Issue: 70

1 September 2018

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.

Ealing Out Of Hospital (OOH) Services Single Supplier 2019 – 2028

The bidding process for a minimum of £450 millions’ worth of work formally ended on 23 August 2018. We are now in the bid evaluation phase with the outcome to be announced at the end of October 2018. There are currently lots of rumours flying around about Virgin Care bidding and then not bidding. If Virgin Care decided not to bid it does seem strange that it should showcase its OOH credentials at a public meeting in Ealing Town Hall on 17 August 2018 (see below).

One organisation we know will not be awarded the contract is NHS LNWUHT, our local Trust which runs Ealing Hospital. On 29 August 2018 ‘The Pulse’ magazine quoted from a letter sent to 800 LNWUHT staff which stated that the money on offer in the Invitation To Tender would not allow the Trust to provide ‘the required quality of care’. So LNWUHT declined to submit a bid.

The question must be asked if one NHS Trust evaluates that there’s not enough money of offer to do the job properly, how could any other Trust come up with a different evaluation?

Accountable/Integrated Care Public Consultation is Underway – But Predictably It’s Not Straightforward

We all have until 26 October 2018 to comment on the draft Integrated Care Provider (ICP) contract. There are three draft Integrated Care Provider contract documents to review. In total there are 227 legal pages to peruse. These are legal draft contracts. It is virtually impossible for a lay person to figure out what these pages actually mean. This is way too much for the general public to deal with. This is an absurd public consultation. It is akin to asking end users of a new computer system to review it by giving them the machine code of the software programmes. Over and above this there is a plethora of supporting documents numbering up to 316 pages. In total there are 543 pages of material to review.

NHS England has provided us all with a set of consultation questions to answer, which could hardly be described as being unbiased. There’s also a questionnaire to fill in which again is ‘directed’ and is really quite long.

View this massive consultation library at:

www.engage.england.nhs.uk/consultation/proposed-contracting-arrangements-for-icps

There are consultation events in London, but you have to register to attend them, and we currently don’t know the venues:

11 September, 10:30am to 12:30pm.

www.events.england.nhs.uk/events/consultation-on-contracting-arrangements-for-integrated-care-providers-icps-34140

11 September, 2:00pm to 4:00pm

www.events.england.nhs.uk/events/consultation-on-contracting-arrangements-for-integrated-care-providers-icps-34144

Court of Appeal Grants Permission to Appeal Against Judicial Review Decision Legitimising NHSE’s New Integrated Care Provider Contract

In April 2018 The High Court ruled against a Judicial Review (JR) application by 999 Save the NHS which sought to question the legality of  NHSE’s Accountable Care (subsequently renamed Integrated Care) contracts and so-called ‘Whole Population Budgets’. 999 Save the NHS decided to appeal against this ruling. On 18 August 2018 it was announced that the Court of Appeal had granted 999 Save the NHS leave to appeal the April judgement. Apparently all seven JR grounds will be reviewed.

This is an enormous embarrassment for the Government. Success in the Court of Appeal could completely invalidate the public consultation on the Integrated Care Providers contract – as the contract itself may not be legally valid.

Over 60 People Demonstrate Against Virgin Care Outside Virgin’s Out of Hospital Services Sales Presentation

On 17 August 2018 Virgin Care presented its Out of Hospital services credentials at a public meeting in Ealing Town Hall. Outside the Town Hall some 60 people noisily protested about the possibility of Virgin Care providing any NHS services in Ealing. Speakers at the demo included Central Ealing and Acton MP Rupa Huq and Ealing Council Leader Julian Bell. The demo was organised by Ealing Save Our NHS. Virgin Care is one of the organisations rumoured to be bidding to run initially 36 care services in Ealing, commencing in May 2019. It’s a 10 year contract which is worth between £450 million and £1.2 billion – with ultimately up to 60 care services to be run by a single supplier.

