All over England public bodies are meeting together in secret to come up with plans to cut £2.3 billion off the annual NHS budget by 30 March 2017. For example here in north west London a Strategic Planning Group (SPG) has been formed to produce a Sustainability and Transformation Plan (STP). Members of the SPG include representatives from eight Local Authorities, eight NHS CCGs and 11 NHS Trusts. The STP has to be completed by 30 June 2016.

The STP must specify how existing local NHS debts are eliminated, how 7-day NHS working is implemented, how hospital beds will be replaced by care at home, how A&E units will be replaced by Urgent Care Centres, and how healthcare and social care will be integrated. The failing 2012 ‘Shaping a Healthier Future’ cost–cutting project is being ‘folded’ into the STP.

If the plan is not produced or is rejected, access to new NHS funding will be denied and a new SPG leader appointed by national NHS bosses.

Creating these public bodies’ ‘supergroups’ has not been the subject of an Act of Parliament. There has been no public consultation. No-one has produced any evidence to indicate that this radical STP initiative will or might improve healthcare and social care services – or in fact will or might achieve the targeted cost savings.

Over the last 10 years 10,000 hospital beds have been lost across the country. In the 12 months up to September 2015, 1,500 care home beds have been lost. Care at home has become discredited by constant stories of under paid care workers only being able to spend 15 minutes per patient.

Far from spending less in healthcare we should be spending much more. The UK spends 6.8% of GDP on its healthcare. In Germany  it’s 10.3% of GDP. In the UK we have 3 hospital beds per 1,000 people – in Germany it’s 8.3 hospital beds per 1,000 people.
The UK is one of the richest countries in the world. We ‘invented’ publicly funded  healthcare and social care services. Why can’t we collectively look after our citizens’ health especially those unable to look after themselves? After all a healthy population is a happier one and a more productive one.

Angry health protesters gathered today outside Greenford Hall as Ealing CCG was considering ongoing cuts to Hospital services.
The CCG (Clinical Commissioning Group) is pressing ahead with plans to close the Charlie Chaplin Children’s Ward at Ealing Hospital, which would also mean children would no longer be accepted at the hospital A&E department.
Eve Turner, from Ealing Save Our NHS, said “If this cut goes ahead the CCG will be responsible for serious delays in seriously injured or ill children getting treatment. No amount of PR waffle or abuse of statistics will change that. It’s dangerous and has no public support.

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Issue: 35

April 2016

This occasional newsletter is researched, written and edited by a group of concerned residents in Ealing, West London who want to preserve our NHS. We view the wholesale engagement of private, for-profit healthcare service suppliers as unnecessary, profligate and dangerous. Process improvement is what is needed in our NHS – not revolution.

The Failing NHS NW London Shaping a Healthier Future Project is Being Buried in the Shiny New Sustainability and Transformation Plan for Integrating Healthcare and Social Care Services

Massive changes are afoot in the creation of new organisations (consortias of public bodies) throughout England which are the vehicle for making massive financial cuts in NHS spending. These new organisations will design and deliver new models of integrated healthcare and social care. The national media and activists on the ground have seemingly not yet woken up to these changes, their inherent risks and implications.

The change agents for all this are Sustainability and Transformation Plans (STPs). STPs are part of NHS England’s Five Year Forward View (FYFV). STPs have a five year budget of £8.4 billion. England has already been carved up into 44 so called ‘footprint’ areas. In each of these footprints NHS CCGs, Local Authorities and NHS Trusts will work together to formulate and deliver an STP. London has five footprints. Our local one is NHS NW London which includes eight CCGs, eight Local Authorities and 11 NHS Trusts. NW London Footprint boss is Ealing’s own Dr Mohini Parmar. She now has four roles/jobs – Footprint boss, SaHF cheer leader, ECCG Chair and local GP. The bosses identified so far are almost all senior CCG types or NHS Trust bosses. None of them are from the social care community. Each footprint has to create its first STP by 30 June 2016.

The prospect of NHS and Local Authority bureaucrats working successfully together and amicably resolving the competing resource demands of healthcare and social care takes quite a lot of believing. It also seems incredible that apparently none of the thousands of care homes in England are represented in these footprints. I now understand one of the reasons why the eight CCGs in NW London have been working together for so long.

Each STP must balance the financial books of local NHS finances by end of March 2017 and achieve this by implementing new models of care set out in the FYFV. The new models include reducing hospital beds and ‘replacing’ them with digital monitoring and home visits. Another new model is for Urgent Care Centres to effectively replace A&E units in hospitals. STPs will also spell out the sale of surplus land and buildings. The STP presents private healthcare providers with huge opportunities.

