Issue: 14

June 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.

The Vulnerable

The true test of any healthcare/social care system is how successful it is in treating and caring for the vulnerable. The vulnerable in our society include the mentally and physically ill and disabled, the frail and elderly, the poor, the uneducated, the homeless, the friendless, those living alone and the very young. This is a growing group as, for example, people are living longer and more people are presenting with mental health problems.

So what recent Government initiatives punish the vulnerable? Well…here’s a few:

+ Reducing the annual spend per head on our State healthcare will put us below 10th in the world (where we stand now)

+ Reducing the number of hospital beds has now placed us below France, Germany and even Eastern European countries in hospital beds /1,000 people

+ Reducing the budgets for the care of the mentally ill

+ 5,000,000 children could be living in poverty in the UK by 2020 (Save The Children)

+ The ‘bedroom tax’

+ Closure of A&E units

+ Closure of Maternity and Paediatric units

+ Demolishing major hospitals and using them the sites for new homes, none of which are Social Homes for Rent

+ Destroying the clinically based NHS Direct telephone advice service and substituting a non-clinically based call centre service

+ Privatising the provision of State healthcare services resulting in NHS services being provided by companies and staff mandated to make a profit for shareholders rather to make patients better.

EALING HOSPITAL FUTURES

Now is a good time to review the unique, revolutionary changes mandated in the NHS North West London ‘Shaping a Healthier Future’ (SaHF). The 2012 proposals were effectively fully given the green light when the London Borough of Ealing’s Judicial  Review of Ealing Hospital closures failed in November 2013. According to the 2012 proposals, SaHF implementation will take ‘at least three years’. That takes us to December 2016. However SaHF fans were no doubt convinced they would win against any legal challenge and will have been working on all the changes since February 2013 – so closure of all four A&Es at Central Middlesex, Ealing, Hammersmith and Charing Cross Hospitals could be much sooner than 2016. However Jeremy Hunt MP said in October 2013 said that Central Middlesex and Hammersmith Hospitals’ A&Es should close ‘as soon as possible’.

What is clearly the future for the Ealing Hospital site is what is happening this year on the adjacent St Bernard’s Hospital land – demolition and new build. The new three ward medical building to be built on the Ealing Hospital site sounds like a Cottage Hospital. It will be rather like a private hospital or even a hotel in some ways as each bed will be in its own room. There will be 82 beds – none of them acute – and the patients will be pre- or post-op patients who will be operated on or have been operated on elsewhere. The medical staff will be GPs and nurses. Diagnostic services will also be provided, no doubt by a private supplier like InHealth. As private healthcare company Circle currently runs the Urgent Care Centre on the site they must be favourite to run the new Cottage Hospital.

Ealing Hospital’s Maternity will be the first service to be destroyed. Sometime during the next nine months no more babies will be born at Ealing Hospital. A lot is being expected of Queen Charlotte’s Hospital Maternity Unit in Hammersmith and Northwick Park Hospital Maternity Unit in Harrow to handle the Ealing workload, which in 2013/14 numbered 2,915 births. A lot is being asked of vulnerable, poor Ealing mothers getting easy access to continuity of care in Hammersmith or Harrow before, during and after their child’s birth.

The General Election on 7 May 2015 could play a crucial part in what happens next. Many Labour Party fans want Labour to campaign on stopping this revolution in the NHS and getting funding levels and funding increases back to pre-Coalition Government levels. This would of course mean cutting budget proposals elsewhere and upsetting those Labour MPs who have financial interests in private healthcare companies. The re-election of the three Ealing MPs (should they all stand for re-election) may to some extent depend on the NHS question.

Ealing Clinical Commissioning Group (ECCG) in Public Open Warfare with Ealing Hospital NHS Trust (EHT)

When I ran my own business I was never at war with my major suppliers. ECCG is seemingly at war with EHT, its historic major service supplier. ECCG claims EHT offers a poor and expensive cardiology service for example. But EHT says after a recent unplanned Care Quality Commission (CQC) visit to EHT all its services got favourable reports. (In fact CQC’s main criticism of EHT was similar to its criticism of ECCG i.e. one of inadequate complaint reporting). ECCG is also claiming failures by EHT uncovered by CQC in ‘patient pathways’. This public bickering between our local service purchaser and our major local service supplier is unseemly and a gross waste of time and money.

NHS NW London Spent Over £10 Million on Management Consultants in 2013/14 and £3.3 Million of it with McKinsey & Company on ‘Whole Systems Integrated Care’

Why oh why is so much public money being lavished on management consultants by our regional NHS organisation? The eight CCGs in NHS NW London employ some 600 staff. Its Commissioning Support Unit (CSU) employs 432 staff. NHS England employs 6,100 staff. There must be a veritable army of accountants employed in these three organisations. Aren’t any of these folks capable of, for example, implementing SaHF or creating business cases or articulating ‘Primary Care Investment Principles’?

But the biggest regional NHS financial car crash concerns ‘integrated care’. NHS NW London spent £3,355,621 with McKinsey & Company on this topic in 2013/14 and the Government (see below) has just delayed (pulled the plug on?) spending the £3.8 billion on the Better Care Fund to implement this ‘integrated care’. What a shambles.

‘Whole Systems Integrated Care’ Approach In Tatters as Government Delays Launching its £3.8 Billion Better Care Fund (BCF)

With just 12 months to go before its introduction, the Government’s grandiose dream of saving money, reducing pressures on hospitals and helping to keep us all healthier in our own homes by integrating health care with social care is turning into a nightmare. The Government’s £3.8 billon Better Care Fund – the vehicle for this ‘integrated care’ – was due to be formally launched on 30 April 2014. The launch never happened and on 7 May 2014 press reports revealed the reason for this. A Government Cabinet Office report now exists which allegedly says the plans lack financial credibility and there is no detail at all as to how savings would be delivered. I’m sure many of us who questioned this very same lack of detail in SaHF will be variously vindicated and furious about this ‘Emperor’s New Clothes’ charade.

One of the cornerstones of BCF was to be the successful interworking between the NHS, Department of Health (DoH) and the hundreds of Local Authorities in England. It is of course the latter who deliver local social care services and the former two who variously deliver local health care services. All three institutions are going through endless organisational changes and financial gyrations. Local Authorities have recently suffered significant budget cuts with the worst of these due in 2015/16. The DoH was slimmed down in 2013. Our own local NHS Ealing CCG has, in its short life, got married to three other CCGs in Spring 2013 and then divorced them and got into bed with three others in December 2013! Our local hospital (EHT) is clearly going to be demolished as is our local mental health hospital (St Bernard’s). Also involved in the mix is the Local Government Association. A meeting of all these parties took place on 19 May 2014.  HSJ magazine remarked that the DoH was planning tougher tests for the BCF. A 15% reduction in emergency activity is apparently expected by NHS England on implementation of the BCF.

Health care is under-funded, undergoing massive service delivery changes and staff are under enormous pressure. Social care is also under funded, much of it in crisis and staff are also under-trained, under-paid and under enormous pressure. Attempting to integrate two dysfunctional services in the hope that some kind of merger and changes to ‘settings of care’ would or will produce a single, efficient integrated care system is fanciful at best and idiotic at worst. Next year Clinical Commissioning Groups throughout England will have to hand over £2 billion to BCF. This money will be used for ‘joint commissioning of out-of-hospital and social care’ (whatever that actually means). The best estimate of when the latest ‘plan of plans’ will be approved is September 2014.

The NHS Trust Development Authority (TDA) – a provider of leadership and support for NHS hospitals – has ‘major concerns’ about BCF because hospitals have not been properly consulted about it. The King’s Fund – a charity formed in 1897 working to improve health and healthcare in England – thinks the financial case for BCF is ‘hopeless’. MHP Health has also done research that suggests that money that might be given to Local Authorities might well not be spent on BCF purposes like finding better ways to join up NHS healthcare with Local Authority social care – but will be spent on propping up existing services.

This major set back is a real embarrassment for two Secretaries of State who publicly backed this initiative – Jeremy Hunt MP and Eric Pickles MP.

NHS Choose and Book  Appointments System to be Scrapped

IT failures are legion in the NHS. Choose and Book, which has cost £356 million since 2004, is being quietly ditched by the NHS. It appears that not enough GPs use it to justify its survival. The DoH and NHS England are expansively talking about introducing a new ‘e-refferal’ system available on ‘mobile apps’ sometime in 2016.  Its development cost is unknown, but is likely not to be cheap.

The NHS Mental Health Service is Failing Children – and it is Getting Worse

NHS England recently revealed that only a quarter of children with mental health conditions are receiving the treatment that they need. It also admitted that there is just one mental health specialist per 30,000 young people under 20 in England. This compares badly with other countries. It’s one per 5,300 in Switzerland, one per 6,000 in Finland and one per 7,500 in France. The mental health charity YoungMinds (www.youngminds.org.uk) recently published a report in which it found that two-thirds of Local Authorities had cut their budgets for young people’s mental health. YoungMinds says that 850,000 children and young people in the UK have been diagnosed with mental health problems. But is this just the tip of the iceberg?

The Association of Educational Psychologists (AEP) says that one child in ten has a mental health problem. With over 11 million under 16 years olds in England that means over one million children in England have a mental health problem. According to AEP three quarters of these young sufferers never receive any treatment or support. The Children’s and Adolescent Mental Health Service (CAMHS) claims that the reduction in prevention and early intervention budgets is denying young people early help. Children are having to travel hundreds of miles for treatment and are regularly and inappropriately being admitted to adult psychiatric wards.

Norman Lamb, the Minister for Care and Support, claims that investing £54 million in children and young people’s mental health will improve matters. Even if the money were spent wisely it’s just a drop in the ocean of funding that is actually needed.

Paediatric Services and Infant Mortality

Mortality and morbidity of children in England and Wales are significantly higher than in Scandinavian countries. Part of the problem is lack of  GP training. To rectify this, a training programme was put forward, but rejected as too expensive. With the reorganisation of the NHS, the Royal College of Paediatrics & Child Health has proposed that there should be fewer in-patient sites, but the number of Consultants should be increased by 66% as well as an increase in advanced children’s nurse practitioners and GPs trained in Paediatrics. So far NHS  North West London CCGs have acknowledged this deficit but have yet to train or employ staff.

A recent confidential enquiry by the Royal College of Physicians reported in the British Medical Journal (10 May 2014) found that two thirds of asthma deaths could have been prevented, with primary care failing in the routine care of  70% of the deaths studied. 28 of the 195 deaths were of individuals under 20 years of age. This investigation underlines the urgent need to improve training of practitioners and also recruitment and training of advanced children’s nurse practitioners. With devolvement of more care to GPs, all General Practices should include at least one member who has been trained in the care of children and employ an advanced children’s practitioner. There should be a network where GPs and advanced children’s practitioners have a working relationship and continuing training with a group of Consultant Paediatricians. If this is no put in place, our child mortality is likely to rise rather than fall.

