Issue: 27

August 2015

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.

No More Babies Born at Ealing Hospital

Around 100 demonstrators turned up outside Ealing Hospital on 1 July 2015 to protest about the closure of the Maternity Unit there on that day. In fact the last baby born there was on 25 June 2015. Given this was the hottest day of the year, the size of the demonstration was remarkable. The core of the protest group were members of Ealing Save Our NHS (www.facebook.com/ealingsaveournhs).

Midwives still working at the hospital came out to greet the protestors. They were cheered. But tears were to follow shed by both staff and protestors. Drivers in car after car hooted their support as they drove past the demonstration. Protestors from Charing Cross, Hammersmith and Lewisham Hospitals were welcomed at the event.

I can’t help but think that this closure is of historic significance. Will it prove to be a dreadful mistake – a tragic error of judgement? Will we ever know? As has been stated so many times before, the people most likely to suffer most from this closure are impoverished, pregnant women in Southall with complex needs.

ITV ‘Exposure’ Documentary Reveals Failings at Care UK’s Urgent Care Centre at Ealing Hospital

On Wednesday evening 22 July 2015 an ITV investigative programme featured covert filming of the workings of Ealing Hospital’s Urgent Care Centre (UCC). The UCC is run by Care UK, a private healthcare company.

The programme highlighted multiple failings whose causes hinged around meeting targets and making profits rather than meeting patient needs.

Failings exposed included:

+ Doctors not fully trained

+ Record keeping ‘fudged’ in order to meet targets

+ Under-staffing

+ Inadequate stocks of drugs

+ Patients discharged too early

+ Triage carried out in public at the UCC reception instead of being carried out by a nurse in private.

For those who missed the programme, it can be viewed until 22 August 2015 at:

www.itv.com/itvplayer/exposure-out-of-hours-undercover

Care UK has responded to the programme and their rebuttal can be found at www.ealingtoday.co.uk. Southall’s MP Vivendra Sharma has called for an investigation. He doesn’t (for some reason) identify Ealing Commissioning Group (ECCG) as having any responsibilities for these failures. The Evening Standard quotes the ECCG Chair. She said ‘…an urgent clinical visit found no immediate cause for concern’. Her statement is very much at odds with the programme content and places ECCG in the category of ‘cause for concern’. After all ECCG chose Care UK to run the UCC and it is the ECCG which is responsible for ensuring that Care UK delivers a first class service.

NHS England (London) has announced it will, along with ECCG, commission an independent clinical and lay review of any patient safety concerns at Ealing Hospital UCC. However the Director of NHS England (London) in an email to colleagues refers to ‘allegations’ made in the ITV documentary. This clearly is misleading as the film/video footage is clearly evidence and not allegations.

AgeUK Ealing’s Survival at Risk as Ealing Council Withdraws Funding for 2016 – 2019

Ealing Council is planning to allocate the entire voluntary sector older peoples budget to just one organisation – Southall Neighbourly Care. This will total £1 million over the next three and a half years.

The impact of this decision will be severe and immediate. AgeUK Ealing – a well established charity serving the needs of many older people – is now severely under threat. Also under threat is the AgeUK Ealing supported Southall Day Centre. Hundreds of centre users demonstrated against these proposals outside Ealing Town Hall on the evening of 28 July 2015.

Doubts are being expressed as to the suitability of Southall Neighbourhood Care to receive all this grant money. It’s a consortium of 21 organisations not all of which are charities, some of which don’t offer services to the elderly and some which don’t even operate in Ealing. Charity Commission records show consistent annual overspend by the organisation over the last five years.

Charing Cross Hospital

Andy Slaughter MP met with Hospitals Minister Jane Ellison in July 2015. He says the SaHF timetable is slipping and SaHF funding may not be agreed till 2018. With £1 billion now needed in capital costs and £250 million required in implementation costs,  SaHF looks increasingly rocky. She did however say the intention was still to demolish Charing Cross Hospital and replace it with a new ‘Local Hospital’. She also confirmed that there would be no new Keogh Report, which supposedly was to be the document which would define the nature of a ‘Local Hospital’.

The Save Our Hospitals (SOH) group in Hammersmith have, surprisingly, received an invitation from Hammersmith & Fulham CCG (H&FCCG). The CCG wants to ‘…establish a more constructive dialogue…’. SOH has yet to decide whether to agree to a meeting.

NHS Announce Eight New ‘Vanguards’ Aimed Towards Transforming Urgent and Emergency Care

On 24 July 2015, NHS England Chief Executive Simon Steven said:

‘Urgent care will be delivered , not just in hospitals but also by GPs, pharmacists, community teams, ambulance services, NHS 111, social care and others, and through patients being given support and education to manage their own conditions’.

These are no doubt laudable aspirations for ‘joined-up’ urgent care operations. Current Vanguard projects around England are trumpeting successful initiatives including mobile treatment services, street triage services and acute home-visiting.

Currently these Vanguards are funded from a £200 million transformation fund. No inner London Vanguards are referenced in the announcement. There is one in outer London at Barking, Dagenham, Havering and Redbridge. One does wonder what the cost would be to run these joined-up urgent care services nationwide.

It is of course ironic that this NHS urgent care announcement came just two days after the ITV documentary portraying Ealing Hospital Urgent Care Centre (UCC) as a shambles. Under the NHS ‘Shaping a Healthier Future’ strategy Ealing Hospital’s A&E unit will close and all we will be left with in Ealing for emergency and urgent care will be Care UK’s UCC. Never mind joined-up urgent care throughout Ealing we, seemingly, can’t even deliver urgent care adequately at Ealing Hospital’s UCC.

McKinsey’s NHS NW London A&E Post Closure Performance Whitewash is Finally ‘Sort of’ Placed in the Public Domain

After disastrous local A&E performance following the September 2014 A&E closures at Central Middlesex and Hammersmith Hospitals, NHS NW London/Shaping a Healthier Future (SaHF) commissioned management consultants McKinsey to research the failure. Ironic really as one suspects that the A&E closure strategy originated within McKinsey themselves!

Sometime in July 2015 a document was quietly published on the NHS England web site entitled ‘Review of the Implementation of North West London A&E Changes’. The document is not the McKinsey review itself, but NHS England London Region’s ‘report’ on it.

The report contains the expected nonsense about ‘…increase in acuity’. In normal speak this means more ‘iller’ people turned up at A&E than expected. However there is no supporting qualitative or quantitative data to support this alleged increased severity of illnesses.

The old chestnut of  ‘…a national increase in (A&E) demand’ is trotted out in the report. Colin Standfield of Save Our Hospitals has repeatedly refuted this lie. In fact the NHS’s own data shows no increase in the numbers of patients visiting our local A&Es. In North West London over the last four years A&E attendance fell by 26.2%.

Another quote is ‘…the underlying cause for this increase in acuity could not have been linked to the A&E changes’. This really is a totally meaningless statement.

And let’s not forget how disastrous the A&E performance was. For example in the week ending 30 November 2014 NHS NW London was the worse performing NHS region in England for Type-1 A&E patients – with only 65.7% of patients being seen within four hours. For the week of 15 December 2014 at Ealing Hospital A&E 62.6 % of patients were seen within four hours – making it the worst performing hospital in England.

The report pats SaHF on the back for getting its post-closure A&E patient modelling correct. It then claims that unfortunately patient demand was not as predicted. How truly pathetic this is.

Over the last two years NHS North West London has spent £33 million on management consultancy help in strategies and programmes to cut and privatise local hospital services. One has to ask whether this really was a good use of public money.

Independent Healthcare Commission to Publish its Final Report in September 2015

This commission – also referred to as the Mansfield Commission – was launched in December 2014. It is examining the progress, success and impact of the NHS North West London ‘Shaping a Healthier Future’ (SaHF) strategy. SaHF, announced in 2012, aims to save money by reducing the number of major hospitals, A&E units, Maternity units, and hospital beds. SaHF envisions better, cheaper healthcare being delivered outside of hospitals. The commission was set up by four Local Authorities – Brent, Ealing, Hammersmith & Fulham and Hounslow.

