Issue: 23

March 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.

‘Shaping a Healthier Future’ Strategy in Tatters as ‘Care Closer to Home’ Fails to Materialise

Colin Standfield of Save Our Hospitals (saveourhospitals.blospot.co.uk) continues to forensically analyse NHS NW London’s performance in implementing its 2012 ‘Shaping a Healthier Future’ strategy.

The central plank of this 2012 – 2015 strategy is ‘shifting more investment into Primary Care and other local healthcare, providing more proactive services in the community closer to patients’ homes’. However no evidence has ever been presented that ‘care closer to home’ results in better care outcomes. There is also no evidence that there actually are any improvements in Primary Care and community care. There is no NHS data available to measure this.

As Colin points out, the budget for ‘care closer to home’ is various pitched at £120 million, £138 million and £190 million. It’s impossible to figure out how much of this money has actually been spent by CCGs on ‘care closer to home’ and there’s certainly no evidence of any cost/benefit analysis of any such expenditure.

If in fact there is no local improvement, then the consequences for residents in north west London will be quite devastating. Closing A&E units and reducing the number of intensive care beds and consultants in hospitals, whilst apparently providing no replacement capabilities in local communities, must result in more pain, anxiety and death.

NHS Suggests More ‘Less Well’ Patients in North West London are the Cause of A&E Meltdown

NHS NW London bosses are suggesting that an independent review has found ‘no direct link’ between closures of A&E units and poor A&E performance in north west London. They are suggesting that an increase in acuity (with people less well leading to increased length of stay and bed occupancy) is the main contributory factor. The publication of this report was due in January 2015 but as of 27 February 2015 it has not appeared.

The performance of A&E units across London generally is above the national trend. It’s only in north west London (where two A&E units were closed in September 2014) that A&Es are performing so badly. It seems incredible that so many of these ‘less well’ patients only live in north west London and not in other parts of London. In fact if this demographic feature is real and sustained, then this is surely a reason for expanding hospital A&Es not contracting them.

23% More NHS Operations Cancelled in October, November and December 2014 in England

At 19,473 cancelled operations this was the worst figure recorded since 2001-02. These last minute cancellations were for non-clinical reasons. Most Trusts were forced to call off planned procedures at short notice because they ran out of beds. Shortage of beds is thought to be caused by the surge in demand for care and the demands of A&E admissions.

However here in north west London the 2012 NHS plan was for the total number of beds to be reduced from 3,268 to 2,470 by 2015. No doubt this plan is being implemented and no doubt it is having a major impact on the number of cancelled operations.

Hospital News

Ealing Hospital

Retiring Ealing Hospital Chief Executive David McVitie made two interesting statements in public in February. He stated that Ealing Hospital Maternity Unit would close in July 2015. (However Ealing CCG is now saying that it might make a decision on the closure date at a meeting on 18 March 2015). Mr McVitie stated that Type-1 (the most ill) A&E patients would still be being admitted to the hospital for the next five years time.

CQC Criticises Hillingdon Hospital

The Care Quality Commission (CQC) states that improvements are needed in maternity. A&E, critical care, family planning and children’s care. It noted an incidence when one nurse was caring for 20 patients. CQC also criticised the state of the hospital buildings.

The problems in maternity are particularly worrying for would-be mothers in Ealing. Hillingdon Hospital Maternity Unit is one of the designated units for pregnant Ealing women when Ealing Hospital Maternity Unit is closed down.

The hospital is to receive £12.3 million Department of Health funding to build a new Urgent Care Centre and improve facilities for A&E, emergency paediatrics, acute medical admissions and endoscopy.

Chelsea & Westminster and West Middlesex Hospitals to Merge

It’s not exactly clear how this merger will improve patient care. It’s also not clear how this merger will improve the finances of these two financially troubled hospitals. It’s also only four months ago that CQC stated that Chelsea & Westminster Hospital needed to improve in A&E, medical care, surgery, children’s services, end of life care and outpatients.

90 Ealing Hospital Midwives Warn that Pregnant Women in Ealing are At Risk

In a long letter to Ealing CCG and to the ‘Shaping a Healthier Future’ (SaHF) team Ealing Hospital midwives describe how their top performing Maternity Unit is ‘rotting away in front of our eyes’. They compare the likely dangerous consequences of closing their unit with the A&E carnage being caused by the closure of Central Middlesex and Hammersmith Hospital A&Es.

Ealing CCG has been telling Ealing GPs not to refer pregnant women to Ealing Hospital. Consequently birthing admissions are down. This action by Ealing CCG is completely contrary to what was agreed in order to keep Ealing open and a safe ‘going concern’ until the point of planned and carefully considered closure.

There has been considerable uncertainty about the closure date for the Ealing unit. In sheer frustration some Ealing Hospital midwives have already quit their jobs. The Ealing Hospital boss is now saying that the Maternity Unit will close in July 2015. However Ealing CCG and SaHF apparently refuse to commit to a closure date, but hint that they might decide on 18 March 2015.

Ealing CCG and NHS NW London has formally responded to the Ealing Hospital midwives. It blames the uncertainty and delays on concerns about patient safety. This is all well and good until we reach the statement ‘The A&E changes have not impaired care or service provision for patients…’. Well blow me down with a feather – this statement is an outrageous distortion of the truth. NHS NW London has for many weeks been the worst performing A&E segment in the whole of London. Ealing Hospital A&E has consistently been one of the six worst performing A&Es in the whole of England. Ealing CCG deny instructing Ealing GPs not to refer mums-to-be to Ealing Hospital. Ealing Hospital midwives dispute this and given the ECCG’s economy with the truth on A&E performance I’m minded to side with the midwives.

One has to ask the question here – who is in charge of and responsible for this chaos?

West London Mental Health Trust (WLMHT) Responds To £4 Million Overspend Allegations in ‘Independent on Sunday’

On 3 February 2015, WLMHT responded to the ‘Independent on Sunday’ 25 January 2015 allegations of financial impropriety at WLMHT. The Trust emphasised that there was no financial overspend at Broadmoor Hospital or for the Trust’s financial year as a whole. It stated that the reason the Lammas Centre Recovery House project (in Mattock Lane, W5) was abandoned was one of building unsuitability and was not related to finance. The Trust did confirm that an independent investigation was underway relating to other projects mentioned in the press article.

Greater Manchester to Get Control of a £6 Billion Health and Social Care Budget in April 2016

This will be a huge reorganisation impacting over 2.6 million residents. It will involve 10 Local Authorities, 12 Clinical Commissioning Groups (CCGs), 14 NHS partners, NHS England and National Government. There will also be a newly elected Mayor for Greater Manchester in 2017 who will control this budget.

On the face of it Manchester CCGs will lose power, as Councillors will decide priorities. Monitor presumably becomes redundant. Some might see this Greater Manchester experiment as a logical development of the national Better Care Fund (BCF). BCF will attempt to integrate social care and health care via local pooled budgets spent jointly by a CCG and a Local Authority. BCF commences in April 2015. It has had a rocky gestation period with accusations of poor planning. There has been little ‘gelling’ of cost cutting aspirations of the NHS and the revenue searching zeal of Local Authorities. BCF is untested.  It may fail and the Greater Manchester plan may similarly fail. However if the latter is seen to succeed we might see other cities being given similar devolved powers.

There are some worrying technology and governance issues being raised. For example there is no common identifier of a citizen shared by health and local government. Tracking patients through the care cycle will be a big challenge in successfully integrating health and social care. There will be IT problems to overcome due to the lack of interoperability between disparate health and social care IT systems. There is also a future worry that cities may devise their own, different ways of integrating health and social care. We could finish up with a ‘patchwork quilt’ of IT approaches to integrating health and social care. This will make life complicated for those patients who move from one city to another or between cities and rural areas.

Sadly there is no indication that the Manchester initiative is some kind of city ‘pilot’ scheme. And anyway if one were choosing a pilot conurbation one would not pick one so large with so many residents, Local Authorities and CCGs.

It’s important to appreciate that none of the £6 billion will be ‘new’ money. The acid test will be to try and deduce whether this regional devolution of integrated health and social care results in improved health and social outcomes. We are unlikely to see any metrics on this before 2017.

NHS England Concedes GP Advice Must be Provided by the 111 Telephone Service at Peak Times

In a policy climb down, NHS England has conceded that its 2013 111 launch policy of just using non-medically trained call handlers is inadequate – certainly during peak periods. A GP presence in call centres or a GP available to provide clinical advice must be put in place as soon as possible.

Major Study Finds the Sustainability of Clinical Involvement in Commissioning (CCGs) of Primary Care Is At Risk

The King’s Fund and the Nuffield Trust have just published a study of six Clinical Commissioning Groups (CCGs) in order to monitor the changing role of CCGs in General Practice.

The risk to clinical involvement is due to waning levels of GP leader engagement in CCGs, potential problems in the recruitment and retention of leaders, and significant pressures on GPs’ time and capacity.

The research suggests that the benefits provided by the shift towards CCGs co-commissioning Primary Care could be compromised by potential conflicts of interest, reductions in running cost budgets and strained relationships with fellow GPs and NHS England.

Issue: 22

February 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.

A&E Waiting Times for the Seriously Ill at Ealing Hospital Worst Ever Recorded in England

A new NHS low was reached in the week of 14 to 21 December 2014. At Ealing and Northwick Park Hospitals only 53.7% of Type-1 A&E patients (the most seriously ill) were treated within four hours. This is the lowest number ever recorded in England. All this is against a backdrop of no increase in Type-1 demand.

We should all sympathise with the heroic staff in Ealing Hospital A&E who are working to their limit with too few beds, too many temporary staff and an uncertain future ahead for all of them.

All this is at a time when the NHS’s own figures show no increase in A&E attendances.

Surely now is the time for the NHS ‘Shaping a Healthier Future’ plans to close Ealing Hospital and Charing Cross Hospital A&E units to be dropped. More acute beds and permanent acute staff must be acquired at these units.

The Solace Mental Health Centre Closure Plans – Linked to Death by Suicide – Are To Be Reviewed

The London Borough of Ealing’s (LBE’s) Solace Mental Health Centre in Bowmans Close, West Ealing has been a 365 day/year walk-in centre for mental health service users for over 22 years. Recently LBE announced plans to discontinue funding the centre as from April 2015. Without the LBE annual grant of £104,000 the centre will have to close.

The likely closure of the centre has caused great anxiety and anguish amongst the 85 regular service users. Two have recently attempted suicide and tragically one of them died under a train at Ealing Broadway Station on 7 January 2015.

On the face of it if the centre is providing a valuable cost effective service.  Why can’t it be funded by the NHS West London Mental Heath Trust (WLMHT)? WLMHT currently provides £47,000 annual funding which pays for the centre to be open at weekends.

Alternatively why can’t funds be found from Ealing’s £29+ million 2015/16 Better Care Fund (BCF)? This pooled fund is operated by LBE and the Ealing Clinical Commissioning Group. BCF exists in order to facilitate the integration of health care and social care. The budget has not been finalised but this should happen in February 2015.

Perhaps WLMHT and the Ealing BCF could jointly fund the £151,000 annual running cost of Solace?

However, with a financial scandal beginning to engulf WLMHT (see below) it seems highly unlikely that it will be in any position to inject funds to save Solace.

