Issue 77

8 April 2019

‘Transformation’ Special Issue

The cancellation of the NHS North West London (NWL) ‘Shaping a Healthier Future’ (SaHF) plan on 26 March 2019 was an event of local, regional and national significance.

The central tenet of SaHF – the reduction in the number of Acute/Major hospitals – has been with us as a ‘transformation’ shibboleth for a number of years. A paper by American management consultant gurus McKinsey & Co published in 2009 famously alleged that 40% of all patients in Acute Hospital beds should not be there. (It’s hard to find any empirical evidence which supports what has become a ’Tablet of Stone’). McKinseys repeated this dogma at a World Economic Forum (WEF) meeting in Davos in April 2012. Attendees at that WEF meeting included the current Chief Executive, ex-Medical Director and the Strategy Director of NHS England (NHSE), two ex-Secretaries of State for Health, Liz Kendall MP, the bosses of BMI Health and the Nuffield Trust and the NHS property disposal expert, Robert Naylor.

A Failed Acute Reconfiguration Transformation

SaHF, announced in summer 2012, embodied the McKinsey metric and proposed closing 37% of the Acute hospital capacity in NWL in ‘at least three years’. On the ground that amounted to downgrading four of the nine Acute /’Major’ hospitals and transforming them into ‘Local’ hospitals with no A&E, no Intensive Care Unit, and no operating theatres. SaHF promised NWL’s 2.1 million residents ‘…changes that will improve care both in hospitals and the community…’. Also promised was ‘world -class healthcare outside of hospital’ in GP surgeries and in health centres. ‘Networks of GP practices will work with other providers of health and social care services to deliver co-ordinated healthcare to the local community.’ Cost savings of 4% would be achieved annually.

In September 2014 the SaHF closure of the A&E units at two NHS NWL Acute/Major hospitals decimated A&E performance throughout NWL to quickly become the worst in England. The two further A&E unit closures planned were delayed/abandoned and to this day the regional A&E performance has still not recovered. However the SaHF threat of downgrading Charing Cross and Ealing District General Hospitals has hung over the staff at these hospitals like the Sword of Damocles for almost seven years. Yet more grief was to be visited on Ealing Hospital in 2015 when Maternity was closed and in 2016 when Paediatrics was closed.

Inadequate SaHF Business Case

NHS NWL SaHF bosses ploughed ahead and in 2016 revealed more details of their business case. The SaHF ImBC Strategic Outline Case (SOC) for Acute reconfiguration 1 and 2 emerged. SOC1 covered building works required in ‘outer’ NWL hospitals, GP surgeries, and new Primary Care/out of hospital Hubs. £513 million was the breathtaking capital request. SOC2 covered building work in ‘inner‘ NWL and was estimated at £314 million. SOC1 was refused by NHS Improvement (NHSI) and NHSE London in September 2017. A second attempt at SOC1 occurred in July 2018 with a more modest capital request of £260 million. This was refused by implication in 2018 and finally went down in flames on 26 March 2019. The SOC2 capital request was never formalised and it was quietly buried by SaHF bosses in 2018.

Apart from Austerity and Brexit, what really killed the SaHF was its Acute reconfiguration business case proposition that Non Elective Admissions (NELs) – largely Emergency admissions – could be reduced significantly over time (probably by the McKinsey magical 40%).  SaHF completely failed to convince NHSI and NHSE London financial bosses that it was making any progress at all to meet its own imposed annual NELs reduction target of 99,000 by 2025/26. Since 2013 no amount of increased GP or community services, specific new treatments or attempts to make more efficient use of hospital beds has had any impact on the annual level of NELs in NWL. In fact the total annual of NELs in 2017/18 were 181,632 and in 2013/14 they were 167,222. ‘Bed blocking’ didn’t help either. Elderly patients can’t be discharged if no places are available in care/nursing homes or family support is not available at home. Another major category is mentally ill patients. If no specialist mental health bed can be found then a patient can’t be discharged from an Acute hospital.

What Did SaHF Actually Cost?

Researcher Colin Standfield calculated in November 2017 that the management consultancy spend by NHS NWL since 2009/10 amounted to over £88 million. He recently re-calculated this and got it down to ‘just’ £72 million. Much, if not all, of this was SaHF related. There’s no easy way of calculating what the staff salary bill might have been for SaHF as it was a project and not a statutory NHS body.

