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Donate to Ealing Save Our NHS!

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Local Health bosses have paid out millions of pounds to management consultants and professional public relations staff – money that could have gone to front line NHS staff.

Their message is that services will somehow be mysteriously be improved by closing hospital departments, cutting services and putting NHS contracts out to tender on the private market.

But the battle to save Ealing Hospital and our NHS continues and we need your support.

 

Ealing Save Our NHS just relies on local people giving their time and money.  We have given out hundreds of thousands of leaflets on the streets; we have to pay for posters, meeting rooms and other costs.

Please contribute to our fight to save NHS services, locally and nationally.  It really is appreciated.

We’d like to thank donors here online, but if you want to be anonymous and discreet, let us know.

 

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To donate please click on the button below or you can contact us if you prefer to donate in other ways.

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Thank you from Ealing Save our NHS

 

 

Problems in the Ambulance Service

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Kingsbury old fire station, The Mall, Kenton, London

 

Changes to health care provision, including the latest ‘Sustainability and Transformation Plan’, usually lead to increased demands on the ambulance service. But few if any increased resources are put in. Stuart Crichton, Assistant Director of Operations at Hanwell ambulance station, tells me that demand has increased greatly over the last 20 years. Staff now do not get any waiting time between jobs.

 

So ‘deficits’ begin to appear. These ‘deficits’ are due to lack of Government funding, not inefficiency on the part of the ambulance service. The London Ambulance Service (LAS) has been placed in ‘special measures’ following an ‘inadequate’ rating by the Care Quality Commission.

 

There is a Patients Forum for the LAS to put the patients’ side of the case. It is a lay organisation that has monitored the LAS for 10 years.

 

It organised a meeting on 11th July 2016 to try to address the problems. Its chair, Malcolm Alexander, has produced a useful report dated 18th May 2016 and addressed to London Clinical Commissioning Groups (CCG’s). It contains proposals to get the LAS out of special measures and “it is aware of the current negotiations regarding funding for the LAS”. This in my view is the crux of the matter. It also notes that “urgent and emergency care services will only radically improve to meet the needs of people in London if the weaknesses of primary care, community health and social care are dealt with”…”The LAS is often forced to take the patient to A&E even though we know this may be the worst option for patients whop have dementia or mental health problems”…”This can amount to a wait of 8-10 hours from 999 call to admission for an elderly vulnerable person”.

 

Stuart Crichton says that the increased pressure has led to staff morale becoming, in his words, “strained”. Qualified paramedics are in great demand. Urgent Care Centres and the 111 service draw staff out of the LAS. It takes three years to train a paramedic and Stuart acknowledges the need to improve the working environment. Staff shortages have led to the use of about 20 private emergency ambulances per day across London. They are staffed by qualified paramedics (trained by the LAS) though Stuart says the LAS is not losing staff to the private providers. Where do they get their staff then? They cover times of peak demand and unsocial hours. On a recent morning visit to Ealing Hospital I counted three private emergency ambulances on the ramp. LAS do plan to end the use of private ambulances but they do not say how or when. Retaining staff is described as “challenging”.

 

The LAS are “full partners” in ‘Shaping a Healthier Future’ and the STP. They agree with the process of developing ‘specialised pathways’ and are “satisfied” with the changes to the system. They are not “engaged” (their word) with Healthwatch but would be happy to be involved.

 

Graeme Crawford observes that the LAS Board seem to be ignoring the financial problems highlighted by the ‘special measures’. They are hoping that GP’s will substitute or help out with situations resulting from ambulance deficiencies. They are relying on increased self-help by patients, friends and family. Ambulances queueing for more than an hour at hospitals has become the norm  Graeme says that there is a need to prioritise informed input to Scrutiny Panels and Healthwatch, and to monitor the impact of the closure of the Children’s Ward at Ealing Hospital on ambulances.

Foto: © Copyright Kevin Hale and licensed for reuse under this Creative Commons Licence.
www.patientsforumlas.net

Performance figures are available on the LAS website

NW London’s Draft STP and an STP Engagement Tool Enter the Public Domain – September 2016

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Issue: 40

September 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.

 

NW London’s Draft STP and an STP Engagement Tool Enter the Public Domain

The Sustainability and Transformation Plan (STP) is the Government’s latest initiative to reduce spending on healthcare and social care. Each of 44 regions (so called footprints) in England will have their own STP. Ours here in Ealing is the North West London STP. We also have a NW London STP Engagement Tool.

 

The draft NW London STP aims to cut the annual care spend by £328.3 million in year 5 of the STP (optimistically set for 2020). On 5 August 2016 the latest draft of our STP was placed into the public domain. On 16 August 2016 the NW London STP Engagement Tool was also put into play.

 

The 55 page draft STP and the 6 page STP tool can both be viewed at:

 

https://healthiernwlondon.commonplace.is

 

The tool is clearly aimed at those with little time to wade through the thousands of words and new acronyms in very small type size in the STP. The STP tool is very, very much shorter with easy to read words and almost no acronyms.

 

STP Engagement Tool

We are asked to submit our views on improving our health, better long term care, home care for the over 65s, improved mental health care and high quality services. However no explicit references are made to across the board cost cutting, hospital bed reductions, staff numbers and closing Ealing Hospital.

 

One of the STP goals is integrating healthcare services with social care services. There is no explicit reference in the tool as to how any of this might be achieved. What about Accountable Care Partnerships (ACPs) – the vehicle being trialled around England to do this job?  The tool doesn’t ask our opinion about ACPs – even though some are planned in NW London. Much more on ACPs below.

 

The tool informs us that the STP will improve ‘housing, employment, schools and the environment that affects health’. This is twaddle. There is absolutely no way that the 31 public sector organizations thrown into a room together and told to cut care costs are going to improve housing, employment, schools and the environment. In a similar vein ‘more focus on preventing ill-health’ is all well and good, but will it achieve anything? Persuading people to adopt healthier life styles costs money and is not always successful. The marketing budgets of drug, alcohol, food and tobacco companies are huge. It took Government action to ban smoking in public places which clearly has reduced the number of people smoking and the amount many smokers smoke. It’s not clear how prevention success might be calculated or measured. So it’s clearly debatable how annual savings of £11.8 million on prevention in five years time might be computed. However the STP tells us that grants of £110 million will be received for ‘investment in prevention and social care’ over five years.