It will be interesting to see what the four authorities decide to do with the evidence collected. The commission’s Interim Report, published in March 2015, was very damning about SaHF in many aspects, which included access to care, quality of care, the business case and the whole SaHF process. It’s quite clear that the body of evidence collected about the operation of SaHF is enormous and unique. I suspect the only external attack which could dent or perhaps ‘sink’ the SaHF supertanker would be one carried out in the Law Courts. The commission’s evidence base would be a crucial weapon to be used in any legal challenge.

Tories Move Towards Inquiry on Whether NHS Should be Funded by User Charges and Insurance

On 9 July 2015 in a debate on NHS sustainability in the House of Lords, Lord Prior announced a move towards setting up an inquiry into ‘Pay NHS’. Lord Prior is an ex CQC boss and an ex deputy Conservative Party Chair.

Not a hint of this came out running up to the General Election. Also the Kings Fund recently carried out an inquiry into the topic and rejected the user charging approach.  

Hammersmith & Fulham Council Challenge the Financial and Operational Viability of the Planned Merger of NHS Chelsea & Westminster  and NHS West Middlesex Hospitals

On 7 July 2015 Hammersmith & Fulham Council (H&FC) for a second time publicly slated the NHS Chelsea & Westminster Hospital Foundation Trust (CWHFT) for its failure to reveal the business case supporting the merger of the two hospitals. H&FC also expressed concerns on the impact of the merger on local services, particularly the potential effects on A&E and paediatric services. CWHFT says it expects the Secretary of State to sign-off the merger in August 2015.

CWHFT says that its Board members have all signed confidentially agreements which prevent them disclosing the financial details of the merger. This clandestine approach seems entirely inappropriate where public money is involved.

Mental Health Risks Top Head Teachers’ Concerns

67% of 1,180 school head teachers surveyed by The Key stated that the risk of children developing mental health problems was their biggest concern. The survey included responses from Primary school and Secondary school heads. Given the budget cuts to mental health spending this widespread concern by head teachers is extremely worrying.

The Key (www.thekeysupport.com) is an independent company providing leadership and management support to 47,000 school leaders and governors.

GP Groups All Highlight that Government Funding for 7 Day GP Working is Inadequate

Dr Morton’s – an online medical helpline staffed by GPs – estimates that 7 day working by GPs will cost over £3 billion/year.

The Royal College of GPs estimates that if 50% of GP practices operate 7 days a week it will cost the NHS £1.2 billion /year.

The BMA GP Committee say that 7 day working by GPs will require more investment by the NHS than what has been promised.

So far the Government has invested just £175 million to facilitate the evening and weekend opening of GP surgeries.

Ealing Clinical Commissioning Group held its AGM last night and gave itself a big thank you for its work over the last year. Closing the only Maternity Unit in Ealing was listed as an “achievement”!
So was all the privatisation and outsourcing of Ealing health services.
The audience of about 80 including GPs, health workers and campaigners obviously wasn’t convinced. Most of the questions were critical and an open letter signed by 500 Ealing residents was given to CCG Chair Mohini Parmar. The letter objected to the indefensible closure of Maternity. A similar letter from Southall residents had already been sent in.

Ealing CCG is engaged on cutting and privatising as part of a Government attack on the NHS. We gave out leaflets saying just that!

Issue: 26

July 2015

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.

Solace Centre Will Remain Open but as a Much, Much Smaller Facility. Will It Still be Viable?

The Solace mental health drop-in centre in Bowmans Close West Ealing, which was in danger of closure this year, has apparently won a reprieve until April 2016. However the funding model must change if the centre is to survive beyond this date. The London Borough of Ealing (LBE), who owns the centre, has looked at five options for alternative funding and an invitation to tender will be issued by LBE in September 2015.

The preferred option, which was agreed at the 16 June 2015 LBE Cabinet meeting, links the continued out-of-hours mental health service with a residential service at Marron House. Marron House is owned by LBE and it houses the Solace Centre. The service supplier will be London Cyrenians. London Cyrenians is a 43 year old charity which provides shelter and support across west London for over 500 single, vulnerable, homeless and mentally ill people. The option involves the conversion of much of the Solace centre into two additional supported living units on the Marron House site.

Activists are up in arms because this arrangement reduces the actual size of the new Solace to just one room and a small kitchen. The fine detail on how an arrangement might work with Solace users, Marron House residents, London Cyrenians, LBE and the NHS West London Mental Health Trust (WLMHT) has yet to be worked out. WLMHT has confirmed that it will continue its annual funding of £47,000 to support the Solace centre service.

Ealing Hospital

A minimalist version of the NHS ‘Shaping a Healthier Future’ plans for Ealing Hospital were aired at the North West London  Joint Health Overview & Scrutiny Committee (JHOSC) meeting on 16 June 2015. The message carrier was the NHS NW London CCG ‘supergroup’ – the North West Collaboration of Clinical Commissioning Groups.

Here below is what the terse statement says about future hospital provision for the 340,000 residents across the 21 square miles of Ealing. I believe this statement has been the one consistently trotted out in recent years.

‘Ealing Hospital

Ealing Hospital is being modernised and redeveloped (as) a new 21st century facility for the local community. The hospital will have a local A&E and 24/7 GP-led Urgent Care Centre, with access to 24/7 specialist care, as well as a range of specialist services designed with – and for – the local community, such as a Diabetes Centre of Excellence.

Ealing will become a new local hospital for the whole of the local population. In particular, it will improve care for elderly patients, those with long term conditions and the most vulnerable members of the community by integrating primary and secondary care with community and social care. Services proposed include: access to specialist opinion; social care and psychiatry; a wide range of diagnostic services including pathology and radiology; the ability to admit people to beds on the hospital site for assessment, treatment, observation and rehabilitation; outpatients services; ‘Transition’ beds; an enhanced diagnostic service, comprising X-Ray, Ultrasound, CT and MRI scanning and ECG; a range of therapies, podiatry, audiology  and dietetics; ophthalmology; education and research; a hospital and community pharmacy; a sexual health clinic; space for GP practices; a day assessment centre; pregnancy assessment centre; ambulatory chemotherapy; and renal dialysis.’

Some questions and comments come to mind which include:  

+ Does ‘modernised’ mean updating and repurposing existing buildings?

+ Does ‘redeveloped’ mean demolish and new build? If so then no doubt a Private Finance Initiative (PFI) will come into play.

+ What exactly is a ‘local A&E’? There is no mention of an Intensive Care Unit or Intensive Care beds

+ What might ‘access to 24/7 specialist care, specialist consultant opinion, social care and psychiatry’ actually mean. Note that there is no mention of ‘on-site access’. Might it mean telephone access, email access, Skype access, ambulance access, guaranteed real time access to staff/beds/resources in other NHS hospitals in the region?

+ No mention anywhere of ‘mental health ‘service provision. If the oft stated NHS goal of treating physical and mental health issues in the same ‘Setting of Care’ has any validity then both physical and mental health care must be delivered in the new Ealing Hospital

+ ‘….integrating primary and secondary care with community and social care’. This is a truly laudable aspiration, but is outside the scope of the specification for a new local hospital on the Ealing Hospital site

+ No indication of how many hospital beds will be provided and for what purposes they will be used

+ No mention of any operating theatres

+ No mention of ante-natal and post-natal Maternity services on site

+ No indication of the timescale for creating this new 21st century healthcare facility

+ Where is the London North West Healthcare NHS Trust in all this? It’s the Trust which currently runs Ealing Hospital and (presumably) it’s the Trust who will deliver the medical services at the new Ealing Hospital. The ECCG is only involved in the purchasing of these services.

+ One of the biggest gripes about Ealing Hospital is the inadequate size of the car park. Surely, with the local population of Southall expected to expand by more than 10,000 people by 2026, a commitment to more car parking spaces is needed?

+ If this is truly going to be a local hospital for local people just how many Ealing or Southall residents are going to be involved in articulating the local needs and specifying the service mix for this new Ealing Hospital?

Healthwatch Ealing: A Sickly Patient?

Each Local Authority has a legal obligation to ‘commission’ and fund a local Healthwatch organisation. These local Healthwatch organisations are independent consumer champions for both health and social care. The Health and Social Care Act 2012 created the Healthwatch initiative.