Apparently NHS London North West Trust (which includes Ealing Hospital) expects to receive £21.5 million for 2016/2017 from the STP. This seems quite high as £2.1 billion nationally for 2016/2017 STP shared by 44 footprints comes to just over £47 million each.

There are just 12 weeks to go to finalise our STP. Ealing CCG’s web site provides details of the NW London Footprint. Apparently a first draft of the local STP was created at the beginning of February 2016. A mind boggling 31 public organisations are represented.  The footprint is led by something called the NW London Strategic Planning Group (NWLSPG). All CCGs, all Local Authorities, all NHS Trusts and The London Ambulance Service are represented, and there are just two patient representatives. I wonder who they are and just how they were selected or possibly elected.

The ailing ‘Shaping a Healthier Future’ (SaHF) project finally gets buried and subsumed into the NWLSPG’s STP initiative. This could well explain Ealing Council’s ‘quietness’ on the subject of SaHF. The Council must be finding it difficult to publicly criticise  SaHF as now it is one of the (admittedly many) organisations now responsible for SaHF. Surely Hammersmith & Fulham Council can no longer seriously pursue a Judicial Review about SaHF when it is now part of the consortium responsible for SaHF. I now also understand why references to SaHF have been curiously disappearing over recent months.

Other existing NHS ‘transformations’ which will be brought into the STP regime include Whole Systems Integrated Care, Like Minded, Primary Care Transformation and Seven Day Services.

On a day to day basis Ealing Council’s Scrutiny is attempting to hold Ealing CCG to account. Surely this becomes mission impossible if the Council and the CCG are getting into a very large STP bed together to design and deliver integrated health care and social care services. Now I understand one of the reasons why ECCG moved into the same building as Ealing Council.

The STP project could learn from some of the missteps of its progenitor – the £5.3 billion NHS Better Care Fund launched in 2013. BCF aimed at ‘…transforming local health and social care by pooling (Local Authority and NHS) resources’. BCF failed to meet its operational and cost cutting goals in 2014. It’s a bit odd that it is not being absorbed into STP.

There is a link here somewhere, somehow with the Accountable Care Organisation (ACO) concept. ACO is a 2006 American idea which became mandated in the US Patient Protection and Affordable Care Act of 2010. The ACO approach is that of a consortium of public and private healthcare and social care organisations delivering services to a defined population for a defined period. Reimbursement is often tied to ACO’s meeting quality and cost targets. Surely these 44 STP footprint consortia are ACOs?

The ACO concept is being trialled in one of the NHS Vanguard projects in Barking & Dagenham, Havering and Redbridge. Other ACOs under consideration include those in Northumbria and Morecambe Bay. Worryingly studies of ACOs in the US showed that projected savings by ACOs in 2011 – 2014 of $320 million were not achieved. In fact a loss of $3 million was sustained.

All these STP activities, costing £millions and requiring extensive organisational engineering, are not mandated by any Act of Parliament and have not been the subject of any public consultation.

When David Cameron said in 2009 and in 2010 that a Tory Government would not bring about a new top down re-organisation of the NHS, he was right. He’s now initiated not one – but two of them.

Hunt Threatens to Remove and Replace NHS Boards for Those Trusts in Deficit on 1 April 2016

Secretary of State Jeremy Hunt MP is going to be very busy this month replacing the Boards of 138 NHS Trusts throughout England. London Health Emergency’s research published in early February 2016 revealed that 138 of the 150 NHS Trusts were in the red. The combined deficit of these 138 Trusts amounted to £2.2 billion. – and it was still rising.

‘…Children Will Die…’ Says Experienced Consultant Paediatrician

This prediction by Tony O’Sullivan, Consultant Paediatrician at Lewisham Hospital, was made to over 100 people at the Ealing Save Our NHS rally in the centre of Ealing on Saturday 12 March 2016. He made it in response to Ealing Clinical Commissioning Group’s (ECCG) ‘Shaping a Healthier Future’ (SaHF) plans to severely downgrade (in fact remove) Ealing Hospital’s Paediatric services. On 16 March 2016 ECCG confirmed to the press that the children’s in-patient ward and the children’s A&E service at Ealing Hospital would close on 30 June 2016.