 

The tool page on improving mental health services opens with ‘We all have mental health’. This is a ludicrous statement. Statistically 50,000 adults in Ealing and 328,000 throughout NW London have mental ill health. ‘Improving mental health services ‘is again a laudable goal, but it’s going to take more money and more staff to achieve this. If you have already been waiting for over six months to see a psychologist only hiring more psychologists is going to improve things. More emailing, more Skyping, more telephoning and new ‘models of care’ just won’t hack it. STP grants expected over five years should total £53.7 million. The annual mental health spend in 2015/16 of £308 million will rise to £358 million in 20120/21. In year 5 annual mental health savings are quoted at £11.8 million.

 

Old people are asked whether they want care at home as opposed to visiting hospital or residing in a care home. The choice being offered here is an illusion. Hospital care is free, but social care at home is not, it is expensive and is, in effect, unregulated.

 

I view the NW London STP Engagement Tool as a deflection or displacement exercise. NHS NW London has for four years been cutting hospital beds, cutting staff and closing  local services. Its excuse for this was that these cuts and closures would provide us all with better healthcare services. The jury is still out on that one. The STP carries on this cuts-mean-better-services charade. The decisions on more home care, more technology, fewer beds, fewer staff and Ealing Hospital closure have already been made. How cruel is it to ask citizens for their opinions after the service re-designs have been completed? This is disrespectful and insulting to people like me whose taxes pay the wages of these after-the-event engagers.

 

Will Accountable Care Partnerships (ACPs) Finally Destroy the NHS?

The national media, thanks to prodding by 38 Degrees, has finally caught up with STPs. But it hasn’t, as yet, cottoned on to Accountable Care Partnerships (ACPs) as the engine of STP change and the harbinger of doom for the NHS. In the NW London STP ACPs are mentioned for delivering ‘end of life’ care for elderly people.

 

ACPs are/will be networks of organisations which will assume clinical and financial responsibility for providing care for a defined service user audience for a fixed price for at least 10 years. The potential area of operations for ACPs is wide, including community care, out of hospital care, core primary care, social care, Acute/hospital care and mental health care. The patient populations will be aggregations of GP surgery patient lists. Partners’ organisational boundaries will be removed and no doubt the partner brands will by subsumed by the ACP brand.

 

The key puzzles ACPs will be asked to solve will surely be cost cutting, integrating healthcare services with social care services and shifting much of Acute hospital care into GP surgeries, the ‘community’ and into people’s homes. There is no doubt that achieving these goals will not be easy. However removing clinical and financial responsibility for these tasks from public NHS and Local Authority bodies and handing it to untested, private partnerships seems foolhardy at best.

 

ACPs are likely to destroy traditional GP practices as federations of GP surgeries are subsumed into ACPs and asked to do more to provide replacement secondary care services for hospitals downsized or eliminated.

 

There are 50 fledgling ACP pilots in operation throughout England. The smallest will serve 97,000 people and the largest some 6 million. None of these ACPs are NHS bodies. Constituent ACP organizations include Local Authorities (LAs), private healthcare and social care providers, NHS Trusts, GP federations, Clinical Commissioning Groups (CCGs), Healthwatches, charities and voluntary groups.

 

ACPs drive a coach and horses through the Health & Social Care Act 2012 as the strict division between commissioners e.g. CCGs and LAs and service suppliers e,g, NHS Trusts and private care suppliers is completely trashed. Still, this is no more respectful to the Act than the 44 footprints which corral a similar cast of commissioners and service suppliers together to create the STPs.

 

The track record in England of ‘real’ ACPs is very limited and not good. There has been only one which became fully operational in 2015. Sadly it lasted just nine months. The Cambridge and Peterborough ACP was a five year, £725 million car crash which failed ostensibly ‘for financial reasons’. There is no convincing evidence around the world (USA and New Zealand ACPs are often quoted) that ACPs actually save any money.

 

Does Brent’s ‘Referral Optimisation Service’  Spell the End of GPs Clinical Independence?

Brent Patient Voice (BPV) has raised concerns that Brent GP referrals are about to be intercepted and reviewed by a private healthcare provider. Brent CCG (BCCG) has hired Bexley Health Ltd for £1million to second guess GPs. The Brent Optimisation Referral Service (BROS) will never have met the patient and will not have access to the patient’s full medical history.

 

BPV were about to meet BCCG to discuss BROS on 16 August 2016. However BCCG pulled out of the meeting. BPV wrote to BCCG about its concerns. No content bearing reply has been received by BPV. BROS goes live on 1 September 2016.

 

BPV further notes the workings of a pilot optimisation service for urology in Devon. 30% of all GP urology referrals to hospital consultants were refused. GPs have had to carry out further investigations themselves, such as ultrasound scans – for which they are not re-imbursed by the NHS. More on this at: www.bpv.org.uk

 

A surprising postscript to this story is my discovery of the Ealing Referral Facilitation (ERF) service which is surely ‘optimisation’ by another name. ERF has been in operation for at least three years and is run by a group of local GPs. ERF works with your GP ‘to ensure that the service you are referred to best meets your clinical need’. In December 2012 Ealing CCG confirmed that the ERF would be ‘challenging referrals ‘in 2013/14. Ealing CCG Governors Dr Mohammad Alzarrad and Dr Vijah Tailor are two of these ERF ‘optimising’ GPs. The ERF is commissioned by Ealing CCG. But surely healthcare commissioners can’t also be healthcare service suppliers?

 

One in Three 14/15 Year Old Girls are Suffering From Mental Illness

A ten year Department of Education (DoE) study of 30,000 school pupils has revealed very worrying mental ill health profiles for teenage girls. 37% of girls had three symptoms or more of psychological distress. In teenage boys the mental ill health profile only affected 15%.