Clara Lowy

NHS NW London CCGs Have Apparently Given their Commissioning Support Unit (CSU) Marching Orders

But marching into the arms of themselves! In the Merry Go Round that is the NHS some of the 432 folks now working for the NHS NW London CSU (who offer outsourced support to the NHS NW London CCGs) will now transfer to the NHS NW London CCGs to work in-house. The decision was apparently made in early May because it would save the CCGs £5 million by 2015/16. NW London CSU now intends to merge with South London and Kent and Medway CSUs. And according to healthcare consultant Roy Lilley,  CSUs are trying to consolidate their place in the market might offer their services to schools, police and prisons. Sounds a bit desperate to me……

Issue: 13

May 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.

Roche Adopts Ransom Aproach – Wanting £180,000 for Each Breast Cancer Patient Having a Few More Months To Live

The new ‘wonder’ breast cancer drug Kadcycla is still in use in the NHS, even though the National Institute for Health and Care Excellence (NICE) says it’s too expensive. Roche, the drug’s developer, seemingly wants to be paid £180,000 per patient treatment (assuming there is no ‘mark up’ by the NHS). Roche pleads that the cost of research, testing, trials, regulation (and no doubt litigation) is so cripplingly high that they have to charge this much. Poor old Roche only made profits of £7.7 billion last year.

The cash behind the drug’s continued use in England is provided by the NHS England’s Cancer Drugs Fund. So the NHS says yes to funding the use of  Kadcycla in NHS hospitals in England and NICE (accountable to the Department of Health) says no. Joined up thinking, eh?

UK Now Has the ‘Least Hospital Beds in Europe’

Shocking figures have emerged from a recent Organisation for Economic Co-operation and Development (OECD) survey of 23 European countries. The UK has fewer than three hospital beds per 1,000 people, compared with over six in France and over eight in Germany. Eastern European countries now have more hospital beds than the UK.

Ealing Hospital currently offers 358 beds. In 2012 it had 327 beds. When Ealing Hospital is closed and demolished a new Urgent Care Centre ‘Plus’ will be built on the site offering just 30 beds, plus some beds moved from Clayponds Hospital in South Ealing (after it is closed and demolished).

GP Surgeries Opening at Weekends? With No More GPs and Nurses Available Surely This Will Just Degrade the Weekday Service?

There’s no sign that many more doctors and nurses are being trained or are signing up to work in GP surgeries. So the 1,147 GP surgeries that take the pieces of silver from the Government and open at weekends will have to work more days a week than they are doing now. Logically, that will degrade the weekday service, as they will almost certainly have a finite staff resource of trained GPs, nurses and administrative staff. If they attempt to operate for 6/7 days and in the evening, the existing staff will become tired, less effective and their error rate will no doubt increase.

There’s also lots of grandiose talk about communicating with patients on email and over Skype. This approach will not appeal to many of the 700,000 or so over 65 year old patients at the 7 day week GP surgeries. Skyping and emailing will of course reduce the quality face to face time GPs and Nurses actually spend with their patients.

Royal College of Physicians’ President Warns Care of Patients is Under Threat

Sir Richard Thompson presides over a well established and respected organisation which represents most of the UK’s 30,000 doctors (except in Scotland). He told ‘The Guardian’ last month that care of patients was under threat because of absolutely destructive case loads. During their shifts acute medicine doctors are regularly facing case loads of more than the recommended maximum of 20. Some, frighteningly, have case loads of up to 70 patients in a single shift. He claimed that ‘the NHS is under-doctored, under-nursed, under-bedded and under-funded’. Dr Mark Porter, the leader of the British Medical Association, immediately endorsed Richard Thompson’s claims.

Surely this is a train crash just waiting to happen.

As We All Suspected – NHS Patient Records Have Been Released to Astra Zeneca, Baxter, Bayer, Bupa, Roche, BMI, McKinsey & Co, PwC, Care UK, Ernst & Young and others

On 3 April 2014 in response to concerns about transparency, the Health and Social Care Centre (HSCIC), a Department of Health body, published data which showed that medical record information had been released on more than 450 occasions to recipients including 56 private sector organisations. Identifiable data has been released on 75 occasions. Critics have pointed out that HSCIC is deliberately concealing releases of data that might cause itself, Ministers or other officials embarrassment or political damage. No details at all have been released concerning Police access to personal medical records.

HSCIS has existed in one form or another since 2005. It stores, analyses (and releases) data on hospital activity in the NHS in England. It also supplies NHS IT systems for health and social care.

www.ealingclinic.com – England’s First Mental Health eClinic

Ealing Council, the ECCG and The TASHA Foundation trumpeted the launch of this ground-breaking  digital ‘walk-in’ mental health clinic in ‘Ealing Gazette’ on 4 April 2014. Sadly on 7, 8, 13,19, 21, 26 and 28 April 2014 the web site was ‘Server not found’.

Not an auspicious start for what might become a useful online help facility.   

Capita Failing to Clear Medical Assessment Backlogs for PIPs for Terminally Ill, Sick and Disabled

The Personal Independence Payment (PIP) was introduced in April 2013 to replace Disability Living Allowance (DLA). PIP is already in a mess. According to the Department of Work and Pensions (DWP) fewer than one in six who have applied for PIP have had their claims decided. Two out of three people who apply for PIP are receiving nothing at all. In February 2014 DWP revealed that 220,300 people had made claims for PIP in the nine months since its inception. Of these only 12,654 have been awarded the benefit.

Capita, ‘a UK leader in business process management and outsourcing solutions’, was awarded the contract to assess PIP claimants in 2013. By February 2014 the National Audit Office had sized the Capita assessment backlog at 92,000 claimants. If Capita is the UK leader in outsourcing one dreads to think what the laggard outsourcers are like……

DWP civil servants have had to abandon their jobs and step in in an attempt to help Capita in its struggle to clear the backlog.

PIP is worth between £21 and £134 per week. Assessment for PIP is made using a points based system. Points are awarded on ‘descriptors’ on a range of activities related to someone’s daily living needs and mobility. Like the other key disability benefits, Employment Support Allowance (ESA) and the controversial Work Capability Assessment (WCA), PIP’s point-based assessments result in poor decision making and widespread appeals. Even the Government’s own figures predict the 600,000 people with disabilities will lose their entitlement to support under the new criteria.

And at www.spartacusnetwork.org.uk ‘Beyond Repair’ research on ESA was published last month. Successful appeals against assessments are at an all time high of 43%. Just 5% of those referred to the Jobcentre Plus Work Programme have found sustained work.

Surely another inevitable disaster is in prospect here.  

Understaffed, Overworked and Underfunded NHS Hospitals Urged to sell Skills Abroad

To add insult to injury English NHS hospitals – many stretched to breaking point with rising demand and depleted budgets – are being officially urged to sell their skills abroad. This brainwave comes from Healthcare UK. Healthcare UK supports the sale of UK public and private healthcare services abroad and the import of any healthcare services. It is a joint initiative of the Department of Health, UK Trade and Investment and NHS England.

Instead of NHS funds being raised by conventional taxation, attempts are being made to persuade NHS hospitals to take on commercial contracts abroad, mainly to provide staff training in places such as China, India and Russia. And foreign nationals in the UK are also fair game for paid treatment by English NHS hospitals according to Healthcare UK.  

EALING CLINICAL COMMISSIONING GROUP (ECCG)

A group of us spent an hour on 2 April 2014 with Dr Mohini Parmar and Kathryn  Magson – Chair and MD respectively of the ECCG. After maybe a year in their Greenford offices ECCG will soon move to occupy a floor in the London Borough of Ealing (LBE) office block Perceval House just next to Ealing Town Hall. The ECCG employs over 80 people and it is supported by the NHS NW London Commissioning Support Group (CSU) with 432 staff. The CSU supports eight CCGs in total.

I pursued my research in trying to understand just how Ealing GPs will deliver mental health primary care. Of course one of the challenges for CCGs is that they have no statutory control over GPs. ECCG has so far managed to persuade (by offering them money) fewer than half of the 79 Ealing GP practices to provide mental health primary care. The mantra seems to be that these 35 practices will only care for the small number of patients in their catchment area with long term but stable conditions. I asked about ECCG commissioning mental health carer support and was directed to the £24 million Better Care Fund (BCF) and asked to contact Andy Roper of the Ealing Community Network. After studying BCF documents I am still no wiser.

The Better Care Fund (BCF) is apparently a £3.8 billion ‘single pooled budget’ to be spent to ensure a transformation in integrated health and social care. Announced in June  2013 its aim is for health and social care services to work more closely together. Organisationally, fiscally and from an accountability perspective this will all be very tricky. CCGs commission hospital/secondary care services. NHS England commissions GPs. Local authorities commission local social care, and health and wellbeing services. CCGs and GPs now appear to be delivering mental health services. In Ealing the BCF is a partnership between ECCG, LBE and the Ealing Health and Wellbeing Board.

We tried to get a handle on what healthcare services the new expanded Urgent Care Centre to be built on the site of the demolished Ealing Hospital will offer. A long discussion ensued about hospital beds. 102 hospital beds will exist and these include those at Meadow House hospice which is thankfully not being demolished. In 2012 Ealing Hospital operated 327 hospital beds.

ECCG did not deny that the birth unit at Ealing Hospital will close by February 2015. Two years ago a brand new birth unit was opened at Ealing Hospital. 2,915 babies were born in Ealing Hospital’s Maternity Department last year. ECCG pooh-poohed home births as just 0.2 % of all births. They seemed very relaxed about Ealing ladies in labour travelling to Harrow, Hillingdon, Hounslow and Hammersmith.

We asked ECCG to explain ‘Co-commissioning’. They were somewhat unsure themselves but they felt it was all about economies of scale, and like minded professionals getting together to bid for service delivery contracts.

ECCG along with the other seven NHS NW London CCGs are attempting to work as one by pooling some of their money over five years. This is currently illegal. However the ever optimistic Daniel Elkeles (Chief Officer of the five CCG ‘federation’ CWHHE) thinks new legislation will arrive in October 2014 to allow this. If this goes ahead £57 million will be available over the next 12 months across 2 million patients to implement the great English NHS healthcare experiment that is ‘Shaping a Healthier Future’ across north west London. £35 million will be available for the eight ‘super-federated’ NHS NW London CCGs to (incredibly) ‘ensure a more level playing field between CCGs’. £47 million will ostensibly be available to ‘improve’ (create?) Out of Hospital services ‘such as seven day opening and community services’. So much for a locally GP driven Clinical Commissioning Group in Ealing deciding and directing how 60% of our National Insurance payments are spent here.

And yet again Greenford GP Dr Parmar was a ‘no show’ at another public event. On 8 April 2014 the Seniors Action Group Ealing (SAGE) gathered some 60 elderly people in Ealing Town Hall to hear Dr Parmar speak about the proposed changes to health services in Ealing. She failed to appear, but said she had arranged for ECCG Vice Chair Dr Raj Chandok to speak in her place. When SAGE contacted him he said that he’d forgotten about the meeting. A sense of déjà vu here as Dr Parmar failed to show up at the equivalent SAGE  meeting on 11 September 2013 and at public events in 2012 on 26 September and 11 October. Maybe SAGE should send her a bill for ‘non-attendance’.