It did seem odd that Virgin would do this presentation during the bidding process. Even odder was the fact that the presentation was ‘hosted’ by Ealing Community Voluntary Service (ECVS). Incompetently Virgin Care attempted to run this ECVS hosted event initially on 31 July 2018. Virgin Care pulled out of the event at 3 hours notice, but failed to tell all those people registered to attend. Those who turned up to find the event cancelled were none too pleased. I do find it hard to think that a company which can’t even run (and cancel) a sales pitch to the public in a competent fashion could be trusted to run over £1 billion OOH Services for 360,000 people for 10 years.

Ealing GP Federation Isn’t Keen to Discuss Local, Regional and National Care Transformations with Ealing Save Our NHS

Ealing GP Federation, formed in 2014, describes itself as ‘representing all 76 practices’. (There are some 200 GPs operating in Ealing). Since the launch of  NHS North West London’s (NWL’s) ‘Shaping a Healthier Future’ (SaHF) programme in 2012, there have been many care service changes proposed and implemented which directly affect Ealing residents. NHS NWL’s 2016 Sustainability and Transformation Plan (STP) and more recently Ealing CCG’s plans for a single supplier of Out of Hospital Services are having and will have profound impacts on care services.

On 9 July and on 13 August 2018, Ealing Save Our NHS (ESON) wrote to the federation requesting a meeting to discuss the issues raised by SaHF, STP and the Ealing OOH contract. The federation failed to reply to either of these letters until 21 August. Even though I’d spelt out in detail who we were and why we wanted to meet, the federation asked me to repeat all this. It’s inconceivable that the federation does not have opinions and policies relating to these transformation issues. Why would it not want to share its views with ESON or in fact with Ealing patients? The federation’s web site provides no information on its stance on these issues. The federation is not a statutory body and is a private company. It would be fruitless to submit Freedom of Information requests as the federation would have no legal liability to respond.

On the OOH Services front, the federation’s web site ( www.ealinggp.com) contains an undated news story stating that it has been ‘commissioned’ to take on 18 OOH services’. How this relates to the ECCG’s beauty contest to find a single supplier of 36 OOH Services is by no means clear.

ESON finally received a letter from the federation on 29 August 2018 in which it declined to meet ESON. The federation’s CEO stated that they were ‘an organization that wants to work collaboratively with partner organizations to try and facilitate excellence in local healthcare, but can’t directly influence commissioner’s decisions’. It does seem odd to refer to ‘commissioning’ as the federation is not ‘commissioned’ by any statutory body (i.e. not NHSE, ECCG or the Local Authority). It’s a private company whose shareholders are the 76 GP practices in Ealing. The federation clearly does not want to work with ESON.

Greater Manchester (GM) Care Devolution Stalling – Non-Elective Admissions Rising Not Falling

Greater Manchester’s efforts to reduce demand for Acute services (especially Non-Elective Admissions – NELs) are failing. According to ‘Health Service Journal’ in August 2018 NELs have consistently risen since the GM care devolution deal in 2016/17. The £450 million ‘transformation fund’ financial support doesn’t seem to have been much help.

The increase in NELs is a national and regional trend. In NHS North West London (NWL) increases in NELs have consistently frustrated any attempts to breathe life into the 2012 NHS NWL’s ‘Shaping a Healthier Future’ programme and the 2016 NHS NWL Sustainability and Transformation Plan.

Ealing Save Our NHS calls for a halt to outsourcing OOH services & a bit of a protest

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Issue: 69

1 August 2018

Who Might Have Bid for the Single Supplier Up to £1.2 Billion Ealing Out Of Hospital (OOH) Services Contract?

Rumour has it that the bidders will have included:

+ Central London Community NHS Healthcare Trust

+ Hillingdon Hospitals NHS Foundation Trust

+ London North West University Healthcare NHS Trust

+ West London Mental Health NHS Trust

+ Virgin Care

Deadline for submitting an intention to bid was 19 July 2018.

All Attempts to Improve Access to Treatment for the Seriously Ill and Critically Injured (Type 1) in North West London (NWL) Have Failed

In April 2014 healthcare researcher Colin Standfield began collecting and collating A&E performance data at the NWL hospitals. In that month the performance for Type1 A&E patients against the 4 hour target was 88%. Clearly below the 95% target. The latest NWL A&E performance figures (June 2018) are at 80% – so no improvement in over four years. At no time since August 2014 has that figure exceeded 90%. Hillingdon Hospital continues to have the worst performing A&E unit in England at 59%.