 

Interestingly enough, alcohol consumption, drug taking, truancy and pregnancy rates have all gone down for teenagers in recent years. However, a variety of reasons have been suggested for this virtual mental ill health epidemic amongst teenage girls. ‘Pushy’ higher social status parents have been suggested as a factor as have social media pressures. Former mental health tsar Natasha Devon thinks, however, that social media is just a reflection of what is going on. She blames community breakdown and Michael Gove’s school reforms in reducing school time for sport, music, arts and dance.

 

The Government has committed £1.4 billion of new money for increased mental health services for children. Let’s hope some of these additional mental health services help the 4,800 or so teenage girls in Ealing suffering (according to the DoE research) from psychological distress.

 

Judicial Review to Challenge Hunt’s Power to Impose Contract on Junior Doctors: 19 and 20 September 2016

Justice for Health, a social justice movement founded by five Junior Doctors, has secured a Judicial Review (JD) on Hunt’s contract imposition. It’s scheduled for the High Court on 19 and 20 September 2016.

 

A full, expedited JD was granted in the High Court on 21 July 2016. Hunt’s blustering approach of asking for high ‘Security of Costs’ (what the doctors would pay if the JD failed) was knocked back by the judge. Justice for Health raised the reduced amount of £130,000 in just four days.

 

The five founding doctors have a combined 37 years’ experience as NHS doctors. Four of them are Registrars. Their excellent web site is clear and concise and puts many commercial sites to shame. More at www.justiceforhealth.co.uk

 

The Future For Healthcare and Social Care Service Delivery in England

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Accountable Care Partnerships – the Future For Healthcare and Social Care Service Delivery in England

NHS and Local Authority bosses have been meeting in secret for over eight months concocting five year plans for delivering healthcare and social care services. The plans are called Sustainability and Transformation Plans (STPs). STPs have to achieve significant cost savings, integrate healthcare and social care services and implement seven day working. Each region (or footprint) in England is writing an STP. There are 44 footprints and ours is North West London. Approved versions of these plans are expected by October 2016. We expect there will be an STP for my town of Ealing.

 

The chosen vehicle for delivering all future State care services is Accountable Care Partnerships (ACPs).

 

On 5 September 2016 I attended a presentation on ACPs. It was delivered by David Freeman who is the ACP boss for CWHHE – a consortium of five NHS Clinical Commissioning Groups (CCGs) which includes Ealing CCG. What follows below is mostly what I gleaned from or had confirmed by Mr Freeman.

 

ACPs will be networks/alliances/consortia of NHS bodies and Local Authorities often joined by CCGs and sometimes by private care suppliers, care charities and voluntary care bodies. The problems ACPs will be aiming to address are fragmentation, misaligned incentives, unclear access and long term system sustainability. ACPs will be set up to provide specific care services for a specific population. Typically these populations will be aggregations of GP patient lists. ACP contracts will be fixed price and long term. ACP revenue will be calculated on a per capita basis. For example, if the ACP commissioner decides the specific service to be provided should cost £100 per head annually and there is a specific targeted population of 500,000, the annual sum paid to the ACP would be £50 million.

 

There are currently 50 ACP pilots operating in England since 2015. On average there are seven partners in each ACP. By no means incidentally 32 of these ACPs have CCGs as partners. 11 of the ACP pilots involve private companies as partners.

 

At some time in the future all State care services in England will be delivered by ACPs.

 

In NW London up to five ACPs will sometime in the future deliver all State care services for seven towns – Ealing, Hounslow, Hammersmith, Fulham, Westminster, Kensington and Chelsea. Up to five ACP contracts will be created. No decisions have yet been made as to what each ACP will be delivering. They might be geographic ACPs or there might be perhaps an ACP for end of life care. ACPs will serve populations of between 500,000 and one million. ACP contracts will be for ten years. The first ACP contract is scheduled to begin in April 2018. Full ACP coverage of all care services across all seven towns will be achieved sometime in the future.

 

The business type to be adopted by ACPs has apparently not been decided. Suggestions include alliances, joint ventures or Accountable Care Organisations (a US style business type). CWHHE will not dictate the business type to be adopted by ACPs, preferring the partners to agree one amongst themselves.

 

Ealing CCG has recently published a 124 page document on ACPs. There are also many STP documents in the public domain – including a draft of the NW London STP. However nowhere in all these documents can I find answers to these questions:

 

+ how free at point of use healthcare services and means tested social care services will be integrated?

 

+ how seven day healthcare services will be implemented?

 

+ the Health and Social Care Act 2012 created a market system with a strict separation of commissioners e.g. CCGs and service suppliers e.g. NHS Trusts. So how can it be legal for CCGs and NHS Trusts to be peer partners in ACPs?

 

+  when and how the shortage of care workers e.g. Doctors, Nurses, Paediatricians, Psychologists, Physiotherapists, District Nurses and Health Visitors – will be made good?  

 

+ when will the destruction of my local Major Hospital – Ealing Hospital – be completed?

 

+ what will happen if an ACP runs out of money/exceeds its fixed budget?

 

+ how it can be possible or sensible to remove clinical and financial responsibility for care from public NHS and Local Authority bodies and hand that responsibility over to untested, private partnerships?

 

Cost Cutting Healthcare and Social Care Plans Published

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On 30 June 2016 North West London NHS and Local Authority bosses submitted their draft five year plan to NHS England for cutting care costs and changing how care services are provided. After considerable pressure from a number of organizations this plan was placed in the public domain on 5 August 2016. The name of the plan is ‘The Sustainability and Transformation Plan’. You can read the plan here

It’s not an easy read and ESONHS members and others have begun meeting, discussing and researching in order to fully understand what these cost cuts and service changes will mean to residents of Ealing. As with the NHS NW London 2012 ‘Shaping a Healthier Future’ plans the survival of Ealing Hospital is at risk.

There are proposals for changing how primary care and community care services are delivered which could threaten the survival of the traditional GP surgery. Services form the seriously mentally ill are seemingly to be improved but the spending on these services will be cut.