I’ve often wondered why Healthwatch Ealing (HE) consistently fails to represent local residents’ concerns about current and planned ‘transformations’ to NHS services. Thousands have taken to the streets in recent years to demonstrate against the NHS ‘Shaping a Healthier Future’ plans to downgrade Ealing Hospital and close its Maternity Unit. But I’ve seen no sign of  HE leading or even joining these demonstrations. On the day the Maternity Unit closed down HE’s web site proclaims details of improvements to local maternity services on its home page!

I recently spent some time perusing the HE constitution. I have to say that it does contain some peculiar clauses. For example it grants extraordinary powers to the housing and support charity Hestia. HE employs Hestia to provide a range of services which include accounting, IT and HR. (In fact all five HE employees are employed by Hestia). There is a historical link here as Hestia performed a similar role for HE’s precursor organisation, Ealing LINk. Another bizarre clause absolves HE from having to convene Annual General Meetings.

Anecdotal evidence suggests that the majority of EH Board members do not see HE as a campaigning organisation, although it’s quite clear that Healthwatch guidelines explicitly allow this. For some reason HE members cannot attend HE Board meetings even as observers.

2015/2016 is likely to be a challenging year for HE as its annual Local Authority grant will be reduced by £57,700 to £140,000. Elections are being held to create a new HE Board and there are rumours of a HE public meeting at Ealing Town Hall on 16 July 2015. Allegedly the composition of the new Board will be announced at this meeting. However as a member of  HE, as at 1 July 2015 I have yet to be invited to this meeting.

HE could be transformed into a really useful open and transparent campaigning group which truly represents Ealing residents. Clearly a new constitution is required along with new leadership. I encourage residents to join HE at www.healthwatchealing.co.uk. If this process is problematic (and it can be) people can always leave a message with their contact details on 0800 652 7200.

NHS Mental Health Services in Ealing

I attended a meeting of the excellent mental health Carers’ Support Group based at NHS WLMHT’s Recovery East Team base at Avenue House in Acton on 9 June 2015. The group receives financial support from LBE. Around 30 carers attended to hear WLMHT’s Robert Murray present and answer questions. Robert is the Senior Manager for Planned and Primary Care Service Line. Interestingly two members of the Care Quality Commission (CQC) also attended. CQC has just completed an evaluation of the performance of WLMHT.

Robert outlined current and future planned changes to local mental health services in the context of the 2012 NHS NW London ‘Shaping a Healthier Future’ programme. He emphasised the goal of treating physical and mental health illnesses in the same ‘Setting Of Care’. The main thrust of achieving this is the ‘discharge’ of as many as possible mentally ill patients (‘service users’) from WLMHT care to GP/Primary Care. Those service users discharged are presumably those who have ‘recovered’ or who have stable behaviour and treatment regimes. Those who are not discharged and remain under WLMHT care are no doubt those who are unstable and/or with complex needs.

Currently 80% of Ealing GPs have contracted to provide mental health primary care. The 179 Ealing GPs are being organised into seven ‘clusters’ of GP surgeries and each cluster will have some specialist mental health support. Concerns were raised about those mentally ill patients whose GP has not contracted to provide mental health primary care. Doubts were also expressed about GPs’ abilities (even after some training) to be able to manage anti-psychotic medication regimes.

Two carers complained about the lack of consultant continuity in WLMHT. Seemingly every time their service user loved one meets a consultant it’s always a different person. Robert suggested that this was happening as consultants were being trained by meeting a wide range of service users in order to gain wide ranging experience.

A heart-rending case study was presented by a local carer about a mother and daughter – both service users – living together in a run-down LBE housing estate. These people are being exploited by drug dealers. Their flat has serious health and safety problems. They have difficulty living independent lives and looking after themselves. The situation became critical one evening when it was no longer safe for them to stay in the flat. All the best efforts of LBE and the NHS came to nothing. After standing outside their tower block for hours in the dark they finally finished up at Acton Police Station.

This case study highlights that there is no joined up out-of-hours emergency service in Ealing to provide health and social care. There are known to be around 10 residents on the estate with mental health problems. Their inability to live an independent life, to cope on a regular basis and to avoid being exploited can lead to their homes being trashed. This can result in eviction and homelessness. This ‘result’ can hardly be viewed as a successful outcome.

I asked how the NHS would measure the improvement achieved by changing the Setting Of Care for many mentally ill patients. He said the NHS uses a ‘Well-being Tool’ to measure mental health service user performance. As interesting as this measuring technique might be I asked whether an increase in the service user population might be an indication of success. This rather stopped him in his tracks. I further pointed out that probably everybody in the room knew of people with mental health problems who were yet to present themselves to the NHS. Getting more of these people into NHS diagnosis and treatment might indeed be an indicator of success. My second question was about time scale. He said it would take another 18 months to transform this Setting Of Care.

Improving Access to Pyschological Therapies (IAPT) in Ealing

Anecdotal evidence collected in recent months indicates progress is being made in making NHS psychological therapy treatment more readily available in Ealing. Self referral on 020 3313 5660 seems to result in a detailed telephone interview within a few days of first contact. NHS Cognitive Behavioural Therapy (CBT) specialists are readily available. NHS Counsellors are less available and there is up to a three month waiting list for treatment. However the IAPT service gives patients the option of using local, inexpensive, charity-based Counsellors who are more readily available.

WLMHT CEO Resigns

Steve Shrubb, WLMHT CEO, resigned his position on 19 June 2015. He had been in the job for just three years. After almost 40 years working in the NHS he is retiring on 20 November 2015 in order to care for his aging and ailing parents.

He’s had some tricky problems to deal with at WLMHT. These include psychologist whistle blower Dr Hayley Dare, poor CQC reports and the recent £3.9 million hole in the WLMHT accounts allied to potential fraud allegations.

NHS Hospitals Paid Out £3.3 Billion on Agency Fees and £600 Million to Management Consultancies in 2014

The Government is unhappy about the level of these costs and will implement some measures to bring about change by September 2015. These measures include:

+ A maximum hourly rate for agency doctors and nurses

+ A limit of £50,000 on all management consultancy contracts.

It’s hard to predict the impact of these measures. If the agency cap results in more staff taking up permanent positions in the NHS it is to be welcomed. If NHS bodies get round the management consultancy contract cap by issuing multiple £50,000 contracts then nothing will have been achieved.

NHS care.data is Still a Shambles

care.data is the NHS medical data service. The data is to be used in enhancing healthcare and social care. Development of the service has stuttered along since 2013. There have been constant fears expressed by various bodies about protecting confidential patient data. A key feature of the service is that patients can opt out of their data being used outside the NHS.

The confidential data of up to 700,000 NHS patients has been shared with insurance companies against their wishes. The breach happened in February 2015. The organisation responsible is the NHS Health and Social Care Information Centre. The data released was line-by-line data – every individual hospital episode for every patient, with unique pseudoanonymised identifiers.

Excellent turnout of campaigners and local residents to protest against the closure of a beloved and much needed Maternity Unit.

A brief and colourful march departed from Hanwell Clock Tower and arrived at Ealing Hospital where a  rally was then held.

Among the many speakers Dr Onkar Sahota, Chair London Assembly Health Committee, Labour Assembly Member for Ealing & Hillingdon. Chair  of Ealing Save NHS and GP, Olivia O’Sullivan from Save Lewisham Hospital and campaigners from Ealing Save our NHS and Hammersmith & Charing Cross Save Our Hospitals, Raj Gill from Unite Community and hospital unions.

Ealing Maternity midwives and staff briefly joined to say thank you to the campaigners.

Press release can be found here

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Issue: 25

June 2015

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.

Politics and the NHS

I thought the ‘noise’ around supporting the NHS prior to the General Election would now subside, but after a short lull it’s headline news again. Jeremy Hunt MP has been re-appointed as Secretary of State for Health. Most NHS activists fear the worst with the prospect of five years of a Tory Government. We see the spectre of the destruction of the NHS as we know it.

On 18 May 2015 PM Cameron announced his desire to meet his pre-election commitment to a 7 day NHS. He said again that he will inject another £8 billion each year into the NHS, but it’s not clear where that money is coming from. The Royal College of Nursing reacted badly to this and its members could take industrial action if 7 day working impacts unsocial hours and weekend working payments. 51 NHS bosses have also written to Cameron saying that the £8 billion extra is not enough and more is needed for ‘transformation and social care’. Cameron committed again to recruiting 5,000 more GPs by 2020.