On 13 January 2015 ‘Ealing Today’ reported that the LBE Councillor responsible for health – Hitesh Tailor – had said that LBE somehow wants to ‘continue the service’ at Solace. LBE has delayed a Cabinet decision on Solace and LBE Officers are now ‘developing proposals’.  

It appears that Mencap might commit £40,000 annually to renting out space at the centre. At an LBE meeting on 27 January it emerged that a final decision could be made before the middle of February 2015.

More on Solace and to sign the Save Our Solace Centre petition see www.saveoursolace.co.uk

Now Ealing Hospital Maternity Unit Closure Date Has Slipped Again

Midwives at Ealing Hospital are mired in uncertainty as to when they might transfer to another hospital maternity unit and when exactly birthing will cease at Ealing Hospital. The likely date for closure of the Ealing Hospital maternity unit was originally 31 March 2015, but the NHS has failed to confirm this. Ealing CCG has told Ealing GPs not to refer expectant mothers to Ealing Hospital any more and currently referrals are down by 50%. Once referrals drop by another 25% the service will be unsustainable. There seems to be uncertainty about when and if extra capacity will exist at other maternity units when/if Ealing Hospital’s unit is closed. An excellent, well established service for diabetic mothers in Southall is now falling apart – as is one for HIV+ mothers in Southall.

When Ealing Hospital maternity unit closes Ealing mothers will be referred to Hillingdon, St Mary’s, Hammersmith, Northwick Park, West Middlesex and Westminster & Chelsea Hospitals. However rumour has it that Hillingdon Hospital will refuse to admit Ealing mothers. After closure of the Ealing Hospital birthing unit and the neo-natal unit, the ante-natal and scanning units will be retained.

Although a relocation process is in place, the 120 staff apparently have no formal job offers or formal start dates. All of the staff have issues which include very low morale, general uncertainty, school drop-off and pick-up arrangements for their children, travel to work and car parking at work. Midwives will soon begin to leave and the birthing service will have to close as it will be deemed ‘unsafe’.

A rethink on the fate of the Ealing Hospital Paediatrics unit has resulted in its retention for a year.

NHS Lammas House Repurposing as Mental Health Residential Recovery House Bites the Dust – As Financial Scandal Engulfs WLMHT

Plans for converting Lammas House on Mattock Lane into a 12 bedded residential mental health Recovery House have clearly gone all wrong, as we hear the building has been sold by the NHS West London Mental Health Trust (WLMHT) for £2.9 million.

‘The Independent on Sunday’ of 25 January 2015 suggested that the Recovery House project was scrapped because of financial turbulence at WLHMT. Anti-fraud specialists Mazars are currently investigating a £4 million overspend on unfunded or unapproved projects at WLMHT.

I understand that alternative facilities have been acquired on a 5 year lease at Amadeus House, 18 Corfton Road, W5. This house has 17 bedrooms and was until recently a care home for 11 mentally ill residents.

The Independent Health Commission Inquiry (IHCI)

The Councils of Brent, Ealing , Hammersmith & Fulham and Hounslow have set up the IHCI in order to investigate the impact of the proposed and actual changes to healthcare services brought about by the NHS North West London  ‘Shaping a Healthier Future’ (‘SAHF’) strategy. The inquiry is chaired by Michael Mansfield QC.

Issues in Ealing include:

+ Demolition of Ealing Hospital and its replacement with a smaller, non-major hospital

+ Closure of A&E and Maternity Units at Ealing Hospital

+ Out-of-hospital provision prior to demolition and closures.

The Royal College of Nursing (RCN) has already submitted written evidence. The RCN wants the SAHF programme halted. It wants no A&E closures at Ealing and Charing Cross Hospitals until adequate out-of-hospital provisions are in place.

If you want to submit evidence you can contact Peter Smith at peter.smith@lbhf.gov.uk or at Clerk to the Commission, Room 39, Hammersmith Town Hall, London W6 9JU. The public hearing in Ealing will take place at Ealing Town Hall on Saturday 21 March 2015.

Labour Party Pledges 10 Year Campaign to Merge Health and Care Services

Labour is promising, if elected, to recruit 20,000 nurses, 8,000 GPs, 5,000 care workers and 3,000 midwives. It plans to end the ‘Tory market experiment’ and repeal the Health and Social  Care Act.

Patients Who Opted Out of Medical Records’ Sharing (care.data) Have Been Ignored and Could be ‘Punished’. Another care.data Shambles

The Health and Social Care Information Centre (HSCIC), which collects patient medical records, has admitted that ‘none of the objections requested by patients …have been enacted’. It is understood that tens of thousands of patients have objected to their personal medical data being shared or sold off.

It also emerged that patients who opt out of this data sharing will be ‘punished’ by not being approached for direct care services. These services include bowel screening and cancer screening.

The persistently stalling care.data scheme is a hugely ambitious programme which aims to link GP, social care and hospital records. A previous abortive attempt to do something similar – NPfIT – was started in 2002 and abandoned in 2011. It wasted some £10 billion of our money.

No Air Ambulances in the Whole of London for Much of January

Only one air ambulance normally operates in London.  It is run by a charity and funded by businesses. However it did not operate for much of January as its annual three week maintenance was carried out.  It seems barely credible that our state run healthcare service does not fund a fleet of air ambulances to serve the eight million residents of London.

Chronic Hospital Bed Shortage in England

The number of hospital beds /1,000 population in England is 2.7. The EU average is 4.2. In Germany it’s 8.2 and in France it’s 6.6. England is seriously ‘under-bedded’ in its NHS hospitals.

‘The Observer’ Reveals Soaring Stress Levels Amongst Nurses. Should We Be Surprised?

A Freedom of Information request has revealed that the incidence of stress, anxiety and depression is rising amongst our 400,000 NHS nurses in England. Since 2012 the number of working days lost due to stress has risen by 48%. NHS Employers estimates that 30% of all NHS sick leave is caused by stress.

Outsourcing NHS Scanning and Pathology Services Leads to ‘Loss’ of Data

Opendemocracy.net/ournhs quotes an anonymous NHS worker bemoaning fragmentation of healthcare caused by outsourcing NHS services to private companies. Often these days X-ray, ultra-sound, blood tests and other pathology and microbiology tests are outsourced to private companies. The results however reside on the private companies’ computers, not on NHS computers. So when NHS clinicians want to check/review these results they can’t find them. Just how this amounts to progress is beyond me.  

One does also wonder who actually owns these images of you and your test results?

What Do NHS Services Cost?

Some recent cost estimates from The Kings Fund:

+ £26: Visit to a GP

+ £44: Visit to a family planning clinic

+ £111: Accident and emergency visit

+ £250: Hospital admission overnight stay

+ £344: Ambulance journey from accident scene

Issue: 21

January 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 Hospital A&E Performance – Now a National Scandal

Only 62.6% of patients attending Ealing Hospital A&E were seen within 4 hours during the week of 15 December 2014. This figure is worse than 139 other NHS hospital A&Es in England. In fact it’s the poorest performance of any NHS hospital in England. 951 people waited over 4 hours to be admitted. The national average was 315 people. As for ambulances queuing outside the hospital there were 227. The average across England was 60.5.

Just what is being done to improve this terrible performance? Who is to blame for this awful service?

According to Lewisham GP Dr Louise Irvine the real problem is the reduction in the number of acute beds. This leads to many more patients queuing on trolleys in hospital – for up to 12 hours in some cases. Delayed discharge of patients also adds to the problem. Social service cuts largely explain the delay in discharges.

We all know that the plan is to demolish Ealing Hospital including its A&E unit. How will this improve performance? This will leave the 338,000 Ealing residents with no major hospital and no A&E unit within the borough’s 21 square miles. This seems like criminal negligence to me.

New Northwick Park Hospital A&E Finally Opens on 10 December 2014

At a cost of £21million this new facility offers 40 individual treatment bays. The number of qualified nurses on each shift has been increased from 24 to 27. No numbers are provided by the NHS on the number of consultants on each shift – which is a concern. No information is provided as to whether additional Intensive Care/Acute beds have been created.

At 40 beds this new facility offers the same capacity as the one it is replacing. Why spent £21 million on a new facility which provides no extra capacity? Apparently a further 66 medical beds are promised for autumn 2015 – but in pre-fab modular units.

Senior staff at the Trust are quoted in the ‘London Evening Standard’ saying ‘…You don’t need a bigger A&E’ and ‘…the needs of the patients are not being met in the community’. Just what these statements mean is unclear to me. Are queues in ambulances, in A&E and on trolleys in hospital going to be reduced by more treatment/care in the community? If so,where, how, when and on whose budget?

Is the NHS Deliberately Confusing Us by Mixing Up Data on A&E Admissions and A&E attendances?

Excellent research by Colin Standfield of Save Our Hospitals has confirmed that there is no increase in patients visiting our local hospital A&Es. However, there is a painful increase in the number of patients waiting more than four hours to be treated in the A&Es. NHS managers are claiming that both the number of A&E admissions and the number of A&E visitors have increased, when it’s only the admissions numbers which have increased. The NHS target of treating 95% of visitors to A&E within four hours is being consistently breached. For the week ending 30 November 2014 NHS North West London Healthcare was the worst performing Trust in the country for Type-1 (most sick) patients at 65.7% waiting over 4 hours.

‘Arrest Drunks Clogging up A&E’ Trumpets National A&E Leader in ‘The Observer’

Dr Cliff Mann, President of the College of Emergency Medicine wants fewer drunks clogging up hospital A&E units. He says threatening drunks with arrest will stop them drinking alcohol.

What a load of nonsense.

For starters not everyone who presents at A&E as being drunk is actually just drunk. They may have other physical illnesses or injuries which require treatment and which may require admission to hospital.

The Police Federation sees little merit in arresting drunks. The charity Alcohol Concern thinks we are not getting ‘to the heart of the problem’.

The heart of the problem, and what is missing in the article, is the direct connection between mental illness and alcohol abuse. For Dr Mann and ‘The Observer’ not to refer to this in the article is gross negligence. The National Bureau of Economic Research (NBER) reports that there is a ’definite connection between mental illness and the use of addictive substances’. NBER research reveals that people who have been diagnosed with a mental health condition at some time in their lives consume 69% of all alcohol consumed.

So what is clearly needed is more money and resource invested in training and employing more therapists in the treatment of those patients whose mental illness symptoms include substance abuse.

More on the links between mental illness and substance abuse at www.dualdiagnosis.org

Some Young Adults Preferring A&E Walk-In Attendance Rather Than GP Appointments System

Citizens Advice researched 900,000 people across England and found that 18 – 34 year olds are more than twice as unlikely to be able to secure a suitable appointment with their GP as those 55 years old and over.  Similarly these young people were twice as likely as 55+ olds to use their local hospital A&E walk-in service rather than their GP. So…even more pressure on A&E units.

‘Sell Off’- A 60 Minute Film Featuring Doctors and Healthcare Researchers Describing the Destruction of Our NHS

This excellent film covers a wide range of NHS issue including:

+ inappropriate and expensive internal market

+ PFI hospitals creating huge public debts and huge private profits

+ Government lies

+ Health and Social Care Act 2012 – fatally flawed

+ Foundation Trusts/mergers – about profits, not patients

+ planned NHS service downgrading as a trigger to introducing private service suppliers

+ politicians joining the boards of private healthcare providers and consultancies

+ CCGs as instruments to bring in privatised insurance based healthcare

+ massive fees paid to management consultancies, especially to McKinsey & Co

+ TTIP – granting power to US corporates on a par with nation states

+ intimidation of whistle-blowing NHS staff

One of the key narrators in the film is the famous healthcare researcher Professor Allyson Pollock. The film is produced by Peter Bach.

http://youtu.be/ultKvnw2h3Q

A must watch.