Healthcare and social care services are to be integrated but this will clearly be difficult as healthcare is free at the point of use and social care is means tested. Again these service improvements are to be achieved at the same time as spending on them will be reduced.

Foto: By Oxyman (Own work) [GFDL, CC-BY-SA-3.0 or CC BY 2.5], via Wikimedia Commons

The Secret Planning of Healthcare and Social Care Services – August 2016

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Issue: 39

August 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 Secret Planning of Healthcare and Social Care Services:

The Sustainability and Transformation Plan (STP):

An Update

At the 6 July 2016 Ealing Clinical Commissioning Group (ECCG) public meeting hard copies of nine NW London STP slides were handed out. In December 2015 NHS England announced that England would be divided up into 44 ‘Footprints’. Each Footprint (let’s call them regions) would create a five year plan (an STP) for delivering cost cutting in the provision of healthcare services and social care services. Each region would pull together a supergroup of all its Local Authorities, NHS CCGs and NHS Trusts to work together collectively to create the plan. These supergroups meet in secret and have no Parliamentary mandate.

 

As well as massive cost cutting, each of the 44 STPs must deliver healthcare services seven days a week. The number of Acute hospital beds must be reduced and more Acute care delivered in the home and in the community. All historic healthcare debts must be eliminated and healthcare services and social care services must be integrated. A fundamental flaw in trying to integrate healthcare and social care in England is that the former is free at the point of use and the latter is means tested.

 

The deadline for submitting the first draft of the 44 STPs was 30 June 2016. However in typical NHS style this deadline was slipped in early June to October /November 2016.

 

Our region is North West London. Our STP supergroup numbers over 30 public bodies. On 5 April 2016 a summary version of our STP was created. An early draft dribbled out into the public domain in June. In April the debt target was £1.1 billion. Now the debt to be cleared appears to be £1.3 billion. On a pro rata basis this would mean an annual reduction in healthcare and social care spend in Ealing of £160 million. In order to comprehend the difficulty of meeting this cost cutting target, let’s look not for the first time at the 2012 NHS NW London ‘Shaping a Healthier Future’ plan (SaHF). SaHF’s cost saving target was 4% per year. So by now SaHF should have a saved over £400 million on the NHS NW London costs. Not once over the last three years has the SaHF brotherhood announced any savings achieved whatsoever.

 

I can find no reference in any of the April or July NW London STP drafts about the projected population increase and how this has been factored into the plan. ONS/GLA figures calculate a current population of 2,093,972. By 2022 they predict it will have risen to 2,206,451 – a rise of 112, 479 people. This equates to adding the population of a city the size of Carlisle or Worcester to our regional population. The population increase for Ealing alone is just under 20,000.

 

Bed Losses: Changing Numbers

Bed losses are on the agenda. In a 15 April 2016 STP document it states the target bed loss is 500 Acute beds. In a 27 May 2016 STP document it states a bed loss of 592. However on 1 June 2016 Carolyn Downs boss of Brent Council and one of the NW London STP hotshots said that the closure of 500 beds target had been dropped.

 

Carolyn Downs is the Local Authority (LA) STP lead for all the eight LAs in NW London. She also said that the three guiding principles of the NW London STP were 1) prevention 2) integration of health and social care and 3) innovation via technology. She voiced LA concerns about closure of Acute beds when alternative community provision was not in place. Also LAs are worried about funding the social care aspects of the STP mandated requirements.

 

Net savings apparently total £328 million This presumably must be annual savings for year one. Apparently £208.9 million will be saved by ‘improving consistency in patient outcomes and experiences regardless of the day of the week that services are accessed’. This clearly is where seven day working is implemented. But seven day working means employing more staff at the weekend and overnight or reducing service levels Monday through Friday. How over £200 million can be saved in this scenario – without massive service deterioration – is beyond my comprehension.

 

Outsourcing Mental Health?

Are the STPs being set up to fail so that the private health companies (‘the cavalry’) can then charge in and rescue our healthcare and social care services? Well, perhaps not. The small print shows us that the cavalry are actually being planned into the STP. Nestling inside ‘Delivery Area 4: Improving outcomes for children and adults with mental health needs’ (net savings of £11.8 million) is ‘implement accountable care partnerships’(ACPs). The ACP idea has been around for a while in the NHS. It is England’s version of the American Accountable Care Organisation which first emerged 10 years ago. (ACO) ACPs are a vehicle for introducing private care companies into the delivery of public care services.  A contract is drawn up with often private care providers, Primary, Acute and social care providers to provide all care for a given population for a defined (long!) period of time. Very often there are tight performance parameters and financial incentives in place when targets are met. The jury is still out in America as to whether ACOs are effective or even cost-effective. Critics of the ACO/ACP approach see them as a means of destroying single payer national care systems. .

 

There are yet again scant details on social care savings or initiatives. Nothing on social workers, personal care, protection or social support services to children and adults with needs arising from illness, old age or poverty. There are clearly planned changes on how the total spend cake will be sliced in 2020/21 compared with 2015/16. However even if, for example the slice for ‘Community’ rises from 9% to 13% there may well be less cash This is because  the total cake is just over £4 billion now but will be less than £3 billion in 2020/21. Astonishingly there is no slice of the total spend cake labeled ‘Social Care’ or even ‘Social Care and Healthcare Integration’.

 

On the mental health front the slice of the cake will stay at the current 8% of total spend in 2020/21. This will represent a serious annual drop in real cash terms of some £80 million. On a pro rata basis that would cut the annual mental health spend in Ealing by £10 million. There is a quite incredible projection about how there will be a 1% fall in serious and long term mental health needs over the next five years. I can find no clinical or research data to back up this claim.

 

The plan for addressing social isolation is amazingly ‘Address Social Isolation’. This really is pathetic. In ‘Socially Excluded Groups’ the only data – and partial data at that -concerns rough sleepers. If the STP creators think rough sleepers are the only socially excluded people they are the wrong folks to be creating my STP.