In North West London the swing to Labour in the General Election was very striking. Many of us feel that was the result of very active grass roots NHS campaigns. For example there were Labour gains in Central Ealing & Acton, Brent Central and Brentford & Isleworth. There were increased Labour majorities in Ealing North, Ealing Southall, Hammersmith, Harrow West, Feltham & Heston and Brent North.

Ealing is now very much a one party state with all Labour MPs and Labour having a massive majority on Ealing Council. It would be good to see all the MPs, Labour councillors and Ealing Save Our NHS working together to save Ealing Hospital A&E. Other local healthcare battlegrounds on which politicians should fight include saving Clayponds Hospital in South Ealing and saving the Solace mental health walk-in centre in West Ealing.

Now all this assumes that UK Labour and Ealing Labour want to make a priority of fighting changes to the NHS. Maybe the £12 billion cuts in welfare benefits will be a much bigger national Labour priority. As UK Labour is currently headless and direction-less, it’s hard to tell. As for Ealing Labour, with austerity cuts continuing unabated. it might be too pre-occupied with keeping the Ealing Council services ship afloat generally to have much time or money trying to save the local NHS.

Ealing Hospital Maternity to Close on 1 July 2015

At a five hour public meeting on 20 May 2015 held at a ‘remote’ location (Ealing Trailfinders Sports Club, West Ealing) the ECCG finally bit the bullet and publicly sanctioned the closure of the Ealing Hospital Maternity Unit as from 1 July 2015. So as of a few weeks time there will be nowhere across the 21 square miles of Ealing where Ealing women can have their babies delivered in a bespoke, hospital ‘setting’. This closure trashes the recent investment in new birthing facilities at Ealing Hospital. Over 27 years of birthing on the Ealing Hospital site is hereby terminated. The major reason given for the closure is the inability of Ealing Hospital Maternity Unit to meet the London Quality Standards for maternity services. The numbers of women having babies at Ealing Hospital has been falling in recent years – not surprising as the decision to close the maternity unit was first announced in 2012!

50 demonstrators turned up outside the venue. They included mums with babies, Ealing MPs Rupa Huq and Steve Pound, Ealing Save Our NHS, Save Our Hospitals, 38 Degrees and Occupy. Many of them attended the meeting, with over ten asking questions.

Southall mothers-to-be with complex needs will be the hardest hit by this closure. 39% of those who gave birth at Ealing Hospital in 2013/14 live in Southall. In future, pregnant women will have to travel to Hillingdon, West Middlesex, St Mary’s, Queen Charlotte’s & Chelsea, Chelsea & Westminster or Northwick Park Hospitals. Average travel times by bus and car for those living in Southall Broadway will almost double according to the ECCG. ECCG says that by the end of May 2015 extra birthing capacity for up to 3,650 additional births will have been added to the six hospitals. Up to 120 staff will have longer journeys to work given they accept their relocation offers.

We were told at the meeting that the closure had nothing to do with cost cutting. It, apparently, is all about providing a better maternity service across the whole of North West London. My take on this is that meeting Ealing mothers’ needs is being sacrificed for a greater ‘good’.

Ealing Hospital Emergency Gynaecology will also close in July 2015, with Paediatrics closing in July 2016.

Healthwatch Ealing – Ignore It or Support It?

A local Healthwatch is a ‘consumer champion for patients and the public in health and social care’. A local Healthwatch is accountable to its Local Authority and has been since Healthwatch came into operation in April 2013. Local Healthwatch bodies have formal working relationships with the Care Quality Commission (CQC).

Concerns have been voiced all over the country that local Healthwatch bodies are too close to Local Authorities to be independent. The People’s Inquiry into London’s NHS recommended that Healthwatch England be closed down and that local Healthwatch bodies be segregated from the CQC and modelled on the old Community Health Councils.

Healthcare is in turmoil in Ealing. The NHS Shaping a Healthier Future (SaHF) seeks to downgrade Ealing Hospital, rob it of its A&E unit as we know it and close its maternity unit on 1 July 2015. Thousands of Ealing residents have signed petitions and participated in marches, rallies and demos in protest against SaHF. To what extent has Healthwatch Ealing represented the views and concerns of these protesters? On current evidence the answer has to be very little.

Healthwatch Ealing’s Chair was interviewed in public by the Independent Healthcare Commission for North West London on 21 March 2015. There were questions about the impact of  SaHF she could not or would not answer. Some of her answers were factually incorrect. It was also revealed that her written submission had not been approved by the Healthwatch Ealing Board! Overall the Healthwatch presentation lacked credibility and was sympathetic to SaHF.

Maybe it’s possible to change Healthwatch Ealing so it does represent the views of patients and residents. In order to bring about change more Ealing residents disaffected by SaHF need to join the organisation and make their views known at Healthwatch Ealing’s AGM on 16 July 2015. BTW funding for Healthwatch Ealing is to be slashed by £100,000 a year beginning on 1 July 2015.

To join Healthwatch Ealing go to:

http://healthwatchealing.co.uk/join_us

SaHF Playing Fast and Loose with the Truth

In a 6 May 2015 email to Peter Latham, SaHF’s Medical Director Dr Mark Spencer gets the facts all wrong in trying to shore up the ailing Shaping a Healthier Future (SaHF) transformation programme for NHS NW London.

Firstly he misquotes the Independent Reconfiguration Panel (IRP) and the Secretary of State (SoS). He states they both forced SaHF’s hand in the urgent closing of Central Middlesex and Hammersmith Hospital’s A&E units ‘as soon as practicable’. The SoS did not ask for urgent closure, but closure ‘as soon as practicable’. As for the IRP it stated that ‘the NHS’s implementation programme must demonstrate that, before each substantial change, the capacity required will be available and safe transition will be assured’. The IRP emphasised the need for and lack of Out of Hospital services. The IRP also did not ask for any urgent closure.

Secondly Dr Spencer states that there is no NHS A&E target for Type-1 patients (the most ill). This is nonsense as there is a target and nationally data is collected for ‘percentage in 4 hours or less (type-1)’. This Type-1 performance in NW London after the two A&E closures has been disastrous. However Dr Spencer shamelessly completely ignores this. As he confirmed at the Independent Healthcare Commission public hearing on 9 May 2015, SaHF likes to consider only performance figures of A&Es and UCCs combined.

Finally, Dr Spencer attempts to rubbish the findings of the Independent Healthcare Commission by labelling it as having ‘pre-formed views’. This really is rich coming from SaHF, as even before SaHF’s public consultation its ‘pre-formed view’ was that four out of nine hospital A&Es in NW London must close.

North West London Independent Healthcare Commission Public Hearing at Brent Civic Centre 9 May 2015: SaHF Supporters in the Spotlight

I listened to three stalwart supporters of SaHF being questioned at this event – Dr Mark Spencer, Dr Mohini Parmar and Ms Ursula Gallagher. Dr Spencer and Ms Gallagher appeared completely unconcerned about the welter of continuous criticism about SaHF. All three of them would not answer any finance related questions. No-one was able to explain why the required, approved business cases for closure were still unavailable three years into the SaHF programme.

Commissioner Dr Stephen Hirst took issue with Dr Spencer about the geographic spread of the proposed five major hospitals. Hirst’s contention is that in the least deprived section of NW London, i.e. in central London, we’ll have two major hospitals (St Mary’s and Chelsea and Westminster) close together with UCH close by. But as for the deprived area of Southall, with Ealing Hospital gone it will have no major hospital close by. Dr Spencer was having none of this. He contended that close proximity by patients to a major hospital A&E had no significant effect on healthcare outcomes.

Commissioner Dr John Lister asked Dr Parmar where the 28,000 seriously ill patients who attend Ealing Hospital A&E each year would go to after its closure. She would not, or could not, answer that question. Dr Parmar said that Ealing Hospital A&E would not close for three years. Dr Lister pointed out that hiring permanent staff in that situation would be very difficult. He also strongly suggested that the recruitment challenges would be so great that this would force the closure sooner rather than later. At least Dr Parmar was aware that after closure the future loading on the London Ambulance Service would be very high.