In summer 2012, NHS NWL’s ‘Shaping a Healthier Future’ (SaHF) programme promised us ‘improved care, both in hospitals and in the community’. Some six years later this promise to the seriously ill and critically injured has not been kept. The original SaHF Medical Director has been long gone from the project. Of the eight CCG Chairs who signed their name to the SaHF programme, five are still in post. It’s surely time for them to publicly apologise for the failure of SaHF and perhaps consider their positions.

In October 2016, NHS NWL published its Sustainability and Transformation Plan (STP). It promised ‘to improve the health and wellbeing of our residents’. This promise to the seriously ill and critically injured has not been met. Of the five STP sponsors, three have already resigned. Maybe it’s time for the other two to remove themselves as well.

Expansion of ‘GP at Hand’ Online Service Blocked by CCGs

On 17 July 2018, Hammersmith & Fulham Clinical Commissioning Group (CCG) formally objected to the expanded use of the ‘GP at Hand’ Smartphone consultation service. Patient safety was the CCG’s concern. This service, launched in 2017 by Babylon, allows for Smartphone based 24/7 consultation services. One of the conditions to signing up to the services is that you immediately transfer to the GP surgery hosting the service. The launch GP surgery was Dr Jeffries in Fulham. Over 30,000 have signed up for the service which now boasts five London GP surgery sites.

Attempts to expand the service to Birmingham have been thwarted. Birmingham & Solihull CCG has raised concerns about Birmingham GP patients being registered at a GP surgery outside of Birmingham. NHS England (NHSE) also raised concerns in November 2017 when the service expanded to five sites across London. Ipsos Mori is currently conducting an independent evaluation of GP at Hand, which has been commissioned by Hammersmith & Fulham CCG and NHSE.

As ‘Private Eye’ recently pointed out, GP at Hand’s privacy policy clearly states that it may take users’ data to share with third parties. This smacks more of being a transparency policy.

Referral Facilitation Services – the Future for Healthcare ‘Demand Management’?

A member of my family, who has had countless ear infections over many years, recently asked his GP to see a consultant. Weeks later he received a letter from the ‘Ealing Referral Facilitation Service’ (ERFS) granting him an appointment with a consultant on 25 February 2019. This is completely unsatisfactory. The letter itself is a strange beast as it does not bear an NHS logo on it.

Another family member received an ERFS letter telling her that if her referral were to be accepted by West Middlesex Hospital the hospital would contact her. If the hospital did not contact her after a period she should contact them .All attempts to get through on the phone to the hospital have so far failed. Months later she gets a letter from the hospital giving her an appointment date.

My surgery’s Patient Participation Group has attempted to explain how the ERFS works in its current newsletter to patients. The description makes no mention that the ERFS might turn down the GP’s request for a consultant appointment. It also states that a hospital will contact the patient with appointment details. My family knows that this contact might takes weeks or months to be made.

It’s clear from anecdotal evidence that there is no consistency in the way the ERFS works. For some patients, the ERFS does not make it easy for them to exercise ‘patient choice’ as to which hospital they want to be referred.

It almost beggars belief that two GP members of the Ealing CCG Governing Body are also paid Clinical Assessors for the ERFS. So not only do these two receive fees from Ealing CCG as Ealing GPs they also get paid for double guessing their GP peers in Ealing on GP patient referrals to consultants. This is conflict of interest on steroids!

I can find no description of ERFS on any NHS web site. Google can’t find one either. Apparently the ERFS is an outsourced operation run by a private company. Ealing CCG accounts state it cost £849,000 to run ERFS last year.

What’s Happening on the Accountable Care/Integrated Care Front?

When Secretary of State Hunt was confronted with the JR4NHS legal challenge on Accountable Care Organisations in February 2018, he conceded that there had been no public consultation on the issue of Accountable Care Organisations. He said no Accountable Care Systems’ (ICSs’) contracts would be signed until after a 12 week public consultation. Well, the JR4NHS Judicial Review has been and gone but there is no sign of any ACS (now ICS) public consultation. Could it be that as the JR judge found  the Health & Social Care Act 2012 gave very broad discretion to CCGs when commissioning services? Maybe this means no new ACO/ICS Government legislation is needed and perhaps no consultation. It could be that as the other major ACO JR – 999 Call For NHS – is appealing its rejection, the way is still blocked for ICS progress.