 

In the plan delivery section it states ‘…delivery to ensure it (the STP) sustains investment on the things that keep people healthy and out of hospital’. Well blow me down with a feather …isn’t that what the NHS was created for in 1948? Also in this section we find that at least 178 NHS and Local Authority staff in north west London are working on our STP. However the number could be over 200. Nationally there might well be over 8,000 paid public servants working on the 44 STPs as well as many £millions being spent on management consultants.

 

There’s reference to ‘joint governance’ and ‘joint accountability’. This is so much nonsense. I keep meeting STP /SaHF staff who tell me that they are being paid and employed by both the Local Authority and the NHS. This sends me berserk. You can only have one boss. You can only be accountable to one bunch of shareholders and one organisation.

 

Multi-Speciality Community Provider: The Outsourcing Vehicle

On 22 July another public NW London STP event took place. Labelled as a workshop so many residents asked questions that the workshop format was abandoned. Allegedly a NW London STP public event will take place in Ealing Town Hall in September or October 2016. There are no explicit plans to involve the local Healthwatch organisations in any NW London STP plan making or public engagement. More emerged on ACPs (see above) and on them being ‘delivered through Multi-Speciality Community Providers (MCPs). I first referred to these MCPs in May 2016 when discussing Devo-Manc Health (in Manchester). The scary idea emerging from the jargon littered verbiage is that traditional GP surgeries might well be closed down. They would be replaced by MCPs /’superhubs’/’networks with shared infrastructure’ which will – using the GP surgery patient lists – ‘provide…the full breadth of services ….including primary medicine and community services’. How this will threaten or destroy the traditional GP surgery is unclear. However in Brent, all the GPs have joined a newly created limited company. It’s no surprise that the directors of that company are GPs who serve on the Brent CCG Governing Body.

 

NW London STP, following the lead of the monster STPs in Manchester and Liverpool, wants a devolved budget. A recent Localis survey says 78% of NHS and Local Authority bosses want this. New London Mayor Sadiq Khan says he wants it for a London STP. However devolving health and social care could create a patchwork quilt of differing approaches and arrangements. It could wreck the NHS as a consistent, universal healthcare service. To give, as some have suggested, tax raising powers to the 44 unelected STP cabals – even with the blessing of Parliament – would destroy this country as a representative democracy.

 

Believe me STP will end in tears – in fact it’s starting in tears. Rumours abound that in my region two of the Local Authorities (LAs) have refused to ‘sign off’ on the latest draft STP. They were recently given a two page STP summary to sign their names to. The two LA bosses refused, saying no-one had showed them the latest full draft. They were then shown the 51 pages of draft version 39 and given just three hours to peruse and sign. Again they refused. NW London STP bosses then told the two LAs that they would ‘take money away from community health services for local people’. The two LAs are the London Borough of Hammersmith & Fulham and the London Borough of Ealing – the areas still most threatened by Major Hospital closures under the 2012 SaHF declaration.

 

The Judicial Review Option

Thanks to research by Peter Latham of Brent Patient Voice it’s clear that Ealing CCG  has a statutory duty under S.14Z2 of the National Health Act 2006 (as amended by Section 26 of the Health and Social Care Act 2012) to involve and consult its publics as to proposals for healthcare commissioning and changes to healthcare commissioning that affects patients. This is clearly not happening with NW London’s STP. ECCG is at risk of the procurement of or changes to commissioned healthcare affecting patients without full statutory patient/public involvement and consultation of being challenged by Judicial Review proceedings in the High Court This will, of course, apply to all 211 CCGs in England.

 

A Government Inspection Reveals Serious Failings at Northwick Park Hospital Maternity Unit: Ealing Mothers Victims of Inadequate Service

Since Ealing Hospital Maternity Birthing Unit closed down at the end of June 2015, mums to be in Ealing have had nowhere to go to in Ealing to have their babies. Some have chosen Northwick Park Hospital Maternity Unit in Harrow.

 

In October/November 2015 the Government’s Care Quality Commission (CQC) carried out an inspection on Northwick Park Hospital. Incredibly it took seven months before the CQC report was published at www.cqc.org.uk. The report contains much criticism generally about hospital services and specifically about the maternity services. These criticisms about maternity are summarised below:

 

Requiring Improvement:

+ Safety arrangements

+ Early Pregnancy Unit cleanliness

+ Medicines sometimes in unlocked cabinets and sometimes stored at the wrong temperature

+ Foetal Heart Rate checks

+ Low Midwife staffing levels

+ Minimum standards of consultant presence per week not met

+ Shortage of Health Visitors

+ Too many non-elective Caesareans

+ No Consent, Mental Capacity Act and Deprivation of Liberty training

+ No documented birth plans

+ Delays in Caesareans, induction of Labour and in Discharge

+ Poor maternity and gynaecology governance.

 

Before the closure of Ealing Hospital Maternity Unit the NHS Ealing Clinical Commissioning Group (ECCG) stated ‘….it has been able to improve maternity care for mothers across North West London’. For many new mums in both Ealing and Harrow this statement has been shown to be patently untrue.

 

The CQC criticised the standard of cleanliness in the whole hospital. There was savage criticism of the London North West Healthcare NHS Trust – the legal entity running Northwick Park Hospital. CQC stated that the Trust had failed to communicate its strategy and vision, it had failed to communicate with staff and it had failed to support staff and make them feel valued.

 

NHS North West London CCGs Spent £5.1 Million on Management Consultants in FY 2015/16

£5,188,001 was spent by the eight NHS NW London Clinical Commissioning Groups on management consultants from June 2015 to March 2016. These contracts concerned work for the 2012 ‘Shaping a Healthier Future’ (SaHF) project and the Sustainability and Transformation Plan (STP). Over £1.8 million alone was paid to McKinsey and Company.

 

The fact that one of the STP contracts was signed in August 2015 leads me to believe that the STP project was up and running secretly for months before it was announced to the public just before Christmas 2015.