A GP Surgery Attempts to Refuse to Treat Mental Health Patients and NHS England Puts a Stop to It

A GP surgery in Newton Abbot in Devon emailed its 10,000 patients recommending they should not seek help from the surgery for a range of conditions, which included ‘mental wellbeing concerns’. Instead these troubled people should contact local NHS mental health services. On 2 December 2014 NHS England intervened to say that the surgery’s recommendations were unacceptable. The Department of Health stated that the surgery’s approach flouted the GP contract and that it is unacceptable for surgeries to turn away patients in need.

Four West London Councils Collaborate and Set Up an Independent Commission to Investigate Deteriorating Local Hospital Services

Brent, Ealing, Hammersmith & Fulham and Hounslow Councils are to work together and impartially study the impact on patient services caused by local hospital closures. The commission will take evidence from the NHS and from other organisations and individuals. Chairing the commission is the human rights specialist Michael Mansfield QC. Other members of the commission include renowned NHS researcher Dr John Lister and retired Chiswick GP Dr Stephen Hirst.

London Mental Health Strategic Network

This new London initiative involving 22 organisations is working on a set of recommendations for commissioning mental health crisis services across London. Recommendations include a round-the-clock telephone help line, 24-hour psychiatric services in accident & emergency departments across London and mental health crisis training for GPs, practice nurses and community staff. The organisations involved include Mind, the Metropolitan Police, NHS, social care, housing and local Councillors.

This initiative is attempting to meet the needs of the Crisis Care Concordat launched in February 2014. The concordat is a national agreement between services and agencies involved in the care and support of people in crisis. It is supported by 22 national organisations.

More on the network and the concordat at www.crisiscareconcordat.org.uk

NHS Spent £640 Million on Management Consultants in 2014

Professor David Oliver writing in the British Medical Journal has slated the NHS for spending so much on management consultants. He quotes day rates of between £3,000 and £4,000. Professor Oliver, a prominent advisor to the Department of Health, believes  adequate management skills exist in the NHS which could be used instead of consultants.. He regards money spent on consultants as wasteful and unnecessary.

Project to Share Patient Data Held by GPs Delayed Yet Again

The Government’s care.data project, which aims to extract and use patient data held in GP records, has suffered yet another set back. This time a report by National Data Guardian Dame Fiona Caldicot and the independent Information Governance Oversight Panel has reported significant questions, concerns and recommendations for the project. Jeremy Hunt wants these issues to be resolved by NHS England before care.data can go ahead.

care.data was initially put on hold in February 2014 after widespread concerns were expressed. Many GPs expressed the wish in May 2014 that the scheme should only go ahead with patients explicitly consenting by opting in.

Issue: 20

December 2014

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.

NHS Funds 23 NHS NW London Staff, GPs and ‘Patient Representatives’ to Visit USA for a Week at a Cost of £120,000

Mystery still surrounds this trip which began on Saturday 29 November 2014. The trip itinerary apparently takes them to Boston, New York, Baltimore and Richmond. Details leaked out a few days before and were reported in the ‘London Evening Standard’. Save our Hospitals Hammersmith complained bitterly about the trip and Imperial NHS Health Trust boss Dr Tracey Batten pulled out of the trip at the last minute. We haven’t discovered who from Ealing is on the trip, but ‘Shaping a Healthier Future’ supremo Dr Mark Spencer is thought to be participating.

The organisers of the trip are management consultants, McKinsey & Company. McKinsey has earned many millions of fees from NHS NW London and is well known to favour marketised, insurance based healthcare. Ex-McKinsey consultants occupy a number of senior positions in the NHS.

+  In view of the well publicised crisis in A&E in NW London right now the timing of this covert junket is appalling.

+  A number of us attend public Ealing Clinical Commissioning Group (ECCG) meetings. The existence of this trip has never been mentioned in these meetings. Why was this?

+  Healthwatch Ealing is supposed to represent NHS patient interests. Why didn’t Healthwatch Ealing publicise this trip? Is Healthwatch Ealing participating in the trip?

Reflecting on the Local NHS Crisis

It does seem quite extraordinary that the Coalition Government and NHS top management can continue saying ‘..A&E units will remain open long term at both Charing Cross and Ealing Hospitals’. Over the last two years I have come to appreciate that when intensive care beds, consultants and services are removed, then A&E services can no longer be provided. We all know that the removal of intensive care at Ealing Hospital is planned for sometime after March 2015, so why can’t the bosses and politicians just be honest about what is inevitably going to happen? It’s common knowledge that it is planned to demolish Ealing Hospital. Most of the land will be re-used for residential development. On a small part of the land a large GP surgery will be built. This new facility will operate as an Urgent Care Centre.

On 11 November 2014 I drove past Ealing Hospital and 12 ambulances were queuing on the road and ramp services at the A&E entrance. I have never seen so many ambulances there before. One has to surmise that most of them were carrying patients queuing for A&E.  Backing this up is an NHS report which placed London North West Hospital Trust (which includes Ealing Hospital) as one of the four worst performing Trusts in England for week ending 19 October 2014. Overall the Trust failed to see 32.32% of A&E patients within four hours. For the week ending 9 November 2014 only 69.2% of Type-1 A&E patients (the most seriously ill) were dealt with in 4 hours.

A&E waiting times have also rocketed at West Middlesex Hospital since the closure of Central Middlesex and Hammersmith Hospital A&Es in September 2014.

Colin Standfield of Save our Hospitals (saveourhospitals.blogspot) made the point recently that we were all promised Community and Primary Care enhancements to take 80% of the A&E load that didn’t need to be in hospital. But, he asks, where are these enhancements? In reality they still do not exist.

On 16 November 2014 Colin Standfield wrote to all our local MPs emphasising that there is no substantial extra A&E demand locally. There is though a crisis in local A&E  services caused by the elimination in September 2014 of Central Middlesex and Hammersmith Hospital A&E units. As well as the increase in pain and possible mortality caused by longer A&E waiting times, there are other disturbing knock-on effects. These include early discharge problems, record rates of day case cancellations and the shuttling of patients around north west London to find admission beds.

The ‘Daily Mail Online’ reported on 22 November 2014 that NHS NW London had launched an inquiry about poor A&E performance at Northwick Park and Ealing Hospitals. This inquiry, amongst other things, will look at death rates at both hospitals. The article strongly suggests that re-organisation supremo Dr Mark Spencer wants to blame our local A&E chaos on poor A&E performance at Northwick Park and Ealing Hospitals, rather than attributing it to the closure of A&Es at Central Middlesex and Hammersmith Hospitals

As for ‘changing settings of care’ it’s clear that what is being pushed is for greater use of pharmacists, paramedics in ambulances and more treatment in existing and new local GP staffed facilities, and at home. For me the acid test will be how this works for the millions of mentally ill patients throughout England.

‘Your Healthcare in Ealing’

On 27 November 2014 a 20 page NHS booklet called ‘Your Healthcare Services in Ealing’ arrived in my letter-box at home. It aim is clearly to tell Ealing residents about local healthcare services. It also gives some information on future local healthcare facilities. On the face of it, the booklet is quite useful.

The booklet’s tragic flaw however is that its content is totally devoted to physical healthcare services. The term ‘mental health’ is not even mentioned once. There are no details on primary or secondary mental health services. There are no details of mental health facilities. One in five Ealing adults are suffering from mental health problems at any one time. Expenditure on mental health services is the single highest item of healthcare service expenditure in Ealing. This absence of mental health service information is disgraceful and totally irresponsible.

In the ‘Improving hospitals’ section it says that there are ‘plans for a redeveloped local hospital with A&E’ at Ealing Hospital. I just don’t believe this. We all know that most of Ealing Hospital will be demolished and that a ‘traditional’ A&E with intensive care consultants and beds will not be retained on the site. It is simply impossible to describe what is planned for the Ealing Hospital (demolishing a major hospital) under a heading ‘Improving hospitals’.

In ‘Improving GP services in Ealing’ we are told that at least 3 GP practices are open every weekend spread across the borough. This is all well and good, but where is the web site address, email address or phone number we can all access to find out which GP surgeries are open on any one weekend?

Closure Date Decision on Ealing Hospital Maternity Unit Delayed at Last Minute

The Ealing Clinical Commissioning Group (ECCG) had planned to discuss(?) and decide/confirm the date for the closure of the Ealing Hospital Maternity Unit at a meeting on 26 November 2014. However on 18 November 2014 we learnt that that meeting had been postponed till January 2015. Later in November this postponement was described by the ECCG as till the New Year. Reasons given for this delay were issues related to Paediatric training. A hospital clinician I spoke to found these reasons not very credible.

Could it be that someone has done the sensible thing and has researched spare maternity capacity accessible to Ealing mothers? If they have, they may have discovered that there is no spare capacity. NHS NW London may be loath to repeat the current chaos being caused by closing two local hospital A&E units in September 2014.

Solace Mental Health Centre to Close

London Borough of Ealing’s (LBE’s) cuts for 2015/16 sadly include the closure of the Solace mental health walk-in centre in Bowmans Close W5. The centre is jointly funded by LBE and the West London Mental Health Trust (WLMHT). It’s unfortunate that WLMHT can’t step in and pay the LBE grant to keep Solace open.

Surely reducing the number of local, mental health facilities is not the way forward? Some 80 patients use the centre – some of them for over 10 years.

However it seems as if mental health service users who use the centre will be offered personal budgets which allegedly will result in £187,000 savings. My experience of mental health service users being able to assemble and manage a ‘personal budget’ is that this is often unsuccessful. LBE says that all eligible users will be able to spend their personal budgets ‘…to buy alternative services in the voluntary sector’. This might prove problematic, as I’m not aware that these alternative services actually exist.

WLMHT Mental Health Lammas Centre Recovery House Project is Scrapped

In July 2014 WLHMT boss Steve Shrubb waxed lyrical about the repurposing of the NHS Lammas Centre in Mattock Lane W5 into a 12 bedded mental health Recovery House. Local Councillors told me on 29 November 2014 that WLMHT had now cancelled this project.

2,100 Mental Health Beds Closed in England Since April 2011

An investigation by ‘Community Care’ magazine and the BBC has revealed mental health bed shortages linked to seven suicides and one homicide in England since 2012. 2,100 mental health beds have been lost since 2011. 468 mental health beds were closed during last year.

Jeremy Hunt and NHS England were warned by a senior Coroner in December 2013 about the dangers of mental health beds not being available in preventing future deaths. Hunt replied that ‘acute beds must always be available for people who need them’. However this investigation reveals that this is just not the case.

The recommended average monthly mental health bed occupancy level is 85%. However this occupancy level has stood at 101% for the past two years. Some Mental Health Trusts have occupancy rates of 120%+ for months.

The investigation has also revealed that a Chief Executive of a major Mental Health Trust wrote to NHS England during the summer informing them that there were no mental health beds available in London in either the NHS or the private sector.

Is Online Healthcare Now the NHS ‘Holy Grail’?

A November 2014 report by the National Information Board (NIB) offers the promise of more ‘digital support’ for patients. NIB claims that in future viewing test results and booking appointments online will make healthcare as simple as online banking.