It’s clear that ICS contracts for front-runner ICSs in Dudley and Greater Manchester have not been signed. NHS England web pages on ICSs have been unchanged since May 2018.

The High Court Overturns £104 Million Virgin Care Contract for Public Health Services in Lancashire

‘Health Service Journal’ has reported that on 22 June 2018 the High Court found in favour of two NHS Trusts in their action against Lancashire County Council. (LCC). Lancashire Care and Blackpool Teaching Hospital Foundation Trusts took LCC to court after LCC awarded a five year contract for school nursing and health visiting to Virgin Care. The Trusts claimed that LCC’s bid evaluation process was deficient. The judge found LCC’s records of moderation processes fell short of standards required to evidence reasons for the scores awarded to the bidders.

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.

In this article Professor Clara Lowy considers the changes in the urology service affecting services in Ealing Hospital.   

A recent decision has been made to remove Urological surgery from Ealing Hospital – further undermining the Hospital

In 2012 the ‘Shaping a Healthier Future’ plan was born following a very limited public consultation claiming that care could be carried out better in the community rather tha in hospitals. The plan did include reassurance that provisions would be in the community before hospital bed closures.

The two hospitals marked for major downsizing were Ealing & Charing Cross. By 2014 Hammersmith & Central Middlesex had lost their A&E departments – but the promised alternative community services were not in place.  As a result the A&E departments at Ealing, Northwick Park and elsewhere filled to overflow.

Despite this, the Ealing Clinical Commissioning Group and The London North West University Healthcare NHS Trust set about downsizing Ealing Hospital.  First they closed the Maternity Department, then Urological Cancer Treatment, then closure of in patient Paediatric Care and A&E Paediatric Care and now in 2018 Urological Services. The reason given primarily was staffing recruitment and shortages, leading to possible unsafe practises.

A review of the proposed urological service change was presented to the Ealing Council Health & Adult Social Scrutiny Panel after the changes had been ‘enacted’ in June.

I provide here a summary of the outline of the current urological services presented to the Ealing Scrutiny Panel now available to Ealing residents.

The changes started in 2012/13 when the Urological Cancer Service ceased at Ealing Hospital.  This resulted in reduced volume and diversity procedures so Health England withdrew clinical training posts. The department had a high turnover of staff, relying on temporary staff.

The options were to consolidate services on two rather than three sites, Northwick Park and Central Middlesex Hospital (CMH) were chosen. So why was Central Middlesex chosen as the second site when Ealing Hospital would have been the much more appropriate since it almost still has a full complement of services including an A&E?

8000 new urological patients attend the 3 sites, of this a quarter are Ealing residents (2000) and a fifth of these (400) are emergency admissions.  The number of emergency admissions is rising by 10% per year.

This reflects the aging population in the Borough. This group also have more co morbidities and therefore should have access to an A&E and a hospital where disciplines are well integrated not only for patients with presenting urological problems but also Ealing in-patients who develop urological emergencies.

Questions and problems

As this reorganisation has already taken place Ealing patients are now being triaged in A&E at Ealing Hospital & transferred if needing admission to Northwick Park. It is envisaged that some patients will not be suitable for transfer. An on-call urologist from Northwick Park will travel to Ealing Hospital to perform the necessary operation. He or she will be operating in non-urological equipped theatre and without designated training junior staff.  Is this good practice?

Ealing Hospital will continue to provide Out Patient, a One Stop Clinic and Enhanced Out Patients Procedures but as Ealing Hospital is no longer recognised for training it is not clear who will be qualified to carry out the outpatient procedures?

A statement is made that Outpatient and onsite specialist cover will be maintained.

How can this be true when an on-call Urologist has to be summoned from Northwick Park Hospital to operate on patients that cannot be transferred?