 

It defies belief that the CCGs are still paying consultants to write/rewrite SaHF business cases for the SaHF which was conceived four years ago. But sure enough, six consultancies were paid over £1.8 million to work on these business cases in 2015/16. And still there are no final, published business cases. Surely the whole idea of a business case is that you get an approved business case signed off before you start a project – not four years into the project!

 

If you thought that NHS England had put a cap on the size of individual management consultancy contracts – think again. In December 2015, for example, Deloittes was awarded a £585,000 SaHF business case support contract.

 

Presumably the hundreds of staff employed by the CCGs are deemed not competent to carry out this work. But surely public money would have been better spent last year and in the last three years if the NHS had hired bright people onto its payroll to do this work? At £80,000 per year (salary plus overheads) it would have cost £3.2 million to have 10 people on board for four years to do this work. Instead the NHS NW London management consultants’ bill for 2013 to 2016 was over £38 million. Truly scandalous.

 

After Spending £50 Million on the care.data Patient Health Records Sharing Scheme, NHS Bosses/Government Scrap It

On 6 July 2016 – the day The Chilcot Report  condemning Tony Blair’s invasion of Iraq was finally published and filled our newspaers and TV screens – the  Government quietly announced that care.data was being scrapped. Launched in 2013 the care.data scheme was an attempt by the NHS to collect patient data from GPs, anonymise it and use it internally and sell it externally. care.data has consistently attracted criticism about  the anonymity and security of patient data.

 

In February 2014, 47 million NHS patient records were sold to insurers. In February 2015, 700,000 NHS patient records were shared with insurance companies without patients being consulted.

 

Tim Kelsey the genius responsible for initiating and running the care.data shambles ran away from it, the NHS and the UK in September 2015 and was last heard of in Australia. However Kelsey clearly does have a sense of humour as he’s recently published a book on the role of transparency in government and business surveillance. To misquote an old adage ‘Nothing succeeds like failure’. Also in September 2015 the care.data pilot trials were halted.

 

Data campaigners are still concerned that the NHS and the Government will continue to sell off confidential patient data – including data from NHS patients, like me, who opted out of the care.data scheme. However the Government has now, apparently, decided that patients can no longer opt out of their medical records being loaded onto a central NHS database.

 

Yet more £millions wasted by NHS/Government and still more erosion of trust between citizens and the State.

 

The NHS Is Not In Debt – But In Surplus – July 2016

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Issue: 38

July 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 NHS Is Not In Debt – But In Surplus: Nationally To The Tune of £600 Million and £72 Million in NW London

Roger Steer is a healthcare audit consultant who has been studying NHS financial data for ten years. On 9 June 2016 he published a bombshell paper which analysed NHS commissioning financial reports for 2015/16. He revealed the following surpluses (what one might call profits) for 2015/16:

 

+ NHS England – £600 million

+ NHS London – £26.5 million

+ NHS North West London – £72 million

 

In fact the NHS in England has been in surplus at the end of the last five financial years – in 2013/14 as low as £1 million and in 2010/11 as high as £1.1 billion.

 

These figures make a nonsense of the scary reports of NHS 2015/16 losses of £2.4 billion. They make no sense in the context of the blanket requirement of the Stevens /NHSE Five Year View/Sustainability and Transitional Plan (STP) imperative of clearing NHS debts – if in fact at a gross level no such debts exist.

 

One wonders whether the Government’s seemingly erroneous debt message is simply scare mongering to somehow justify the STP cost cutting without Parliamentary scrutiny or any public consultation.

 

North West London’s Sustainability and Transformation Plan (STP) Finally Enters the Public Domain on 16 June 2016

NW London’s 15 April 2016 initial draft STP submission can be viewed at:

 

www.bpv.org.uk/nw-london-sustainability-transformation-plan-15-april/

 

STPs are the latest device being foisted on us by Government in an attempt to eliminate alleged historic NHS debts, reduce future healthcare and social care costs and extend healthcare and social care services. Simon Stevens, boss of NHS England, published a national Five Year View care strategy in late 2015. In it he created 44 care regions (weirdly called ‘Footprints’). Each Footprint threw together all the Local Authorities, NHS CCGs and NHS Trusts in that region. Each of these footprints has this year to produce a first year STP and submit it to NHS England for review. All STPs have to indicate how current NHS ‘debts’ would be paid off, 7 day working would be implemented, hospital A&Es would be replaced by Urgent Care Centres, Acute hospital care reduced and replaced by care at home or in the community, and healthcare integrated with social care. The STP must also supply details of the sale of surplus land and buildings.

 

Our footprint is North West London with over 2 million people and a Government estimate of over £4 billion spent last year on NHS healthcare and Local Authority social care.

 

Before I make any comments on the 18 page NW London draft STP I think it’s worth exploring the attempts in recent years to cut healthcare and social care costs nationally and regionally. This exploration will help to answer the question (or question the question): why STP?

 

Healthcare Cost Cutting

+  In 2010 the Government announced that annual NHS costs would be reduced by $20 billion by 2015. However annual healthcare expenditure (according to Roger Steer – see above) rose over five years from £97.5 billion to £101 billion in 2015/16.

 

+  The Health and Social Act 2012 created a market for healthcare which separated healthcare professionals into buyers and service providers. Profit and loss accounts were created for hospitals. However mystery and confusion surrounds the NHS accounts for 2015/16. All but seven of the 138 NHS Hospital Trusts supposedly made a loss in 2015/16. NHS England says the NHS losses for the year were at least £2.4 billion. However the recent Roger Steer report (see above) has added up the NHS figures and he states that in 2015/16 the NHS in England made a profit/surplus of £600 million.

 

+  In 2012 NHS NW London launched its ‘Shaping a Healthier Future’ (SaHF) strategy. NHS expenditure in NW London was then stated to be £3.6 billion. The target for annual cost savings was 4%. By now over £400 million should have been saved. As SaHF has not trumpeted details of any savings one can presume that none have accrued from SaHF. However Roger Steer has analysed all eight NW London CCG accounts and calculates a £72 million profit (or surplus in NHS speak) was achieved in 2015/16.