Tony’s nightmare scenario is that in 12 weeks time  a very sick child may arrivie at the doors of Ealing Hospital being carried by a parent. With no A&E facilities available for children, the Urgent Care Centre (UCC) – devoid of Paediatric Consultants and Paediatric Nurses – will likely have difficulty in accurately diagnosing and adequately stabilioasing such a sick child.

Currently 93% of all sick children arriving at Ealing Hospital are brought by their parents and carers and not by ambulance. Around 6,000 children annually attend Ealing Hospital A&E. Just under 2,000 children annually are admitted as patients to the hospital.

So what will happen to the thousands of sick children who the Ealing Hospital UCC determine need A&E services? The plan is that the NHS Patient Transport Service (PTS)  – not the London Ambulance Service – will transfer them variously to hospital A&E units at remote locations including those in Harrow, Hillingdon and Isleworth. The NHS PTS has a poor reputation. A comprehensive report on PTS in London by Transport for All in October 2014 discovered many patients facing long waits for transport to hospital appointments. It’s unclear (and almost certainly unlikely) whether a Paediatric nurse or doctor would accompany each sick child on his or her trip out of Ealing. Distraught parents and carers will have to make their own way to these remote hospitals to be re-united with their sick child.

It is an absolute certainty that the time to expert diagnosis and commencement of treatment will be increased by these closures. This will inevitably introduce the risk of increased physical and mental pain, condition deterioration and death.

ECCG presented a paper on its Paediatric reconfiguration aspirations at Ealing Council’s Health and Social Care Scrutiny Panel on 8 March 2016. The paper was almost completely bereft of Paediatric patient numbers, explanations and analyses. Scandalously the paper makes no mention at all about how the specific emergency needs of children arriving at Ealing Hospital suffering from severe mental health episodes and conditions will be diagnosed and treated.

The MindEd Trust has recently publicised the fact that just 0.7% of the NHS budget is spent on the mental health needs of children and adolescents. The ECCG’s apparent ‘blindness’ with regard to mentally ill children presenting themselves at Ealing Hospital is symptomatic of the empty senior NHS rhetoric of ‘parity of esteem between physical and mental health’. Still the ECCG approach is horribly consistent with the 2012 SaHF proposals which contain no mention of mental health services whatsoever.

If  A Child Dies As a Result of  Removing Accident, Emergency and Acute Services for Children at Ealing Hospital – Whose Fault Will It Be?

The answer to this one is quite simple. It’s the Ealing Clinical Commissioning Group (ECCG). We should hold the ECCG Governors personally and collectively responsible. I have attended quite a few public meetings of the ECCG Governing Body. They are very strange meetings. No-one ever argues. There is very little discussion or debate. I have never witnessed a vote on any issue or policy choice. Surely a few of these Governors must have had their doubts about closing Maternity or downgrading children’s services at Ealing Hospital. Why have none of them put their hands up and said something like ‘you know, I’m not entirely convinced that this will work/that we’ve thought this through properly/that this is the right thing to do…’.

And who are these people anyway?

Let’s identify them:

+  Dr Mohini Parmar, NHS ECCG Chair and newly appointed boss of the NHS NW London Footprint (Sustainability and Transformation Fund).

She signed her name on the 2012 ‘Shaping a Healthier Future’ Consultation document. GP working at the Barnabas Medical Centre, Ealing.

+  Dr Raj Chandok, NHS ECCG Vice Chair

GP working outside Ealing

+  Dr Mohhammad Alzarrad

Southall GP

+  Dr Arjun Dhillon

West Ealing GP

+ Dr Vijar Tailor

GP at Hillcrest Surgery, Acton

+ Dr Shanker Vijayadeva

GP working with Dr Parmar at the Barnabas Medical Centre, Ealing

+ Fionnula O’Donnell

Ealing GP Practice Manager

+ John McNeill

Healthwatch Ealing Chair

+  Jonathan Webster

Qualified nurse now in nursing management in NHS North West London

+  Ben Westmancott

NHS North West London manager and administrator

+  Dr Jackie Chin

Ex-Director of Public Health, London Borough of Ealing

+  Keith Edmunds

Chief Finance Officer

+ Sally Armstrong

Hanwell GP Practice Nurse

+ Philip Young

Accountant and management consultant. Has experience as Trustee of a respected local care home

+ Philip Portwood

Ex-Acton Councillor

+ David Archibald

Ex-social worker and ex-Executive Director for Children and Adults, London Borough of Ealing

+ Clare Parker

NHS ECCG Chief Officer and qualified accountant

+ Tessa Sandall

NHS ECCG Managing Director

+ Carmel Cahill

Ex-Healthwatch Ealing Chair

This line-up does not tally exactly with the ECCG web site, which sadly is not up to date.

