new guise as the Accepted Safe Havens (ASH) scheme. Instead of personal medical data being stored nationally it will be stored regionally in an ASH. The same worries still exist of course about whether the planned ‘pseudonymisation’ of our records will indeed render them completely anonymous. care.data still lives on in a 265 GP pilot scheme.
Ealing Better Care Fund (BCF) Proposals for 2015/16 are Approved by Government
The Government BCF is a pooled fund for Clinical Commissioning Groups and Local Authorities to spend on integrating health care and social care. The 2015/16 budget for Ealing is over £29 million. Ealing Clinical Commissioning Group (ECCG) and the London Borough of Ealing (LBE) submitted their BCF plan in early October. The plan has been approved, but there are some parts of it unresolved. Final proposals are due on 18 November 2014, but further refinements are expected in mid February 2015.
The plan is very complex and at 112 pages very long. The key defining principle apparently is for patients and care users to direct their own care in their homes and in the community. Reducing unplanned hospital admissions is an investment priority. Given there will soon be no hospitals at all in Ealing, this does seem to be a prudent approach.
In BCF GPs will be at the centre of the system and co-ordinate delivery of integrated care. In Ealing there will be seven local GP networks and a new overall GP federation. There will be seven day appointments, but not all 79 GP surgeries will offer this.
There are plans to develop two new ‘Health and Wellbeing Centres’ – one in LBE north and one in LBE east. Further such centres will be located on the Ealing Hospital site, Grand Union Village and Jubilee Gardens and on the Mattock Lane Healthcare Centre site.
There are commitments to improved diagnosis of depression and dementia, especially in Southall. There are also plans to boost Improved Access to Psychological Therapies (IAPT) services and IAPT recovery rates. There are a whole range of prevention, information, day care and out-of-hospital initiatives aimed at older people. Ealing AgeUK will pilot a new home visiting scheme.
The ‘Healthy at Home’ budget is over £13 million. £875,000 has been allocated for additional support for carers.
The voluntary sector has a key role to play in spending the BCF. Andy Roper of Ealing Community and Voluntary Services (ECVS) is working hard to unravel Ealing BCF complexities to help volunteer groups to bid for BCF projects. See www.ealingcvs.org.uk
Less Than 1.5% of Local Authority Public Health Budgets Spent on Mental Health Services
Local authorities collectively spent just £40 million of their Public Health budgets on mental health in 2013/14. This compares with £671 million spent on sexual health and £160 million on smoking. These figures have been researched and published by the mental health charity Mind.
Currently mental health problems account for 23% of the total disease burden in the UK.
Parity of Care for Mental Health and Physical Health Patients
Nuffield Trust research has revealed that mental health patients are waiting, on average, 48 days for treatment after referral by a GP. This compares badly with a 27 day average wait for physically ill patients. £120 million is being invested over the next five years in an attempt to achieve a parity of care across mental and physical health domains. I suspect though that considerably more money and additional high quality trained human resource will be needed to create this care parity.
Terminating Hospital PFI Contracts
Private Finance Initiatives (PFIs) are opportunities for private companies to make huge profits but incur minimal risks. Originally dreamed up by the Tories in 1992 it was New Labour in 1997 who created the current PFI contract conditions so loved by private investors.
So far 118 new NHS hospitals have been built in England using PFIs. Most are 30 year contracts. Total build costs are over £11 billion and total repayment costs are over £79 billion. Some will give returns to investors of up to 70%. Annual interest payments are high and are often major factors in tipping Trusts into so called debt. NHS England boss Simon Steven’s finger prints are all over many of the early hospital PFIs. In 1997 he became policy advisor to Health Secretary Alan Milburn and then he was Prime Minister Blair’s health adviser 2001 to 2004.
In June 2014 the NHS hospital PFI worm finally turned and the first English hospital PFI was terminated. This termination was in Northumberland and concerned Hexham General Hospital which was opened in 2003. It cost £54 million to build. It cost Northumberland NHS Healthcare Foundation Trust £114 million to pay off the hospital ‘owners’ the Catalyst consortium. Catalyst members included Bank of Scotland and Bovis. Savings of almost £67 million (3.5 million each year for the next 19 years) accrue from the termination. The average interest charged on PFI contracts is 8%. However borrowing though government is half that. In order to finance the deal the Trust borrowed £114 million from Northumberland County Council. In turn the Council borrowed the same amount from The Treasury. As ever with the PFI ‘witchcraft’ the Healthcare Trust refused to reveal the details of the original PFI deal.
In October 2014 ‘Private Eye’ revealed that PFI specialist Deloitte had been contacted by ten other NHS trusts about the possible termination of their PFI contracts.