 

+  In June 2013 the Government’s Better Care Fund (BCF) was introduced to oil the wheels of reducing costs by integrating NHS healthcare and Local Authority social care services. £3.8 billion was to be invested with the target of saving £1 billion by 2015/16. In November 2014 the Government’s National Audit Office produced a report stating that in its first year BCF savings of just £55 million were realised. Since that announcement we’ve heard little more about BCF.

 

Social Care Cost Cutting

+  What is social care? It’s the provision of social work, personal care, protection or social support services to children or adults in need or at risk or adults with needs arising from illness, old age or poverty.

 

+  Since 2010/11 annual social care expenditure in England has decreased by over 10% to £13.3 billion. The expenditure on children in care in England in 2013/14 was £2.5 billion. Try as I might I can’t find any other meaningful historic or current expenditure details on children’s social care in England, London or NW London.

 

NW London STP 15 April 2016 Submission

So against a backdrop of austerity, population increase and people living longer 31 regional public bodies were thrown together and told to come up with a plan to both cut costs and improve healthcare and social care services across North West London. There clearly is some logic in trying to integrate the service supply of physical health, mental health and social health. To make this work would almost certainly involve the creation of a single business model and a single organisation to provide all these services. But we have the NHS, Local Authorities and private care homes each with different mission statements and different reporting structures.

 

I can only sympathise with the plan makers as what they are being asked to do is impossible. They must surely know this.

 

There are very few relevant, understandable numbers in the plan. Two are:

 

+ Over £1 billion annual savings by year 5 (2021/22?)

 

+ Lose 500 Acute beds.  

 

There are seven ‘Emerging Priorities’, which bizarrely are not the Stevens/NHE Five Year View goals. They are really seven aspirations as opposed to priorities. There are no real, tangible clues as to how these aspirations will be met. Quite simply these aspirations might be summarised as wanting better healthcare and social care services for everyone in NW London. As such they represent what citizens have thought the NHS and Local Authorities have aspired to deliver for decades.

 

On the financial side on page 11 there is an impenetrable table of financial numbers and unexplained acronyms. The table doesn’t even has a title –  which if it existed might help the reader to gain some understanding. However what stands out like a sore thumb are the entries associated with ‘NW London social care’ financial figures. The entries state ‘not available’.

 

Returning to the Stevens/NHE Five Year View goals the STP gives very little detail on how they might be met. For example there is little explicit detail on how 7 day working will be achieved or how healthcare and social care will be integrated.

 

Apparently there is some kind of risk register. Number 1 risk is ‘Access to capital for estates and IT investment’. SaHF (which is included in the STP) has wanted up to £1billion for capital projects for quite some time now. However there are no signs or hints anywhere that the Treasury will stump up the cash.

 

What’s missing from the STP?

There very little in it concerning GP services, social care services generally and care homes specifically. There is nothing on the sale of surplus land and buildings. None of the statutory Healthwatch organisations have been given a role in the formulation or implementation of the plan. And of course there is nothing in the STP about residents and patients being involved in the plan making process.

 

Finally the North West London Footprint wants a ‘Devolution Deal’. This  would mean that the self appointed healthcare and social care bosses would have direct control of over £4 billion annually to spend as they thought fit. A scary prospect.

 

Ealing CCG Hosts Vacuous STP Public Meeting on 13 June 2016: Announces STP Deadline Slip to October/November 2016

 

Ealing Clinical Commissioning Group (ECCG) announced at a rare public STP meeting on 13 June 2016 that NHS England had cancelled its 30 June 2016 deadline for submitting draft STPs. Now the deadline date is a vague October/November 2016.

 

Fewer than 20 residents attended this poorly advertised Ealing STP public meeting. I asked why the meetings of the 31 public bodies over the last four months concocting our STP were held in secret and why we couldn’t see a copy of the latest STP for North West London. ECCG said that NHS England had told them to exclude the public from involvement in the plan making exercise.

 

So, how do you run a public meeting on a plan the details of which can’t be revealed to the public? What you do is split the audience up into little groups and ask them to discuss huge societal and political issues like ‘how do we reduce social isolation’ and ‘how do we improve children’s mental and physical health and well-being’? I’m surprised in a way we weren’t asked how to reverse climate change and eliminate world poverty. This is so unbelievably patronising and belittling to citizens. Some people got angry and raged about the UK’s low % of GDP spent on care, the impossibility of improving care services when hospital and care home beds were being lost and how is it that healthcare in Cuba is better than it is in England. The thorny issue of STP legitimacy was raised, as no Act of Parliament supports STPs’ existence.

 

I lobbied hard with a senior ECCG person on the need for NHS staff and Ealing Council officers to work in tandem with informed volunteers to provide, for example, mental health caring services. NHS England’s approach of shutting out and antagonising volunteers was very unhelpful. I told her I thought it was unlikely that more paid staff would enter the fray and deploying significant numbers of well managed volunteers integrated with paid staff offered some hope of ‘doing more with less’. Her elliptical response was ‘we are working with partners’.

 

No details emerged from the meeting about how the alleged enormous NHS debts would be paid off, how 7 day working would be implemented, how Acute hospital care would be reduced (rumours of 500 bed losses) and replaced by care at home/in the local community and how healthcare and social care would be integrated.

 

Apart from losing 90 minutes of my life I will never get back, my overriding impression was that the STP project is doomed. The no doubt well paid public servants in the room tried hard to show enthusiasm for the STP project but this was not entirely convincing as they shut down responses to difficult questions. No Ealing GPs, Ealing Hospital staff or anyone working for an Ealing care home bothered to attend the meeting. No-one mentioned SaHF and the usual SaHF cheer leaders were absent. Ealing Council’s presence was minimal and very low key.

 

The reality is that if NHS England do not like submitted plans they will send them back to footprints who will have to re-do them. And Thatcher-like, if NHS England finally does not like the re-worked STP the threat is that no new money will be sent to that footprint.

