Issue: 32
January 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.
EALING HOSPITAL NEWS
Ealing Save Our NHS (ESON) Meets Some of the Ealing Hospital ‘Bosses’
Representatives of ESON (www.ealingsaveournhs.org.uk) met with Ealing Hospital bosses on 23 December 2015. We originally arranged to meet Dame Jacqueline Docherty, the CEO of the Trust which runs the hospital, on 11 December 2015 but she cancelled. She never turned up on 23 December either but Peter Worthington (Trust Chair) and Simon Crawford (Trust Director of Strategy) did. None of the three BTW work at Ealing Hospital – they all work in Harrow.
It became very clear fairly quickly in the meeting that the fate and future ‘shape’of Ealing Hospital is not in the hands of Ealing Hospital officers or Trust officers but in the hands of Ealing CCG, the eight North West London CCGs and the ‘Shaping a Healthier Future’ (SaHF) cabal. When we asked who, employed on the Ealing Hospital site, runs the hospital, they both said there was someone but neither of them could remember his name. I asked whether there was a Clinical Director based on site and the answer was no.
We talked about the potential public relations disaster when the parents of the 64,000 children in Ealing realise that there would be no paediatric A&E at the hospital as from June 2016. We told them we felt cheated that an MP and a minister had lied to us all about the fate of A&E at the hospital. We had been lied to in connection with the impact of the two September 2014 A&E closures. None of this elicited any comment or response.
Mr Crawford suggested a new completion date for SaHF of 2020/2021. (Interesting this as the 2012 SaHF documents stated the SaHF rollout would take at least three years).
I showed them both the NHS 28 page colour ‘Stay Well’ – guide to Ealing local health brochure, which is currently being delivered to all 100,000+ Ealing households. As the document has some inappropriate content, I asked if Ealing Hospital or its ‘owner’ Trust had reviewed/approved the document. They astonished us by admitting that they had never seen it before.
We asked about much needed new transport services to take patients and family to remote hospitals outside Ealing’s borders. They said they were researching their own shuttle bus service to link Ealing Hospital with Northwick Park Hospital in Harrow – for staff. Room might be found for patients who could prove they had hospital appointments.
Ealing’s 64,000 Children Will Be Excluded from Local Accident and Emergency Services at Ealing Hospital as from June 2016
Ealing Clinical Commissioning Group (ECCG) voted unanimously at a meeting held in public on 9 December 2015 to delete Children’s A&E services at Ealing Hospital as from June 2016. As from then nowhere across Ealing’s 21 square miles will a chronically physically or mentally ill or seriously injured Ealing child be found life saving treatment, surgery and intensive care in Ealing. Ealing children are being sacrificed for the greater good of children in other parts of North West London.
So much for Tory ministers’ and Tory MPs’ promises in May 2015 of ‘A&E saved at Ealing Hospital’ and ‘no more changes to Ealing Hospital A&E for three years’.
As a replacement for A&E paediatric services in Ealing, more beds, consultants and nurses will be added to five ‘remote’ hospital A&Es outside the London Borough of Ealing. These remote hospitals are Hillingdon, Northwick Park, Chelsea & Westminster, St Mary’s and West Middlesex.
In future paramedics in ambulances and parents in cars in Ealing will have to decide themselves how ill or injured a child is before taking the child to the poorly rated Ealing Hospital Urgent Care Centre – to be seen by a GP – or to one of the five remote hospital A&E units.
There appears to be no strategy in place for providing additional mental health A&E facilities in the five remote hospitals for Ealing children. The number of children presenting with mental health problems at A&E in England in 2015 has doubled to 20,000 in just four years. West London Mental Health Trust out-of-hours services are virtually non-existent.
A new ill-named facility has been opened at Ealing Hospital called ‘Rapid Access Clinic’ (RAC). This is for children. It’s not rapid access for children and their parents as it’s not walk-in and attendance is only by GP referral. We all know that access to GPs is not rapid. Another limiting factor is that the RAC is only open for four hours each weekday.
Ealing residents in attendance at the meeting voiced their concerns about the legality of and risks inherent in the changes. Residents also pointed out that the Mansfield Commission had recently discredited the NHS NW London ‘Shaping a Healthier Future’ (SaHF) strategy and programme. Dr Mark Spencer – a SaHF lead – said that the NHS had pronounced the changes ‘legal’ and that it was 100% certain that no child would die as a result of the changes.
