Issue: 35
April 2016
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.
The Failing NHS NW London Shaping a Healthier Future Project is Being Buried in the Shiny New Sustainability and Transformation Plan for Integrating Healthcare and Social Care Services
Massive changes are afoot in the creation of new organisations (consortias of public bodies) throughout England which are the vehicle for making massive financial cuts in NHS spending. These new organisations will design and deliver new models of integrated healthcare and social care. The national media and activists on the ground have seemingly not yet woken up to these changes, their inherent risks and implications.
The change agents for all this are Sustainability and Transformation Plans (STPs). STPs are part of NHS England’s Five Year Forward View (FYFV). STPs have a five year budget of £8.4 billion. England has already been carved up into 44 so called ‘footprint’ areas. In each of these footprints NHS CCGs, Local Authorities and NHS Trusts will work together to formulate and deliver an STP. London has five footprints. Our local one is NHS NW London which includes eight CCGs, eight Local Authorities and 11 NHS Trusts. NW London Footprint boss is Ealing’s own Dr Mohini Parmar. She now has four roles/jobs – Footprint boss, SaHF cheer leader, ECCG Chair and local GP. The bosses identified so far are almost all senior CCG types or NHS Trust bosses. None of them are from the social care community. Each footprint has to create its first STP by 30 June 2016.
The prospect of NHS and Local Authority bureaucrats working successfully together and amicably resolving the competing resource demands of healthcare and social care takes quite a lot of believing. It also seems incredible that apparently none of the thousands of care homes in England are represented in these footprints. I now understand one of the reasons why the eight CCGs in NW London have been working together for so long.
Each STP must balance the financial books of local NHS finances by end of March 2017 and achieve this by implementing new models of care set out in the FYFV. The new models include reducing hospital beds and ‘replacing’ them with digital monitoring and home visits. Another new model is for Urgent Care Centres to effectively replace A&E units in hospitals. STPs will also spell out the sale of surplus land and buildings. The STP presents private healthcare providers with huge opportunities.
Apparently NHS London North West Trust (which includes Ealing Hospital) expects to receive £21.5 million for 2016/2017 from the STP. This seems quite high as £2.1 billion nationally for 2016/2017 STP shared by 44 footprints comes to just over £47 million each.
There are just 12 weeks to go to finalise our STP. Ealing CCG’s web site provides details of the NW London Footprint. Apparently a first draft of the local STP was created at the beginning of February 2016. A mind boggling 31 public organisations are represented. The footprint is led by something called the NW London Strategic Planning Group (NWLSPG). All CCGs, all Local Authorities, all NHS Trusts and The London Ambulance Service are represented, and there are just two patient representatives. I wonder who they are and just how they were selected or possibly elected.
The ailing ‘Shaping a Healthier Future’ (SaHF) project finally gets buried and subsumed into the NWLSPG’s STP initiative. This could well explain Ealing Council’s ‘quietness’ on the subject of SaHF. The Council must be finding it difficult to publicly criticise SaHF as now it is one of the (admittedly many) organisations now responsible for SaHF. Surely Hammersmith & Fulham Council can no longer seriously pursue a Judicial Review about SaHF when it is now part of the consortium responsible for SaHF. I now also understand why references to SaHF have been curiously disappearing over recent months.
Other existing NHS ‘transformations’ which will be brought into the STP regime include Whole Systems Integrated Care, Like Minded, Primary Care Transformation and Seven Day Services.
On a day to day basis Ealing Council’s Scrutiny is attempting to hold Ealing CCG to account. Surely this becomes mission impossible if the Council and the CCG are getting into a very large STP bed together to design and deliver integrated health care and social care services. Now I understand one of the reasons why ECCG moved into the same building as Ealing Council.
The STP project could learn from some of the missteps of its progenitor – the £5.3 billion NHS Better Care Fund launched in 2013. BCF aimed at ‘…transforming local health and social care by pooling (Local Authority and NHS) resources’. BCF failed to meet its operational and cost cutting goals in 2014. It’s a bit odd that it is not being absorbed into STP.
There is a link here somewhere, somehow with the Accountable Care Organisation (ACO) concept. ACO is a 2006 American idea which became mandated in the US Patient Protection and Affordable Care Act of 2010. The ACO approach is that of a consortium of public and private healthcare and social care organisations delivering services to a defined population for a defined period. Reimbursement is often tied to ACO’s meeting quality and cost targets. Surely these 44 STP footprint consortia are ACOs?