WEST LONDON MENTAL HEALTH TRUST (WLMHT)

Every now and then I come across a real hero manager in the NHS. On 8 April 2014 I (along with 20 other mental health volunteer carers) spent 2.5 hours with Jeremy Mulcaire, Sector Manager, WLMHT. He runs Avenue House in Acton, which houses Recovery East Team. There are two Recovery teams to cater for the whole of Ealing – Recovery Team East and Recovery Team West (based at The Limes, Southall), plus a single Assessment Team (at Cherrington House in Hanwell) and a single Cognitive Impairment and Dementia Team

The headlines of his job are too few staff trying to help too many patients (‘service users’). There are 2,000 registered service users. To service them he has 8 Social Workers (case loads of 25 – 35 patients!), 6 Psychiatrists, 2 Occupational Therapists, 4 Psychologists and 13 Community Psychiatric Nurses (CPNs) – full and part-time. A recent (and useful) innovation is that the Community Forensic Service has installed one of its CPNs at Acton Police Station – now the solitary Police Station across Ealing’s 21 square miles which is open all hours. The incidence of mental health problems is rising. WLMHT budgets are falling. The number of staff on the WLMHT payroll has dropped by 500 over the last two years. WLMHT disputes this arithmetic and says ‘(we) have achieved reductions in posts by not filling vacant job roles and where people have left the trust or retired we have evaluated posts and reduced numbers where possible….’. WLHMT is also claiming that it is now ‘treating more patients in the community, with more mental health primary care workers who work alongside GP’s…’. Next month I’ll try to find out just how many of these workers are in place in Ealing and just how effective this ‘changing settings of care’ approach is.

Avenue House serves a population of 170,000 residents, of whom 125,000 are adults. MIND and others assess that 9% of the population in England suffer from the most common mental illness – anxiety and depression – to meet the criteria for diagnosis. So for Avenue East just for this one mental health condition and just dealing with adults  there are 11,250 people in need. If one then adds up the % of the population with Phobias, Schizophrenia, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Eating Disorders, Bipolar Disorder, and Personality Disorders we get to 17.7%.To be fair some patients present with or are diagnosed as having multiple disorders. So if we cut this to 5%, that’s another 6,250 adults in need. In total 17,500 sufferers in need.

Clearly not all those in need are seriously ill, self harming or a danger to other people. But with ever diminishing financial and professional resources within the WLMHT service, Jeremy and his peers have to be very hard working and creative with resource utilisation. He makes use of trainee Social Workers and medical students. The fact that Jeremy spent one of his week day evenings talking to carers shows he appreciates how with more information and training carers can make a huge difference to their loved ones’ quality of life and to the overall mental health community care service in Ealing.

The evening’s presentation was organised by the excellent Carers Support Group, which meets every second Tuesday in the month at Avenue House, Acton. The volunteer Carer Supporter who runs this is Paulette Ranaraja, Sadly the group’s grant funding from the London Borough of Ealing ran out on 31 March 2014. Lobbying WLMHT and the ECCG for some financial support has yet to bear fruit. More on this hopefully next month.

And more news on the demise of mental health care facilities at St Bernard’s Hospital in Southall. 270 new mixed tenure homes are to be built on 5.6 acres of the St Bernard’s site. Catalyst Housing, part of the G15 Group, beat private house builder Bellway to the deal. Catalyst paid £24 million for the land and plans to spend £65 million developing the site beginning in Autumn 2014. WLMHT is of course going to build a new medium secure mental health unit on the St Bernard’s site.

85% of Older People With Depression Get No Help from NHS

Last month the Royal College of Psychiatrists (RCP) estimated that two thirds of elderly people with a mental health problem have a condition other than Dementia. Bereavement, loneliness and loss of physical independence can all trigger depression says the RCP – but depression is a treatable condition. The RCP points out that as well as a general lack of awareness of the size of the depression problem amongst the elderly, there is a severe lack of treatment resource throughout the NHS.

The NHS Confederation reports that NHS investment in mental health services dropped in real terms by 1% and 3.1% for older people in 2011/2012 (the most recent figures available).

Teachers Report Rise in Mental Health Fears

A recent poll of members of the Association of Teachers and Lecturers (ATL) reveals that 38% of school and college staff have seen a rise in mental health issues amongst colleagues in the past two years. 80% admitted they were stressed. 70% said they were left feeling exhausted by their work. Worryingly, 68% of those dealing with a mental health problem had decided to keep it secret from bosses, compared with 38% who kept a physical health issue to themselves.

The Department of Education’s (DoEs) response to the ATL findings was that statistics show  that teaching had never been more ‘attractive, more popular or more rewarding’ – so no mental health issues over at the DoE then…….

NHS Bosses ‘Gifted’ Huge Pay Rises and Immoral Redundancy Payments

Just by staying alive, NHS Directors John Holden, Richard Murray, Ben Dyson and Miles Ayling had their salaries raised by at least £30,000/year to at least £115,000/year. 3,950 NHS managers have received redundancy payments only to return to other NHS positions. 330 of them were each given over £200,000. Surely someone should go to gaol for this robbery.

Lord Norman Warner Wants Us All to Pay £120 Each Year So that We Can Continue to Enjoy Our Free Universal Healthcare System

Norman Warner, a former Labour Government Health Minister, may have dozed off when his school History teacher waxed lyrical about Pitt the Younger introducing Income Tax in 1798 and about the National Insurance Act of 1911. He wants to introduce a new form of taxation paid to Local Authorities in order to increase NHS funding.  Given we have a well established taxation system either increase people’s contribution to fund the NHS or stop funding other initiatives and use the saved money on the NHS.

NHS Employs 826 Public Relations Staff at a Cost of £34 million Each Year

The Tax Payers Alliance has revealed scandalous PR staff numbers at the NHS. I have to say that given there are 826 PR folks at the NHS and given its reputation is at an all time low, there’s not much value for money in the £34 million per year  being spent. That of course is assuming that all these PR people are being paid to try and generate good news and not bad news…..

Guys and St Thomas’ NHS Foundation Trust employs an incredible 22 PR staff at an annual cost of £1.1 million. West and South Yorkshire and Bassetlaw Commissioning Support Unit employs an eye watering 36 PR people at an annual cost of over £1.4 million.

Maidstone and Tunbridge Wells NHS Trust: Famous For All the Wrong Reasons

2013

February: Novovirus closed hospital wards

February: Trust Faced £3.5 million C.difficile fine

August: Agency nurse paid £1,500 for 11 hour shift – a UK record

October: £400,000 damages over ectopic pregnancy death

November: Director of Finance resigns

2014

March: Deaths of five cancer patients halts surgery

March: Fined £1.5 million again for failing to control the incidence of C. difficile

Issue: 12

April 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.

Demand Drives Investment in State Transport – But Not Investment in State Healthcare

Adding runways at Heathrow, building a new airport on ‘Boris Island’ in the Thames Estuary and creating HS2 – are all examples of UK plc driving investment to meet current and projected travel demands. However when it comes to healthcare the Government is clearly devoted to the notion that in the face of rising current demand and rising projected demand cutting £20 billion off NHS costs is the way to go.  

In January 2014 we had the highest ever recorded waiting-for- NHS-treatment figures. 2.9 million patients.

We make it quicker, easier and better for people travelling but you might not be alive to avail yourself of this – or you might have to travel in considerable pain.

Welcome to the sixth richest country in the world.

The People’s Inquiry into London’s NHS – A Unique Evidence Base Underpins 18 Recommendations

A group of experienced and well informed healthcare experts recently ran The People’s Inquiry in to London’s NHS. It involved hearing contributions from 95 people at seven public meetings throughout London , 30 hours of oral transcripts, 50 written submissions and evidence taken from the public, NHS staff, professional bodies, medics, clinicians and the great and good (and possibly the bad). Started in autumn 2013 the independent six-person panel was chaired by former NHS trust chair Roy Lilley. The Trade Union Unite funded the inquiry. The Executive Summary and much of the evidence can be viewed at www.peoplesinquiry.org.

The recommendations are indeed wide ranging but include the future of PFI, public engagement and funding, transparency, integration and right up-to-date the impact of Section 119 of the Care Bill (soon to be enacted). At the very least I urge you to view the 10 page Executive Summary.

Scrap Equal Rights When Assessing New Drugs Says NICE Boss

Sir Andrew Dillon, Chief Executive of the National Institute for Health and Care Excellence (NICE) stated last month that saving the lives of the elderly is less valuable to society than saving younger people. Critics have argued that this is blatant age discrimination. Extra weighting by NICE when assessing new drugs for end-of-life-treatment is being abolished. So much for my paying National Insurance then for 43 years.

Nicholson Out.. and Stevens In

This month sees Simon Stevens finally and formally take over running the NHS from disgraced David Nicholson. Nicholson’s exit has been ‘graced’ by his plea for more cash for the NHS. This might have been be construed as a glorious farewell gesture were it not for the fact it was he who told us all in May 2009 that the NHS must cut costs by £20 billion by 2015.

Leaving private healthcare giant UnitedHealth (where he was ‘Global Health President’) to run our free universal healthcare service Mr Stevens will clearly have profit and loss on his mind. He has graciously agreed to be paid only £189,000 in his first year – just £46,500 more than our Prime Minister.

Nicholson’s tenure at the helm of the NHS became unsustainable when the Stafford Hospital scandal revealed that at its worst he was then running the local health authority.

MENTAL HEALTH

Bosses of many UK mental health charities wrote to ‘The Guardian’ last month warning of the dangers of cutting funding for mental health services by 20%. The proposal has been made by NHS England and Monitor. The mental health charity bosses further point out that 28% of the NHS’s disease burden is mental health but mental health attracts just 13% of the budget. This makes a complete farce of the Government’s promise of ‘parity of care’ and ‘parity of esteem’ between physical illness and mental illness. As for aspirations for 24/7 operations in mental health services this surely is a cruel joke.

Roy Lilley of nhsManagers.net has recently pointed up the fact that the Bedroom Tax is shifting families out of their homes to areas where housing is cheaper. Children have to change schools, parents might lose employment (if they have any), friendship circles are lost and families broken up. Cuts in Social Services mean there are no job clubs, support services…. ‘This puts pressure on the NHS, not least Mental Health Services’.  

The Elderly

There are 10 million people in the UK over 65 years of age. According to the Royal College of Psychiatrists (RCP) 10% of them have mental health problems. That’s two million people. In Ealing there are 34,000 over 65 year olds so 3,400 with mental health problems. In my Electoral Ward there are 1,419 people over 65 years old so 141 of them have mental health problems. One wonders just how many of my troubled neighbours have been diagnosed and/or are being treated? Just how many of them have close family carers?

And the Young

The Princes Trust tells us that 750,000 young British people feel that owing to unemployment they cannot cope with day-to-day life. 25% of young people who are long term unemployed have been prescribed antidepressants and 32% have felt suicidal.