Who Can be Held Responsible for the SaHF Failure?

Of the eight NHS NWL Clinical Commission Group (CCG) Chairs who signed their names to SaHF in 2012, four of them are still in post. They are Dr Mohini Parmar, Dr Tim Spicer, Dr Ian Goodman and Dr Nicola Burbidge. At least two of them are earning over £100,000/year. They must all consider their positions. The original SaHF Medical Director, Dr Mark Spencer moved into management consultancy a few years ago. However the current SaHF Medical Director, Susan La Brooy should also consider her position. The two NHS NWL Chief Officers behind the failed SaHF SOC1 £513 million bid (Clare Parker and Rob Larkman) gracefully resigned their posts in 2018. However the Accountable Officer responsible for the 2018 failed SaHF SOC1 £260 million bid, Mark Easton, is still in post and he surely must consider his position. Juliet Brown, Director of SaHF Implementation, must surely be made redundant.

What Can the Failed SaHF Tell us About Current and Future Transformations Like STPs and ICSs?

I find it hard to believe that all 44 NHS areas/’footprints’ were allowed to spend tens of £millions on management consultants to design’ prototype’ Acute reconfiguration projects. The 44 October 2016 Sustainability & Transformation Plans (STPs) throughout England borrow hugely from the SaHF approach (albeit with the addition of integrated healthcare and social care, and mental health). With SaHF failing, this calls into question the whole STP approach. Since 2017, STPs have morphed into Sustainability & Transformation Partnerships  (again confusingly called STPs). In NWLthe STP was renamed the North West London Health and Care Partnership (HCP). The new NHS Long Term Plan has determined that all STPs will become Integrated Care Systems (ICSs) by April 2021.

NHS NWL STP Transformation To Be ‘Retired’?

Probably the primary goal of the NHS NWL STP/HCP is to plug the expected ‘do nothing’ annual funding gap of £1.41 billion by 2020/21. With just two years to go to meet this financial target who knows whether NHS NWL is on track to achieve this.  Many commentators over the last two years have deduced that this financial STP target is unachievable and common sense tells me that they are right. I’m sure NHS NWL was disappointed to receive just £10 million funding in the 2018 round of national STP funding. There are plenty of SaHF ‘ghosts’ in the NHS NWL STP. One of them can be found in Delivery Area 5C. The downgrading of Ealing District General Hospital is cited here in the context of ‘…reducing demand for Acute services through investment in the proactive out of hospital care model enabled by investment in the Hubs’. We are back to Acute reconfiguration here and the need to radically reduce the number of NELs, which NHS NWL has failed miserably to do for over five years. Requests for capital funding to build Hubs were turned down in 2017 and in 2018.

It’s abundantly clear from recent comments in public by Mark Easton that the NHS Long Term Plan (LTP) presents NHS NWL with an opportunity to abandon its failing STP/HCP and carry out ‘re-modelling’ to produce an NHS NWL Integrated Care System (ICS). The fatal flaw in this, I suspect, is there is no compelling evidence that integrating healthcare and social care services will result in better care outcomes and reduced overall costs.

Will the NHS NWL ICS Transformation Go ‘Full Term’

However, what is clearly needed now is a STP/HCP rewrite to produce a deliverable ICS plan, aligned with the LTP. The architects of this new plan should not be authors of the SaHF or the STP/HCP or their management consultants. What is needed is new blood to create a viable plan based upon clear assumptions and credible evidence.

It would be painfully sad if this newsletter had to report in 2021 that the NHS NWL ICS was to be ‘re-modelled’ and replaced by a new acronym/plan. Surely at some point these repeated cycles of plan creation, failure, and re-branding have to come to an end and be replaced by stable, sustainable, adequately funded and maintained care services.

Finally what could tell us all a lot more about how and why SaHF failed is an independent Government inquiry or even an independent project review carried out by informed individuals who have had no involvement with SaHF. Surely by this means some valuable lessons could be learned from this expensive and, for some, painful failed attempt at transformation?

Eric Leach

EALING SAVE OUR NHS PRESS RELEASE

Finally – at last, the Government has admitted the horrible ‘Shaping a Healthier Future Plan’ (SaHF) is not workable.  It’s dead!