Number of Arrivals at NHS Hospital A&Es is FALLING: Shortage of Beds and Staff is Causing the A&E Treatment Crisis

A&E waiting times in many areas of England are missing performance targets. Patients in NW London are amongst those suffering because of this. Closure of hospital A&Es across England, including closures at Hammersmith and Central Middlesex Hospitals in September 2014, is clearly the recent historic driver for this local service deterioration.

The NHS figures extracted and presented by Colin Standfield of Save Our Hospitals show unequivocally that there has been no increase in A&E arrivals since April 2013. His figures and graphs show this to be the case for England, London, NW London, London excluding NW London, and Ealing and Northwick Park Hospitals. In fact the number of attendances nationally actually dropped in recent months. According to a King’s Fund report of 6 March 2016 ‘…so far this year, total A&E attendances for the first three quarters are slightly down on the same period last year’.

However the Department of Heath and NHS England is consistently lying about the numbers of A&E arrivals. They keep saying that ‘demand’ is increasing. But they won’t quote real data and NHS England’s refusal to publish weekly A&E performance data any more looks like a pathetic attempt to hide the actual data. Also even monthly data is not made publicly available on a timely basis. No such data has as yet been released for January and February 2016.

The ever worsening crisis in A&E is being caused by shortage of staff and shortage of Acute beds. Dr Cliff Mann, President of the College of Emergency Medicine says the crisis in A&Es is ‘unprecedented’. With the future of many NHS hospitals uncertain (eg Ealing and Charing Cross) and high levels of pressure and overcrowding in A&Es it’s not surprising that doctors are not signing up for permanent A&E positions.  Just one quarter of new A&E consultant posts in England were not filled this year. The recent caps on rates of pay for locums has lowered pay levels three times – in November 2015, February 2016 and March 2016. So vacancies are either unfilled – permanently or temporarily – or Trusts are risking censure or worse by breaking the temporary pay rate rules. Dr Mann says that hospitals are drafting non-A&E hospital staff into A&E. With finite and perhaps reducing medical staff resources, hospitals are having to delay or cancel elective and non-emergency treatment.

I went to the Ealing Hospital rally in support of junior Drs, which was brilliantly organised by local campaign group, Ealing Save Our NHS. It was a very powerful event and I felt quite emotional standing together with over 100 people – junior and senior Drs, nurses, relatives of patients from within the hospital, union representatives, parents of young children and elected politicians – to protest loudly against the unfair and unsafe contract for Junior Drs.
The speakers were varied and inspirational. Although, at times, the crowd had to strain to hear over the continuous noise of drivers on Uxbridge Road tooting their horns in support of the junior doctors picket. A few things that the speakers said stood out. Firstly, Dr Ravi Ganepola was quite emotional when he said that ever single striking doctor in the country would much rather be working on the ward, helping their patients, than picketing outside the hospital in the rain. These Drs are very reluctant activists who are simply desperate for the Government to listen to their fears about what this contract will do to patient care. He is very worried there will an exodus of junior Drs when the contract is imposed.

Meanwhile, local celebrity, Shappi Khorsandi echoed the concerns of parents from across the community. I have a one year old and a three year old, and I am worried that the children’s A&E that is currently closest to my home will be shut. And finally, there was a call to action from virtually all speakers to tell friends, families and colleagues about what the Government is actually doing to our NHS. It’s starving our hospital of funds, selling of chunks of the NHS to private companies who are running them for profit and stretching every single member Dr, nurse, radiologist and ambulance driver to breaking point.

Jeremy Hunt is desperately hoping that we won’t notice and that we won’t protest the destruction of our health service. Judging by the strength of feeling at yesterday’s rally, and at public demonstrations across the country, Mr Hunt is out of luck.
I feel lucky that we have such a strong local group in Ealing Save Our NHS, which supports our local hospitals and is leading efforts to protect our local hospital and support NHS staff.

As you probably know on 16 March 2016 the local CCG confirmed that the children’s in-patient ward and the children’s A&E service at Ealing Hospital will close on 30 June 2016.

Please consider writing or speaking to your GP and local councillors.  Your GP or Councillor might not know or understand everything that’s going on….

If we work together we can put some pressure on the people who make these decisions.