Private Mental Health Care Provider Sees ‘Significant Growth Opportunities in the Mental Health Market’

Cambian, the UK’s biggest private mental health services supplier, is planning to raise £20 million via a flotation on the London Stock Exchange. The flotation is likely to value the company at around £500 million on 2013 earnings of £41.1 million. The company is, owned by private equity investors GI Partners, and provides services to more than 1,100 mental health patients in over 60 facilities across the UK. As well as providing mental health services the company also offers educational facilities to children with autism, learning disabilities and challenging behaviour. The 10 year old company employs 6,000 people across 23 schools, 35 hospitals, 188 specialist homes and three fostering offices.,

MENTAL HEALTH IN EALING

Most of the mental health services in Ealing are provided by the West London Mental Health Trust (WLMHT). WLMHT employs 3,500 staff and attempts to meet many of the mental health cares needs of the 770,000 people who live in Ealing, Hounslow and Hammersmith & Fulham. In 2012 WLHT employed 4,000 staff. Dr John Lister of London Health Emergency estimated in 2012 that between £43 and 54 million would be cut from the WLHMT budget between 2012 and 2015.

However the draft Ealing Clinical Commissioning Group (ECCG) mental health budget for 2014/15 (beginning today) is £46.019 million. In 2013/14 it was £45.003 million. Of this year’s budget WLMHT is allocated £31.871 million (in 2013/14 it was £33.005 million). This year there is also £2.110 million for Improving Access to Psychological Therapies (IAPT) and £2.573 million for High Cost Area Supplement (HCAS) both relating to WLMHT services. Neither of these amounts are much changed from 2013/14.

Budget cuts and ‘reconfigurations’ of staff are apparently ongoing at WLMHT. But capital investments are still being made. However the jury is still out on the efficacy and utility of the new £250,000 WLMHT ‘Meridian’ Electronic Patient Feedback System so revered by management.

Support for Carers

West  London Mental Health Trust (WLMHT) has allocated £150,000 to be spent by volunteers over each of the next three financial years (April to March)  to improve mental health service user and carer experiences in Ealing, Hounslow, Hammersmith & Fulham. One might naively think that that is the role of WLHMT, and the three Clinical Commissioning Groups along with the three Local Authorities.

WLMHT’s Flippa Watkeys (Local Services Recovery & Involvement Lead/Professional Lead for Occupational Therapy) and WLMHT service user Jane McGrath are running a WLMHT project (currently called ‘The Voice’) with service users and carers to try and formulate how this money might be spent. No carer is part of the team running this project. The Voice currently has no written draft Constitution

A number of meetings of The Voice have taken place in 2013 and 2014, most of them apparently dominated by service users. The latest meeting took place at St Bernard’s Hospital on 14 March 2014. It has already been decided that the Accession social enterprise will ‘host’ The Voice. Accession was set up largely by effort and finance from WLMHT and the London Borough of Ealing. The Voice describes Accession as ‘an independent social enterprise’. Accession will get £30,000/year for its efforts. This leaves £120,000 each year to help improve the lots of the service users and carers in the 770,000 tri-borough area population. Using the RCP estimates quoted above there are some 7,700 over 65 year olds with mental health problems in the WLMHT catchment area. If only 50% of them have family/loved one carers that means around 3,850 volunteer carers for over 65 year olds alone. That’s a lot of people spread out over a wide geographic area.

At the 14 March 2014 meeting a group of carers presented some views on how some of the £120,000 annual grant money should be spent to expand and improve carer support. However the tone of most of the meeting was that most (all?) of the £120,000 would be spent on service users by service users. I’m part of the Carers’ Group based at Avenue House in Acton. This group offers excellent support, information and training for carers across Ealing. LBE has discontinued its grant to the group so it’s looking like being broke as from today. I attended the WLMHT Carer’s Strategy Group Meeting on 25 March 2014 (ably Chaired by WLMHT Service Manger Kieran McCann) at which it was resolved unanimously that some of the £120,000 should be used to support existing Carers’ groups in Ealing, Hounslow and Hammersmith & Fulham. It will be interesting to see how much of these suggestions find their way into The Voice’s business plan which is due in July 2014.

On 26 March 2014 I spoke to Dr Serena Foo, GP Lead for Mental Health, about funding for mental health carers. She did seem to grasp what I was saying but whether ‘quick’ money can be found quickly to help the Avenue House based Carers’Group and other similar groups in Ealing is anybody’s guess. How frustrating it is to have to lobby both the mental health services purchaser and the mental health service supplier in order to try to get even miniscule funding.

Support for GPs

A support group of four mental health Primary Health Care workers has been established to provide mental health support to Ealing GPs. We understand that two of them are locums. Anecdotally it’s proving hard work training some of the Ealing GPs at the 30+ Ealing GP practices who have signed up to providing Primary Care mental health services. (There are 79 GP practices in Ealing). Instead of 24 hour real time psychiatric telephone support, the Ealing GPs have seemingly decided on just one hour of psychiatric consultant telephone support during the weekday daytime. How this will assist a suicidal patient who presents him or herself at even a participating Ealing GP surgery for seven of the eight hour GP weekdays is worryingly difficult to deduce.

EALING HOSPITAL

Apparently Ealing Hospital Trust (EHT) has managed to break-even in its financial year which ends today. This is in spite of  ‘Non NHS Staff Costs (Agency)’ of over 17 million which were budgeted in February 2013 at £1.73 million. Still when NHS bosses (led by McKinsey and Co) condemned Ealing Hospital to death in 2012’s ‘Shaping a Healthier Future’, why would anyone want a permanent staff post at Ealing Hospital?

At a public meeting attended by 150 people on 26 March 2014 Ealing Council Leader Julian Bell announced that Ealing Hospital’s Maternity Unit would close by February 2015. On 27 March 2014 I attempted to attend an EHT Board Meeting to confirm financial and maternity details. But closed doors kept the public out for over 40 minutes as confidential matters were discussed by a worried looking Board. I left before the public were allowed into the meeting.

Apparently the ‘must have’ merger between EHT and the North West London Hospitals NHS Trust has been delayed by three months as everyone and his brother has to sign off the finances which underpin the deal.

EHT has got a £500,000 grant to equip District Nurses and Midwives with ‘mobile working technology’. We might find that there are more ‘tablets’ than District Nurses as only five new District Nurses qualified throughout the whole of London in 2013.

NHS Rates Ealing Hospital as The Best Performing Hospital in London        

Truly astonishing performance figures have just emerged from NHS Trust Development Authority slides shown at the ‘London Trust Chairs Meeting, 16 January 2014’. Of all the  NHS Trusts reviewed in London, Ealing Hospital Trust came out overall top in the only three ‘Performance Highlights’ slides. In the ‘Referral To Treatment (RTT) Months Achievement of 90% Standard’ performance metric – which measures how quickly a hospital treats a patient – Ealing came first.  In the ‘NHS Cancer Plan 62 Day Standard’ Ealing came way out in front. In the ‘Year to date A&E Performance’ Ealing came second. Of the 42 cases of MRSA diagnosed throughout London only one case was at Ealing Hospital.

The Coalition Government and NHS bosses signposted plans in 2012 to close Ealing Hospital A&E, Maternity, Paediatrics and downgrade the service to one provided by just by GPs and nurses. Recruiting permanent staff at the hospital against a backdrop of doom and gloom about its future has been very challenging. Temporary staff costs are well over £10 million for the current financial year just ended.    

In 2006, the Healthcare Commission interviewed 75,000 patients throughout England. Out of 165 Acute and Specialist Trusts in England, Ealing Hospital was rated as providing the worst care of all of them.  

All the staff at Ealing Hospital should be congratulated on their current performance. Dr William Lynn and Mr David McVittie, who jointly run the hospital, deserve special praise.

NHS Strike on the Cards Nationally and 150 On Strike at Ealing Hospital

Health Secretary Hunt in a seeming attempt to goad 600,000 NHS staff into industrial action has frozen their pay. Unite the Union is consulting its 100,000 NHS members regarding industrial action. The Royal College of Nursing accused Mr Hunt of treating nursing staff and patients with contempt. The TUC commented that its members were being hit by an escalating cost-of-living crisis whilst 2,400 NHS bosses were earning more than the Prime Minister.

At Ealing Hospital Trust (EHT) 150 domestic, catering, porters and help desk workers are earning at an hourly rate of £6:31 some 44% below comparable London NHS workers. They receive no sick pay. These poorly paid GMB members work for EHT outsourcers Compass Medirect. They went on strike in February 2013 and again from 14 to 21 March 2014. EHT management detects no disruption in safe and effective services. Clearly EHT/NHS have no blanket commitment for their suppliers to pay the London Mayor’s  London Living Wage of £8:80/hour.

EALING CLINICAL COMMISSIONING GROUP

Our attempts to get a meeting with ECCG Chair Dr Mohini Parmar in March were unsuccessful. We had a date but then she postponed the meeting until 2 April 2014 when she’ll just have returned from her skiing holiday. In her place as Chair at the public ECCG meeting on 26 March 2014 surprisingly was appointed lay member Philip Wood. At this meeting ECCG Chief Officer Daniel Elkeles waxed lyrically about co-commissioning and the federation of the five CCGs ECCG (CWHHE) is now embedded into. NHS Co-commissioning, perhaps currently illegal until the law likely changes in October 2014, is where two or more NHS Service Commissioners align their priorities while retaining responsibility for their own resources. Critics of this practice bring up a range of related issues which include coercion, lobbying, personal influence and conflicts of interest. At least Mr Elkeles is cognisant of the latter as he himself raised it as an issue to be resolved.

Community Care – Underfunded and Possibly Unsustainable

Only 8.39% of the NHS budget is spent on community care – the rest is spent on hospitals. The community care share has been falling since 2003/4. The Royal College of GPs (RCGP) warned in March 2014 that GP services are ‘under severe threat of extinction’ because they cannot cope with the growing demand for care. RCGP also reported a ComRes finding that 28% of patients in England are currently unable to book an appointment within the week of their request. The RCGP says that the NHS needs another 10,000 GPs in order to provide timely access and high quality care.

6 out of 10 GPs are considering early retirement says the British Medical Association (BMA) online tracker survey. 50% of GPs also say that their workload is unmanageable and that their morale is either low or very low.

BUPA Global Profits are Up, But Says it Can’t Make Enough Profit Out of NHS Trusts  

BUPA, one of the oldest private healthcare companies in the UK, upped its global profits last year to £635 million. However, BUPA claims that it can’t make enough profit out of NHS Trusts when providing chemotherapy, intravenous feeding and rehabilitation at home for elderly and bed ridden patients. BUPA treats 28,000 NHS patients.

NHS CCGs Want To Train Us All in Planning, Designing and Commissioning Healthcare Services

Five free sessions for patients and carers in Ealing and Hounslow are being offered this training at Ealing CCG offices in Greenford April through July 2014. Email healthwatchcwl@hestia.org  for more information or to register.

Issue: 11

March 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.

In this issue:

This issue is a very long one and reflects the local and national chaos as the Government attempts to reduce NHS costs by £20 billion every year. In Ealing there have recently been a host of London Borough of Ealing (LBE) meetings allied to a veritable snow storm of written reports.