Former NHS England chief executive Sir David Nicholson had called these plans “the most significant reconfiguration project in the country”.  But since they first announced the SaHF plans to cut nine major hospitals in North West London down to five, Ealing Save Our NHS has been campaigning against it side by side with many others including Save Our Hospitals Charing Cross and the Councils in Ealing and Hammersmith & Fulham.

SaHF had offices in posh Marylebone and spent  tens of millions of pounds of NHS cash on management consultants.  All for nothing.

Now the Secretary of State for Health, Matt Hancock, has admitted that the Department of Health  no longer supports it.  The application for £500 million pounds by local health bosses had been turned down twice because the figures didn’t work.

No surprise to us.  They never worked.

A report from John Lister produced in 2012 for Ealing and Brent Trades Councils, clearly outlined that the whole thing was nonsense.  So did subsequent reports commissioned by Ealing and Hammersmith & Fulham Councils.

Ealing Save Our NHS has distributed a quarter of a million leaflets on the streets, held protests, attended carnivals, organised parties, lobbies, petitions, car conveys and much else to spell out the truth, all paid for out of our own pockets and donations.

On the other side huge amounts of NHS money was spent on public relations staff and glossy leaflets to pretend that our health would mysteriously be improved if they closed departments, A&Es and hundreds of beds.  It didn’t work.

Even then, after the funding was turned down and 7 years of a failed five year plan had gone by, local health bosses still carried on pretending the emperor was wearing clothes.

So what will happen now?

Ealing Save Our NHS will keep on campaigning.  This disastrous SAHF plan has seen closure of two local A&Es, Central Middlesex and Hammersmith, as well as the closure of Ealing A&E to children.  As a direct consequence, waiting times for Type 1 urgent A&E visits increased greatly.  Ealing Hospital’s excellent maternity department was also  closed, forcing Ealing mothers to travel and making continuity of care more difficult for many.

But health bosses appear to have learned nothing and to defend the indefensible.  They try to conceal the A&E figures and deny there has been a problem.  Mark Easton, the head of the North West London Clinical Commissioning Groups, in announcing the death of SaHF has just made the mind-boggling claim that maternity care and emergency paediatric care have improved.  This is certainly not the view of local parents whose local services have closed!

Ealing Hospital remains seriously underfunded and in crisis.  But at least there is a ray of sunshine – the horrible plan underlying all these cuts has gone and we can focus on calling for proper funding and restoration of local health services.

More information: 

Oliver New 07931 198501

The NHS North West London ‘SHAPING A HEALTHIER FUTURE‘ TRANSFORMATION IS FINALLY ABANDONED By The Department of Health

Secretary of State Matt Hancock MP announced the end of SaHF in the House of Commons on 26 March 2019 in response to a question asked by Greg Hands MP for Chelsea and Fulham.  This ends years of SaHF failings and NHS bosses being in complete denial. It also marks a campaigning victory for many people, especially Ealing Save Our NHS (ESON), Save Our Hospitals (Hammersmith & Fulham) and Brent Patient Voice.

Changes to Ealing and Charing Cross Hospitals mandated by SaHF will not now be implemented.  

SaHF all started in 2012 with an awfully flawed public consultation which effectively set up nine NHS North West London ‘Major’ Acute hospitals to compete with each other for survival.  SaHF promised ‘..changes that will improve care both in hospitals and the community and will save many lives each year’. Annual savings of 4% were promised. SaHF promised that these changes would take ‘at least three years.’ By 2013 Ealing Hospital and Charing Cross Hospitals were singled out in SaHF to be closed down as ‘Major’ hospitals. In September 2014 SaHF closed A&Es at both Central Middlesex and Hammersmith Hospitals. A&E performance throughout the whole of North West London dropped immediately and massively. It has never really recovered over the last 4.5 years. Subsequently Ealing Hospital ‘s Maternity unit and Paediatric units were closed down.

In 2015 Michael Mansfield QC led a masterful Independent Healthcare Commission which concluded that SaHF was neither affordable nor deliverable. In 2016 Hammersmith & Fulham and Ealing Council commissioned Roger Steer, John Lister and Sean Boyle to review SaHF and the related NHS NWL Sustainability and Transformation Plan (STP). The authors recommended that SaHF should be abolished/suspended.