This prediction by Tony O’Sullivan, Consultant Paediatrician at Lewisham Hospital, was made to over 100 people at the Ealing Save Our NHS rally in the centre of Ealing on Saturday 12 March 2016. He made it in response to Ealing Clinical Commissioning Group’s (ECCG) ‘Shaping a Healthier Future’ (SaHF) plans to severely downgrade Ealing Hospital’s Paediatric services. On 16 March 2016 ECCG confirmed to the press that the children’s in-patient ward and the children’s A&E service at Ealing Hospital would close on 30 June 2016.

Tony’s nightmare scenario is of a very sick child arriving at the doors of Ealing Hospital being carried by a parent in 12 weeks time. With no A&E facilities available for children, the Urgent Care Centre (UCC) – devoid of Paediatric Consultants and Paediatric Nurses – will likely have difficulty in accurately diagnosing and adequately treating a very sick child.

Currently 93% of all sick children arriving at Ealing Hospital are brought by their parents and carers and not by ambulance. Around 6,000 children annually attend Ealing Hospital A&E. Just under 2,000 children annually are admitted as patients to the hospital.

So what will happen to the thousands of sick children who the Ealing Hospital UCC determine need A&E services? The plan is that the NHS Patient Transport Service (PTS)  – not the London Ambulance Service – will transfer them variously to hospital A&E units at remote locations including those in Harrow, Hillingdon and Isleworth. The NHS PTS has a poor reputation. A comprehensive report on PTS in London by Transport for All in October 2014 discovered many patients facing long waits for transport to hospital appointments. It’s unclear (and almost certainly unlikely) whether a Paediatric nurse or doctor would accompany each sick child on his or her trip out of Ealing. Distraught parents and carers will have to make their own way to these remote hospitals to be re-united with their sick child.

It is an absolute certainty that the time to expert diagnosis and commencement of treatment will be increased by these closures. This will inevitably introduce the risk of increased physical and mental pain, condition deterioration and death.

ECCG presented a paper on its Paediatric reconfiguration aspirations at Ealing Council’s Health and Social Care Scrutiny Panel on 8 March 2016. The paper is almost completely bereft of Paediatric patient numbers, explanations and analyses. Scandalously the paper makes no mention at all about how the specific emergency needs of children arriving at Ealing Hospital suffering from severe mental health episodes and conditions will be diagnosed and treated.

The MindEd Trust has recently publicized the fact that just 0.7% of the NHS budget is spent on the mental health needs of children and adolescents. The ECCG apparent ‘blindness’ with regards mentally ill children presenting themselves at Ealing Hospital is symptomatic of the empty senior NHS rhetoric of ‘parity of esteem between physical and mental health’. Still the ECCG approach is horribly consistent with the 2012 SaHF proposals which contain no mention of mental health services whatsoever.

Julia Farrington from Shropshire Defend our NHS wrote to Ealing Save our NHS:

[dropshadowbox align=”none” effect=”lifted-both” width=”auto” height=”” background_color=”#f0e9c3″ border_width=”1″ border_color=”#dddddd” ]Hello from a fellow campaign. Our Womens and Childrens Department was closed a few years ago at the Royal Shrewsbury Hospital and it has caused chaos.   The Royal Shrewsbury has an A&E department, which is due for closure too but it is still the trauma centre and has to accept paediatric patients, it a farce and dangerous. The sister hospital is the Princess Royal Hospital in Telford some 15 minutes away on a blue light…if there’s an ambulance available, if the roads are clear, no road works, no rtcs. The management team were repeatedly warned by senior staff in Paediatrics and the Emergency Department, they now regret ‘ the hasty decision to move Women and Childrens Department’
to one site. I am a mother with a child who has been in resuscitation area of the Emergency Department with a hospital minutes away that we now cannot access, it is frightening! I wish you all the best and please have a look at our website, Shropshire Defend Our NHS but we are a rural campaign with different dangers but we are all trying to do the same thing, I just wish we were listened to![/dropshadowbox]

While we have “Shaping a Healthier Future”, in Shropshire they have “Future Fit” but have a look at their website, it all sounds very much the same. You can also find Shropshire Defend Our NHS on Facebook.

We totally reject the claims by local Health bosses that it is safe to close the Children’s ward at Ealing hospital on June 30th.  We believe that children may die as a result.
The Clinical Commissioning Group and their management consultants are making unsubstantiated claims so as to cut vital services.  They were publicly proved wrong that it was OK to close the A&Es at Central Middlesex and Hammersmith Hospitals. Instead, delays for emergency treatment in North West London shot right up and became the highest in the whole country. Their investigation into that disaster was simply passed over to the same private companies who had recommended the cuts.
The closure of Maternity and the Children’s Ward is part of a plan to prepare closure of 300 beds and the A&E at Ealing Hospital.