But First  The Care Bill – Clause 118 now 119!

If this clause becomes law hospitals will be shut at the whim of  Whitehall bureaucrats – without full and proper consultation and without even the  saintly, so called ‘local GP driven’ CCGs having a say. This is being rushed through Parliament. The third reading will take place in the first two weeks of March 2014. Email you MP and tell him or her to vote against Clause 118 (amended to 119).

The Better Care Fund (BCF)

LBE  Cabinet papers for its 18 February 2014 meeting set out the BCF stall. BCF is for providing ‘better integrated care and support’. Vulnerable people are a priority. It involves ‘…a significant expansion of care in community settings’.  For Ealing it looks like £18.7 million in 2014/15 and £26.9 million for 2015/16. LBE puts in £5.4 million in 2014/15 and £2.1 million in 2015/16. The rest of the money comes from the Ealing Clinical Commissioning Group (ECCG). However in the hard to interpret figures a total of £77.4 million is quoted for 2014/15 for ‘BCF 3.0  Commissioning of Community Based Support Services’. The 2014/15 spend will focus on management of the impact in the acute sector, the protection of social care, embedded care coordination, sustaining our improved performance on Delayed Transfer Of Care (DTOC), and reducing avoidable admissions, expanding 7 day working and accelerating data sharing.

LBE Vision for Ealing

‘In Ealing organisations will work seamlessly to promote and deliver healthier communities. Patients and carers will be at the heart of decisions about their well being. Health and care services will be person centred and efficient in design and will deliver positive experiences and improved health outcomes’.

Let’s hope these bold aspirations can be met.

Shaping a Healthier Future (SaHF) Enters its ‘On the Buses’ Phase in Ealing

The grandly titled ‘Ealing Council Scrutiny Review Panel 2 – Transport’ met in Ealing Town Hall on 11 February 2014. The meeting amounted, in part, to 17 people sitting round a table discussing non-existent proposals for new bus services to take Ealing A&E sufferers and their loved ones to West Middlesex and Northwick Park Hospitals prior to Ealing Hospital being demolished. Ealing Councillors and Ealing Council Transport Officers rubbed shoulders with Transport for London (TfL) and NHS representatives. NHS Ealing Clinical Commissioning Group (ECCG) sent its new boy Andrew Pike (Communications/PR) to update the panel on the SaHF Travel Advisory Group’s  (TAG’s) work plan on strengthening patient transport. No new information emerged apart from a figure of 175 additional trips/day predicted to be ‘displaced’ from Ealing to West Middlesex Hospital which was passed onto TfL’s London Buses a few days before the meeting. TfL estimates a cost of between £550,000 to £700,000 per year to extend just one bus route (E2 or E8) to West Middlesex Hospital. As TfL’s minimum threshold of 1,250 trips/day was not met it was clearly not interested in running the service unless someone else funded it.

No mention was made about ‘strengthening patient transport’ for much-sooner-to-close A&Es at Hammersmith Hospital and Central Middlesex Hospital. And where was ECCG’s Chief Officer Daniel Elkeles who recently announced in public that ‘everything was in hand with his discussions with TfL and London Ambulance’? Mr Elkeles is now Chief Officer of the new CCG federation of Ealing, Central London, West London, Hammersmith & Fulham and Hounslow CCGs. (CWHHE). CWHHE, servicing a population of over one million patients, is hardly a local GP-driven healthcare commissioning service.

Some citizens attendees in the audience are attempting to work constructively with Ealing Council, TfL and the NHS to more accurately size current and future Ealing  patients’ and loved ones’ public transport needs for accessing West Middlesex and Northwick Park Hospitals. The Department of Health’s figures for 2011 show there were 84,000 A&E attendees at Ealing Hospital of which 30,000 were seriously ill.

TfL presented some slides which strongly suggested that TfL Buses’ Network Development folks have no community engagement strategy whatsoever.

The Joint Health Overview & Scrutiny Committee (JHOSC) Makes a Very Poor Attempt to Unscramble SaHF  for 1.8+ Million Citizens in North West London

Again in Ealing Town Hall, the JHOSC met on 20 February 2014. JHOSC is made up of elected representatives from eight North West London Borough Councils who represent the interests of over 1.8 million citizens. It’s Ealing, Hounslow, Harrow, Brent, Richmond, Kensington & Chelsea, Hammersmith & Fulham and Westminster Councillors who attend. There was plenty of pre-meeting reading matter – in fact 84 pages of it. At their previous meeting on 3 December  NHS SaHF evangelists, Elkeles, Spencer and McGoldrick, led the SaHF sermon. Ealing Councillor Abdullah Gulaid attempted to gain some clarity on Mr Hunt’s fudge on future ‘A&E services’ at NHS Ealing Hospital. Spencer replied with another fudge of ‘….GP led service connected to emergency care networks’. Whether these networks were to be physical, telephonic, internet, neural, social media or telepathic was not revealed. Mr Elkeles bragged that three GP Surgeries in North West London had opened at weekends. I estimate that there are over 400 GP surgeries serving the 1.8 million people in North West London.

Of the 16 elected Councillors who attended on 20 February only one appeared to have read or be interested in either the 84 page document provided prior to the meeting or the 71 page document provided at the meeting. This was Councillor Mary Daly from Brent Council. She was the only Councillor who made strong objections to the way SaHF was being conducted and demanded real information. She complained about the unintelligible business jargon being used, as well as questioning SaHF evangelist Dr Mark Spencer about the cuts. He replied that the funding would accrue from ‘2% QIPP savings from CCGs’.  QIPP stands for Quality, Innovation, Productivity & Prevention. QIPP is the Philosopher’s Stone of medicine. It’s like the trick of turning water into wine. It’s all about cutting £20 billion from the annual NHS budget whilst at the same time improving the quality of care.

It emerged that Hammersmith Hospital A&E will close around August/September 2014. Northwick Park Hospital had hired two more A &E consultants and that that the target for a full complement – being aimed at – is eleven

In the plethora of slides presented at the 20 February meeting just one was used on ‘Mental Health Transformation’ and even that was sparse, with just 34 words on the slide….oh dear… oh dear. And as for Maternity, there was just one slide which depicted Ealing Hospital with lines round the compass linking it to Northwick Park, Hammersmith, St, Mary’s, Chelsea and Westminster, West Middlesex and Hillingdon Hospitals. The title of the slide was ‘Maternity and Paediatric Zone’. The reality of this slide is the annual dispersal of 2,500 pregnant Ealing women to these six remote maternity units. If this constitutes scrutiny of the future of childbirth for Ealing mothers then we should all be very afraid.

Living in North West London we are all part of a huge, unique experiment. No such radical healthcare transformation as SaHF has ever been attempted anywhere in England. Not only that, we are now part of yet another experiment  This one is called ‘Living Longer, Living Well’ (LLLW). This is an integration initiative which will allow patients, carers and families to decide whether they want to be treated at home or ‘in their local communities’. GPs will coordinate care ‘working with others in integrated networks to support people to meet their individual goals’. Will it work? Can it ever work? Future issues of this newsletter will monitor and attempt to ‘test’ these grandiose ambitions and aspirations.

Two Page Misleading Advertisement by the NHS in ‘Ealing Gazette’

The 21 February 2014 edition of the ‘Ealing Gazette’ contains two full-page NHS colour advertisements. One of these is selling SaHF, and the other is selling the 111 telephone help line and the availability of .GP services in the evening and at the weekend. Just why our National Insurance taxes should be spent on this sales effort. is really quite beyond my comprehension. The ads contain some inaccuracies too.

+ ‘Services….are chosen by a group of local GPs known as the Clinical Commissioning Group’. This statement is what we call a lie. Of the 20 people on the Ealing CCG Governing Body  just 5 of them are Ealing GPs.

+ There as no mention of the A&E Unit closing at Ealing Hospital. One might refer to this omission as NHS bosses being economical with the truth.

+ ‘…urgent care centres (UCCs) which will  have the capacity to treat the majority of injuries which currently go to A& E’. This statement is almost maliciously confusing. Ealing Hospital UCC will have no acute beds, no Acute Care Unit, no surgeons or A&E consultants on site. No flashing blue light ambulances will deliver the dying and those in pain to Ealing Hospital. What Ealing Hospital UCC will have is GPs and nurses. Currently there are 44 accident and emergency conditions which Ealing Hospital UCC cannot and will not handle.

+ ‘….these changes ….will help save 140 lives in North West London each year’. Quite a claim with no reference to any evidence to backup this statement

+ Do try calling 111. The robot answering service does not recognise West London as a geography of choice – so for 1.8 million citizens you get shuffled into the ‘don’t know where you live’ category. When I did make contact with a  human being the line quality was so bad I had to hang up.

Failing A&E Service in North London Putting Lives At Risk

The A&E Unit at NHS Barnet Hospital turned away all sick and injured patients on 31 January and 2 February 2014. It is by no means a co-incidence that NHS Chase Farm Hospital A&E Unit some six miles away was closed by NHS diktat on 9 December 2013. Since the closure of  NHS Chase Farm Hospital A&E, NHS official figures show that ambulances have had to wait outside NHS Barnet Hospital – with patients on board – more than 30 minutes on 236 occasions. The only other ‘local’ NHS A&E Unit, also 6 miles away from NHS Chase Farm Hospital, is North Middlesex University Hospital. Here, since the closure of NHS Chase Farm Hospital A&E, ambulances have had to queue outside for more than 30 minutes on a staggering 941 separate occasions.

Department of Health (DoH) Wants the NHS to Prioritise Treatments for Patients Who Contribute to the Economy

The DoH has instructed the National Institute for Health and Care Excellence (NICE) to consider overhauling the way it assesses the cost-effectiveness of drugs to take into account the benefits that successful treatments have on society. NICE will do this as it is accountable to the DoH. One of the quoted exemplar benefits is treatments allowing people to return to work. NICE, Age UK and others have pointed out that no such return-to-work benefit could be gained by successful treatments undergone by retired people. Presumably treatments which prevented mentally patients from committing suicide would also arguably not directly bring about return-to-work benefits either. Also taking this argument close to absurdity, we could just not offer any treatments to habitual convicted criminals or to the long term unemployed.

Competition Thoughts of CQC Chairman David Prior

The Care Quality Commissions’s (CQC’s) David Prior worries in the Sunday Telegraph that if the NHS doesn’t change it might go bust – but presents little evidence to back up his views. He states that the NHS needs ‘more competition to drive up standards of care’. However he cites no academic, clinical or business research which demonstrates this. This is probably because no such evidence exists. The former Deputy Chairman and Chief Executive of the Conservative Party and former Tory MP also has a lot to say about bullying in the NHS. He may well know quite a bit about bullying as anecdotally there is plenty of bullying in his own organisation – the CQC.