The ACO concept is being trialled in one of the NHS Vanguard projects in Barking & Dagenham, Havering and Redbridge. Other ACOs under consideration include those in Northumbria and Morecambe Bay. Worryingly studies of ACOs in the US showed that projected savings by ACOs in 2011 – 2014 of $320 million were not achieved. In fact a loss of $3 million was sustained.
All these STP activities, costing £millions and requiring extensive organisational engineering, are not mandated by any Act of Parliament and have not been the subject of any public consultation.
When David Cameron said in 2009 and in 2010 that a Tory Government would not bring about a new top down re-organisation of the NHS, he was right. He’s now initiated not one – but two of them.
Hunt Threatens to Remove and Replace NHS Boards for Those Trusts in Deficit on 1 April 2016
Secretary of State Jeremy Hunt MP is going to be very busy this month replacing the Boards of 138 NHS Trusts throughout England. London Health Emergency’s research published in early February 2016 revealed that 138 of the 150 NHS Trusts were in the red. The combined deficit of these 138 Trusts amounted to £2.2 billion. – and it was still rising.
‘…Children Will Die…’ Says Experienced Consultant Paediatrician
This prediction by Tony O’Sullivan, Consultant Paediatrician at Lewisham Hospital, was made to over 100 people at the Ealing Save Our NHS rally in the centre of Ealing on Saturday 12 March 2016. He made it in response to Ealing Clinical Commissioning Group’s (ECCG) ‘Shaping a Healthier Future’ (SaHF) plans to severely downgrade (in fact remove) Ealing Hospital’s Paediatric services. On 16 March 2016 ECCG confirmed to the press that the children’s in-patient ward and the children’s A&E service at Ealing Hospital would close on 30 June 2016.
Tony’s nightmare scenario is that in 12 weeks time a very sick child may arrivie at the doors of Ealing Hospital being carried by a parent. With no A&E facilities available for children, the Urgent Care Centre (UCC) – devoid of Paediatric Consultants and Paediatric Nurses – will likely have difficulty in accurately diagnosing and adequately stabilioasing such a sick child.
Currently 93% of all sick children arriving at Ealing Hospital are brought by their parents and carers and not by ambulance. Around 6,000 children annually attend Ealing Hospital A&E. Just under 2,000 children annually are admitted as patients to the hospital.
So what will happen to the thousands of sick children who the Ealing Hospital UCC determine need A&E services? The plan is that the NHS Patient Transport Service (PTS) – not the London Ambulance Service – will transfer them variously to hospital A&E units at remote locations including those in Harrow, Hillingdon and Isleworth. The NHS PTS has a poor reputation. A comprehensive report on PTS in London by Transport for All in October 2014 discovered many patients facing long waits for transport to hospital appointments. It’s unclear (and almost certainly unlikely) whether a Paediatric nurse or doctor would accompany each sick child on his or her trip out of Ealing. Distraught parents and carers will have to make their own way to these remote hospitals to be re-united with their sick child.
It is an absolute certainty that the time to expert diagnosis and commencement of treatment will be increased by these closures. This will inevitably introduce the risk of increased physical and mental pain, condition deterioration and death.
ECCG presented a paper on its Paediatric reconfiguration aspirations at Ealing Council’s Health and Social Care Scrutiny Panel on 8 March 2016. The paper was almost completely bereft of Paediatric patient numbers, explanations and analyses. Scandalously the paper makes no mention at all about how the specific emergency needs of children arriving at Ealing Hospital suffering from severe mental health episodes and conditions will be diagnosed and treated.
The MindEd Trust has recently publicised the fact that just 0.7% of the NHS budget is spent on the mental health needs of children and adolescents. The ECCG’s apparent ‘blindness’ with regard to mentally ill children presenting themselves at Ealing Hospital is symptomatic of the empty senior NHS rhetoric of ‘parity of esteem between physical and mental health’. Still the ECCG approach is horribly consistent with the 2012 SaHF proposals which contain no mention of mental health services whatsoever.
If A Child Dies As a Result of Removing Accident, Emergency and Acute Services for Children at Ealing Hospital – Whose Fault Will It Be?