 

Opposition to Inadequate Funding and Resourcing for Care Grows Locally, Regionally and Nationally

Locally here in Ealing the Ealing Save Our NHS (ESONHS) group remains strong and new blood and new leadership is maybe coming onto the Board of Healthwatch Ealing (HE). HE so far has been largely ineffective. A Judicial Review on the paediatric closures in Ealing is being mounted by a local parent.

 

Regionally there has been a first meeting of North West London Health Matters. The organisation was inspired and organised by activists in Hammersmith and Fulham. It aims to co-ordinate opposition to closures and cuts throughout NW London.

 

Nationally, Keep our NHS Public (KONP) seems to have stopped arguing with itself so much and its newish, knowledgeable leaders John Lister and Tony O’Sullivan are making their mark. Health Campaigns Together offers the prospect of an entity supporting and representing all healthcare activist groups nationally.

 

Inspiration for all care activists has come from Shropshire where a CCG voted against the closure of a hospital A&E department. Rumour has it that the CCG and the Local Authority in Bedford are at loggerheads over reviewing services. News came, initially from Yorkshire, that the deadline for creating Sustainability and Transformation Plans (STPs) has been/will be extended. We now know from Ealing CCG that the submission deadline has been delayed. Sometimes delays in state programmes are precursors to programme change or programme deletion. One suspects that the competing goals of Local Authorities and NHS CCGs and Trusts have resulted in acrimonious and protracted rows about how big financial cuts should be ‘shared’ across  social care and healthcare.

 

A Government Inspection Reveals Serious Failings at Northwick Park Hospital Maternity Unit

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A Government Inspection Reveals Serious Failings at Northwick Park Hospital Maternity Unit: Ealing Mothers Victims of Inadequate Service

Since Ealing Hospital Maternity Birthing Unit closed down at the end of June 2015, mums to be in Ealing have had nowhere to go to in Ealing to have their babies. Some have chosen Northwick Park Hospital Maternity Unit in Harrow.

In October/November 2015 the Government’s Care Quality Commission (CQC) carried out an inspection on Northwick Park Hospital. Incredibly it took seven months before the CQC report was published at www.cqc.org.uk. The report contains much criticism generally about hospital services and specifically about the maternity services. These hospital maternity services criticisms are summarised below:

Requiring Improvement:

+ Safety arrangements

+ Early Pregnancy Unit cleanliness

+ Medicines sometimes in unlocked cabinets and sometimes stored at the wrong temperature

+ Fetal Heart Rate checks

+ Low Midwife staffing levels

+ Minimum standards of consultant presence per week not met

+ Shortage of Health Visitors

+ Too many non-elective Caesareans

+ No consent, Mental Capacity Act and Deprivation of Liberty training

+ No documented birth plans

+ Delays in Caesareans, induction of Labour and in Discharge

+ Poor maternity and gynaecology governance.

 

Before the closure of Ealing Hospital Maternity Unit the NHS Ealing Clinical Commissioning Group (ECCG) stated ‘….it has been able to improve maternity care for mothers across North West London’. For many new mums in both Ealing and Harrow this statement has been shown to be patently untrue.

The CQC criticised the standard of cleanliness in the whole hospital. There was savage criticism of the London North West Healthcare NHS Trust – the legal entity running Northwick Park Hospital. CQC stated that the Trust had failed to communicate its strategy and vision, it had failed to communicate with staff and it had failed to support staff and make them feel valued.

A bad day for Ealing Children

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Ealing Save Our NHS organised an angry protest outside the hospital on the day they closed the Charlie Chaplin Children’s Ward.
The protest was covered on ITV’s news at 6.00 and was supported campaigns from Lewisham and Hammersmith as well as Ealing.  Paediatric Consultant Tony O’Sullivan, local MP Virendra Sharma and many others turned up on a working day to show their feelings.
Excluding children from A&E is as disgusting as it gets….
Now we want political parties to commit themselves to reversing these cuts and to defending Ealing A&E.
Reports on our protest are here in the Evening Standard and Get West London

Ealing Save our NHS Childrens Ward Closes, We Need A Hospital from Ealing Save Our NHS on Vimeo.

Ealing Save our NHS Childrens Ward Closes, Bring Services Back from Ealing Save Our NHS on Vimeo.

Ealing Save our NHS Childrens Ward Closes, Fight Goes On from Ealing Save Our NHS on Vimeo.

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NHS North West London CCGs Spent £5.1 Million on Management Consultants in FY 2015/16

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£5,188,001 was spent by the eight NHS NW London Clinical Commissioning Groups on management consultants from June 2015 to March 2016. These contracts concerned work for the 2012 ‘Shaping a Healthier Future’ (SaHF) project and the Sustainability and Transformation Plan (STP). Over £1.8 million alone was paid to McKinsey and Company.

SaHF is a 2012 NHS NW London strategy to cut costs. Two full hospital A&Es, a children’s hospital A&E and a hospital Maternity unit have already been closed, but no financial savings have been announced. SPT is a national cost cutting scheme whereby Local Authorities, NHS Trusts and NHS Clinical Commissioning Groups ( CCGs) try to thrash out regional five year plans for delivering less expensive healthcare and social care services. In NW London the goal is to save £1.3 billion by 2020/21.   

The fact that one of the STP contracts was signed in August 2015 leads me to believe that the STP project was up and running secretly for months before it was announced to the public just before Christmas 2015.

It defies belief that the CCGs are still paying consultants to write/rewrite SaHF business cases for the SaHF which was conceived four years ago. But sure enough, six consultancies were paid over £1.8 million to work on these business cases in 2015/16.

If you thought that NHS England had put a cap on the size of individual management consultancy contracts – think again. In December 2015, for example, Deloittes was awarded a £585,000 SaHF business case support contract.

Presumably the hundreds of staff employed by the CCGs are deemed not competent to carry out this work. But surely public money would have been better spent last year and in the last three years if the NHS had hired bright people onto its payroll to do this work. At £80,000 per year (salary plus overheads) it would have cost £3.2 million to have 10 people on board for four years to do this work. Instead the NHS NW London management consultants’ bill for 2013 to 2016 was over £38 million. Truly scandalous.

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