No-one will argue about his aspirations for the NHS to ‘drive up standards’, protect vulnerable patients, and to see ‘an end to pointless targets’. However all this guff about hospitals going bust is all based around the pointless construct of hospitals and Trusts being profit and loss bodies, whereas in the sensible world of public services they would be cost centres. He also bangs on about the NHS failing to listen to staff who challenge poor care and champion the rights of patients. This makes me wonder how CQC treats its own staff who blow the whistle.

All in all there is something inappropriate and unsavoury about someone who is paid to enforce a set of rules arguing publicly about those very ‘rules’. Hopefully political party politics does not play a part in this outburst…….

Police to be Able to Access Our Personal Medical Records – as a Matter of Right

David Davis MP warned us all in The Guardian last month that the Police will in future be able to access our personal medical records even if we have formally opted out of allowing our data to be passed on to Government. (If you have received the NHS ‘Better information means better care’ leaflet through your door, you have just four weeks to let your GP know if you don’t want your data to be ‘shared’). Currently the Police have to track down a person’s GP and go to court for a disclosure order in order to access your personal medical records. In future they will be legally able to hack into a massive single Government repository of 55.5 million personal medical records in England. So much for the confidentiality of the doctor/patient relationship then.

And More and More on ‘care.data’

‘care.data’ is the name of the Atos software driven NHS personal medical records/Atos managed NHS personal medical records data extraction and data sharing service. Dr Clare Gerada, a respected former Chair of the Royal College of GPs, has stated that patients who refuse to share personal medical records data are selfish. She sadly seems to miss the point that many of us can no longer trust the Government or NHS bosses generally and specifically on the handling of data. Here in NHS NW London, patients were not involved in the formative stages of ‘Shaping a Healthier Future (SaHF)’ plan making. We all took part in a flawed SaHF public consultation exercise the results of which were manipulated to ‘fix’ the result to suit NHS bosses. And the ‘Daily Mail’ has published data obtained from the Office of the Information Commissioner which sizes the number of NHS medical records lost at a staggering 2,152,560! Is it any wonder we have lost trust in NHS bosses and their Government puppet masters.

Roy Lilley in nhsManagers.net explains to us all that the legislation underpinning the NHS  ‘care.data’ personal medical records sharing is Section 251 of the Health and Social Care Act. He also explains that the folks who make the decision to ‘over-ride the common law of confidentiality’ are the 17 unelected members of the NHS Data Access Advisory Group (DAAG). DAAG meets monthly and recently gave permission, for example, for Corin Ltd to purchase NHS personal medical records. Corin is global private healthcare company specialising in orthopaedics.

The ‘Daily Telegraph’ has waded into the subject quoting 40% of GPs polled by the Royal College of GPs (RCGPs) saying they intend to opt out of sharing personal medical records. Also Mencap, Action on Hearing Loss, the Royal National Institute for the Blind, the National Autistic Society and Sense have written to Minister Hunt expressing concern that little effort has been made to ensure those with sensory impairment  are aware that their data will be harvested.

And the ‘Oxford Mail’  revealed in February that a GP has vowed to take the NHS to court if he is forced to hand over personal medical records without the consent of over 4,000 patients. Dr Gordon Gancz of King Edward Street Surgery near St Bartholomew’s Hospital in the City of  London says that the NHS data collection edict ‘..removes my right to protect my patients’ confidential information’. He added that ‘someone other than your doctor will know whether you have had a mental health problem, an abortion, gone to the STI clinic or just had a cold in the last week’.

On 19 February 2014, NHS England retreated from instantly implementing care.data and announced a six month delay in implementation. It claimed (very much as Government/NHS bosses claimed in 2011 with the Health & Social Care Bill) that citizens needed more time and more  information to understand the benefits of sharing personal medical records. We should beware of this ‘pause’ and bemoan perhaps our National Insurance contributions being spent yet again on printing and delivering a further 26 million leaflets.

Even worse it was revealed on 25 February 2014 that an insurance company – Staple Inn Actuarial Society – has been able to access the NHS records of 47 million patients over 13 years!

Quite understandably criics of care.data claim that the care.data database’s real worth is as an intrusive marketing tool.

Redundancies and Rehiring Chaos at NHS

Roy Lilley’s nhs.Managers.net summarises some of the Government inspired human relations chaos at the NHS:

+ Up to 10,000 NHS clinicians and nurses gone

+ 40,000 NHS managers gone

+ One in five NHS staff made redundant have been rehired

+ Redundancy bill of about £450 million

48 Pages of Strategy from the Health and Social Care Information Centre (HSCIC)

The HSCIC seems to really fancy itself as in January 2014 it published 48 pages of ‘strategy’. Strange that it’s only a two year strategy (2013 – 2015). Government spatial strategies are for 15 years! News to me is that HSCIC will be the NHS IT systems delivery vehicle. New NHS IT systems have an awful contemporary  history with losses of well over £20 billion. Perhaps governance of NHS IT by HSCIC might improve on this. The document emphasises regaining citizens’ trust in the NHS and the NHS HSCIC earning our trust to safeguard our personal medical records. This is a big ask. Towards the end of the document HSCIC goes large on ‘supporting the wider economy’ and on HSCIC’s ‘international reputation’. HSCIC has 2,100 staff and is headquartered in Leeds. It began life in April 2005 but became a ‘non-departmental public body’ (a sort of Government quango) in April 2013. It is not exactly clear who appointed or voted for the members of the HSCIC Board, but the Board Chair is Kingsley Manning, an ex McKinsey & Company consultant. More at www.hscic.gov.uk

NHS Mental Health in Numbers

22.8% – proportion of NHS health problems in England in 2010/2011 which were mental health problems (The Royal College of Psychiatrists – RCP)

11% – proportion of NHS budget devoted to treating mental health problems in England in 2010/2011(RCP)

2% – size of NHS mental health spending cuts over the last two years (The Guardian)

16% – increase in referrals to NHS crisis and mental health teams over the last two years (The Guardian)

1,700 – number of NHS mental health beds in England closed since April 2011 (Community Care magazine/BBC)

3,800 – number of staff in the West London Mental Health Trust (WLMHT)

800,000 – number of mentally ill people in UK signed off sick (OECD)

1.2 million – number of UK people receiving state financial support because of mental illness (OECD)

£70 billion – annual loss to UK economy caused by inability to work due to mental health problems (OECD)

Are GPs Breaking the Law By Charging Care Homes for Treating The Elderly?

‘The Sunday Times’ last month quoted the British Geriatrics Society (BGS) condemning some GPs who are charging fees to care homes for treating elderly patients. ‘People who live in care homes have already paid through their National Insurance contributions for the basic care provided by a GP,’ said BGS Hon Secretary, Dr Adam Gordon. The Care Quality Commission (CQC) found that 10% of care homes paid GP surgeries for visits.

310,000 Increase in Patients Waiting for NHS Hospital Treatment

NHS data shows that 2.88 million people in England were waiting for consultant-led treatment in December 2013 – up 310,000 or 12% on May 2010. NHS England (that genius organisation employing 6,100 people) opined that citizens growing older and having more than one illness was creating more demand for NHS services. Talk about stating the bleeding obvious….The Labour Party blamed David Cameron and the Conservative Party bamboozled us all with 18 week, 26 week and 52 week waiting figures and quoting a largish number not directly pertinent to the issue  ie 475,000 more NHS operations per year.

Jeremy Hunt Hires Retail Expert to Train NHS Hospital Bosses

Health Secretary Jeremy Hunt MP has hired Sir Stuart Rose to advise him on building up a new generation of managers to transform so-called failing NHS hospitals. Mr Rose has a long pedigree of retail and retail management experience having worked for Burton, Argos, Booker, Arcadia and latterly Marks & Spencer. He had a roller-coaster ride at M&S which he ran from 2004 to 2011. In 2006 he was named ‘Business Leader of the Year’, but in 2008 M&S share price dropped by over 30%. I can’t help but think that this ‘off the wall’ type hiring is as bizarrely unintuitive as the Government hiring Sir Alex Ferguson to transform the management of failing prisons or asking Jamie Oliver to transform the management of failing social services. Estimated to be worth £34 million, Mr Rose will no doubt  feel comfortable working with another multi-millionaire – Mr Hunt. Mr Rose recently defended immigrants arriving in the UK, but not on the grounds of universal equality. His support for immigration into England is based upon the financial benefits it offers UK businesses.

Atos wants To Pull Out of  its £500 Million Work Capability Assessment Contract

Following swiftly on a day of protests outside Atos offices throughout England on 19 February 2014 (including a noisy demo in West Ealing), Atos is now telling the world that it’s attempting an early exit from its contract with DWP which ends in August  2015 The Government is hinting that it might be ‘pushing’ Atos out, as it is mumbling about adding other companies to carry out the controversial assessments. Atos has revealed that its staff have been assaulted 163 times each year during the 600,000 assessments it has carried out. The Labour Government originally contracted with Atos in 2008. Horror stories abound about the 10,000+ deaths recorded soon after disabled citizens were assessed fit for work. Over 40% of those who appealed against Atos assessments have won their appeals. Atos workers went on strike recently for fair pay, at a time when  the Atos Chief Executive took a 14% pay rise.

Issue: 10

February 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.

In this issue:

+ More on Clause 118 – fascist/communist approach to NHS Decision Making

+ Blue Lights Still Flashing at A&Es

+ A&E Closure Offers No Help to Dying Baby

+ We Spend Less/Head than Other Countries on Government Health Spending

+ Want to give Atos Your Identifiable Medical Health records?

+ Will Chemists  Replace or Augment GPs?

+ Mental Health Beds Nightmare

+ The People’s Inquiry for London’s NHS

+ England’s NHS in Numbers

+ No Smoking Anywhere for the Dying, those in Pain and Anxious Carers

+ Circle Private Healthcare on the Sick List

+Upcoming Events

Clause 118 Update

Clause 118 is a proposed amendment to the Health and Social Care Bill currently going through Parliament. It will effectively allow the Secretary of State for Health to close, merge or privatise any hospital willy-nilly. The sweeping new powers would mean that decisions about local hospital provision could be taken in as little as 40 days, regardless of how hospitals are performing. Absolute power will be granted to Trust Special Administrators (TSAs) to make these decisions without any requirement for community engagement or public consultation. A TSA would be brought in under the ‘Unsustainable Provider Regime’ to ride roughshod over local views and impose a reorganisation of any part of any Trusts in the vicinity of the ‘Failing Trust’.

Opponents of Clause 118 include the British Medical Association, the Royal College of Physicians, Save Lewisham Hospital, Unite, the GMB, Our NHS, Keep Our NHS Public, National Health Action Party, NHS Support Federation, GMB and Ealing TUC Save Our NHS Campaign.

A final vote in Parliament is due in February 2014.  

Accident & Emergency Departments in England in Crisis

Dr Cliff Mann, President of the College of Emergency Medicine, says that there should be 260 new A&E Registrars each year, but over the last three years only half that number have been recruited.

Many A&E doctors are working at understaffed A&E departments throughout England. Mann describes these working environments as ‘intense, unremitting and increasingly unrewarding’. Doctors regularly work extended shifts and weekend shifts.