The answer to this one is quite simple. It’s the Ealing Clinical Commissioning Group (ECCG). We should hold the ECCG Governors personally and collectively responsible. I have attended quite a few public meetings of the ECCG Governing Body. They are very strange meetings. No-one ever argues. There is very little discussion or debate. I have never witnessed a vote on any issue or policy choice. Surely a few of these Governors must have had their doubts about closing Maternity or downgrading children’s services at Ealing Hospital. Why have none of them put their hands up and said something like ‘you know, I’m not entirely convinced that this will work/that we’ve thought this through properly/that this is the right thing to do…’.
And who are these people anyway?
Let’s identify them:
+ Dr Mohini Parmar, NHS ECCG Chair and newly appointed boss of the NHS NW London Footprint (Sustainability and Transformation Fund).
She signed her name on the 2012 ‘Shaping a Healthier Future’ Consultation document. GP working at the Barnabas Medical Centre, Ealing.
+ Dr Raj Chandok, NHS ECCG Vice Chair
GP working outside Ealing
+ Dr Mohhammad Alzarrad
Southall GP
+ Dr Arjun Dhillon
West Ealing GP
+ Dr Vijar Tailor
GP at Hillcrest Surgery, Acton
+ Dr Shanker Vijayadeva
GP working with Dr Parmar at the Barnabas Medical Centre, Ealing
+ Fionnula O’Donnell
Ealing GP Practice Manager
+ John McNeill
Healthwatch Ealing Chair
+ Jonathan Webster
Qualified nurse now in nursing management in NHS North West London
+ Ben Westmancott
NHS North West London manager and administrator
+ Dr Jackie Chin
Ex-Director of Public Health, London Borough of Ealing
+ Keith Edmunds
Chief Finance Officer
+ Sally Armstrong
Hanwell GP Practice Nurse
+ Philip Young
Accountant and management consultant. Has experience as Trustee of a respected local care home
+ Philip Portwood
Ex-Acton Councillor
+ David Archibald
Ex-social worker and ex-Executive Director for Children and Adults, London Borough of Ealing
+ Clare Parker
NHS ECCG Chief Officer and qualified accountant
+ Tessa Sandall
NHS ECCG Managing Director
+ Carmel Cahill
Ex-Healthwatch Ealing Chair
This line-up does not tally exactly with the ECCG web site, which sadly is not up to date.
Number of Arrivals at NHS Hospital A&Es is FALLING: Shortage of Beds and Staff is Causing the A&E Treatment Crisis
A&E waiting times in many areas of England are missing performance targets. Patients in NW London are amongst those suffering because of this. Closure of hospital A&Es across England, including closures at Hammersmith and Central Middlesex Hospitals in September 2014, is clearly the recent historic driver for this local service deterioration.
The NHS figures extracted and presented by Colin Standfield of Save Our Hospitals show unequivocally that there has been no increase in A&E arrivals since April 2013. His figures and graphs show this to be the case for England, London, NW London, London excluding NW London, and Ealing and Northwick Park Hospitals. In fact the number of attendances nationally actually dropped in recent months. According to a King’s Fund report of 6 March 2016 ‘…so far this year, total A&E attendances for the first three quarters are slightly down on the same period last year’.
However the Department of Heath and NHS England is consistently lying about the numbers of A&E arrivals. They keep saying that ‘demand’ is increasing. But they won’t quote real data and NHS England’s refusal to publish weekly A&E performance data any more looks like a pathetic attempt to hide the actual data. Also even monthly data is not made publicly available on a timely basis. No such data has as yet been released for January and February 2016.
The ever worsening crisis in A&E is being caused by shortage of staff and shortage of Acute beds. Dr Cliff Mann, President of the College of Emergency Medicine says the crisis in A&Es is ‘unprecedented’. With the future of many NHS hospitals uncertain (eg Ealing and Charing Cross) and high levels of pressure and overcrowding in A&Es it’s not surprising that doctors are not signing up for permanent A&E positions. Just one quarter of new A&E consultant posts in England were not filled this year. The recent caps on rates of pay for locums has lowered pay levels three times – in November 2015, February 2016 and March 2016. So vacancies are either unfilled – permanently or temporarily – or Trusts are risking censure or worse by breaking the temporary pay rate rules. Dr Mann says that hospitals are drafting non-A&E hospital staff into A&E. With finite and perhaps reducing medical staff resources, hospitals are having to delay or cancel elective and non-emergency treatment.