In 2012 SaHF stated that its cost-cutting transformation programme would take ‘at least three years’. SaHF also stated in 2012 that Out of Hospital replacement services ‘are already (being) put in place..’ However Dr Spencer told the commission that the transformation was ‘complex’ and would take ‘five or six years’. So now SaHF is at least an eight year programme…..

West London Mental Health Trust (WLMHT) Refuses to Reveal Findings of Fraud Investigation

‘The Independent’ has revealed that WLMHT has refused to publish the findings of a year long fraud investigation. The investigation was triggered by the discovery that the Capital, Estates & Facilities department had initiated several unfunded and unapproved schemes. A £4million ‘black hole’ in the accounts led to the scrapping of several clinical projects.

Apparently there were a number of ‘failed’ projects. £560,000 was overspent on refurbishing the Lakeside Mental Health Unit on the West Middlesex Hospital site. £80,000 was spent on building a cafe which has failed to open.

WLMHT, the UK’s largest mental health trust, is ranked in the bottom five of the 56 mental health organisations nationally – and has been for four years. CQC will be inspecting WLMHT later this month.

Management Consultancies Invited to Spend Our NHS Money on ‘Commissioning Support’ – Money Which Should Be Spent on Patient Care

NHS England has published a list of approved private suppliers who can and will no doubt exert enormous power and influence over CCGs. The question to be asked is why can’t the NHS hire and train its own staff to provide this commissioning support?

Management consultants dominate the list, which includes McKinsey, PwC and KPMG. These companies will no doubt replace the role of NHS Commissioning Support Units, many of which have disappeared anyway. One of the companies on the list is healthcare services giant UnitedHealth. Surely there is a conflict of interest here, as it legitimises UnitedHealth’s role as both a healthcare service supplier and as an adviser to CCGs on the selection and management of healthcare service suppliers.

US Senate Votes to Block TTIP

President Obama’s plan to ‘fast track’ both TTIP and TPP in the US Senate has failed.

The Transatlantic Trade and Investment Partnership (TTIP), a treaty being negotiated in secret, is aimed at making it easier for the US and Europe companies to trade. However it’s really all about large US corporates having the right to bid for European contracts and to enjoy unusual rights to compensation should they fail to win them. (TPP is a Pacific TTIP look-alike).A major worry is that the NHS would prove to be a TTIP victim.

Senate democrats who voted against TTIP warned of its threat to US manufacturing jobs. Commentators predict even tougher opposition to TTIP in its attempted passage through the US House of Representatives.  

In the European Parliament its trade committee has backed trade commissioner Cecilia Malstroem to remove public service from TTIP. The proposal also, apparently, disposes with the Investor-State Dispute Settlement (ISDS) at the heart of the contract.

NHS Out of Hospital (OOH) Care By Private Companies is Supported by Tax Relief

‘The Independent’ has revealed that whereas NHS hospitals have to pay VAT on purchasing drugs, private companies under contract to the NHS do not. This arrangement skews any comparison on costs between NHS OOH services provided directly by NHS and those provide by contracted out private companies, as the procurement of drugs by the latter is 20% cheaper.

The truth is that health bosses still intend to knock down both Ealing Hospital and Charing Cross and replace them with far smaller units. Hundreds of beds would go, along with the existing Accident and Emergency Departments. These plans are in a document called ‘Shaping a Healthier Future’, which is supported by local health chiefs, and the Government.

They tell us they will SPEND £80 MILLION on new NHS facilities, but what they DON’T say is that this money is just to pay for their small replacement hospitals with a quarter of the beds there are now. Then they would sell off the remaining land to property developers.

Health bosses say Ealing and Charing Cross will keep our A&Es. But in the small print these so-called A&Es would not take emergency ambulances or have consultant cover. They will be urgent care centres, the real A&Es would be miles away.

Now they are closing our Maternity!

Health bosses are going to close Ealing Hospital Maternity Unit on July 1st, along with gynaecological services. After that, there will be no more babies born in Ealing, except at home.

So once again, Southall is chosen for cutbacks…Southall mothers will be affected the most. Next year, the same people want to close our paediatric (children’s) services.

These closures have no public support, they are part of Government plans to cut and privatise our NHS.

Government-appointed health bosses have plenty of money for their friends: in the last two years North West London NHS has given £33 million pounds of our NHS money to private management consultants, to advise them how to cut and privatise local hospital services.

One firm called McKinsey & Co has been paid £27,000 every day for the last year. That alone could have been used to pay for over 300 new nurses.

Follow Ealing Save our NHS on Twitter @EalingSoNHS or on Facebook

Ealing Save our NHS campaigners were joined by 38 degrees with their Save our NHS ambulance and local MPs Rupa Huq and Steve Pound.

The CCG meeting rubber stamped the closure of Ealing Maternity, a decision which had been postponed to after the General Election.

Ealing Maternity and  Emergency Gynaecology will close by the 1st July, followed by the closure of Paediatrics a year later.

Ealing NHS Campaigners will carry on the fight to save Ealing A&E and all remaining NHS services in the area.

Read some of the reactions on Twitter:

#EalingMaternity If we pay for NHS then why our concerns are ignored for closure.This can’t be correct.

— saptarshi mukherjee (@sapmuk) May 20, 2015

This has got to be the worst day of my career to date and a very sad one for Ealing maternity unit. — #Lesleythemidwife (@lesleyd1975) May 20, 2015

@sam4wong @EalingSoNHS fighting to stop these closures. Westbury Hospital Wiltshire to be sold for housing. don’t give up! good luck

— penelope birnstingl (@bassoonstingl23) May 20, 2015

@RupaHuq @EalingSoNHS This is so important not just for Ealing, but the knock on will be felt in maternity services all over London.

— Alice Perry (@AL1CEPERRY) May 20, 2015

Concerns raised from within CCG re monitoring of impact of transition. Given change in 6wks, some mums will be in a pickle! #EalingMaternity

— Jos Bell (@Jos21Bell) May 20, 2015

@Jos21Bell @EalingSoNHS I really fear that there will be an increase in perinatal and maternal mortality with this closure

— Manj Kaur (@manjkaur21) May 20, 2015

This makes me angry. Yes, angry. Just decided: no maternity unit in Ealing from July 1st. Watch how things fall apart http://t.co/GBcZ1tVk85

— Drew White (@drewsonix) May 21, 2015

Issue: 25

May 2015

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 Save Our NHS (ESON)

For over three years this campaigning group has fought to save Ealing’s hospitals and our NHS from cuts, closures and privatisations. On 30 April 2015 ESON together with Hammersmith’s Save Our Hospitals campaigning group presented a 15,000 signature petition to Health Minister Jeremy Hunt at the Department of Health in Westminster. The signatories want the new Government to suspend plans to close Ealing Hospital Maternity unit, cut 600 beds from Ealing and Charing Cross Hospitals and take away their A&E units.

See https://www.facebook.com/ealingsaveournhs

Will NHS Still Be Centre Stage After the General Election?

Somehow I doubt it – whatever the result.

However, locally politically sensitive healthcare documents and decisions – no doubt many of them already written and made – may well enter the public domain after the election. They include:

+  The new ‘Shaping a Healthier Future’ Business Case

+  The date of the closure of Ealing Hospital’s Maternity Unit

+  The demolition and new build plans for the Ealing Hospital site

+  Sir Bruce Keogh’s new definition of a ‘Modern A&E Unit’ which no doubt will be the blue print of the yet to-be-built new not-really-an-A&E-unit –as-we-know-it on the Ealing Hospital site

+ The McKinsey report on the reasons for the A&E Type-1 chaos in NHS North West London post the September 2014 A&E closures

+ The final report of the North West London Commission on Health

+ The fate of Solace, the Bowman’s Close, West Ealing walk-in mental health centre.

Pressure on A&E Has Not Increased and Is Not Increasing

Colin Standfield of Save Our Hospitals continues quoting NHS statistics which refute the Coalition Government’s lie that there is increasing pressure on NHS hospital A&E units.

From November 2010 to March 2015 Type-1 A&E (the most seriously ill) attendances have remained steady – averaging at 273,388 per week. In fact recently they have dropped below this figure.

So the recent A&E chaos is not to do with what patients are doing to A&E, it is a result of hospital closures (5 in London alone, 2 of those here in NW London), bed cuts and savage culling of social care, meaning that people cannot be discharged from hospital.