It is claimed that there will be better continuity of care. If so where is the evidence to support this claim?

Is there sufficient capacity on the NWP site to absorb the emergency urological patients arriving from the Ealing A&E?

Unless there are clear answers to these questions, we can be forgiven for concluding that the changes are driven not by clinical reasons but as part of the unsuccessful ‘Shaping a Healthier Future’  plan for North West London.

Clara Lowy is a local resident and Emeritus Professor of Medicine

Thursday 5 July was seventy years to the day since the introduction of free health care and the founding of the NHS.

Ealing Save our NHS – 70th Birthday Party Outside Ealing Hospital, 5/7/18 from Martin Woodford on Vimeo.

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Issue: 68

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.

Ealing Out Of Hospital (OOH) Services Outsourcing Contract: More Questions Than Answers

Rumour and speculation are rife about who might bid for and who might win this contract. The names of four London NHS Trusts have been mentioned. We are still no nearer discovering the real reason why this 10 year, £450 million minimum/£1.2 billion maximum, single supplier contract has even been proposed. The Invitation To Tender (ITT) was issued on 22 March 2018.  If awarded, this contract is likely to be the longest and potentially most lucrative NHS outsourcing contract ever awarded in England. It could make the local commissioner – the NHS Ealing Clinical Commissioning Group (ECCG) – quite famous.

Quite simply, OOH services in Ealing might be described as some of the day care services currently provided inside Ealing Hospital, outside Ealing Hospital and not provided in GP surgeries. Virtually all the OOH social care services included in the initial 36 services’ specification are outsourced to private operators by Ealing Council.  

Is It to Reduce OOH Services Costs?

No – says ECCG. Cost saving would be accrued by reductions in Non-Elective Admissions (NELs) to hospitals says ECCG. NELs are mostly accident and emergency admissions. The NELs volumes have remained pretty much at the same level in Ealing and North West London (NWL) since we have been monitoring NELs starting in April 2013. It will take some special magic for the appointed single supplier of OOH services in Ealing to significantly reduce the Delayed Transfers of Care (DTOCs or ‘bed blocking’) predominantly caused by lack of social care capability or mental health beds

Is It to Improve the Quantity and Quality of OOH Services?

No explicit claims have been made or evidence provided to support such improvement by ECCG, the NHS NWL Collaborations of CCGs, the NHS NW Sustainability and Transformation Partnership (STP) , NHS NWL ‘Shaping a Healthier Future’, NHS England or NHS Improvement.

Why is it a 10 Year Contract?

We can find no answer to this one.

Is It to Cut Down ECCGs Workload?

If a single supplier is to manage and resource 36 (and maybe 60) OOH services in Ealing over a 10 year period it makes little sense that ECCG would be micro-managing service delivery (i.e. ‘commissioning’) as well.  

Is It A Trojan Horse for a Pioneer Integrated Care System (ICS) in Ealing?

ECCG says it’s not an ICS (ACO in ‘old money’), which implies the budget will not be set using a ‘Whole Population/Capitated Budget’ and fixed price approach.

Who Will be Writing the Responses to the ITT?

No doubt it will be management and healthcare consultants. More £millions of public money sacrificed on the altar of  marketisation.

When Do Responses to the ITT Have To be Submitted?

Initially this was to be by 23 August 2018, with an earlier deadline of 19 July 2018 for submitting a completed ‘Selection Questionnaire’. However as the procurement documents were delayed till 4 May 2018, there is a ‘revised procurement closure date and associated deadline for submission of tenders’.

Are There any Precedents of Any Similar NHS Outsourcing Contracts?

Ominously the answer is yes, in Cambridgeshire in 2015. A five year £800 million NHS outsourcing contract ended expensively after just 8 months of operation. The contract was for a single supplier to manage and deliver community healthcare services to adults and elderly people in Cambridgeshire from 2015 to 2019.The company running it, called UnitingCare, pulled out saying that the contract was not financially sustainable. Warning signs appeared early on in the performance of the contract. Uniting Care had boldly promised estimating savings of £178 million by 2020. However they requested   £34 million of extra funding from the local CCG – just four weeks into the contract going live.