Part of this nirvana is that by the end of 2015 everyone will have online access to their GP records. After a 47 year career in IT, I just don’t believe this will happen. Even more grandiose is the aspiration that emergency, urgent and primary care patients will be digitally monitored in real time by 2018 and all patients by 2020.

A big plug is given to University Hospitals of Leicester NHS Trusts whose nurses have been given iPads and iPhones to record and share patients’ vital signs. This has seemingly lifted staff morale, cut down on paperwork and allowed nurses more bedside time.

Mental health apps will also become available including one offering Cognitive Behavioural Therapy (CBT). It is, however, hard to imagine that CBT could be successfully delivered without considerable expert human counselling.

By 2020 there will be over six million people in the UK of 75 years old or older. I wouldn’t have thought many of these folks will be willing or able to use these new online healthcare initiatives.

Agency Nurses Now Cost NHS £5.5 Billion a Year

On 2 November 2014 ‘The Observer’ reported this figure and added that the cost had risen each year over the last four years. In 2009 the annual agency nurses’ salary bill was £734 million. Agency nurses are now costing the NHS up to £1,800 per head per day.

I suppose this is a predictable development when many hospitals are under threat of closure and constant change seems to be the order of the day.

Better Care Fund (BCF) Appears on Brink of Collapse. Hillingdon Just Refuses to Entertain BCF

In November 2014 ‘The Guardian Online’ reviewed the National Audit Office’s (NAO’s) unflattering review of the Government’s Better Care Fund (BCF) initiative. BCF, announced in autumn 2013, aims to integrate NHS healthcare services with Local Authority social care services. The plan is for BCF to go live in April 2015.

The BCF business case is about saving money and reducing admissions to hospitals. The NAO is clearly unconvinced that the latest savings estimate of £523 million is a credible one. NAO states that the BCF plans contain ‘bold assumptions’ about savings next year. It views planned reductions in emergency admissions to be based ‘on optimism rather than evidence’.

The NAO blames the Department of Health, the Department of Communities and Local Government and the Treasury for:

+ failure to agree financial and service objectives

+ failure to put in management resources, time and contingency planning appropriate for the scale of the project

+ failure to set out who was responsible for what

+ failure to look at the evidence of what works.

The London Borough of Hillingdon is so unimpressed with the BCF that it has refused to implement it.

Issue: 19

November 2014

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.

Delays at North West London Hospital A&Es Follow September 2014 Closure of Central Middlesex and Hammersmith Hospital A&Es

Entirely predictable but lamentable increased delays are being reported at Chelsea and Westminster and Northwick Park Hospital A&Es. The reports come from CQC and the Department of Health respectively. At Northwick Park Hospital a quarter of ‘Type-1’ (highest need) patients are waiting over four hours for A&E treatment.

The obvious conclusion to be drawn from these deteriorating A&E services is that the promises of the provision of alternative A&E facilities before the two A&E units in Park Royal and East Acton were closed have not been met.

400,000 NHS Staff Strike for Four Hours on 13 October 2014

After three years with no pay rise, 400,000 NHS staff have had to strike to gain the nation’s attention. It’s the first such strike for over 30 years. For midwives it’s their first strike ever. Ealing midwives joined the picket line outside Ealing Hospital. On 20 October NHS radiographers also went on strike.

According to Unite one in five NHS staff have second jobs as this is the only way they can make ends meet.

Senior Tories Admit ‘Huge Strategic Error’ in Implementing Controversial NHS Reforms

On 13 October 2014 ‘The Times’ revealed what many of us had suspected – that senior Tories had failed to grasp the explosive content of Andrew Lansley’s NHS plans. And now they regret allowing his ‘revolution’ to take place. No doubt with a General Election just six months away, senior Tories are worried that electors’ unhappiness with NHS performance will cost them votes. Most recent polls are showing that the NHS is the leading national issue amongst electors.

The Tory led Coalition Government spent £3 billion on an unpopular and potentially unproductive re-organisation when this money, and more, was needed to treat a growing, aging population.

Nuffield Trust Report Confirms that NHS Performance is Deteriorating

The highly respected Nuffield Trust along with the Heath Foundation recently revealed the results of its research into NHS performance. Some of the findings:

+ Four hour+ ‘trolley wait’ rose by 79% from 2010/11to 2013/14

+ One in ten patients waited longer than the prescribed 18 week maximum for planned treatment

+ Mental health assessment waiting times have risen by one third.

+ The psychiatric hospital nurse workforce in mental health fell by 13%, whilst mentally ill patients detained rose by 17%.

These figures make a nonsense of the Government’s and NHS bosses’ claims that the massive changes and financial cuts in the NHS are making it more efficient. Many of us would welcome some honesty along the lines of – we know the NHS needs more money; we won’t find this money; and so service levels will inevitably deteriorate.

London Ambulance Service (LAS) Admits Patient Demand is Up and Staff Recruitment , Retention and Morale is Down

LAS reported in September 2014 that demand for its services is up 11% over last year. 238 staff left LAS in 2013/14. Only 80 staff left in 2011/12. A fully staffed LAS should have 3,000 front-line staff, but this year it is short of 320 paramedics and 130 emergency medical technicians. The results of a recent LAS staff survey are not encouraging either. 71% of respondents would not recommend LAS as a place of work. Only 46% said that they would recommend LAS care to friends and relatives.

Meanwhile NHS spending in London on private ambulances rose 1,000% between 2011 and 2013. In 2011 the spend was £795,000 and in 2013 that had ballooned to £8.84 million.

Campaign of the NHS Reinstatement Bill 2015

Launched on 4 October 2015, the campaign aims to reverse the failings of the Health and Social Care Act 2012 and fully restore the NHS in England as an acceptable public service. More information at www.nhsbill2015.org

care.data Rears its Head Again – But This Time it’s as the Accredited Safe Havens (ASH) Scheme

care.data is/was a national Government scheme for collecting, storing and using confidential NHS patient information. It stalled earlier this year when GPs and patients expressed concerns about privacy and the requirement for patients to actively opt out if they didn’t want their personal medical records involved.

The scheme has seemingly risen from the dead under a new guise as the Accepted Safe Havens (ASH) scheme. Instead of personal medical data being stored nationally it will be stored regionally in an ASH. The same worries still exist of course about whether the planned ‘pseudonymisation’ of our records will indeed render them completely anonymous. care.data still lives on in a 265 GP pilot scheme.

Ealing Better Care Fund (BCF) Proposals for 2015/16 are Approved by Government

The Government BCF is a pooled fund for Clinical Commissioning Groups and Local Authorities to spend on integrating health care and social care. The 2015/16 budget for Ealing is over £29 million. Ealing Clinical Commissioning Group (ECCG) and the London Borough of Ealing (LBE) submitted their BCF plan in early October. The plan has been approved, but there are some parts of it unresolved. Final proposals are due on 18 November 2014, but further refinements are expected in mid February 2015.

The plan is very complex and at 112 pages very long. The key defining principle apparently is for patients and care users to direct their own care in their homes and in the community. Reducing unplanned hospital admissions is an investment priority. Given there will soon be no hospitals at all in Ealing, this does seem to be a prudent approach.

In BCF GPs will be at the centre of the system and co-ordinate delivery of integrated care. In Ealing there will be seven local GP networks and a new overall GP federation. There will be seven day appointments, but not all 79 GP surgeries will offer this.

There are plans to develop two new ‘Health and Wellbeing Centres’ – one in LBE north and one in LBE east. Further such centres will be located on the Ealing Hospital site, Grand Union Village and Jubilee Gardens and on the Mattock Lane Healthcare Centre site.

There are commitments to improved diagnosis of depression and dementia, especially in Southall. There are also plans to boost Improved Access to Psychological Therapies (IAPT) services and IAPT recovery rates. There are a whole range of prevention, information, day care and out-of-hospital initiatives aimed at older people. Ealing AgeUK will pilot a new home visiting scheme.

The ‘Healthy at Home’ budget is over £13 million. £875,000 has been allocated for additional support for carers.

The voluntary sector has a key role to play in spending the BCF. Andy Roper of Ealing Community and Voluntary Services (ECVS) is working hard to unravel Ealing BCF complexities to help volunteer groups to bid for BCF projects. See www.ealingcvs.org.uk

Less Than 1.5% of Local Authority Public Health Budgets Spent on Mental Health Services

Local authorities collectively spent just £40 million of their Public Health budgets on mental health in 2013/14. This compares with £671 million spent on sexual health and £160 million on smoking. These figures have been researched and published by the mental health charity Mind.

Currently mental health problems account for 23% of the total disease burden in the UK.

Parity of Care for Mental Health and Physical Health Patients

Nuffield Trust research has revealed that mental health patients are waiting, on average, 48 days for treatment after referral by a GP. This compares badly with a 27 day average wait for physically ill patients. £120 million is being invested over the next five years in an attempt to achieve a parity of care across mental and physical health domains. I suspect though that considerably more money and additional high quality trained human resource will be needed to create this care parity.

Terminating Hospital PFI Contracts

Private Finance Initiatives (PFIs) are opportunities for private companies to make huge profits but incur minimal risks. Originally dreamed up by the Tories in 1992 it was New Labour in 1997 who created the current PFI contract conditions so loved by private investors.

So far 118 new NHS hospitals have been built in England using PFIs. Most are 30 year contracts. Total build costs are over £11 billion and total repayment costs are over £79 billion. Some will give returns to investors of up to 70%. Annual interest payments are high and are often major factors in tipping Trusts into so called debt.  NHS England boss Simon Steven’s finger prints are all over many of the early hospital PFIs. In 1997 he became policy advisor to Health Secretary Alan Milburn and then he was Prime Minister Blair’s health adviser 2001 to 2004.

In June 2014 the NHS hospital PFI worm finally turned and the first English hospital PFI was terminated. This termination was in Northumberland and concerned Hexham General Hospital which was opened in 2003. It cost £54 million to build. It cost Northumberland NHS Healthcare Foundation Trust £114 million to pay off the hospital ‘owners’ the Catalyst consortium. Catalyst members included Bank of Scotland and Bovis.  Savings of almost £67 million (3.5 million each year for the next 19 years) accrue from the termination. The average interest charged on PFI contracts is 8%. However borrowing though government is half that. In order to finance the deal the Trust borrowed £114 million from Northumberland County Council. In turn the Council borrowed the same amount from The Treasury. As ever with the PFI ‘witchcraft’ the Healthcare Trust refused to reveal the details of the original PFI deal.

In October 2014 ‘Private Eye’ revealed that PFI specialist Deloitte had been contacted by ten other NHS trusts about the possible termination of their PFI contracts.  

Issue: 18

October 2014

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.

Labour Party Finally Go Public on Saving the NHS and the Social Care Service

Andy Burnham, Labour’s Shadow Health Minister, delivered a good speech at Labour’s Annual Conference in Manchester on 24 September 2014. He not only talked about repealing the Health and Social Care Act 2012, but talked about creating a single national health and social care organisation. This is clearly what is needed as we now we have a universal healthcare system interfacing, often unsuccessfully, with a means-tested, public/private social care system.

Labour is also talking about recruiting 8,000 more GPs, 20,000 more nurses and 3,000 more midwives. But some GPs say it’s difficult to hire GPs and as GPs are seen to be under great pressure, one wonders just how many medical students are attracted to become GPs. Many nurses and midwives are up in arms about a pay rise and are threatening industrial action. This is unlikely to act as a magnet to attract new recruits either.