ECCG/SaHF executives became somewhat tetchy about the Mansfield Report. They said they knew about it but it did not come up with any alternative approaches. This comment was a red herring as the Local Authorities who commissioned the report asked the Commission to review the implementation of SaHF. When an activist suggested that SaHF costs had ballooned to £1.3 billion, ECCG/SaHF said that this figure was inaccurate. I then asked them to tell us what is the current cost for SaHF. Complete silence followed. Maybe the cost has now risen beyond £1.3 billion.
ECCG/SaHF is still clearly in denial about the 12 months of awful A&E performance in NW London being directly related to the closure of two hospital A&Es in September 2014. They quoted the £150,000 ‘independent’ report (by McKinsey & Co) on the subject in their defence. This was just plain silly as the report actually provides no hard evidence to dispute the reason being the closures. In fact pages 45 and 72 of the McKinsey report identify extra loading at St Mary’s and Northwick Park Hospital A&Es due to ‘sector changes’ and ‘additional pressure from A&E changes’. See:
https://www.england.nhs.uk/london/2015/11/09/healthier-future/
For the children of Southall these paediatric A&E changes are a tragedy. The closure of Ealing Hospital maternity in June 2015 was also a tragedy for Southall mothers. Parts of Southall are some of the most deprived areas in the whole of England. Just what has Southall done to deserve such a tragic downgrade in its local healthcare services?
Ealing Hospital Told to Only Use 2nd Class Stamps as ‘Planned’ £88 Million Deficit by Parent Trust Might be Exceeded
‘The Independent’ newspaper has reported on a letter sent to staff employed by the London North West Healthcare Trust NHS Trust (LNWHT). Ealing Hospital is one of four hospitals in LNWHT. The letter orders them to cut down on their expenses. Austerity measures introduced include:
+ only 2nd Class stamps to be used
+ computer upgrades have to be agreed with senior management
+ fewer taxis to be used
+ old furniture to be recycled instead of thrown away
+ nursing managers to ‘have a day on the ward roster every two weeks’
+ overtime only in exceptional circumstances.
With a new cap on using agency staff, permanent staff are being asked to work longer hours. Is this any way to run a national health service?
As 95% of all NHS Trusts are in so-called deficit then none of them are in deficit. They are just simply underfunded.
London Healthcare and Social Care Devolution Could Lead to the Destruction of Our NHS
On 15 December 2015 the government announced – somewhat out of the blue – that healthcare and social care is to be devolved in London. Agreements have been signed with all London CCGs and Local Authorities. London GPs were apparently not invited to join in with discussions on devolution and no-one seems to know how GPs will be affected by the plans. Apparently Parliament, local MPs and the GLA were not consulted. The London Ambulance Service is not included in the devolution deal.
Five new devolution pilot schemes were announced. They are all concerned with integrating services. None of them are in West London. The largest is in Barking & Dagenham, Havering and Redbridge. Here a new Accountable Care Organisation (ACO) is to be created. This ACO will ultimately control the healthcare and social care spend for the combined authorities of £1.2 billion. One assumes this will be the first of many ACOs. Very worrying is the fact that ‘partner’ organisations involved in these pilots have agreed to look at local flexibilities in payment and tariff mechanisms. Make of that what you will.
No budget was announced for London care devolution. However the Manchester care devolution announced in May 2015 carried a budget of £6 billion. With just over three times as many residents in London compared with Manchester a budget of at least £18 billion might be expected for London. However Boris Johnson at the launch pegged the figure at £15 billion.
The London devolution agreement needs to be read in conjunction with the draft Cities and Local Government Devolution Bill 2015/16 currently at committee stage in Parliament. Clauses 8 and 17 in this Bill provide for the dissolution of NHS bodies and the transfer of their functions and assets to Local Authorities or combined authorities.
If local government effectively takes over procuring healthcare services will the healthcare budget be ring fenced? Will local/regional care priorities hold sway over national priorities? Who will hold the whip hand in an ACO? Will it be the (NHS) healthcare folks or the (Local Authority) social care executives?
Just how might this London devolution impact NHS North West London’s ‘Shaping a Healthier Future’ (SaHF) vision/strategy/programme? Well SaHF prescribes changes to healthcare and not social care and does not address integrating primary healthcare, secondary healthcare and social care. SaHF is already unproven, late, over budget and unfunded. Maybe it will soon become a dinosaur because it does not address integrated care.
One thing is for sure and this is that yet more future upheaval in managing and delivering healthcare and social care in Ealing is on its way.
There hasn’t been a referendum in London on the issue. It should be no surprise that activists in Manchester have been clamouring for months for a referendum on Manchester care devolution.