Closing the Charlie Chaplin children’s ward and removing the paediatric consultants and other specialist staff would mean that local children would no longer be treated at Ealing E&E.

The CCG say ambulances will simply take children elsewhere, but 93% of children are taken to hospital by their families, not by ambulance so when there is an emergency cases would be subject to serious delays.  They would have to be assessed at the non-specialist Urgent Care Centre, then await transport to another hospital – ambulances won’t do this- then await assessment and treatment at another hospital.

Even apart from the disastrous risk to emergency cases, other sick children will end up in hospital miles from home.  How could a working parent from Southall or Hanwell possibly look after a child at home and visit another child in Northwick Park Hospital?

The introduction of a Rapid Access Clinic is no substitute for the existing service.  It will only see a handful of children, it won’t deal with emergency cases and it can only be accessed by GPs.  The CCG are using it as a smoke screen.

22,000 children are taken to Ealing Hospital annually. 6,000 are seen by A&E.  How on earth will these be taken to other hospitals?
This closure is terrible news for local families and it should be stopped until basic questions are dealt with.

At our rally last Saturday, Consultant Paediatrician Tony O’Sullivan said:

“No paediatricians, no guarantee of paediatric nurses, I just think that this is absolutely disgraceful people will die from that and some of them will be children.” 

At the end of our short march on Saturday 12th March, a rally took place outside Perceval House in Ealing. We have a short video with excepts of some of the speeches.

Ealing Save Our NHS, some speakers from Ealing Save Our NHS on Vimeo.

Consultant Paediatrician Tony O’Sullivan said:

“No paediatricians, no guarantee of paediatric nurses, I just think that this is absolutely disgraceful people will die from that and some of them will be children.”

Mary Lynch a nurse and a mother of three children added:

“A few years ago, out of the blue, my son had a grand mal seizure, it was extremely frightening even for me. The ambulance team came, stabilised him and then we were brought to Ealing where a whole team were waiting for us and brought us to the Paediatric Ward. And it did not happen once, it happened twice. For me, I have two other children at home, I had to go with James to the Paediatric Ward and leave them on their own at home and it meant a lot to me that I could get home quickly…”

Helen Laycock a junior doctor and mother living in Ealing said:

“I am sorry Mr Hunt and Mr Cameron, we provide an emergency 7 day NHS already. I should know. I have worked nights and weekends for the last ten years providing it. So don’t tell us that we don’t”.

Merril Hammer from Save our Hospitals Hammersmith and Charing Cross also spoke at the rally:

“Just as the closure of A&Es across North West London shows disregard to the health needs of local people. Just as the closure of the Maternity  Unit in Ealing denies the needs of young women and their families to local provision. the proposedclosure of the Paediatric Ward demostrates only too clearly that the needs of children of ordinary people are not important to the ultra wealthy who form our Government. “

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Issue: 34

March 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.

What is Going to Happen to Ealing Hospital?

In 2012 NHS NW London’s ‘Shaping a Healthier Future’ proposed to downgrade Ealing Hospital from a ‘Major’ to a ‘Local’ Hospital. What has happened so far is the removal of Maternity birthing services in 2015 and the threat to discontinue any services for children in June 2016.

According to rumours picked up by Andy Slaughter Hammersmith & Fulham MP more departments will close at Ealing Hospital but the building of a new Local Hospital on the site will not happen. The closed departments will just be mothballed. Of course most hospital Trusts are in debt and the NHS bosses say that those hospital Trusts that don’t balance their books by the end on March 2016 will get no extra cash in 2016/2017. Ealing Hospital’s Trust is hopelessly in debt. In fact John Lister’s research in early February 2016 reveals the debt for London North West Healthcare Trust to be the second largest in England at £76.3 million. As such no ‘new’ money’ will be forthcoming for demolition and new build on the Ealing site – or for anywhere else in Ealing.

It is clear that daily heroics are taking place at Ealing Hospital A&E. Few medics want to take on a permanent position at the hospital because of the three years of continuous uncertainty about its survival. NHS bosses have capped Agency temporary staff use. What immediately follows from this Catch22 scenario are staff shortages, tired staff and higher risk of staff errors. Staff will become increasingly susceptible to stress, domestic disruption and physical and mental illnesses.