In November 2017 after years of painstaking research and data collection Colin Standfield reported that NHS NWL had spent over £88 million on management consultancy since 2009/10 – the bulk of it on SaHF.  What a tragic waste of public money.

No SaHF cost savings have been announced. In December 2016 SaHF asked NHS bosses for £513 million for building work, which was refused. NHSE/I London described the SaHF business case logic as ‘counterfactual’. In 2018 SaHF asked NHS bosses for £260 for building work. It received only £10 million but kept on believing it was going to get the big bucks – until today when reality hit hard.

A New Clinical Commissioning Group CCG) for NHS North West London (NWL) Could Mean 100s of Redundancies at the 8 NHS NWL CCGs

As a requirement of the January 2019 NHS Long Term Plan, an Integrated Care System (ICS) needs to be created for each CCG. At first I naively assumed this would mean eight ICSs in NHS NWL to ‘match’ the eight CCGs. But this is apparently not so. What seems to be on the cards is the creation of a new NHS NWL CCG which would commission the new NHS NWL ICS. As night follows day this new CCG would replace the existing eight CCGs.

This new ‘regional’ CCG would simply blow out of the water the original 2013 notion that CCGs would be locally led by local GPs who would have local knowledge. So how might a Southall GP sitting on the new NHS NWL CCG have any sort of knowledge of health care and social care issues in, say, Westminster?

I have not counted the staff in the eight NHS NWL CCGs, but as of 31 March 2019 there were 680  staff members in just four of the CCGs (Brent, Ealing, Hillingdon and Westminster CCGs). Surely the new CCG would not employ anything like this figure so one can assume lots of redundancies. Also no rational person would surely advocate that the 17 Public Relations staff currently employed by the eight CCGs would all be given jobs in the new NWL CCG.

It looks as if at a borough level in the absence of CCGs eight Integrated Care Partnerships (ICPs) will be established for each ‘town’. These ICPs would have no statutory legitimacy in terms of the 2012 Health and Social Care Act. The ICPs concept (originally conceived as ACPs) were STP vehicles for functional service delivery (not commissioning). In fact the 2016 NHS NWL STP cites ACPs to deliver elderly care in 2020/21. All very confusing.

The New Ealing Out Of Hospital (OOH) Services Single Supplier Initiative

On 14 February 2019 a 10 year Ealing OOH Services Single Supplier contract was signed by ‘West London and Ealing CCG’ (whatever body that might be) and West London NHS Trust (WLNT). WLNT is what used to be called West London Mental HealthTtrust and is the only NHS Trust which is based in Ealing.

The 2017 Ealing OOH Services single supplier proposals stated that the preferred provider would begin operation by the end of June 2019. A 1 May 2019 start date was also stated as a target.  July 2019 is now the estimated start date being quoted by WLNT.

It will be interesting to discover when this service begins when the Single Point of Access (SPA) for Ealing OOH services will go live. In the 2017 plan, the SPA would go live (with clinical triage) by 1 October 2019. When the SPA does go live, it might well take a while for patients, service users and carers to understand to which healthcare and social care services the SPA relates. Of course it won’t deal directly with any OOH mental health services, but will refer callers to the mental health SPA.

Of the 15/16 members of the Strategic Oversight Partnership Board, who will ‘oversee’ the new   Ealing OOH Services performance, four are Ealing Clinical Commissioning Group (ECCG) bosses. When the ECCG closes down by 2020/21 (and is replaced by a new North West London CCG) these four will have to be replaced.

Since 2017 Ealing Save Our NHS (ESON) has repeatedly asked ECCG to see a copy of the Ealing OOH Single Supplier business case. The ECCG is still refusing to supply this to ESON. Now that the contract has been awarded and the award presumably blessed by NHS England and the Department of Health bosses it seems ridiculous that ECCG should continue to withhold the business case.

Issue 75

5 March 2019

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. Increased financial funding is what is needed in our NHS – not financial cuts, closure of vital services or privatisation.