North West London Commission on Health: Initial Report

This excellent report, published on 26 March 2015, contains the initial findings of the independent commission chaired by Michael Mansfield QC. The report was written by independent consultants Sean Boyle and Roger Steer. For those of you who may not have the time to read the 119 page report, I have tried below to summarise and highlight the findings which constitute a review of ‘Shaping a Healthier Future’ (SaHF).

1. SaHF HISTORY

A McKinsey and Company report to Government in 2009 put forward the view that the NHS spends too much money on acute care and that £billions could be saved by shifting care from acute hospital settings. NHS boss Nicholson demanded £20 billion savings on NHS costs across England during the period 2009 to 2015.

Out of this came the approach in NHS North West London to save one £billion by 2015 by downgrading four of the nine major hospitals, moving expensive acute hospital care into cheaper Out of Hospital (OOH) services and primary care, and centralising services at five major hospitals.

The decision to downgrade four major hospitals – and close four hospital A&E units – was taken before any public consultation was undertaken. The report is critical of the consultation as it simplistically asked residents which hospital they wanted downgraded.

2. ACCESS TO CARE

SaHF offers poor access to care especially for those living in deprived areas. A formal needs assessment for the 1.9 million population is missing from SaHF. What is evident is that SaHF supplied a set of assumptions about what reductions in demand were needed for all SaHF’s pre-determined capacity reductions to work.

A&E Capacity and Performance

SaHF claimed that North West London is overprovided with A&E units. The commission could find no data to back up this claim. Authoritative data from multiple sources shows that reducing A&Es from nine to five would create loadings on each of the surviving A&Es which would be 50% more than the national average.

In North West London over the last four years A&E attendance fell by 26.2 %. Urgent Care Centre usage seems to be the explanation here. A&E performance in North West London has deteriorated since the closure of the A&Es at Hammersmith and Central Middlesex hospitals in September 2014. Type-1 (the most ill patients) performance is the most concerning. For some weeks performance was the worst in England. SaHF is in denial about A&E closures being responsible for this disastrous performance. SaHF refused to release a report on the subject produced by McKinseys.

OOH Care

SaHF proposed to transform OOH care – spending up to £310 million over five years. All eight Clinical Commissioning Groups (CCGs) provided detailed plans on what they would achieve by March 2015. However there is very little to show what has been actually achieved by this date.

Beds

SaHF claims there is excess capacity, but it is unclear whether the growth in population has been sufficiently factored into calculations of the number of beds required.

3. QUALITY OF CARE

SaHF is all for specialisation and centralisation of services. It favours big hospitals. However the commission could find no recent evidence which supports the case for centralisation of acute services.

Maternity

SaHF’s reason for reducing the number of maternity units is difficulty in recruiting and retaining consultants and midwives at each of the seven sites. SaHF also claims it’s uneconomic to retain Ealing Hospital’s maternity unit. However SaHF has not provided a detailed financial analysis to back up this claim is not available from SaHF.

Emergency Services

Lots of published papers quoted in the report refute SaHF’s claims for centralisation of services and closure of four A&Es. The commission’s findings are that a much stronger case should have been put forward to justify the closure of one A&E unit – never mind four!

OOH

The evidence on the impact of OOH services on the demand for acute services does not support the conclusion that five acute units will be able to support the needs of 1.9 million people.

4. THE BUSINESS CASE

Financial considerations are the ultimate driver for SaHF. This section of the report examines the unproven results of OOH expansion, the affordability, risks, uncertainties and deliverability of the SaHF programme. It questions whether the SaHF costs are under control, whether double –counting is going on in SaHF, and whether too little is being spent on our healthcare anyway.

SaHF cost £62.9 million in 2013/14, yet NHS NW London enjoyed a cash surplus of £100.1 million. In 2014/15 figures are more difficult to source but an overall loss of £14.9 for NHS NWL is identified. (The overall cost of SaHF (2010/11 to 2017/18 ) is projected to be £235.5 million of which £35.43 million is for management consultancy.)

NHS NWL is apparently in overall balance so why were there two A&E closures in September 2014? This was at a time when it had not been proven that SaHF plans were affordable, deliverable or financed.

QIPP and SaHF Entanglement

Possible double counting of cost savings revolve around the NHS Quality, Innovation, Productivity and Prevention ( QIPP) programme and SaHF. QIPP may have already succeeded in making the savings needed without recourse to SaHF closures. The Commission thinks it unlikely that QIPP or SaHF programmes will meet the 44.5% savings required by 2020. SaHF’s refusal to release its latest business case makes it impossible to unravel SaHF (and QIPP) projections and savings.

Should More Be Spent on Healthcare?

Whether you choose money, nurses, doctors or beds as your yardstick the UK has lower numbers than Germany, France and the USA. But in 2009 McKinsey told the Government that the UK had high hospital costs and utilisation costs.

Financial Benefits of SaHF

In 2012 annual savings by implementing  SaHF of £135 million were stated. However the commission has been told that the capital costs have been significantly underestimated, as has population growth. Annual savings might be significantly lower that £135 and might render SaHF plans unaffordable.

Investment in OOH

The creation of new and enhanced OOH services should precede any reconfiguration of acute services. There is no evidence of these new or enhanced services. There is no evidence that there are large reductions in acute capacity as a result of extensions to OOH services.

Affordability

As well as investing £250 million in OOH services, SaHF needs £750 invested in acute services. Can NHS NWL afford this? Only a review of the latest SaHF business case might provide clues to this.

Risks

The report questions whether the SaHF is deliverable. It questions who owns the project – the NHS Commissioning Board, local CCGs or key local providers? The fact that the programme director has changed several times is not a positive sign. The report highlights many risks – service planning, safety, quality, business interruption, estates and construction, delay and adverse publicity.

The report proposes that SaHF develop a more conservative ‘Do Minimum’ option which would be easier to finance and easier to manage.

5. A FLAWED PROCESS

Framing the Problem

SaHF came into being during a period of great turbulence in the NHS nationally, regionally and locally. The North West London Strategic Health Authority and Primary Care Trusts were being abolished. CCGs were being created and many hospitals were wrestling with trying to attain Foundation Trust status. There was therefore no stable strategic platform to plan major changes in service delivery.

The report cites the failure of the ‘Better Services Better Value 2011’ project in South West London. With many similarities to SaHF the project was abandoned in the face of its unsustainability. The commissioners predict a similar fate for SaHF.

Diagnosing the Problem

SaHF is based on assertions. These assertions include that only five major hospitals are affordable in North West London and that the need to improve quality of primary care implies there should be a reduction in acute capacity. However the SaHF strategy should have been based on local needs’ assessments, a deep analysis of the nature of the problems and detailed research on costs in the current system.

SaHF Objectives

Not  clearly stated or followed. Why choose A&E services for reconfiguration-based quality improvement? A&E represents a small percentage of healthcare spending. Quality improvements could be made which would not involve a major reconfiguration and a capital spend of £1 billion.

The Options Appraisal Process

The commissioners believe too few options were considered by SaHF. Critically a ‘Do Minimum’ option was not considered. This breaks Treasury guidelines and its absence could lead to SaHF failing to gain Treasury approval.

Public Consultation

The public in 2012 were not presented with an approved business case. (In fact an approved business case still does not exist). Current plans are much more expensive and the benefits much less that those initially proposed to the public in 2012.

Local Authorities Ignored

Local authorities have been starved of information and involvement. It’s clear that they have developed doubts as to whether SaHF can deliver what it has promised.

RECOMMENDATIONS

The commissioners want the whole SaHF programme to be halted and independent reviews to take place on the September 2014 A&E closures and the planned A&E closures at Charing Cross and Ealing Hospitals. They want the assertion that OOH services can effectively substitute for acute capacity and save money to be reviewed. When the new business case emerges if it is significantly different from the one presented to the public in 2012, then a new public consultation exercise must be mounted.

More on the Healthcare Commission

The fourth public hearing of evidence by the commission will take place at Brent Civic Centre on Saturday 9 May 2015 from 9:30am to 4:30pm. Representatives of SaHF have promised to attend and be interviewed at this event.

Health Commission witness statements, hearings, transcripts etc can be viewed at:

http://www.bpv.org.uk/the-independent-healthcare-commission/

How Seamless and Effective is integrated Healthcare and Social Care in England?