Ideas have been mooted for visitors to England, immigrants to England and English expatriates to pay for treatment at NHS Hospital A&E departments. So, as well as NHS A&E staff overnight on Friday and Saturdays nights cleaning up vomit, breaking up fights and episodes with drunks, drug addicts and the mentally ill,  they will also have to act as surrogate immigration officials.

According to a poll conducted by ‘The Guardian’ newspaper 88% of GPs don’t believe that the 2004 GP contract changes have contributed to greater overcrowding in NHS A&E units. The changes meant that GPs no longer had to provide out-of-hours care. Jeremy Hunt has often cited the 2004 contract changes as a key contributor to current A&E overcrowding.

The Labour Party has calculated that spending on temporary locums in A&E in England is up 60% since 2009. £83 million was spent on A&E locums last year, with some temporary staff earning £1,500 per shift.

In January 2014 the NHS announced it would give more money to support A&E units. The money was originally to be spent by local NHS organisations to set up initiatives to reduce avoidable trips to A&E. According to ‘The Guardian’ very few of these schemes have been set up. Monitor, the NHS Regulator, will decide which A&Es get more cash and how much. Critics say that the current funding rules have deprived A&E units of £500 million a year.

Annual attendance at A&E units in England in 2003 was 16,516,845 and in 2013 it was 21,724, 841.

Two Year Old Boy Dies After Mother Rushes Him to Chase Farm Hospital A&E – Only To Find It Closed

A sick two year old boy – Muhammad Hashir Naveed – was rushed by his 27 year old mother Maryam to her local Chase Farm Hospital in Enfield at 3:00am on 15 January 2014. The Government closed this A&E unit on 9 December 2013 – but tragically Maryam did not know this. She frantically got a nurse on the phone and an ambulance was called. It took her son to Middlesex Hospital A&E in Edmonton some five miles away. However it was too late to save him and he died at 4:00am.

No-one knows whether the so called Urgent Care Centre (UCC) at Chase Farm Hospital could have saved Muhammad’s life. This is all a bit irrelevant though as the UCC closed for the night six hours before mother and baby arrived outside the defunct A&E building.

Are We Spending Too Little on Our NHS?

The World Health Organisation (WHO) has calculated the per capita spend (in $s) of Government spending on health. The UK rate at $2,919/head is way below the US at $4,437, The Netherlands ($3,991) and Denmark ($3,861). We also lag behind Austria, Germany, Switzerland, Canada, France and Belgium.

Do You Trust the Government Not To Sell Your Identifiable Personal Medical Records?

The Government wants us all to agree to our personal medical records being anonymised or ‘pseudonymised’ by civil servants and then sold off to anyone who wants to buy them. 26 million Government leaflets aimed at trying to persuade us all to go along with this have been printed and are now being delivered to households throughout England.

This data for sale will include personal data, including National Insurance Number, date of birth, mental health, cancer and substance abuse habit data. Prime potential data purchasers would be insurance companies, pharmaceutical giants and private healthcare suppliers.

The Government recently set up the Health and Social Care Information Centre (HSCIC) which will administer the data collection, pseudonymisation and sale of this data. Worryingly the HSCIC boasts a Public Assurance Director. Even he admits that with plenty of other data a third party could identify individual patients from the data supplied by HSCIC.

Also worryingly, the pseudonymisation software is being written by none other than Atos. The software and the service Atos will create and manage is grandly called the General Practice Extraction Service (GPES). Atos has been working on the software since early 2012. Atos is famous (or possibly infamous) as the software and service supplier for the much discredited Incapacity Benefit assessment service.

And just what is the Government’s recent track record in handling and managing people’s personal medical histories? In a word – disastrous. Prime Minister Blair’s  ‘NHS National Programme for IT’ in 2000 had as one of its objectives the creation (in just three years) of a single electronic system for storing patient records in England which ultimately would be accessible 24/7 by anyone authorised to do so. What happened? The project lurched from crisis to crisis and was effectively abandoned massively unfinished in 2011 with a loss of at least £20 billion to the taxpayer.

And Now It’s Pharmacists Who Will Be Our NHS ‘Primary’ Care Entry Point

NHS England, The Royal College of GPs and Pharmacy Voice have proposed that NHS primary care triage should be carried out at your local Chemist’s.

However, Patient Concern is not happy with the idea that Pharmacists act as almost a ‘gatekeeper’ to conventional NHS Primary and Secondary Care.

Quite frankly, if we are unwell we need someone trained in healthcare – not in medicines – to carry out first contact diagnosis, prognosis and treatment. A severe headache could be treated with pain killers off the chemist’s shelf, but it could also require brain surgery. It’s unlikely that Pharmacists would be able to offer any ‘medicine’ to treat first contact mentally ill people.

However here at Ealing Hospital the A&E and other units will be wound down over the next six years. When  seeing your GP might take days or a week; the NHS 111 telephone service response is slow or deficient; you are not Internet savvy or connected and can’t go online to NHS Choices, then many more ill people are likely turn to their local chemist to help them.  

More on Shortages of NHS Mental Health Beds

The ‘Sunday Times’ has revealed results of research by the Royal College of Psychiatrists (RCP). It was stated that there were 32,000 mental health beds in England and Wales in 2004. ‘Community Care’ magazine has also revealed that in 2011/12 that number in England had dropped to 18,924.

The RCP says that the number of acute mental health beds currently available in the NHS in England has fallen by at least 1,700 since April 2011 – a drop of 9%.

Lack of locally available beds is resulting in treatment delays, and in some cases suicide. In other emergency cases mentally ill patients have variously travelled from Croydon to Hertfordshire, Kent to Somerset and Kent to Carlisle.

The RCP’s recommended maximum occupancy rate for acute psychiatric beds is 85%. Of the 28 Mental Health Trusts who responded to the research all reported occupancy rates of over 85%.

The Care Quality Commission (CQC) has revealed that the number of people detained for mental health treatment under the Mental Health Act was 50,408 in 2012/13. This represents a 14% rise over the five previous years from – 44,093 in 2008/9. CQC also criticised the fact that more than three quarters of wards in mental health hospitals were denying basic human rights such as patients’ use of the internet, use of a mobile phone and use of a secure outdoor space where they could smoke. Mind, Rethink Mental Illness and a group of MPs have all expressed their concern over these figures, the lack of staff and the implementation of the Goverenment’s laudable aspiration to give mental health ‘parity of esteem ‘ with physical health.

And in a January 2014 announcement worthy of inclusion in ‘Alice in Wonderland’, the Government stated that mental health patients are to have the same right to choose where they are treated as those with physical health problems. Let’s hope the mentally ill who live in Croydon choose to be treated in Hertfordshire and those in Kent continue to choose Somerset and Carlisle for their treatment.

The People’s Inquiry for London’s NHS

The People’s Inquiry is a unique, independent exercise in gathering and analysing many peoples’ views on and experiences in London’s NHS. Seven hearings were held across London over October, November and December 2013. At these meetings people presented verbal and written evidence. Funded by the Unite Union the inquiry is chaired by experienced NHS analyst Roy Lilley. The six person panel is currently reviewing and discussing the submissions of almost 100 people. A detailed response with recommendations is expected in March 2014.

An overview of the structure of the final report has been released and its headlines are:

1. The financial squeeze
2. The democratic deficit
3. The Health & Social Care Act has made things worse
4. The new bodies supposed to represent local people are weak and ineffective
5. Management and staff are under pressure.

More at www.peoplesinquiry.org

England’s  NHS in Numbers

+ 4,000 emergency doctors (Keep Our NHS Public –KONP)

+ 32,000 General Practitioners (KONP)

+ 26% of NHS doctors in England are foreign nationals (Health and Social Care Information Centre – HSCIC)

+ 34% of all UK- registered doctors were trained outside the UK (HSCIC)

+ 200 countries are the birth places of staff in the NHS and community health services in England (HISCIC)

+ 135,000 NHS beds in 2013/14 (KONP)

+ 297,000 NHS beds in 1987/88 (KONP)

+ 70% of all NHS contracts for services between April and   December 2013 won by private firms (NHS Support Federation)

+ 80,000 – the number of mental health patients waiting 28 days or more for access to ‘talking therapies’ (HSCIC)

+ £105 billion – estimated cost to the economy due to mental health problems (researched by the Centre for Mental Health and quoted by Minister of State, Paul Burstow MP)

+ 211 – the number of Clinical Commissioning Groups (CCGs) in England

+ 152 – the number of Primary Care Trusts (PCTs) in England effectively replaced by CCGs in April 2013

NHS Addenbrooke’s Hospital in Cambridge is now No-Smoking Inside and Outside. Just How Helpful is this in Reducing Patient and Carer Stress Levels?

This is one of the biggest hospitals sites in the country with a large catchment area. For those seriously ill and for their stressed out carers, having a cigarette might be one of their few pleasures.

Circle’s Credibility Dented Yet Again by its Financial Difficulties and by the Competition Commission’s criticism of its Business Model

‘Private Eye’ had private healthcare services supplier Circle in its sights in January 2014. Circle made a loss of £9.7 million on 6 months sales of £44 million up to June 2013. Conventional debts of £60 million were declared to add to an estimated ‘Enron-esque’ off-balance-sheet (and off-shore) debt of £40 million.

On 27 January 2014 it was the turn of ‘The Times’ to report that the Competition Commission (CC) intended to crack down on schemes whereby doctors who refer private patients to particular hospitals are rewarded with either cash or shares. The CC cites Circle’s business model  – the would-be ‘Big Society’ solution for medicine – as a non-compliant scheme. The CC wants to ban free secretarial services, free consulting rooms for doctors and a £500 limit of ‘freebies’ doctors can receive. These preliminary sanctions will be subject to consultation.

Circle, founded by a Goldman  Sachs banker, is the only private healthcare supplier in England to be running an NHS hospital – Hinchingbrooke Hospital in Cambridgeshire. It also owns and runs its own private hospitals in Bath and Reading and runs the Urgent Care Centre at Ealing Hospital.

Issue: 9

January 2014

HAPPY NEW YEAR!

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.

In this issue:

+ Clause 118 – Unilateralism Gone Mad

+ Elderly Northern Widows – Not an NHS Budget Priority

+ Beveridge-style NHS – On the Sick List

+ NHS Mental Health – Disappearing Beds

+ The Nirvana of ‘Whole Person Care’

+ Serco in Healthcare – Not a Perfect Role Model

+ Is 24/7 NHS Healthcare Achievable?

+ Legal Drug Addicts

+ Primary Care Commissioning is a ‘Mess’ – says NHS Boss

Clause 118: A Fundamental Attack on Democracy

Behaving like, and sometimes looking like, a petulant schoolboy, Jeremy Hunt MP is apparently furious after a humiliating double defeat by judges who ruled that his attempts to close Lewisham Hospital A&E unit were unlawful.

Mr Hunt now wants to have the law changed so he can get his own way. He is championing Clause 118 in the Care Bill. This clause, if adopted, would grant powers to the Government to close a successful and financially viable NHS hospital if a neighbouring NHS Trust was deemed by Government to be failing.  Clause 118 eliminates the need for consultation with patients, the public and even the local CCG.