Of course there is the no small matter of money to pay for all this. Raising £2.5 billion annually through a mansion tax, increased duty on tobacco and cutting tax avoidance is a start. But it’s probably going to cost much more than this.

Appalling ECCG 2014 AGM Serves No Useful Purpose

On 17 September 2014 Ealing Clinical Commissioning Group (ECCG) held what it called its Annual General Meeting (AGM). It chose Greenford Hall at 6:00pm on a Wednesday. Currently the centre of Greenford has messy road works and with rush hour this made it very challenging for those who had to travel to the meeting.

In the financial year 2013/14 ECCG purchased £426 million of  healthcare services for the citizens of Ealing. ECCG has published online an annual review of its work. This is over 90 pages long! Even NHS England’s annual review report is only 25 pages.

Even though I and others had pre-registered to attend the meeting, there were no badges prepared or agendas or AGM papers given to us. Attendees were asked to submit questions beforehand and Ealing Save Our NHS Campaign – of which I am a member – submitted 20 questions. The meeting Chair said that sometime in the future I would receive written answers to all the questions.

Various ECCG managers spoke at the audience for 50 minutes. Oddly the ECCG Chair did not speak at the meeting and did not even attend it. The visual facilities were dreadful and most people could not read many of the slides displayed. No slide hard copies were made available. Two speakers even covered the same ground – ECCG’s top priorities.   

Our questions were very specific. They included concerns about A&E closures and capacity, Maternity accessibility and capacity, Paediatrics, GP challenges, hospital closures, actual out of hospital locations and mental health. However the ECCG speakers were all about the ‘Shaping a Healthier Future’ aspirations and vagaries,  with regular doses of ‘pathways of care’, ‘care close to home’, ‘transformation’, ‘reconfiguration’, ‘integrated care’ and ‘patient empowerment’. We’ve heard this stuff so many times now for almost two years. Now clearly the citizens want facts, answers and efficient services. We did hear about the good work that has been done on diabetes, but many of us had heard this success story before.

Although the ECCG had purchased £47 million of mental health care services, the words ‘mental health’ were mentioned by ECCG just twice and 40 minutes into the event. This is the largest individual service spend, but not even headline details were given as to how this cash was spent. There was also very little mention of the increasing demands of the growing elderly population. There was only one mention about the Better Care Fund (BCF), which is a new pooled budget – aiming to integrate health care and social care – to be spent by London Borough of Ealing (LBE) and the ECCG. It was useful to discover that the LBE/ECCG purchasing template for the next two years was to be submitted to NHS England on 19 September 2014. It was underwhelming for ECCG to not even give us the headlines of what LBE/ECCG were wishing to spend the BCF cash on. ECCG never even told the meeting they were soon to move from Greenford to Perceval House in central Ealing.

Incredibly only 15 minutes were allocated for questions and answers. Five of our questions were dealt with (quite inadequately), as well as a few more from the floor. On A&E closures and poor CQC reports about Northwick Park Hospital (NPH), ECCG management were very sanguine. That was until a member of the audience explained that only in the last few days NPH reached capacity in its cardiac unit and new patients were all diverted to Ealing Hospital. Ealing Hospital will soon be eliminated as a major hospital, and what will happen should NPH reach capacity again? Oh, just a one off, said ECCG worthies. The audience was not really convinced of this.

ECCG is accountable to NHS England. It’s also accountable to LBE’s Health and Wellbeing Board. However the latter is dominated by NHS nominees.

An organisation running an AGM normally invites its ‘members’, shareholders and/or stakeholders to an AGM. It’s normal for the financial report to be ‘approved’ by the invitees. None of this went on at this meeting. So one wonders just what was the point of inviting Ealing citizens to this meeting?  Was it a public relations exercise? If this is the case, then in my view it was an abject failure.

NHS Central Middlesex and Hammersmith Hospitals’ Accident and Emergency Units Both Close on 10 September 2014

The closure of two NHS hospital A&Es on the same day is unusual enough, but the closure of two of them just two miles apart is surely unprecedented.

Over 50 activists turned up at Central Middlesex Hospital on the morning of the closure to demonstrate their opposition. All the boss of the hospital could offer them was free tea and biscuits.

Reassurances have been given by the NHS that alternative A&E services are readily accessible and available. However one of the local speakers at the demo told us all that he was directed to take his sick child to Northwick Park Hospital A&E in Harrow. It took him an hour by car and when he arrived he was told his child would have to wait three hours for treatment. By 29 September 2014 Northwick Park Hospital bosses were admitting that the hospital needs 80 to 100 additional beds in order to provide an adequate service.

Throughout the whole of the 21 square miles of the London Borough of Ealing there is now just one A&E unit – at NHS Ealing Hospital. And even this unit will be closing before long.

All this is part of the brave new world of the NHS ‘Shaping a Healthier Future’ experiment. But what happens next if the experiment is a failure?

Crazy Accounting Predicts 50% of English NHS Hospitals Will Rack Up £1 Billion in Debt by Financial Year End

If more than half of all NHS hospitals in England are predicted to be showing big annual losses at the end of March 2015, surely there is something seriously wrong with NHS budgeting and NHS financial arrangements?

With rising demands come rising costs to meet these demands. Maybe the £3 billion being spent on re-organising the NHS will result in some efficiency and throughput improvements and maybe it won’t.

What is clearly needed is more cash to be found for NHS hospitals, so that they can continue to provide and maintain quality services that meet peoples’ needs.

Integrating Universal Healthcare With Means Tested Social Care – Is This and the Better Care Fund (BCF) Mission Impossible?

In March of this year the Department of Health admitted the NHS will collapse under pressure if something is not done to improve the way health and social care is provided.

Put quite crudely, hospitals are expensive to run and caring for patients at home and at day care centres is much cheaper. According to Birmingham Community Healthcare NHS Trust it costs £276 a day to keep a patient in hospital. It costs £160 a day to give a patient the maximum amount of care they are allowed at home. Over a year this can mean the care in the community costs £40,000 less than care in hospital. Allegedly 30% of all hospital beds are ‘blocked’ by patients who would be much better off at home, if care could be provided there.

Here in NW London the Government/NHS is cutting costs by closing four out of eight hospital A&E departments and is reducing the number of hospital beds across the region by almost 1,000 by 2015. National Government pays for universal healthcare.

Care homes are also expensive to run. 152 Local Authorities (LAs) pay for means tested social care, which includes funding care home places for those deemed eligible. On average in England it costs £95 a day for day care with nursing. Only those with assets under £23,250 receive financial support. The cost of care is soaring. However, two million new claimants are expected by 2016. Currently 43% of all people receiving social care have to fund it entirely themselves.

Elderly people, who represent more than a third of the patients in hospital beds, are the group which has experienced the greatest reduction in support services as a result of LA budget cuts. According to AgeUK the total number of older service users supported by LAs dropped by 35% to 548,000 between 2006 and 2013.

This is where, presumably, the Government’s Better Care Fund (BCF) comes in. Announced in June 2013, BCF is aimed at funding a transformation in integrating health and social care. It goes live in April 2015. BCF is a single pooled budget to enable the NHS Clinical Commissioning Groups (CCGs) and LAs to work closely together. £1.9 billion will be taken out of local NHS hospital budgets in 2015/16 with a view to it being spent by LAs to divert people from A&Es and speed up discharge. BCF is a five year strategy.

LA Health and Wellbeing Boards in collusion with their local NHS CCGs have less than five months to submit a template setting out their two year BCF proposals to NHS England. These templates will be assessed against a range of criteria, which include delayed transfers of care, emergency admissions, effective re-ablement, admissions to residential and nursing care, and patient and service user experience.

One hopes LAs will spend this money wisely, including helping the one in three over 65s suffering from dementia. What they and their carers need are specialist day care, respite care and intensive domiciliary care, funded by social services but with psycho-geriatric support.

However there is a sting in the BCF tail for LAs. If annual unplanned admissions to hospital by LA patients are not reduced by 3.5% then the NHS BCF money will not be paid to LAs.

Better Care Fund  – The Ealing Perspective

Later this year Ealing CCG will move offices from Greenford to the London Borough of Ealing’s (LBE’s) Perceval House offices in the centre of Ealing. This will co-locate the ECCG with LBE Officers carrying out the LBE Health and Wellbeing Board’s (H&WB) wishes.

The composition of the LBE H&WB is intriguing. Out of the 15 members seven are NHS employees! Two of the others have yet to attend a meeting. There are only four elected Councillors. Even Rob Larkman – ex-advertising executive and management consultant – is on the board and he’s had no direct involvement in Ealing healthcare and social care for many moons. He’s no longer a member of the ECCG Governing Body. This board looks to be very much NHS dominated, so in what way is it a legitimate arm of Local Government?

LBE Chief Executive Martin Smith also happens to be Chair of the London Health and Care Integration Collaborative, so he will be well placed in his Perceval House office to oil the wheels of LBE/ECCG collaboration. However, in August 2014 Mr Smith publicly expressed reservations that any further changes to BCF could make it ‘untenable’. He is unconvinced that BCF is a ‘good deal’ for local government.

Achieving Parity of Esteem Between Physical and Mental Health

In September 2014 the Royal College of Psychiatrists published details of six specific areas which the Government must address in order to deliver on its commitment to parity of esteem between physical and mental health. These are:

+ tackling the bed crisis

+ introducing maximum waiting times

+ improving crisis care

+ improving liaison psychiatry services

+ introducing minimum unit pricing for alcohol

+ investing in parenting programmes.

More at www.rcpsych.ac.uk

Key EU Trade Commissioner Says Public Services (eg NHS) are Always Exempted from Free Trade Deals Like TTIP

The BBC has reported that Karel de Gucht, who leads the European TTIP negotiation team, says TTIP will not undermine our NHS. This is good to hear.

The Transatlantic Trade Investment Partnership (TTIP) aims to remove trade barriers between the USA and Europe. Critics argue that it will allow US corporates to run rampant across UK industry and make profits by stripping away regulations which protect our privacy, food safety, the environment and the economy. TTIP threatens to give US corporates powers to take action against private and public UK organisations whose actions they see as endangering their profits. With increasing privatisation on the cards within the NHS, many worry that (via TTIP) US healthcare companies will be enabled to run NHS services and it will be very difficult to get rid of them if they fail to perform.

Health and Social Care in England – By Numbers

+£26 billion – Cost of Dementia (LSE)

+ 6,500,000 – Carers (Carers UK)

+ 1,300,000 – NHS employees

+ 800,000 –    Dementia sufferers (DoH)

+ 450,000 –    People in care homes

+15,000 –       Annual number of patients who die during emergency surgery (Royal College of Surgeons)

+ 7,800 –  NHS staff earning over £100,000/year

+ 211 –     CCGs (DoH)

Issue: 17

September 2014

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.

‘Nearly 100 GP Surgeries in London Face Closure’

So says the Royal College of General Practitioners (RCGP). RCGP blames this on the Government’s changing the funding formula and taking money away from deprived areas such as East London. This funding change is the removal of the Minimum Income Practice Guarantee (MIPG). The MIPG was introduced in 2004 to support practices moving to a new GP contract. It’s a top up payment given to some GP surgeries. The Government began stopping these payments in a phased programme over seven years which began in April 2014. The Government argues that MIPG funding is not weighted to reflect the demographics of a practice population.