Government Attempts to ‘Sneak’ Through New Legislation Which Legitimises Integrated Care Systems – without Any Parliamentary Discussion or Vote

On 13 February 2019, the Department of Health announced ‘Statutory Instrument 248 – The Amendments Relating to the Provision of Integrated Care Regulations’. These amendments are aimed at changing existing secondary legislation to enable Integrated Care Providers (ICPs) to run a whole range of hospital, Primary Care, community health and social care services. It is due to take effect on 1 April 2019. The National Audit Office, the Nuffield Trust and the BMA have all expressed concerns that there is no evidence to suggest that these new ICPs will reduce costs or improve the quality of patient care.

MPs have not had the chance to debate these ‘amendments’. The Labour Party is attempting to have the Statutory Instrument (SI) annulled. The means to achieve this SI annulment is through ‘National Health Service Early Day Motion #2103’. The deadline for this so called ’Prayer Motion’ to be debated is 24 March 2019.

How this SI might affect any future Supreme Court appeal hearing on the 999callforNHS Judicial Review questioning the legitimacy of Accountable (Integrated) Care organisations is by no means clear. Somewhat inappropriately at the 31 January 2019 NHS England (NHSE) Board meeting it was stated ‘…the Supreme Court is unlikely to grant permission to appeal’. Does this suggest that NHSE has some inside track on how the highest Court in the land will perform?

I urge you all to email your MP and request he/she signs EDM #2103 as soon as possible.

NHS North West London (NWL) Has the Highest Hospital Urgent Repair Liabilities in England – Four Hospitals Alone Need £729 Million in Repairs

A ‘Sunday Times’ investigation published on 10 February 2019 has revealed a £3.06 billion NHS hospitals’ maintenance backlog of ‘high risk’ and ‘significant risk’ problems throughout England in 2017/18. This represents an increase of 102% in three years.

The biggest NHS urgent repair bill in England is at Charing Cross Hospital (£312 million). Following this are St Mary’s Hospital (£229m), Hammersmith Hospital (£108m) and Hillingdon Hospital (£80m). So, NHS NWL has the four biggest hospital repair liabilities in the whole of England.

Maybe one of the reasons for the now discredited NHS NWL 2012 ‘Shaping a Healthier Future’ plan to destroy Charing Cross District General Hospital was to avoid paying the huge (and no doubt growing) urgent repair bill. It’s also interesting to note that the current urgent repair bill for Ealing District General Hospital is less than £41 million.

NHS NWL has made two abortive attempts in recent years to gain capital grants for ‘transformation’ building work (£513m in 2016 and £260m in 2018). Isn’t it about time NHS NWL stopped wasting time and money on failing ‘transformation’ bids and submit some rather more utilitarian bids for urgent repairs to its crumbling hospitals?

NHS England (NHSE) Clears the Way for ‘GP at Hand’ Online/Video Consultations to Expand Out of London to Birmingham

On 13 February 2019 ‘Health Service Journal’ revealed that NHSE had agreed that the Babylon Health’s ‘GP at Hand’ (GPaH) service could be expanded out of London to Birmingham. NHSE had previously stopped the geographic expansion of the use of GP at Hand due to safety concerns. GPaH has been described as an Artificial Intelligence (AI) ‘solution’.

GaH is a digital GP practice, whose terrestrial base is Dr Jefferies’ GP surgery in Fulham. When you sign up to the service your name is added to Dr Jefferies’ list and your name is immediately deleted from your local GP surgery list. So far over 44,000 patients have joined up since the service was launched in 2017. In November 2017 there were some 4,000 patients using the service.

One of the major attractions of the digital service is that patients who are accepted can get an online/video 24/7 Smartphone consultation with a GP within two hours. However, if you are pregnant, have cancer or are mentally ill you are unlikely to be accepted.

NHSE agreed to a six month trial of GPaH in January 2018 in Camden, Islington, Enfield and Barnet. On 17 July 2018 Hammersmith & Fulham Clinical Commissioning Group (H&F CCG) formally objected to the expanded use of the service.  Patient safety was the CCG’s main concern. In 2018 NHSE and H&F CCG commissioned Ipsos Mori to carry out an independent evaluation of GPaH. The final report on the £250,000 evaluation is due in March 2019.

Strong objections to this GPaH expansion to Birmingham have been voiced by the British Medical Association and the Royal College of GPs. These objections include concerns over safety, effectiveness and the threat to ‘place-based’ care delivered by GP practices embedded in local communities.