UnitingCare was a consortium of Cambridge and Peterborough NHS Foundation and Cambridge University Hospitals NHS Foundation Trust. The local CCG chose UnitedCare because it was the lowest bidder.Unsuccessful, more expensive bidders were Virgin Care and Care UK. Both the Government Committee of Public Accounts and the National Audit Office were severely critical of the lack of commercial skills exhibited by the commissioning NHS CCG.

Are Integrated Care Systems a Bad Idea Poorly Implemented?

Integrated Care Systems (ICSs) appeared on our radars in January 2018. They were a new name for Accountable Care Systems (ACSs). The justification for the renaming was never explicit, but many of us assumed what was behind it was that Accountable Care sounded too ‘American’.

In May 2018 NHS England announced four more ICSs to add to the existing 10. The timing of this was appalling. The highly rated Judicial Review on ACS/ICS legitimacy by JR4NHS had just enjoyed its two days in the Royal Courts of Justice. The 12 week public consultation on ACS/ICS promised by NHSE in February 2018 has still failed to materialise. The ACS/ICS enabling Parliamentary legislation the Government planned for February 2018 also never happened. The four new ICSs are Gloucestershire, Suffolk and North East Essex, West, North and East Cumbria, and West Yorkshire and Harrogate.

According to ‘Heath Service Journal’ none of the original 10 ICSs have reached an agreement with NHSE/NHSI about finances. Technically the arguments are about ‘Control Totals’ which seem to be the financial targets to be attained by end of March 2019. The sticking point is apparently that ‘organisations are unwilling to risk losing their sustainability funding if a neighboring Trust or CCG fails to meet its financial plan’. Not much peer trust or respect at work then.

None of these 14 ICSs are any more than talk and good intentions. There are, apparently, no signed ICS contracts. If any of them were ‘real’ then NHS Clinical Commissioning Groups would be winding up as they would have lost their commissioning roles for healthcare. Local Authorities would be re-structuring as they would have lost their social care commissioning roles.

Only an idiot would argue against the principle of integrating healthcare services and social care services. But with the current organisational structures and with the proposed ICS structure, the component care bits just do not ‘fit closely and seamlessly together’. The size and content of any NHS patient database is very different from its Local Authority (LA) social care service user database. The NHS and LA payment protocols, financial regimes, management accountability, cultures, IT and even vocabularies are alien to each other.

The vast majority of social care services are outsourced to the private sector and are means tested. NHS healthcare services are largely ‘insourced’ and are free at the point of use. Finally, NHS bodies and LAs don’t seem to trust each other enough to open up their financial books to each other. What both healthcare services and social care services do have in common is that they are both under-funded and under-resourced.

If  ICSs are implemented as advertised, this spells the end of the NHS. 44 private ICSs will run healthcare and social care services throughout England on fixed price, long term contracts. NHS Trusts, private care homes, private healthcare providers, NHS staff, NHS buildings etc will all be just resources which the ICSs may deploy or dispose of.

The Mass Transfer of Property from Public to Private Ownership: The NHS ‘Journey’

Consider the following:

+ University College London Hospital Foundation Trust recently boasted a £76 million surplus after asset sales and a Sustainability and Transformation ‘bonus’. (‘Health Service Journal’).

+ The NHS is planning to develop Royal Free Hospital nurses’ homes into luxury flats. (‘The Guardian’).

+ The Health and Social Care Act (2012) sanctioned NHS Property Services Ltd (PropCo). This company now owns the property which was previously owned by NHS Strategic Health Authorities and NHS Primary Care Trusts. The company is a private one which is wholly-owned by the Secretary of State for Health, Jeremy Hunt MP.

+ Public-Private ‘Project Phoenix’ will create six major regional public/private property deals by June 2019. The companies formed by these deals will be ‘off balance sheet’.

They will sell publicly owned property and replace it with private rented property. They will be the cash-raising vehicles for Sustainability and Transformation Partnerships.

+ Sir Robert Naylor carried out the review of NHS property which led to the creation of Project Pheonix. He thinks the fire sale of NHS property could raise £5.7 billion.