The Jubilee Street GP surgery in Bow, London faces losses of over £900,000 if these funding cuts go through says Practice Manager, Virginia Patania. She expects her practice to close in November unless the NHS provides them with another funding support solution.

Replacement GP Surgeries May Be Run By Private Providers

On 18 August 2014 ‘Pulse’ magazine revealed that all new GP contracts are to be thrown open to private providers. Allegedly Competition Law now demands that GMS or PMS contracts are no longer appropriate and time-limited APMS contracts will be used instead. General Medical Services (GMS) contracts and Personal Medical Services (PMS) contracts both exclusively contract GPs with the NHS. Alternative Provider Medical Services (APMS) contracts were introduced in 2004 to support the Labour Government’s ill-fated polyclinics initiative.

APMS facilitates a whole host of types of organisations to provide primary healthcare. These include commercial providers, voluntary sector providers, mutual sector providers, social enterprises and public sector bodies. APMS allows one private provider to transfer the GP surgery contract to another private provider. There have been some APMS contract failures including Camden Road Surgery in London. UnitedHealth ran this surgery for three years under an APMS contract. It then sold it to another private firm – The Practice – who closed it down in April 2012, leaving 4,500 people without a doctor.

Ealing GPs Publicly Silent on the Challenges Facing Them

Given the obvious pressures on GP surgeries it seems quite odd that apparently none of the 200+ GPs practising in Ealing and none of the 79 GP surgeries have apparently spoken publicly about the pressures they face.

These challenges and pressures include:

+ Heavy case loads – each GP seeing 30 to 40 patients every day

+ Being encouraged to extend surgery hours

+ Threats by CQC to place under-performing GP surgeries in ‘Special Measures’

+ 90% of GPs feel pressure from patients to hand out antibiotics (research by Nesta)

+ Offering (or not offering) mental health primary care

+ The impending closure of Central Middlesex Hospital A&E (10 September 2014)

+ The impending closure of Ealing Hospital A&E (When?)

+ Ealing GPs to work in six ‘Health Networks’

+ Patient consultation by telephone – just how effective and efficient is this?

+ An additional 10,000 GPs needed nationally for a sustainable service (RCGP)

+ 56.6% of GP surgeries have been unable to recruit doctors (RCGP)

+ Shortage of District Nurses and Community Matrons

+ Implementing the Better Care Fund (BCF), which aims to integrate healthcare with social care

A&Es at Central Middlesex and Hammersmith Hospitals To Close on 10 September 2014: NHS Public Leaflets  Inform, Mislead and Infuriate

It’s very worrying to be just days away from one of the early phases of the unique social experiment that is ‘Shaping a Healthier Future’- i.e. the closure of NHS A&E units in Park Royal and in East Acton.

NHS leaflets publicising the closures were delivered to homes in Hanwell, Ealing in August. The leaflets are strangely incompetent as regards the mentally ill. 1 in 5 adults and 1 in 10 children are mentally ill. There is guidance in the leaflet as to which physical medical conditions are suitable for treatment at big GP surgeries called Urgent Care Centres (UCCs) and which are suitable for treatment at NHS hospital A&Es. However no guidance at all is provided for those who are mentally ill. This omission makes an absolute nonsense of the 2013 guidance from NHS National Medical Director Sir Bruce Keogh for parity of care and esteem for both physically and mentally ill patients. Whoever approved this leaflet text ought to be fired.

The leaflet also strangely lists ‘the nearest A&E departments’ as those at Northwick Park Hospital, St Mary’s Hospital and Charing Cross Hospital. This statement is quite clearly a lie. Ealing Hospital A&E and West Middlesex A&E are the two closest A&Es for those living in Hanwell, Ealing. Also the new A&E unit at Northwick Park will not be complete till October 2014.Were the wrong leaflets delivered to homes in Hanwell?

The latest CQC report on Northwick Park Hospital A&E describes significant staff shortages and states that the service requires improvement. Services which CQC say need improvement also include surgery, critical care, maternity and family planning, services for children and old people and outpatients. So the suffering citizens of Hanwell are to be directed (by ambulance) to Northwick Park Hospital A&E as from 11 September 2014. How this will play out in a short staffed/improvement needed A&E department some five miles away though congested traffic is all too clear. Long waits for an ambulance, long waits inside an ambulance, long waits in A&E reception, more pain and possibly more deaths.

Self-Harming and Overcrowding on the Increase in England’s NHS Mental Health Trusts

The Labour Party, using Freedom of Information requests, has discovered a 56% increase in self-harming over four years in NHS mental health trusts. Also instead of trusts operating up to a maximum of 85% capacity, some of the trusts are operating at up to 135%.

More ‘Physician Associates’ is Jeremy Hunt’s Solution to Shortages of Doctors and Nurses

To cope with the shortage of doctors and nurses in NHS GP surgeries and NHS hospitals the Government is advocating training and using more science graduates with just two years medical training. ‘Real’ doctors receive seven years medical training.

Apparently these associates are allowed to carry out triage, diagnoses, admission and discharge of patients. However they are not allowed to sign off prescriptions and will not be registered with the General Medical Council. Annual salaries of £30,000 to £40,000 per year make these associates a much cheaper option than fully qualified doctors.

Fans of these associates cite the fact that there are 80,000 of them (presumably operating successfully) in the US healthcare service. There is also a move in England to re-name these associates as ‘assistants’ on the basis that this would clarify their role.

The role of a Physician Associate in the NHS sounds somewhat similar to Police Community Support Officer (PCSO) in the Metropolitan Police. PCSOs look like ‘real’ Police persons, but are no such thing and have only limited powers. PCSOs get paid less than real police.

Incompetent triage and diagnosis could lead to more pain, longer lasting medical conditions and possibly unnecessary deaths.

50 Carers for the Disabled in Doncaster On Strike: Care UK Cuts Wages of 237 Former NHS Staff by 25%

‘The Observer’ has reported on a long running strike by former NHS staff in Doncaster. Care UK won a contract in November 2013 to run community care services for the NHS, involving 140 people with learning disabilities located in about 40 properties in Doncaster.  237 NHS staff transferred to work for Care UK.

When Care UK reduced wages by 25% some staff left in disgust. 50 of them went on strike. When they worked for the NHS, the carers’ basic hourly rate was £8.91. Care UK cut this to £7/hour. 100 new staff are being recruited at £7/hour. On 11 August 2014 the 50 strikers voted to extend the strike – taking their action with no pay to nearly 70 days.

Care UK says that workers’ demands are unrealistic in the light of reduced funding available for the NHS. However the company would have been only too aware of the funding realities when they signed the contract ten months ago.

There is no legal requirement for support workers to have qualifications before they deliver care. Less than half the British care workforce have completed a basic NVQ Level 2 qualification.

Care UK was acquired by private equity firm Bridgepoint Capital in 2010. Bridgepoint owns a range of businesses which include the Pret à Manger café chain and clothing retailer Fat Face.

Surely NHS Hospitals Should be Cost Centres Not Revenue Earning Organisations?

One of the most ludicrous aspects of the Health & Social Care Act 2012 is that it allows NHS hospitals to ‘earn’ up to 49% of total revenue from treating private patients. As more resources are used on treating private patients, then clearly fewer resources are devoted to ‘public’ patients who have already paid for their treatment via National Insurance payments.

London NHS hospitals which are devoting reduced resources to treating public patients include:

Name                    Increase in private patient revenue  

2010/11 to 2013/14                             

University College                  39.63% to £10.3 million

Royal Brompton                      37.7% to £33.6 million

Moorfields Eye                        31.84% to £21.3 million

Chelsea & Westminster           20.99% to £13 million

Failed ‘NHS National Programme for IT’ (NPfIT) Project Just Cost Us All Another £481 Million

In 2002 Microsoft founder Bill Gates persuaded our then Prime Minister, Tony Blair, to set up an online system so that NHS patient records could be accessed instantly anywhere. This promised to be the biggest civil IT project in history. The cost of the project was estimated at £11.4 billion. The project was spectacularly mismanaged and was terminated with nothing or little to show in 2011.

Fujitsu, just one of the IT suppliers involved, had its £896 million contract terminated in 2008 and it threatened to sue the Government.  On 1 August 2014 it was leaked that the Government would pay Fujitsu £400 million in compensation and £50 million to cover Fujitsu’s legal costs. The Government’s legal costs are £31.5 million. Estimates of the total losses on the whole NPfIT project range from £10.5 billion to £13.2 billion.

Issue: 16

August 2014

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.

Will the NHS be a General Election Issue in May 2015?

With a General Election just 10 months away, the Tories will have to make lots of right noises here in Ealing about the NHS for Angie Bray (MP Ealing Central & Acton) to keep her seat. Nationally the Labour Party could actually get elected if they back a 100% reversal of four years of changes to the NHS. Labour must commit to injecting more money into the service and bring us more in line with state healthcare spend per head in France, Germany, the Netherlands and Belgium. Labour must promise to dismember the 2010 Health and Social Care Act.

Many think the LibDems will be wiped out in the May elections. Nick Clegg MP’s failure to hold the Coalition Government to account over ‘…no top down re-organisation of the NHS’ will be part of this. Shirley William’s surprisingly inept support in the Lords of Section 75 of the 2010 Act – which paved the way for wholesale privatisation of NHS service provision – will also be part of this.

3,950 NHS Staff Made Redundant in 2010 to 2013; Paid Off; and then Rehired

How it can be ethical, legal or sensible to do this is almost beyond belief.

£1.55 Billion Paid Out in NHS Staff Redundancy Payments Since 2011

40 of the redundancy payments to NHS staff in 2013 each exceeded £200,000. This really does seem obscene when compared with nurses being denied even a very modest pay rise.

Audit Commission Raises Concerns About Value For Money at Ealing, Northwick Park and Central  Middlesex Hospitals

The Audit Commission’s ‘Auditing the Accounts 2013/14’ report criticises Ealing Hospital NHS Trust and North West London Hospitals NHS Trust (Northwick Park and Central Middlesex Hospitals) for ‘non-standard conclusion of Value For Money arrangements’. The annual accounts for NW London Hospitals NHS Trust are also subject to ‘Referral to the Secretary of State for Health’.

Ealing Clinical Commissioning Group is also criticised in the report because of ‘difficulties making pension-related disclosures in the remuneration report’.

Private Healthcare Companies Invited in Staffordshire to Bid for £1.22 Billion NHS Cancer Care Contracts

Likely bidders for these 10 year contracts include Virgin Care, Care UK and Ramsay Health. Macmillan Cancer Support is advising the four ‘federated’ CGCs who will commission these for-profit companies should one or more of them be selected. NHS England is heavily involved in this initiative.

The Royal College of Radiologists (RCR) writing in ‘The Guardian’ on 5 July 2014 voiced its ‘..fear that there might be unintended consequences’. RCR described this move to privatisation as ‘..a gamble’.

It’s important to note that the four CCGs allied to NHS England do not equate to ‘local GP driven services’ as CCG and NHS colour brochures have been telling us for years now. This is top down privatisation of the NHS – ‘red in tooth and claw’.

The revered publication ‘The Lancet’ takes a dim view of privatisation. Of the Staffordshire tender it says ‘…to try to excise an entire clinical pathway that has several links to other parts of the NHS is an ill-considered fix to a complex issue, and will ultimately not serve those for whom the NHS was first created’. Unison called this procurement process ‘a dangerous experiment’ and Labour’s Andy Burnham MP said that the public had not given the government permission to ‘put the NHS up for sale’.