H&F CCG is still hoping it will be bailed out by NHSE for the cost of funding 1,000s of new patients for Dr Jefferies (£11 million) never mind picking up the tab for new Birmingham based GPaH patients. However re-imbursement is by no means guaranteed.

The Secretary of State Matt Hancock MP has publicised the fact that he is an enthusiastic user of GPaH.  This seems at best a naive admission. Acting as a ‘poster boy’ for Babylon Health appears to be poor judgement. Agreeing to the geographic expansion of the service before the full results of the expensive Ipsos Mori evaluation are made public smacks of incompetence.

The idea that an AI application can of itself ‘replace’ face-to-face consultations with a GP is a dangerous one. AI can, at best, provide useful decision-support tools to support GPs diagnosing a patient’s physical, mental and social problems.

Our GP Workforce is Shrinking – and Future Predictions Suggest Much Worse to Come

A recent survey of 929 GPs in Hampshire and Dorset carried out by ‘BMJ Open’ has revealed that 42.1% of GPs are looking to quit or retire early within the next five years. This figure has risen by a third since 2014. Over 50 % of the GPs said they were working more hours than two years ago, with work intensity and amount the main reason for planning earlier retirement.

According to the Royal College of Nursing (RCN) research about 2.5 million patients are at risk of their local GP practices closing because many rely on GPs close to retirement. 762 GP practices could close within the next five years.

The Government planned to increase the GP workforce by 5,000 by 2020 but the latest NHS figures show that the GP workforce has actually decreased by 1,000. The current national, annual waiting time to see a GP is in excess of two weeks.

Can’t Meet Performance Targets? Oh Well – Let’s Just Scrap Them…..

NHS England (NHSE) has announced it is to scrap the four hour A&E waiting time standard. Introduced in 2004, the target of 95% has not been met by any NHS hospital since July 2015. It has been known for years that hospitals have ‘gamed’ the system by prioritising those patients who have been waiting to close to four hours, rather than those in the greatest need for care. It’s truly ironic that NHSE should be announcing this target scrapping at a time when Type 1 (seriously ill) waiting times across England are the worst ever at 76.1%.

NHSE has itself tinkered with the performance reporting system when it stopped reporting weekly figures and replaced this with monthly figures. NHSE also allowed some hospitals to present A&E performance data in a form inconsistent with most other hospitals. For example Chelsea & Westminster Hospital’s A&E data has for years been concocted in a dissimilar way to all the other six Acute District General Hospitals in North West London.

NHSE says it will investigate other methods of measuring A&E performance. Let’s hope whatever option is selected is one which can’t be ‘gamed’ and one that is consistently implemented and ‘policed’ effectively.

Sign and share our petition

Why are there More Than Double the Number of Non-Elective Admissions to Hospitals of Ealing Patients than Westminster Patients?

Issue: 74

1 February 2019

In the ‘Financial Times’ on 31 December 2018, the article ‘Poor have worse access to GP services’ quoted research that Emergency admissions to hospital were nearly 30% higher in the most deprived areas in England compared with the least deprived areas. The research data was complied by the think tank Nuffield Trust.

The Department of Health and Social Care has just published the Annual Report by the Chief Medical Officer (CMO). In it she reveals that the most deprived children and young people are 60% – 70% more likely to go to A&E than the least deprived. Also a recent report by Dr Foster reports that 70% of High Intensity Users (HIUs) of A&E live in more deprived areas. It states the proportion of HIUs that live in areas in the most deprived decile is around 21.9% compared with around 12.9% for other users of A&E.

Research by retired Medical Physicist Tony Brewer has revealed that big inequalities in hospital Non-Elective admissions are to be found in NHS North West London. (Non-Elective admissions (NELs) are those which have not been arranged in advance. NELs may be Emergency admissions, maternity admissions or transfers from hospital beds in other health care providers).

In 2015/16 there were more than twice the number of Ealing patient NELs compared to Westminster patients. Of the 426,086 patients registered with Ealing’s 79 GP surgeries, 31,726 of them were NEL admissions to hospitals. Of the 177,950 patients registered with 25 Westminster GP surgeries, there were 6,286 NEL admissions.

NHS England employs a technique of ‘Weighted’ GP patient list numbers using the Carr Hill Formula. This weighting takes into consideration patients’ age, gender and health conditions and calculates a weighted count of patients according to need.