One can see a future of a patchwork quilt of devolved ‘care’ regions – Manchester, London, Cornwall, Birmingham, etc. There will be no mandated consistency of approach to care in these devolved regions. Our national healthcare body (our NHS) could well disappear and our national social care body – which never existed – will stay unborn.
NHS England Decides to Ban the Publication of Regular Performance Updates this Winter
As an indication of how desperate NHS England is about its inability to maintain, or improve, NHS performance – it’s now blocking the publication of key waiting-time figures. As of 15 December 2015 no Winter figures will be published on:
+ A&E waiting times
+ ambulance waiting times
+ last minute cancellations of operations
+ patients on hospital trolleys waiting more than four hours.
One of the major concerns about the Winter NHS service is shortage of staff. Feeding this shortage are disgruntled doctors and nurses leaving the NHS, permanent staff vacancies at the many major hospitals threatened with closure and the Government clampdown on hiring agency staff.
The degraded hospital performance figures will now be published monthly (not weekly as before). Also the NHS England has ‘re-sized’ Winter. Previously the NHS England Winter ran from the beginning of November to the end of March. Now the new NHS England Winter runs from the beginning of November to the end of February – ie a month shorter!
It’s clear that the Government and NHS England fear that NHS performance over this Winter will be the worst for years. However they do not want citizens to be updated on a regular basis with statistics informing them of just how bad it is.
To make matters worse the Government chose to release this degeneration on the day Parliament debated bombing Syria – surely a device to ‘hide’ bad news.
Mansfield Commission Final Report Calls for a Halt to NHS NW London’s ‘Shaping a Healthier Future’ (SaHF). Calls on Local Authorities to Seek a Judicial Review if it is Not Halted
On Wednesday 2 December 2015 on London’s South Bank Michael Mansfield QC launched the final report of the Independent Healthcare Commission for North West London. The 87 page document presents a devastating critique of NHS North West London’s abortive attempts over the last three years to implement change and reduce running costs by £1 billion.
All written evidence and witness statements along with the final report can be viewed at:
www.lbhf.gov.uk/healthcarecommission
There are 12 recommendations:
- The current Business Case is immediately made available for proper public scrutiny. This is the only way to ensure that the SaHF programme has taken full account of the current and projected population changes in North West London since 2012 and is soundly based on an up-to-date assessment of needs. The need for this is reinforced by the Finance and Economics section of the report.
- The National Audit Office undertakes a review of the value for money of the SaHF programme.
- A fresh consultation on the Business Case (referred to as the Investment Business Case in official guidance but as the Implementation Business Case by SaHF programme leads) as the programme has changed significantly since the Pre-consultation and Decision Making Business Cases were published. There should be extensive and uniform publicity across the region and a clear consultation document with appropriate translations made available in areas of high concentrations of BME communities.
- No further implementation of SaHF in two principal respects:
- There must be no further closures of any A&E departments in North West London. Ealing and Charing Cross hospitals must retain full ‘blue light’ A&E services for the foreseeable future;
- An equalities impact assessment to be carried out into the whole SaHF programme, with particular focus on the communities that will be deprived of services at Ealing and Charing Cross hospitals, as it is clear to the Commission that the selection of these hospitals for service closures will adversely affect the more deprived BME communities in the region.
- The UCCs in North West London should be co-located with A&E departments. Where this is no longer the case there should be an immediate and extensive publicity campaign mounted to raise awareness as to what such centres can provide and who should be referred or self-refer there.
- The decision to close Ealing Maternity unit should be reversed with immediate effect.
- The A&E departments at Central Middlesex Hospital should be re-opened to alleviate the burden on other A&Es, especially Northwick Park.
- A substantial investment in GP services, which are clearly overwhelmed and inconsistent, to meet the additional demands of more vulnerable patients, and a recruitment drive for additional GPs and primary care staff.
- A sub-regional out-of-hospital strategy to be produced, with clear metrics and targets setting out what level such services will be considered sufficiently successful to allow for further reconfiguration.
- The levels of spending on social care in North West London and elsewhere have been hit by ill-conceived central government policies, but the Commission recommends that social care budgets are increased and protected to maintain patient flows from hospital to domiciliary and residential care.
- Elected local authority representatives be invited to attend SaHF Programme Board meetings to give greater public accountability and transparency.
- NHS issues up to date guidance to CCGs and Healthwatch England as to the exact scrutiny role of Healthwatch bodies and Patient Participation Groups in all matters of commissioning and service reconfiguration.
Of the five local authorities who sponsored the Commission Hammersmith & Fulham and Ealing have both stated publicly that they will actively consider mounting a legal challenge against SaHF based upon the Commission’s findings and recommendations.