The Department of Health (DoH) – clearly confused – bleated that NHS competition rules have not changed under this Government. If the DoH can’t see that competition rules changed dramatically with the 2010 Health and Social Care Act and with Section 75, they really do need to go to SpecSavers.

Insane Scheme by NHS Boss to Give Cash Directly to the Mentally Ill

NHS boss Simon Stevens wants vulnerable ‘people with severe and enduring mental health problems’ to be given cash to spend as they see fit on health and social care services. As a registered mental health carer I find this alarming. From my direct experience and drawing on the experiences of other mental health carers, the mentally ill often manage their finances badly, can be manipulated by others into buying alcohol and recreational drugs, give money to strangers and lie about how they have spent cash.

The initiative begins in April 2015 and is called the Integrated Personal Commissioning (IPC) programme. Stevens says that ‘voluntary/Third Sector organisations will be commissioned locally to support personal care planning, advocacy and service ‘brokerage’ for these individuals enrolled in the IPC programme’. I have no idea what this actually means.

He also says that this initiative ‘builds upon, but is in addition to ….the ground breaking Better Care Fund (BCF)’. BCF itself is a worry as it attempts to knit together the NHS, Department of Health and hundreds of Local Authorities in melding together healthcare and social care. The £3.8 billion BCF cash will be spent in order to make savings. A leaked Cabinet report earlier this year reveals concerns about how these savings will actually be achieved.

Improving Access to Psychological Therapies (IAPT) Shines a Ray of Hope on the Mentally Ill

I, along with over 100 others, attended a public interview by BBC’s Andrew Marr of Professors Layard and Clark at LSE on 10 July 2014.

Sixty years ago William Beveridge wrote a report to the British Parliament which provided a summary of principles necessary to banish poverty and ‘want’ from Britain. He described five giants on the road to reconstruction – want, disease, ignorance, squalor and idleness. According to Professor Lord Layard of LSE a missing giant in that list was mental illness. Because this giant was not identified, the mentally ill suffered decades of inadequate or non-existent treatment. Layard estimates there are six million mentally ill people in this country.

The major reasons for decades of inadequate treatment can be grouped into three categories. Firstly the words that have historically been used have not been helpful. ‘Talking Therapies’ have been construed by many as just the simple act of talking to the mentally ill, whereas in reality it comprises specialist interventions by trained therapists. Secondly there has been no definition and monitoring of outputs. Thirdly investment in recruitment and training of therapists has been woefully inadequate until recent years.

Lord Layard has worked with Chartered Clinical Psychologist, Professor David Clark of Oxford University since 2006 to establish evidence-based psychological therapies. They have worked successfully with the previous Labour Government and the Coalition Government in establishing the funding for the training of 6,000 psychological therapists. Those 6,000 therapists have treated 250,000 patients so far, half of whom have ‘recovered’ and for many of the others their lives have improved. The NHS treatment programme is called Improved Access to Psychological Therapies (IAPT).They now want the next elected Government to fund the training of an additional 6,000 therapists. An early supporter of IAPT Alan Johnson MP and the Coalition Government’s current IAPT standard bearer Norman Lamb MP were both in the audience.

Layard is an economist and he emphasise that the implementation of these treatment programmes saves, and will continue to save, money. Most mental illness occurs during people’s working lives (whereas physical illness is most prevalent during retirement). If the mentally ill can be helped so that they can carry out paid employment this will save on benefits payments. A course of IAPT costs £650, but a monthly benefits payment is £615. The mentally ill also often have associated physical illnesses. On average these cost the NHS £2,000 per head per year. Successfully treat a mentally ill patient and the cost of his/her physical health treatment is reduced or eliminated. Dealing with alcohol and drug abuse (often associated with mental illness) costs the country £1 billion annually. The cost of a complete psychological therapy programme would be £0.5 billion and there would be significantly reduced costs for handling substance abuse.

Treatment for mentally ill children has been even more scandalous in England. The earlier an individual is diagnosed and successfully treated the greater the chance of that individual enjoying a ‘happy’ adult life.

When I first heard about Lord Layard’s proposals in 2012 the target number of newly trained therapists was 10,000 and the proposals also included the establishment of 250 new mental health centres throughout England. There was no mention of these centres at the event.

Layard and Clark have just written a book which supports IAPT. It’s called ‘Thrive’ and is published by Allen Lane. ISBN: 9781846146053.

To put all this in a local context, the Ealing Clinical Commissioning Group (ECCG) mental health spend on IAPT with the West London Mental Health Trust in 2013/14 was £2.085 million. The IAPT budget for 2014/15 is £2.110 – a negligible increase. The 2014/5  ECCG budget for learning difficulties is £4.250 million. Public Health England states that there are 36,436 people in the whole of London known to have learning difficulties. HealthWatch Ealing states that there were 34,415 adults who had a common mental health disorder in Ealing in 2012.

However mental health spending as a percentage of total health care spending is the highest in the country in NHS West London at 18.02%. This compares with the lowest in NHS Surrey Heath of 6.55%. It’s hard to believe that the need for mental health care in Ealing is almost three times greater than in Camberley.

Jeremy Hunt Now Threatens Care Homes and GPs with ‘Special Measures’

Mr Hunt is apparently setting up an inspection system for England’s 25,000 care homes. 700 people are to be recruited and those homes ‘failing’ could be placed in Special Measures by Spring 2015.

Hunt is also threatening GPs with Special Measures if they are judged to be failing patients. No doubt inspectors will have to be recruited to inspect the 8,000 GP surgeries in England. The doctors’ union – the British Medical Association – thinks a witch hunt amongst GP surgeries may not be helpful. Some GP surgeries are suffering because of lack of GP or nursing resources and /or ironically struggling because the NHS itself is denying GPs adequate funding and resourcing.

These ‘special’ moves are thought to be inspired by his placing 11 hospitals in Special Measures last year. Three of the 11 have now been taken out of Special Measures – presumably because they are now judged to be performing satisfactorily.

No doubt all of this additional inspecting will be carried out by the Care Quality Commission (CQC). The CQC – infamously accused of cover ups and a bullying culture in 2013 – will soon have much more on its plate. Let’s hope it’s special enough to make a positive contribution to improving primary care and social care in England.

We Must All Fight to Kill Off TTIP

Transatlantic Trade and Investment Partnership (TTIP) is not a negotiation between two competing trading partners, but an assault on European and US societies by transnational corporations seeking to remove regulatory barriers to their activities and to massively undermine democracy.

For many years big business on both sides of the Atlantic has long dreamt of creating a transatlantic free trade zone in which large corporates can make even more money in deregulated markets. Private meetings on the subject are known to have begun in 1995. In 2011 the European Commission and US officials announced the formation of a working group on the topic. Over 100 closed door meetings have taken place since then. Barack Obana is keen to rush TTIP through and no doubt David Cameron and Nick Clegg are too.

TTIP seeks to create new markets by opening up public services and government procurement contracts to competition from transatlantic corporations. This threatens to introduce a further wave of privatisations in key sectors such as health and education. TTIP poses demonstrable and measurable threats to food safety, environmental regulations and jobs.

A key component of TTIP is the Investor-State Dispute Settlement (ISDS) mechanism. ISDS effectively elevates transnational capital to a status equivalent to the nation state itself, and threatens to undermine the basis principles of democracy in the EU and USA alike. ISDS exists in a number of existing international bilateral treaties. These ‘Kangaroo’ secret ISDS tribunals involve a small clique of lawyer arbitrators. The largest ISDS award yet made involved Ecuador paying Occidental Petroleum $1.77 billion for terminating the oil giant’s contract when Occidental broke Ecuadorian law.  

Here in Britain TTIP/ISDS, if introduced, threatens to grant US and EU corporations the power to challenge democratic decisions made by the British Government and to claim compensation where those decisions have an adverse impact on their profits. British MEPs and MPs are being denied the chance of knowing what the USA is demanding and no documents relating to the negotiation or development of TTIP/ISDS will be placed into the public domain.

50% of NHS Maternity Units Closed for Periods Because of Lack of Staff or Lack of Beds in 2013

Most closures were for only a few hours, but some lasted over 48 hours. Nottingham University Hospitals NHS Trust’s Maternity Unit closed 97 times! The Royal College of Midwives claims England needs an additional 4,500 midwives.

NHS Ealing Hospital however was fully staffed in 2013 and over 2,900 babies were born there. The unit is modern and includes a new £300,000 birthing centre. However under the NHS NW London Shaping a Healthier Future ‘fatwa’ Ealing Hospital Maternity Unit will be closed down.

Now the Government Wants to ‘Mutualise’ the NHS

Francis Maude MP, the Cabinet Office Minister, is peddling mutualisation as a future ownership/management model for delivering NHS services as well as other public services. He says he wants NHS hospitals to be owned by the people who run them. Mutualisation is a big step down from 100% public ownership. The classic mutual organisation has the majority of its shares owned by customers, staff and suppliers. In real mutuals and co-operatives customers, staff and suppliers are all peers and work together collaboratively and democratically.

However the Coalition Government’s new mutuals will never have more than 25% of shares owned by staff. 25% of any corporate ownership grants virtually zero power to those shareholders. So Francis Maude is being somewhat economical with the truth here. The successful NHS example quoted by right wingers is Hinchingbrooke Hospital in Cambridge. However, although there is significant employee ownership it’s still less than 50%. One suspects that the money men who own 50%+ of the shares hold the whip hand.

The unions’ view is that mutualisation is just privatisation by another name.

Issue: 15

July 2014

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.

NHS is the Cheapest Healthcare System in the World – Offering the Best Health Outcomes

The New York-based Commonwealth Fund ranks Britain top of 11 advanced countries’ healthcare systems for cost and health outcomes. Britain spends $3,404 per head compared with $8,508 in the US with the other nine countries in between. On ‘effectiveness, safety, patient-centredness, co-ordination, quality and access’ Britain’s NHS  rates number one.

Who Cares for the Carers?

In 1983 Crossroads was founded in Brent. It’s a charity which provides respite breaks and information for unpaid carers of adults and children which grew to provide these services throughout Brent, Hounslow and Ealing. Well it did until 11 June 2014 when it closed down. Around 300 family carers who support disabled, elderly and vulnerable people in Hounslow, Brent and Ealing will lose the help of 60 support workers.

Block grants from Local Authorities have over time been replaced by competitive bidding processes, which led to financial uncertainty and now to closure. The closure of Crossroads is cruelly ironic given the increasing size of the aging local population and the financial cuts in welfare payments, in the NHS and social care budgets throughout Local Government.

Accident and Emergency in Crisis – Yet Again

The week ending 15 June 2014 saw 297,527 attendances at major A&Es in England. This is the highest weekly figure ever recorded, and this is the summer not the winter. 97% of patients were seen in less than four hours.

As ever the Government after taking money out of A&E services is now throwing ‘crisis’ money back into it. No doubt ad hoc emergency beds are sourced from somewhere. Expensive Agency staff are hired in haste. And no doubt tired and harassed staff are coerced into working too many extended shifts.

What a way to run a national health service….

West London Mental Health Trust (WLMHT) Boss Opens Up to Ealing Carers

On 10 June 2014 Steve Shrubb, Chief Executive of WLMHT spent 75 minutes talking with 50 volunteer Ealing mental health carers at NHS Avenue House in Acton. WLMHT is the major supplier of NHS mental health services to the 780,000+ people who live in Ealing, Hounslow and Hammersmith & Fulham. It also manages the Broadmoor high security psychiatric hospital in Berkshire.