Calculated as NELs per 1,000 weighted registered patients, Ealing scored 74.46 whilst Westminster scored 35.32. Admittedly there are only 25 GP surgeries (out of a total of 35) in Westminster included, because there were fewer than 50 NELs or less than 500 registered patients at 10 surgeries.

Further research is underway to expose the inequalities of NELs which occur across Ealing. All this research is using NHS data obtained through Freedom of Information requests.

It would be helpful to discover why these inequalities exist. Possible reasons include:

+ Availability of /access to GPs

+ Differing rates and consequences of Do Not Attend (DNA)

+ Levels of Deprivation

+ Ethnicity

+ Public health factors, including diet

+ Are rich people healthier than poor people?

+ Proximity to Heathrow Airport

+ Use of private hospitals.

London North West University Healthcare NHS Trust (LNWUHT) Attracts Publicity For All the Wrong Reasons

The NHS Trust which runs Ealing Hospital – LNWUHT – scored very poorly in three recent national research surveys:

100% Bed Occupancy

In December 2018, the Trust was one of only two in England which recorded 100% bed occupancy. 95% bed occupancy is the generally accepted safe level.

Did Not Attend

Patients using the Trust hospitals were the worst in England for not turning up for appointments.

Junior Doctors

‘Health Service Journal’ recently published the results of the first national survey of Junior Doctors, following the introduction of the controversial Junior Doctors contract. Junior Doctors are allowed to file a report when they work beyond their contracted hours or work without breaks, as well as other contract breaches. NHS Trusts can be fined for such breaches. The reports are called ‘Exception Reports’. LNWUHT reported the highest number of Exception Reports submitted in England – 25,690 of them by 440 Junior Doctors since 2016.

West London NHS Trust is Amongst 29 NHS Mental Health Trusts Failing to Publish 18 Week Refer To Treatment (RTT) Performance Data

When a GP refers a patient to an NHS Trust consultant-led service for diagnosis, the legal maximum waiting time for the first appointment – as stated in the NHS Constitution – is 18 weeks. This applies to non-urgent referrals for all physical or mental health conditions. All NHS Trusts and all independent providers who provide services by contract with the NHS are legally obliged to record ‘Referral-to-Treatment (RTT) statistics, so that compliance with the 18 week target, and zero tolerance of RTT waiting times over 52 weeks, can be monitored.

Acton based researcher Victor Leser has examined the reported RTT figures for the last complete year. For the month of March 2018, there appear to be 37 NHS Trusts which did not supply/publish the RTT statistics that are legally required. Of the Trusts, 29 mainly provide mental health services, 6 mainly Acute services and 2 are health and care Trusts.

One of the mental health Trusts failing to publish RTT data is West London NHS Trust, which provides mental health services for Ealing residents. Anecdotally Ealing mental health service users and carers were told in 2018 that RTT waiting times would be measured in months or even years. This on the face of it is as scandalous as is the Trust not documenting these RTT waiting times.

Accountable Care Organisation (ACO) Contract Judicial Review  Appeal is Turned Down – but Campaigners Will Fight On to The Supreme Court.

The Court of Appeal ruled in November 2018 against the ‘999callforNHS’ Judicial Review (JR) claim that the Government’s ACO contract is illegal. The campaigning group’s JR was initially unsuccessful in the High Court in April 2018. The group now intends to pursue the case in the Supreme Court. For more details see:

www.999callfornhs.org.uk

Collaboration of NHS North West London (NWL) CCGs

The Collaboration of the eight NHS NWL Clinical Commissioning Groups (CCGs) is a non-statutory body which acts as a cheer leader for the ailing 2012 NHS NWL ‘Shaping a Healthier Future’ (SaHF) project. Rumours abound about financial problems afflicting three of these collaborating CCGs. Harrow CCG is, apparently, soon to enter ‘Special Measures’. Hammersmith & Fulham CCG is suffering a £28 million shortfall largely because of one GP surgery adding 30,000 + new on-line ‘GP at Hand’ patients. Ealing CCG’s £4.8 million A&E costs’ shortfall have just come to light.

The Collaboration’s attempts to gain £millions to implement the NHS NWL 2012 SaHF plan and destroy Ealing Hospital as a District General/Major Hospital seem to have come to an end. The Collaboration’s supremo Mark Easton told the public on 24 January 2019 that any cash it might receive for building work would be for maintenance not for ‘transformation’.