Care UK, who were shown to be incompetent at Ealing Hospital’s Urgent Care Centre (UCC) in an ITV documentary in July 2015, take their leave of the hospital sometime before the end of April 2016. Replacing them to run the UCC is the Greenbrook Healthcare Consortium. Greenbrook Healthcare looks quite experienced on paper. They have managed aggregated GP practices since 2007 and UCCs since 2012. Greenbrook manages UCCs in Hounslow, Harrow, Bromley & Beckenham, Kensington & Chelsea, Hillingdon, Woolwich, Orpington and Surrey.

If A&E does close down completely at Ealing Hospital, the impact on Ealing residents and A&E performance in north west London will be devastating. Quite simply more people will suffer pain and die unnecessarily.

Musings on Ealing Clinical Commissioning Group (ECCG)

ECCG  will soon be five years old. Many of us have been consistently critical of it. We believe the ECCG costs  £10 million a year. I recently spent some time reviewing the ECCG web site. Below are some of my reflections on the web site’s content.

There are still only six GPs on the 20 person ECCG Governing Body. So much for it being a GP-led body. It is quite extraordinary that only 10 of the 20 Governing Body members have their pictures displayed on the site. For seven of the body there are no biographical or qualification details. Is the turnover of the staff on the Governing Body really so rapid that the web site content maintainers can’t keep up?

On the ‘Shaping a Healthier Future’ web page this sentence appears:

‘The Department of Health is expecting to review these (SaHF business) cases during the second half of 2014’.

The sentence suggests that it was written before July 2014. Did this review ever take place? No clues are given as to when the final business cases for the 2012 conceived SaHF will be published.

There are also many references to ‘Better Care, Close to Home: our three year strategy for co-ordinated, high quality care out of hospital’. However the Strategy details ‘initiatives’ which were to be completed by March 2015, with cumulative savings of £27 million. There is no mention of completing these initiatives and achieving these savings in the ECCG 2014/2015 Accounts. Goodness knows whether these initiatives were completed or are still to be completed. As for the savings…. if they had been achieved ECCG would have trumpeted this from on high.

On the ‘News’ web page what’s not there sticks out like a sore thumb. For example:

+  No reference to ECCG’s response to the damning ITV documentary on Ealing Hospital Urgent care Centre (UCC) in July 2015

+ No reference to Greenbrook Healthcare Consortium taking over the running of Ealing Hospital UCC by April 2016

+ No reference to the fact that children’s services (including A&E) at Ealing Hospital will close in June 2016.

Hammersmith & Fulham Council Leads The Way in Pursuing the Mansfield Independent Healthcare Commission Recommendations

In 2012 NHS NW London announced its ‘Shaping a Healthier Future’ (SaHF) programme. SaHF proposed changes that would ‘improve care both in hospitals and in the community’. Put crudely the strategy revolved around demolishing some hospitals, reducing the number of hospital A&E units and hospital beds, and replacing acute hospital care with ‘Out of Hospital’ care. Opposition by local citizens to the proposed changes was immediate and has been extensive and continuous. In fact this monthly newsletter came into being in May 2013 to document SaHF’s ‘progress’ along with the impact of a constant stream of unhelpful NHS, Department of Health and Government healthcare initiatives.

In 2014 Hammersmith & Fulham Council (H&FC), supported by Brent, Ealing and Hounslow Councils, set up the Independent Healthcare Commission (IHC) chaired by Michael Mansfield QC. Its brief was to examine whether or not SaHF was, is, or could be, fit for purpose. The commission’s final report was published in December 2015. The report documented evidence of SaHF failing to meet its healthcare, operational and financial goals.

At a public meeting in Hammersmith Town Hall on 23 February 2016 Stephen Cowan. Leader of H&FC announced to the 200 attendees how H&FC were pursuing the implementation of the main IHC recommendations:

+ He met with a Barrister QC during the week of Monday 15 February 2016 to investigate legal/ Judicial Review options with regards to halting SaHF.

+ He has written to the National Audit Office about the value for money aspects of  SaHF.

+ H&FC Scrutiny is pursuing SaHF and the Hammersmith Clinical Commissioning Group with regards to access to the final business cases for SaHF.

+ H&FC has sent every GP in Hammersmith and Fulham a copy of the 87 page IHC report.

Doctor and Nurse Vacancies Still Rising: 4,669 Doctors and 18,714 Nurses

The Office for National Statistics has revealed worrying increases in permanent staff vacancies in the NHS. For the period 2013 to 2015 the increase in the vacancy rate for doctors was almost 60%. For nurses it was 50%. Research by the BBC has revealed that 69% of all Trusts are seeking staff from overseas.