Not very might well be the answer.

In 2014/15 there was a 23% annual increase in ‘delayed transfer of care’ – 306,581 incidents in 2013/14 and 375,700 incidents in 2014/15. These transfers are from acute to non-acute (including community and mental health) care and occur when a hospital patient is ready to be transferred but can’t be for one reason or another and is still occupying a hospital bed. These figures suggest that patients’ length of stay in hospitals is rising – however the most recent data on this is not yet available.

For patients to be transferred back to their homes engagement with family and friend carers is necessary, as can be nursing and social care staff who can visit the patient at home. NHS district nurses often provide or manage the healthcare needs of those at home. However, during the period 2003 to 2013 there was a 47% reduction in qualified district nurses in England. In 2014 the Royal College of Nursing called for the number of district nurses in England to rise to 10,000 (what it was in 2009). In 2013 there were only 6,700 district nurses and more than a third of them were over 50 years old.

As for social care provision, this is a Local Authority service. According to the Association of Adult Social Services (ADASS) Government funding for adult social services has dropped by 12% since 2010, whilst demand had risen by 14%. Age UK reported in January 2015 that the number of people receiving meals on wheels had declined by 64% between 2010/11 and 2013/14. During the same period those receiving home help for washing and dressing fell by a third and the number of day care places dropped by two-thirds.

Only the vulnerable poor who are assessed as having ‘substantial’ or ‘critical’ needs get free social care from Local Authorities. The rest have to pay for social care. Most Local Authorities have sold off the care homes they once owned. In fact of the 430,000 elderly and disabled people who live in care homes only 10% live in those still owned by the NHS or a Local Authority.

It seems to me that many thousands of care co-ordinators are needed across England to knit together community healthcare and social care. Logic says that they should be employed by the state. However looking at job advertisements for care co-ordinators they have all been placed by private care companies. None of them seem to be NHS vacancies. If elderly people are blocking beds surely pro-active initiatives (research/co-ordination) by hospital co-ordinators with close family/friends, the Local Authority, Age UK, District Nurses and care homes might just unblock beds somewhat faster? Or maybe GP surgeries should employ care co-ordinators for their vulnerable, disabled and elderly patients. However Local Authorities, NHS hospitals and GP surgeries will all claim that they cannot afford to employ care co-ordinators.

Which brings us to the £5.3 billion Better Care Fund (BCF) which went ‘live’ on 1 April 2015. BCF’s original reason for existence was to transform local health and social care services by pooling resources. However it’s still mired in conflict. Local government wants the funds to be used to support adult care services. The NHS wants it to be spent on healthcare. National Government wants it spent on reducing hospital admissions and making £1 billion NHS savings by 31 March 2016.

For the first time in our history there are over 10 million over 65 year olds in the UK and of these 1.4 million are over 85. The ONS predicts that these figures will rise to 15 million and 4.2 million by 2035. Improving the quantity and quality of healthcare and social care and their integration for the elderly is going to be an even bigger challenge in the future than it is now.

Issue: 24

April 2015

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.

Over 500 Attend Evening Save the NHS Rally in London on 10 March 2015.

Patients, clinical staff and politicians  from all over London came together for a lively rally at Hammersmith Town Hall on Tuesday 10 March 2015. It was a show of force by those who are worried and unhappy with the actual and planned NHS cuts, closures and privatisations. Many of the attendees were members of NHS campaigning groups throughout London.

The mood amongst speakers and audience members was one of optimism that the Government’s assault on the NHS could be challenged and defeated. Everyone was encouraged to vote at May’s General Election for candidates and political parties who would defend the NHS. A vote for the Conservative Party was universally viewed as a vote for the death of the NHS.

One of the most impressive platform speakers was Ealing Hospital consultant Gurjinder Sandhu. He caught the mood of the meeting perfectly when he asked ‘…we bailed out the banks in 2008 so why can’t we bail out the hospitals in 2015?’

Read Rally Chair Anne Drinkell’s report on the event at:

www.saveourhospitals.blogspot.co.uk

Ealing Hospital A&E Outperforms Northwick Park A&E in February 2015

NHS figures show that Ealing Hospital A&E outperformed Northwick Park A&E and London and national average A&E performances in February 2015. These figures relate to waiting times for the most seriously ill patients (so called Type-1).

This poor performance by Northwick Park comes 12 weeks after the opening of its new £21 million A&E unit.. Many local ambulance, GP and CCG initiatives are also in place to stop A&E patients being taken to Northwick Park, presumably to take the pressure off Northwick Park A&E.

And so the questions must be asked again and again:

+ Why plan to close Ealing Hospital A&E unit?

+ What more can be done to improve the performance of Northwick Park A&E unit?

(From information supplied by Colin Standfield of Save Our Hospitals)

NHS Resorts to Untruths in Defending its ‘Shaping a Healthier Future’ (SaHF) Strategy

The NHS NW London SaHF Winter 2015  newsletter states ‘…while performance nationally dipped, the North West sector was the highest performing in London in the last few months of 2014 – at 92.87% – for all types of A&E performance and was above both the London and the national average performance for the quarter’.

However, NHS official data reveals that at no time in the last quarter of 2014 was the North West London figure above the London average and in only 4 weeks did it creep above the England average. If you take ‘Type-1’ performance rather than ‘All Attendees’ the figures were,  and continue to be, even worse.

NHS NW London SaHF continue to state publicly that ‘there were increases in demand in A&E services across the country during the winter period’. However the NHS’s own data clearly shows that there was no significant winter pressure on A&E demand, anywhere. For example in November 2014 the NHS huffed and puffed about a ‘surge’ in A&E demand reaching 417,000 in England in one week. Given that the nation’s A&Es in June 2014 had coped with 460,000 attendances/week, highlighting this November figure was disingenuous to say the least.

So just what are we to make of these untruths? Is it merely incompetent reading and interpreting of the NHS data or does it amount to attempted deception by NHS NW London SaHF?

(Information again supplied by Colin Standfield of Save Our Hospitals)

No More A&E Closures – NHS NW London SaHF Bombshell

The SaHF newsletter tells us this as well as that there will be no ‘further changes to local A&E services in the next three years’. All this makes a mockery of the SaHF Option allegedly chosen by residents in 2012. Within three years the four A&E units at Central Middlesex, Hammersmith, Charing Cross and Ealing Hospital would be closed. Well the first two were closed – in September 2014. And now Charing Cross and Ealing A&Es will not close at all. The Independent Reconfiguration Panel pronounced in September 2013 that it was unconvinced by proposals to close Charing Cross and Ealing A&Es. The hospitals (Trusts) were told to maintain A&E services until more convincing plans had been drawn up and alternative services put in place. Here we are 19 months later and such plans and alternative services are clearly not in place.

The newsletter goes on to say that (as from 2018) Charing Cross and Ealing A&Es will continue to operate ‘from new buildings’. One does wonder where these new buildings will be built on the Ealing Hospital site and which current buildings will be demolished to make way for them. But these post-2018 A&Es will be ‘modern A&Es’ – a term yet to be defined by the NHS. Many of us are certain that no blue light ambulances will deliver patients to these modern A&Es and that they will have no intensive care beds or consultants. Put crudely these ‘modern A&Es’ will not be A&Es at all. Yet another NHS untruth raises its ugly head.  

Ealing Hospital Maternity Unit Closure Date is Still a Mystery

At the ECCG meeting held in Ealing Town Hall on 18 March 2015 it was announced that there was still no confirmed date for the closure of the maternity unit. Ealing mothers-to-be, 120 Ealing Hospital midwives and local NHS activists are variously anxious, angered and bemused by this continuing management failure.

SaHF plans in February 2013 included the closure of Ealing Hospital Maternity Unit. This was confirmed in October 2013 by the Secretary of State. In October 2014 ECCG stated that closure would be ‘as soon as possible’. March 2015 was suggested as a likely date for closure.

Here we are 17 months on from when the Secretary of State decided on the closure and NHS NW London is still unable to organise future childbirth provision alternatives to Ealing Hospital. Surely this is incompetence. Is this a failure of the SaHF strategy? Is this a failure by ECCG and/or NHS NW London? Is it all about the money and space not being available to expand other maternity units in north west London?