Steve joined the NHS as a ‘domestic’ in 1976, trained and practised as a Cognitive Therapist   and rose to a number of mental health Chief Executive positions. He took charge of WLMHT two years ago and is likely to do another three years and then retire. His appreciation of the carer role has been sharpened recently with the onset of dementia in one of his parents.

He says that WLMHT could not function without the contribution of volunteer carers.

Although he has 3,500 staff he admits it’s not enough. In 2012 he had 4,000 staff and in 2013 3,750. In 2012 the Trust’s annual budget was £250 million – this year it’s £230 million. He thinks the Trust is ‘holding its own’ in helping those with anxiety and depression, but he feels the Trust is failing the seriously mentally ill – especially those with Schizophrenia. He then said that if he’d been talking to cancer carers and told them the NHS was providing an inadequate service they would have torn him apart limb by limb. This is because awareness and visibility of cancer suffering is much, much greater than with mental illness. We must all work much harder to raise awareness and visibility of mental illness.

That all being said, one carer whose son is a serious long term Schizophrenia sufferer said she is devastated by her poor son getting only 15 minutes face to face with a specialist and it was such a short time as to be completely useless. I piped up to point out that my troubled mentally ill son has had five different diagnoses over the last 20 years and, even if his treatment had been first class, it really counted for little if it was treating the ‘wrong’ illness.

With inadequate resources, Steve has to be quite creative in making sure the budget is used cost effectively. Hence WLMHT ‘partners’/employs/outsources with charities, volunteer groups and private suppliers. In effect in Ealing, the Trust is outsourcing mental health Primary Care (via the Ealing Clinical Commissioning Group) to 39 of the 79 Ealing GP surgeries. Of course some of the troubles and risks associated with outsourcing include:

– losing control. Atos’ broken promises, delays and huge backlogs in assessing claimants eligibility for Personal  Independence Payments (PIPs) is a recent dramatic example of this.

– the risk of losing the ‘spirit’ or even the content  of the original intent of the task, especially in, a ‘daisy chain’ of outsourcing deals.

– those providing the service are not accountable to the commissioning stakeholders (e.g. citizens if it’s the NHS) but are accountable to some other group who could be commercial shareholders

– if outsourced to a commercial for-profit company that company will structure its business and its resourcing so that its priority is to make a profit for its shareholders as opposed to providing a superior product or service. The Department of Education recently ‘pulled back’ from privatising child protection services after considerable negative feedback on profit taking degrading the private service supplier offering.

Steve is a big believer in the positive impact of good physical health for mental health patients. He’s also a big fan of Lord Layard’s proposals to train 10,000 mental health therapists and set up 250 mental health centres in England. In fact in a previous role he was a lobbyist for this cause.

He wants us all to get involved with ‘Time to Change’ – the organisation dedicated to challenging mental health stigma and discrimination. I have, and you can too at www.time-to-change.org.uk

The initiative to convert the NHS Lammas Centre in Mattock Lane, W5 into a 12 bedded residential mental health Recovery House is his. When he arrived at WLMHT he was surprised to find no residential Recovery Houses – half way houses between long term admission wards and going back home. Two more are planned in Hounslow and Hammersmith & Fulham. The mental health charity Rethink will run the Lammas Recovery House. WLHMT prides itself on rarely having to send service users outside Ealing, Hounslow and Hammersmith & Fulham for treatment.

Steve seems to be re-thinking the Trust’s approach to volunteer carers’ groups and has commissioned an internal report on a way forward. Spending so much quality listening time with the Carers Support Group – probably the largest and best run volunteer mental health carers group in Ealing – is a very good start to his own personal research on support for carers.

Jean-Claude Juncker will Scupper TTIP/ISDS – Which Would Be Good News for Our NHS

Without going into mind bending details, the proposed Transatlantic Trade and Investment Partnership along with its Investor-State Dispute Settlement adjunct (TTIP/ISDS) aims to give greater powers to big international businesses and undermine democracy. Under ISDS large global corporates will challenge national regulations and go straight to Industrial Tribunals (ITs). Theses tribunals will consist of just three arbitrators – one chosen by the company, one by the State and a third agreed by both. These tribunals are not answerable to any British or European courts.

So if UnitedHealth of Minneapolis was not invited to bid to run NHS Ealing Hospital under an open tender, it could immediately go to an IT with no doubt its own world expert barrister as one of the three decision makers.

If TTIP/ISDS gets sadopted it will make the privatisation of our public services permanent.

No wonder Prime Minister Cameron is so agitated. Mr Juncker is courting European Greens and socialists who want to kick out TTIP/ISDS. With Juncker now elected lets hope TTIP/ISDS does not get signed!!!!

Future NHS Cash ‘Crisis’

The Conservative, Labour and LibDem political parties have all recently tried to ‘out doom’ each other by variously saying ‘no more cash for the NHS’ and ‘£30 billion 2020 deficit in the NHS budget’. But Labour is also talking about ‘re-setting the NHS’ by, in effect, suggesting it will roll back much of what is contained in the Health and Social Care Act 2012.

Labour’s pronouncements come out of the mouth of Andy Burnham MP, but not from Labour Top Trumps Ed Milliband MP or Ed Balls MP. Also some of Burnham’s statements are not really credible. He said on 5 June 2014 that patients can expect a single point of contact to co-ordinate their NHS care. So every one of 250,000 adults in Ealing would have a single point of contact? So one person would deal with my arthrytis, blepharitis, psoriasis, back problems and no doubt possible future dementia – never mind a one in five chance of mental health problems. This is just not credible for the 47 million adults in England.

NHS Hammersmith Hospital A&E and NHS Central Middlesex Hospital A&E (Harlesden) to Close on 10 September 2014

NHS St Mary’s Hospital in Paddington will in just few weeks time become very crowded in its A&E department as many people in pain in Hammersmith, Harlesden and Acton will have to travel there.  Charing Cross A&E in Hammersmith will also get very busy, but it may well also close this year with a formal announcement scheduled for July/August 2014. We know the future of NHS Charing Cross A&E. It will close, even though Prime Minister David Cameron shamefully lied about this in Hammersmith on 15 May 2014.

The future of Ealing Hospital’s A&E in Southall is well known. It will also close. What we don’t know is when. Dr Mohini Parmar Chair of NHS Ealing CCG and David McVittie, NHS  Ealing Hospital Chief Executive, both tell us that its closure will only take place when adequate replacement, accessible A&E facilities are available. Trouble is ….we just don’t believe them.

After 10 September 2014 a large GP surgery staffed only by GPs and nurses will provide a 24 hour service on the site of  Hammersmith Hosppital. In NHS jargon it’s called an Urgent Care Centre (UCC). Flashing blue light ambulances do not travel to UCCs. UCCs have no Intensive Care beds, consultants or equipment. You will not find an Intensive Care Unit in a UCC and there are 44 defined medical conditions not treated in a UCC.

NHS Ealing Hospital and NHS Northwick Park Hospital are Clearly ‘In Love’ and are Desperate to Get ‘Hitched’

In the middle of all the carnage wreaked by the ground breaking (could be career breaking) ‘Shaping a Healthier Future’ blitzkrieg, Ealing and Northwick Park Hospitals are desperately trying to ‘live together’ in order to save money. ‘Two can live as cheaply as one’ is the guiding maxim no doubt. £Millions have been spent on this shot gun wedding with full colour brochures being distributed like confetti.  

The ‘marriage’ target date keeps changing and now it’s October 2014. We even know who the designated non-executive directors are (four months before the nuptials). It’s interesting that NHS bosses have plumped for folks with experience in Southern Cross Healthcare, Barclays Bank, the Probation service, the Magistrate service, the Employment Tribunals service and Housing Associations. To be fair there is some medical experience in there too.

Will Charities and Volunteers Have to ‘Rescue’ Huge Swathes of NHS Services?

‘The Guardian’ of 6 June 2014 featured the impressive set of services provided by the 30 staff at the charity Integrated Neurological Services (INS) of Twickenham, West London. INS is funded by the NHS and by the Big Lottery and provides creative and wide ranging support for sufferers with MS, Parkinson’s, strokes and many other neurological complaints.

With local staff cuts and budget cuts will local volunteer groups and charities have to fill in gaps with carer services, carer recruitment and carer training?

NHS Midwives Could Go On Strike

The Royal College of Midwives (RCM) is recommending industrial action if the 1% pay rise for NHS staff is killed off. On 9 June 2014 RCM began consulting its 30,000 midwives and maternity support staff about industrial action. The Royal College of Nursing (RCN) and Unite have variously described the 1% pay rise climb down by the Government as ‘shameful’ and ‘insulting’.

Ealing Hospital midwives have been, in effect, been given their marching orders but they don’t know where they are marching to or when.

‘care.dot’ Makes a Re-appearance

‘care.data’ is the name of the Atos software driven personal medical records /Atos managed personal medical records data extraction and data sharing service. ‘care.data’ was revealed to the public in January 2014. It caused a furore. Citizens had to write to their GPs to stop their data being used. And then it was revealed that our personal health medical records had already been sold to pharma companies, insurance companies and goodness knows who else. On 19 February 2014 NHS England retreated from instantly implementing care.data and announced a six month delay in implementation.

Well, barely four months on, NHS top brass is banging the jungle drums about care.data. Tim Kelsey, NHS England National Director for Patients and Information said at a conference on 6 June 2014 ‘…the true scandal in our health service is ignorance’. He went on to say that plans for a giant GP database (i.e. care.data) were ‘the biggest data revolution any public service had embarked upon’.

Oh dear….

Firstly citizens no longer trust the Government /NHS bosses with our personal data. Don’t trust it to collect it accurately, anonymise it consistently and effectively and don’t trust that it will not give it /sell it to Tom, Dick or Harry.

Secondly, citizens (and IT folks specifically) have zero confidence in the Government/NHS successfully designing, building, implementing, managing and maintaining such a giant database. Aren’t  we all still paying for the abortive fiasco hatched by Bill Gates and Tony Blair in 2002 to computerise all English medical records and make them accessible 24/7 anywhere in the world? The initial budget for the project named NPfIT was £11.4 billion. The project was abandoned in 2011 with no usable value created. We are all still paying for it and the current losses are £10 billion and rising.

BMA Accuses Government of ‘Economic Illiteracy’, Being ‘Bonkers’ About Seven-Day Working and Driving GP Surgeries Out of Business

The British Medical Association (BMA) – the doctors’ trade union and professional body – is demanding a £2 billion cash injection into the NHS in order to head off a crisis in patient care. The BMA is also saying that seven-day working can’t be done without the investment of more state money. It says seven-day working is unfeasible without cuts during the week or hospital closures.

The BMA claims that there has been a reduction of £450 million in funding GP practices in real terms allied to a 40 million increase in annual demands for appointments. These changes are driving GP surgeries out of business. An ominous forecast by the BMA is that a 6% reduction in GPs seeing patients will double the number of patients at hospital A&E units. Apparently the Department of Health (DoH) is in complete denial about the BMA’s accusations and predictions. The DoH describes it all as ‘scaremongering’. Yet again….oh dear….

CORRECTION

In June’s issue we publicised England’s first mental health eclinic. Sadly we were given the wrong URL for this useful resource. www.ealingeclinic.com is a useful online facility for service users and for carers.