The NHS is very much in the news again with the publication of the Government’s ‘NHS Long Term Plan’, which sets out how the much publicised £20.5 billion will be spent over the next 10 years. There will be some further analysis from Keep Our NHS Public and Health Campaigns Together but their initial thoughts and comments suggest we can expect more bed cuts, rationing and privatisation. –  More on this later. 

First Street Stalls of 2019 – Saturday 19th January:

We are back on the streets, with two simultaneous Stalls from 11.00 – 1.00pm in Pitshanger Lane (near the Co-op) and in Greenford Broadway (near the Wishing Well Bar). Hopefully it won’t be too cold! We will have plenty of leaflets, stickers and ‘Save Ealing Hospital’ posters to give out.  If you can spare an hour or so to help, it would be lovely to see you.

Half of CCGS ‘require improvement’ or ‘inadequate’ and many are in financial trouble!

The National Audit Office has published a really interesting report on the role and costs of Clinical Commissioning Groups (CCGs). These local health bosses, in our case Ealing CCG, commission, monitor and pay for local health services such as Ealing Hospital and community health services (out of hospital services)

They are monitored by NHS England and frankly they are not doing too well. Of the 195 CCGs; 42% are rated ‘requires improvement’; 48% rated ‘good’ and only 10% rated ‘outstanding’. 50% of the criteria are financial sustainability and quality of leadership. It is quite alarming to read that 24 CCGs are reported to be ‘failing’ or ‘at risk of failing’ and one of these is likely to be Harrow, who are commissioners for Northwick Park Hospital.  We have also heard that other North West London CCGs are in financial difficulties including Hammersmith & Fulham and Ealing, which we shall certainly be following up.

The Report can be read here –

Leading NHS campaigners say Government’s ‘NHS Long Term Plans’ spells danger.

Overall the key feature of the 10 year Plan is to keep people out of hospital by whatever means they can, and open the doors to even greater privatisation – all of which spells danger for the NHS.  Plans to cut beds, ‘reduce demand’ through care in the community and ‘self – care’ may sound all too familiar. Well it should, as that’s what North West London’s bosses ‘Shaping a Health Future’ plan has been trying to do in Ealing, and now they are rolling it out around the country.

As well as ‘treating more people’ in the community, the government wants virtual consultation and online diagnostic tools to increasingly replace face to face consultations with GPs.  Greater emphasis is to be placed on telling patients to look after themselves (’empowering us to take more care of our health’) through health prevention schemes and so-called ‘social prescribing’ of dance classes and the like. 

Big plans are also afoot to change the way GPs operate with huge primary care networks servicing up to 50,000 patients and cash incentives for GPs to avoid referring patients to hospital.  

And as for the much publicised  ‘extra’ £20.5 billion, I think Roy Lilley, one time NHS Trust Chair and health policy analyst sums it up rather well – “ After nearly 10 years of flat line funding if anyone says to you the ‘NHS has had a bonanza bung’, they are either fools, liars or can’t add up!  

Please read the initial thoughts from leading campaigners, Tony O’Sullivan, KONP Chair, and John Lister, Editor of Health Campaigns Together here – 

You might also be interested in this article on the dangers of privatisation from GP, Youssef El Gingihy

‘NHS Plan Unfit’ – Protest Thursday 31st January

NHS England, the architects of the 10 year plan have their Board Meeting on 31st January. Keep Our NHS Public wants to give them a clear message from campaigners – ‘NO TO CUTS, RATIONING AND PRIVATISATION’.  There will be a Rally outside the meeting on 31st January from 10.00 onwards at Skipton House, 80 London Road, SE1 6LH.  Our Ealing Save Our NHS banner will be there from 10.30 to 12.00.

Ealing Save Our NHS  AGM & Campaign Meeting – Tuesday 15th January:

It’s the time of the year when we review developments, what we have achieved over the past year and discuss our campaigning priorities for 2019.  It is a good opportunity to find out what we have been doing and help us plan our campaigning for the next few months. Why not come along?

The meeting starts at 7.30pm Northfields Community Centre, 71a Northcroft Road, Ealing W13 9SS (Come a few minutes early if you want tea and coffee)