160 People Attend Ealing Save Our NHS Meeting in Ealing Town Hall on 2 February 2016

Tony O’Sullivan was our first speaker. He is Co-Chair of Keep Our NHS Public and a Paediatric  Consultant at Lewisham Hospital. He pointed out that the NHS NW London ‘Shaping a Healthier Future’ (SaHF) plans said very little about children. With 400,000 children up to the age of 19 in NW London – and 86,000 of them in Ealing – this was disturbing. 50% of all critically ill children arrive at hospital A&Es in a parent’s arms and Ealing Hospital needs 24×7 coverage by Paediatric Consultants. He urged local activists to find out how many children are attending Ealing Hospital now; how long now parents have to wait for ambulances to ferry their sick children to the hospital; and how the integrated networks of care for children in Ealing will be built again should all children’s services at Ealing Hospital be curtailed in June 2016. He finished by asking just how constructive was it for Health Secretary Hunt and senior NHS executives to make virtually all 1.3 million NHS staff angry.

Next up was John Lister who is Director of London Health Emergency and was one of the commissioners on the Mansfield Healthcare Commission into SaHF. He has been campaigning for healthcare in London since 1983. He ripped into the unaccountability of CCGs. He highlighted some failed NHS outsourcing deals with private healthcare suppliers. He listed the impossible recent stream of demands from government on hospitals. If they don’t balance their books they will get no extra money. Demands on Mid Staffs to save £10 million led to it cutting corners and failing. SaHF was set up to save £1.5 million over five years. It’s now come to light that SaHF is demanding 1.3 billion in capital costs. But there is no money for this. We can’t go backwards but all we can look forward to is more closures but no new build as there is no money for this. There’s no evidence that even if out of hospital services could adequately replace acute care in hospital it would save any money. And there are no detailed plans or any implementations of these out of hospital services. The local population continues to grow but if Ealing and Charing Cross Hospitals cease to be Major Hospitals we’ll lose 700 to 800 hospital beds. Urgent Care Centres cannot replace A&Es. What we want are no more A&E closures and Maternity re-opened at Ealing Hospital. Rousing applause!!!

Dr Ajaob Sandhu spoke next. She is an 80 year old GP who has practised in Southall for 49 years. She bemoaned that humanitarian grounds had been ignored in the closures and closure plans. It is shortening life expectancy. The impending closure of children’s A&E will be disastrous for children especially ‘late presenters’ who are seriously ill.

Ealing Hospital Junior Doctor Ravi Ganepola was the final speaker. He cut through much of the misinformation about the Junior Doctors’ dispute. The bosses want to make remuneration for Saturday work the same as weekday work. The 5pm to 1am shift is to be remunerated as a day shift and not a night shift. Junior Doctors are being co-erced into working longer hours and they are worried that when tired they will make mistakes. The government’s linking of higher mortality rates to weekends is based on data for Fridays, Saturdays, Sundays and Mondays. The regulatory safeguards being proposed are inadequate.

Advertising Standards Authority Rules Against Brent CCG’s Misleading Posters on ‘A&E Only for Life-Threatening Emergencies’

In October 2015 Clinical Commissioning Group (CCG) posters proclaiming ‘A&E for life–threatening emergencies only’ appeared across north west London. We pointed this out in our November 2015 newsletter and I saw such a poster on the Brentford to Southall 195 bus. We commented that this A&E statement was incorrect. If I broke my leg it would not be life threatening, but is the NHS really telling me not to go to a hospital A&E? Where should I go – perhaps to my GP or to a pharmacist?

Brent Patient Voice (BPV) asked its members what they thought of the posters. All of them who replied felt that the description of A&Es was incorrect. BPV (www.bpv.uk) tried several times to persuade Brent CCG (BCCG) to withdraw the posters but it refused. BPV wrote to the Advertising Standards Authority (ASA) to complain about the posters.

On 3 February 2016 the ASA ruled against the BCCG and told them not to use the posters in their current form. ASA further told BCCG not to make misleading and potentially harmful claims about the scope of A&E services in the future. No doubt this ruling will apply to Ealing CCG and in fact to all CCGs.

BCCG has responded by telling the local press that its ad promoted patient safety. It has shied away from saying that it accepts the ASA adjudication and it has not apologised to Brent residents. Why is BCCG so tragically dysfunctional in this way?