Much of this information was gleaned from Jessica Ormond’s piece at www.opendemocracy.net

GPs Under Attack! NHS plans to Reduce 8,000 GP Surgeries/Practices to 1,500 GP ‘Super-Hubs’

‘Pulse Today’ has documented the Government/NHS saga which could decimate the GP Surgery/Practice population in England. It all started with Tony Blair’s introduction of the GMS contract for GPs in 2004. This began the trend towards larger practices or federated models of working. The APMS contract followed which allowed multi-nationals like UnitedHealth and groups of GPs to run practices.

The Sustainability and Transformation Partnership (STP) and the Integrated Care System (ICS) juggernauts are now aiming to reduce our 8,000 GP practices down to 1,500 GP ‘Super-Hubs’. We now have the very real prospect of the ‘family doctor’ concept disappearing forever.

Annual Number of Re-Admissions to A&E Units on the Rise: Pneumonia Sufferers Re-Admissions Up 72.5% Over the Last Six Years

The Nuffield Trust and the Health Foundation have published research on annual re-admission numbers to hospital A&E units since 2010/11. Re-admission within 30 days has risen 19.2% over the last six years. The re-admission number for 2016/17 was 1.158 million patients. In the case of blood clots, pneumonia and bed sores the annual rate rose by 41.3%. The rise for pneumonia was a very worrying 72.5%.

Allegations that patients are being discharged too soon have been made by the Society of Acute Medicine. Under-staffing and under-bedding are seemingly forcing hospital staff to get patients out of hospital as quickly as possibly – and for over one million patients last year possibly too quickly.

458,000 NHS Patients Abandoned as 134 GP Surgeries Closed Down in 2017

In 2017, 57 GP practices along with 77 GP satellite surgeries closed down leaving 458,000 patients with no registered GP. Since 2013, 445 GP practices/satellite surgeries have closed leaving over one million patients without a GP.

‘Diagnosis Critical’ Report Advises that More Money and Care Integration Alone will Not be Enough to Provide Care For All

This 46 page report, published in June 2018, launches an inquiry into health and social care in England. It’s published by a new economic think tank called the Centre for Progressive Policy (CPP). There’s plenty of useful, well presented data, backed up by lots of relevant referenced papers.

The report asserts that more money alone will not satisfy the NHS constitutional core standards for improving cancer services, A&E performance or the number of elective admissions. (It fails – as does the NHS – to reference mental health services standards).

It points out the dichotomy of separate healthcare and social care workforces and opines that integration of the two will fail to address the needs of an aging population. It quotes a National Audit Office report which stated the NAO had studied 20 years of integration initiatives and found ‘no compelling evidence to show that integration in England leads to sustainable savings or reduced hospital activity’.

It is critical of the 2014 NHS Five Year Forward View and the 2017 update on the grounds of finance, performance, missed targets and productivity.

There are valuable insights into deprived areas care needs and the uneven geographic distribution of elderly social care needs. There is plenty of discussion on a range of new funding models which might generate more cash for care services. CPP is keen to ‘tackle social determinants of health as part of health and social care re-design’.

The current and future roles of Clinical Commissioning Groups (CCGs), Sustainability and Transformation Plans/Partnerships (STPs) and Integrated Care Systems (ICSs) are hardly mentioned at all in this report. On the face of it this is an odd omission.

There will be a range of ‘engagements’ in 2018/19 with a final report due in May 2019.

CPP is wholly funded by 77 year old, multi-millionaire Lord David Sainsbury, who is Chancellor of Cambridge University. CPP has an advisory board of 14 people, all of whom are unknown to me. More at www.progressive-policy.net

78% of Local Authorities Social Care Services Close to Collapse

A survey of 152 Local Authorities (LAs) by the Association of Directors of Adult Social Services has revealed that 78% of them are close to collapse in providing residential care homes and domiciliary care. 44 LAs said that companies had given up contracts because they were losing money.

In 2017 £2 billion was injected into the care system by Jeremy Hunt MP, Secretary of State for Health and Social Care.  In July 2018 he is expected to publish a plan to reform social care.

This is our latest newsletter, you can subscribe if you would like to receive our updated news and events straight in your inbox.