This is no way to run a public healthcare service.

NW London Hospital Health Commission

Chaired by Michael Mansfield QC, this is an independent investigation on the impact of the ‘Shaping a Healthier Future’ (SaHF) programme. The programme includes the closure of 4 of our 9 hospital A&E units, two of which closed in September 2014. The Commission is funded by Brent, Ealing, Hammersmith & Fulham and Hounslow Councils.

After three of the four public hearings – in Hammersmith on 14 March, Ealing on 21 March and Hounslow on 28 March – a distinct pattern is emerging:

+ SaHF is about cost savings and generating capital receipts by land disposal

+ Hospital A&E services have been reduced before any out-of-hospital alternative services have been established in the community

+ 90%+ of witnesses cannot see how longer journey times and fewer hospital beds and services will give us all a healthier future

+ SaHF strategy completely ignores current population growth as well as future London Plan residential growth

+ No high level engagement between SaHF and senior Local Authorities’ staff at any time – 2011 to 2015

+ No local senior NHS /SaHF staff have accepted invitations to give verbal evidence. Why won’t Dr Spencer, Dr Spicer, Dr Parmar and Thirza Sawnett defend the SaHF strategy in public?

+ The management consultants who conceived SaHF (notably McKinsey & Co) have failed to participate in these hearings

+ Healthwatch sees itself as a ‘friend of CCGs’ – not surprising in a way as it was set up and is funded by the Department of Health

+ The SaHF transformation seems to have casually expanded from taking ‘at least three years’ in 2012 to now in 2015 being a five year project ‘ending’ in perhaps 2018

+ Magnificent and courageous verbal evidence delivered by practising clinicians

For reports and YouTube coverage of the Commission see: www.saveourhospitals.blogspot

Keep Our NHS Public (KONP) in North Central London To Take Five CCGs to Court for Failure to Consult on Privatisation Plans

Five Clinical Commissioning Groups (CCGs) – in Camden, Islington, Haringey, Brent and Enfield – have decided to combine Out Of Hours (OOH) GP service and the 111 telephone helpline and put it out to tender. This decision was taken without any consultation with the one million patients who use these services. KONP in north central London wants these services to be run by NHS staff and is taking these CCGs to Court for their failure to consult. More at www.camdenkeepournhspublic.org.uk  

NHS NW London Spent Over £13 Million on Management Consultancy Since 1 April 2014

A Freedom of Information request has revealed that NHS NW London has spent over £13 million on management consultancy over the last 11 months. The money was spent to support the NHS NW London ‘Shaping a Healthier Future’ (SaHF) strategy.

Three companies received the bulk of our money – McKinsey (and McKinsey-led consortia) £7, 237,600, PA Consulting £3,366,336 and PWC £1,528,06.

NHS NW London is just one of 27 NHS area teams in England. If all of them have spent similar amounts on ‘strategy and transformation’ then the total national spend on management consultancy over the last 11 months could be over £350 million. In London alone if the other two area teams spent as much as NW London then the total London management consultancy spend would be almost £40 million.

Let’s hope that the independent NW London Mansfield Healthcare Commission reveals just how well or badly our £13+ million has been recently spent on the SaHF ‘strategy and transformation’.

REPORTS ON LONDON’S NHS

Two reports were published in March 2015 on this topic. The larger report is ‘London’s NHS Into the Unknown’ which is the second report by The People’s Inquiry into NHS London. ‘Critical Condition: London’s NHS’ is a smaller report from the London Assembly Labour group.

‘London’s NHS Into the Unknown’

This 47 page report is an updated version of the original March 2014 report. A deepening divide is identified between Clinical Commissioning Groups (CCGs) and the hospitals, mental health and community health service trusts which deliver front line services.

The report reveals increasing concerns about the lack of strategic overview of healthcare in London. It is very critical of the operation of a number of healthcare initiatives. It finds no grounds for optimism that anything substantial will be achieved by the Better Care Fund. It finds no evidence of the work of the local Health and Wellbeing Boards and Health Watch organisations and little evidence of local engagement.

The report finds that the London Ambulance Service performance has weakened. It also finds little improvement in mental health resourcing or funding. On the Primary Care front there is frightening evidence that community nursing services don’t exist.

A new recommendation is to tackle system failure and integrate care in and outside hospital. A repeated now urgent recommendation is an independent review of the clinical case for reconfiguration.

The people’s Inquiry is chaired by Roy Lilley and sponsored by Unite, the Union. The report can be downloaded at www.peoplesinquiry.org.uk

‘Critical Condition: London’s NHS’

Dr Onkar Sahota AM, Chair of the GLA Health Committee, has authored this interesting 22 page report on behalf of the Greater London Assembly/London Assembly Labour. The report highlights problems with GP services and the provision of emergency care throughout London. It is packed with useful, well presented data.

The report calls on the London Mayor to halt any further closures of A&E and Maternity wards and to prohibit the reduction in hospital beds until a full comprehensive review has been carried out across London. A London-wide strategic approach to providing health and social care in London is proposed – along the same lines of the one recently announced for Greater Manchester.

Read the report at http://ow.ly/KbNL5

Child Mental Health Crisis

Government research in 2004 revealed that one in ten children in England have a diagnosable mental health problem. Government figures released in March 2015 reveal sharp increases in the number of children being admitted to hospital for self-harm, eating disorders, depression and other psychological disorders. 17,278 under 18 year olds attended hospital A&E units with psychological problems in 2014. In 2010 the number was 9,328. Also over a ten year period the number of children treated on wards for anorexia (2,965 in 2014) has doubled.

However only 6% of the total mental health budget is spent on services for children and teenagers – totalling £50 million in cuts. Allied to this the overall spend on mental health services has fallen every year since 2010.

However a little help is on the way. In the 18 March 2015 Budget an additional £250 million each year for five years was promised to improve mental health services for children. This LibDem initiative is aimed at helping some 100,000 young people.

NHS Election Promises Given by Political Parties

+ Conservative

The NHS is not one of its six key themes. It says ‘not a penny’ is to be cut from the NHS budget. It plans to spend £2 billion more annually on the NHS. Recently Mr Cameron has talked about creating a ‘truly seven-day-a-week NHS’.

+ Labour

It will add 8,000 more GPs, 20,000 more nurses, integrate health care and social care, guarantee 48 hour GP appointments, and cancer tests within one week. It will invest an extra 2.5 billion each year in the NHS. It will repeal the Health & Care Act and Section 75 in First Queens Speech. It plans to cap at 5% the profit that private companies can make providing NHS services. Will take the NHS out of TTIP.

+ LibDem

Is pledged to protect the NHS from cuts. It will add £8 billion in NHS funding by 2020. It is committed to improving the NHS mental health service.

+ Green

It wants to protect the NHS, end NHS privatisation, repeal the Health and Social Care Act, support the NHS Reinstatement Bill and give a higher priority to mental health.

+ UKIP

Says it is the party of the NHS. Invest £3 billion in NHS frontline services, £130 million in dementia services, £1 billion in social care for the elderly and merge health care and social care. It would abolish the CQC and scrap hospital car parking charges. Nigel Farage, UKIP’s leader, advocates moving to an insurance-based system of healthcare.

+ National Health Action Party

Supports local A&E and maternity provision, removal of a health care market, and stopping privatisation. It wants to reverse government cuts. It is anti TTIP and wants to renegotiate PFIs.

‘NHS For Sale: Myths, Lies and Deception’

This is a new book written by Jacky Davis, John Lister and David Wrigley. Jacky is a consultant radiologist and David a GP. Jacky co-authored the 2013 book ‘NHS SOS’. Jacky and David are both members of the BMA UK Council. John is a founder member of KONP and a respected health researcher, speaker and writer.

The book details forensically what has happened since Oliver Letwin first floated the concept of privatising the NHS in his book ‘Privatising the World’ published in1988. It tracks the emergence and implementation of the 2012 Health and Social Care Act and sets out what needs to be done to protect the NHS from corporate greed. ‘NHS For Sale’ provides a veritable arsenal of information to be used in the war against those who seemingly want to undermine the future of the NHS.

Book royalties will go to KONP.

ISBN.978-0-85036-627-3

To order a copy go to www.merlinpress.co.uk