The big focus for our Campaign over the next month is the 70th Birthday of our NHS which came in to being on 5th July 1948 and put and end to the horrific situation whereby many people couldn’t afford to get help when they were ill.

We will be celebrating 70 years of a free, publically owned and publically run NHS and having a bit of a protest too against cuts and privatisation, especially here in Ealing.

Hanwell Carnival 16th June – join in the fun!

The 70th NHS Birthday will be the big focus for our Stall and on the Parade at Hanwell Carnival on 16th.  

This year we are hoping to have our very own ESON Choir performing at the Stall in Elthorne Park. If you enjoy singing and would like to join us please let me know.

We will also have some photo opportunities for carnival goers, although probably not any TV stars as below!

Join the Carnival Parade: We usually get a good crowd joining our Ealing Save Our NHS Contingent. This year we have 70th Birthday hats for people to wear with our NHS sashes (very swish!) and of course Arthur’s legendary bed will be on the Parade too. If you would like to join in please go to Hanwell Community Centre on Sat 16th between 10.00-11.00am (departure time). Look for the ESON banner and bed!

Of course we also need people on our Stall to help and give out leaflets as well. You can find us in Elthorne Park from 12.00 noon – 6.00pm. Read more here.

Crazy Economics at Charing X and Ealing:

The London North West Healthcare Trust who run Ealing, Northwick Park & Central Middlesex Hospitals have ‘planned’ for a £31.4 million deficit for 2018/19.  However the £31.4m deficit is based on them receiving extra funding of £27.3m (only paid if their A&E 4 hour waiting time is 90% across the Trust) and that they can deliver £34m worth of “savings” (i.e. cuts). Bizarrely they are allowed to borrow up to £31.4 million to cover the deficit at 1.5% interest thereby adding a further £4.6 million to the amount! 

And it’s a similar story at Imperial NHS Trust, who run Charing X, St Mary’s and Chelsea & Westminster. They are planning £48 million worth of cuts to ‘help’ with their planned £20.6 million budget deficit for 2018/19 and get their loan. What about just giving them the funds they need to run our hospitals!

Please support the National Health Singers Appeal:

The National Health Singers will be recording a single to celebrate the 70th birthday of the NHS and raise awareness on the current plight of our NHS. They are not just your usual choir but are a protest choir made up of a range of NHS staff and allies. They sing at protests and demonstrations including the forthcoming 70th Anniversary event on the 30th June. If you would like to support them and help fund the cost of the new single the link is here–

And here the video of the choir’s previous single –

DATES FOR YOUR DIARY:

OUR NEXT CAMPAIGN MEETING is Tuesday 19th June, 7.30pm in Northfields Community Centre. All welcome.

Saturday 30th June

Please join us on the Big 70th NHS Birthday Celebration & Demonstration. We are meeting up at Ealing Broadway Station at 11.30am with our banner and placards.

Thursday 5th July: 12.00 – 2.00pm

Our 70th Birthday Party outside Ealing Hospital with music, singing, cake, balloons and speakers; including Council Leader Julian Bell and Virendra Sharma MP (parliament permitting)

AND SOME INTERESTING READING:

New article on our website: “The Ealing MCAP Debacle” by Colin Standfield.

In an effort to do the undoable, Ealing’s health bosses hired a private American firm called Finnamore to ‘fix’ what they claim is the overuse of hospital beds. Colin Standfield lifts the lid on what actually happened, using his usual dry humour and focus on facts. Colin shows that the people who are now offering a billion-pound contract for our Out Of Hospital services really don’t know what they are doing. 

You can read it here:

The Great NHS Property sell-off

This is a good round up of what’s happening to NHS assets. It’s story of how the NHS is selling off assets to pay for their vision of developing out of hospital care and care in the community, centralising services and of course giving the private sector a bigger share of the cake.

Read it here

8,900 checks on ‘NHS health tourists’ find only 50 liable to pay 

Latest figures from London hospitals involved in a trial which asked 8,894 people for two forms of ID prior to treatment showed that only 50, or one in 180 had to pay for their care. This included patients attending Maternity & Cardiology at Ealing Hospital. More on this story here–