Clause 118 is a fundamental attack on local democracy and is completely at odds with the Government’s commitment to localism.

The Care Bill was debated in Parliament on Monday 16 December 2013. A 140,000 signature petition to drop Clause 118 was delivered to the Department of Health. Activists rallying outside the DoH’S Richmond House in Whitehall can be seen here: http://www.youtube.com/watch?v=abritFBRs-0

This is the start of the campaign to stop Clause 118 with a final vote in Parliament likely in February 2014.

Beveridge-style NHS Privatisation – History, International Perspective and Bleak Future

Dr Lucy Reynolds in a recent editorial for ‘NHS Managers’ traces the history of state health service privatisation and paints a bleak future for the UK.

John Redwood MP invented the Clinical Commissioning Group device in 1986 as a transitional step to enable the wholesale transformation of our NHS into an insurance-based system.

In Spain, the Beveridge-style NHS has largely been destroyed now as part of the upcoming US-EU trade merger (Transatlantic Trade and Investment Partnership – TTIP) and this has lead to riots over the introduction of charges. The Swedish one has been privatised under competition law, and Sweden’s rural areas now lack medical services. Both Israel and Saudi Arabia had Beveridge-style systems which performed well at low cost, but both are in the midst of privatisation now. It’s only the chaos in Italian politics that has stalled the race to privatisation of health services in Italy under the cloak of European competition law.

In the Cuban Beveridge-style health care system we still have the world’s most competent health service in terms of value for money.

Next year is the target year for signing the TTIP. Probably the most toxic part of the draft TTIP is the ‘investor-state dispute settlement’. This latter mechanism allows big corporations to sue Governments before secret arbitration panels composed of corporate lawyers, which bypass domestic courts and override the will of parliaments. So for example, if the NHS decided in 2018 to outsource the management of the new Ealing Hospital (i.e. the Ealing Urgent Care Centre + ‘Local Hospital’) and UnitedHealth of Minneapolis USA was not invited to bid, UnitedHealth could sue the UK Government. The Green MP Caroline Lucas has published an early-day motion on this ‘investor protection’ issue, but so far only seven MPs have signed up for it.

The EU is attempting to charm us all by predicting the TTIP will create a £1 trillion surge in trade, investment and jobs which will benefit everyone. But the EU just invented that figure and so called ‘free trade’ agreements already in place internationally give the lie to this invention. For example Obama pledged the US-Korea Free Trade Agreement would increase US jobs by 70,000: in fact they dropped by 40,000. Clinton claimed the North America Free Trade Agreement would create 200,000 new jobs but it actually lost 680,000 jobs.

The outsourcing of commissioning support scheduled for 2016 potentially hands control of £65 billion for commissioning NHS secondary and community healthcare to the for-profit sector.

NHS North /South Funding Disparity Penalises The Elderly

David Blunkett MP, writing on the online Guardian web site, points up north/south NHS funding differences. For example the north of England is bracing itself for NHS cuts of £722 million, whilst the Thames Valley can look forward to a growth in NHS allocated funding of £148 million.  

This disparity seems somewhat unfair on the elderly, who are generally better off in the south than in the north. There may be more retired people in the south, but many are retired comfortably with income to buy in the kind of help that keeps people active, interested and alive. Many elderly people in the north, already historically disadvantaged, are currently struggling to make ends meet.

The over 85 population in England and Wales reached 1.25 million in 2011 with over 830,000 of them women, of which 620,000 are widows. So it’s the ‘oldest old’ northern widows out of the whole elderly population who are likely to suffer most from the regional disparity of NHS budget cuts.

NHS Mental Health Bed Shortages

‘Health Service Journal’ recently reported that the provision of mental health beds in England had fallen by 31 % over the last 10 years. Over that same period mental health detentions have increased by 6%. Zero psychiatric beds were available in London on two occasions in August 2013. Out of area placements are not uncommon and the use of private provider beds at up to £3,000/week is also not unusual. Long journeys for patients and their loved ones are on the rise. The worst example is that of Manchester Health and Social Care this summer sending 86 patients to a string of private providers some as far away as Harrow – nearly 200 miles distant.

In London, over the last 10 years the number of mental health beds per 100,000 population dropped from 51 to 32 by September 2013.

The NHS mandate states:

‘By March 2015….we expect measurable progress towards achieving true parity of esteem (for mental health), where everyone who needs it has timely access to evidence based services’.

Only 14 months to go for the NHS to meet these expectations…….

The Nirvana of ‘Whole Person Care’

The ‘Toward Whole Person Care’ report from the  Institute for Public Policy Research (IPPR) recently tackled this subject. Jackie Ashley’s recent review of this report in ‘The Guardian’ makes for interesting reading.

Anecdotally, it appears, most of us would prefer a health service where we are treated through a single reliable contact. We need to feel more in control and would prefer to stay at home. The seamless knitting together of health care and social care is what we want. Also we’d all like to own our patient records.

However the implications of providing such idealised arrangements are daunting. Providing and maintaining a single point of contact for each of the 45 million adults in England and for each of the 11 million parents and guardians of the children in England is a very big ask.

Healthcare is funded nationally through general taxation, whereas most social care is funded through local authority block contracts and a mix of means-testing and private money.

As for staying at home and making use of home monitoring or tele-monitoring this could become more widespread and save on hospital and GP surgery visits, lengthy journeys and money. But England lags way behind the US and Japan on this.

Owning our own patient records sounds like a great idea. Record sharing and joint care planning offer huge benefits. But not all the historic data is held digitally and the consistent updating of 56 million personal databases sounds like a nightmare project.

Serco Accused of Overcharging and Lying, and Issues a Profit Warning

Serco is one of the country’s leading service outsourcing companies. It claims to employ 5,000 scientists and a forward order book worth £19.1 billion. Serco appears to be good at under bidding for health care contracts, but poor at delivering the contracted service effectively and /or profitably.

+ GP Services, Cornwall

The Government has found that Serco resorted to lying in order to hide the poor quality of its understaffed service. The contract has been terminated 13 months early with Serco stating it will make a £5 million loss on the contract.

+ Managing Braintree Hospital, Essex

Serco was awarded this contract in 2011. It was supposed to run until March 2015, but will now terminate early in December 2014. The hospital apparently failed to attract enough patients and Serco states that it will lose £3 million on the contract.

+ Community Health Service, Suffolk

This contract is currently the subject of a National Audit Office (NAO) inquiry.  NAO concerns about the £140 million service include delays in producing care plans for palliative patients and carrying out health assessments for children in care. Serco expects to make a £9 million loss by contract end in October 2015.

+ Abandons Managing GP Practices and Large Hospitals in England

Serco announced in December 2013 that it was pulling out of managing large NHS hospitals and NHS GP surgeries in England. In October 2013 Serco’s healthcare boss resigned and in November 2013 its UK boss quit.  

Consistent 24/7 NHS Hospitals by 2016?

Sir Bruce Keogh, NHS Medical Director, trumpeted in December 2013 that he wants NHS hospitals to perform consistently seven days a week, every week. Reports suggest that this is much more about resource utilisation than meeting patients’ needs. Trail blazer NHS Salford Royal Hospital, according to 15 December ‘Sunday Times’, is already offering seven day working and is boasting saving 80 beds and £4.5 million in costs delivering urgent care.  However even Keogh admits that seven day working could cost the NHS anything up to an additional £2 billion each year.

On the face of it this will surely generally mean using more dieticians, occupational therapist, speech and language therapists, nurses, healthcare allied professionals, ward clerks and so on it goes. It will also mean needing more beds. If it doesn’t then the NHS secondary care hospital services Monday through Friday must logically be degraded.

Presumably this upgrade in weekend hospital care and treatment will apply to the biggest single cost item in healthcare – mental health. Will the additional mental health staff be available in 2016 to provide 24/7 treatment and care for the mentally ill in NHS hospitals?

All this gush about the ‘inconvenient truth’ that patients fall ill seven day a week makes little sense when seven day, 24 hour GP primary care services are not being simultaneously trumpeted.

Part of the PR splash about this is that it fits in with the goal of fewer but larger and safer hospitals. ‘Safer’ is a tricky one for those whose medical condition will deteriorate or who will die waiting for an ambulance…. travelling in an ambulance….or being parked up in an ambulance queuing outside a rare but large NHS Major Hospital.

Some Privatisation Numbers

+ 10% – of all GP Surgeries in England are run by private companies

+ 358 – the number of GP Surgeries in England run by Virgin Care

+ £20 billion – the value of the NHS budget in England available to private companies over the next few years

+ 105 – the number of companies that have been licensed to provide NHS Community Services

More at www.nhsforsale.info

Deaths from Prescription Antidepressants, Tranquillisers  and Painkillers On the Rise

The ONS has reported that 807 people died last year from overdoses of prescription drugs – a rise of 16% in five years. By far the highest proportion of these deaths – 468 in fact – were prescription antidepressant–related deaths.

An estimated 32,000 Britons are thought to be addicted to painkillers such as Solpadeine and MPs think that 1.5 million people are abusing tranquillisers.

Compared with available help for illegal drug addicts there is relatively little help available for legal addicts.

Obsessive Attempts by Jeremy Hunt MP to Micromanage the NHS

Secretaries of State are appointed presumably to be responsible for strategies and policies. Civil servants are paid to implement these strategies and policies.

So why is Hunt himself phoning NHS hospital managers who have failed to meet performance targets? He also keeps banging on about taking money away from clinicians who fail to meet his targets and standards.

Sir Malcolm Grant, Chairman of NHS England with a staff of over 6,000, has publicly berated Hunt and other politicians about continued meddling in the running of the NHS.  

Primary Care Commissioning is a ‘Mess’ Admits NHS England Director

‘PULSE’ December 2013 quotes NHS England Medical Director Dr. Mike Berwick saying his organisation is making a ‘mess’ of Primary Care commissioning.

He says NHS England needs closer engagement with GP-led CCGs to sort this out. A recent survey showed that 40% of CCGs believed that NHS England does not share their vision for Primary Care.

With the 152 PCTs having been replaced by 27 ‘Area Teams’ no doubt GPs feel somewhat remote from NHS regional management. To illustrate this the Area Team where I live in Hanwell is called NHS North West London and is the aggregation of eight CCGs across eight Local Authorities. It serves two million people through the services of 1,100 GPs in 400 GP practices.

Berwick is calling for ‘co-commissioning’ of CCGs with Area Teams. What is co-commissioning you might ask? According to the ‘Governance International’ web site:

‘Co-commissioning involves the public sector and citizens working together, using each other’s knowledge and expertise, to prioritise what services should be provided for which people , using public resources and the resources of communities’.

Now I’m all for citizens being involved in the formative stages of requirements definition and plan making for a whole range of public services, but I’m somewhat apprehensive about citizen involvement in prioritising resources for services such as brain surgery, mental health therapy and the removal of limbs and internal organs.

Ealing Hospital is Open For Business

This was the message which came out loud and clear from Ealing Hospital bosses on 7 November 2013. A group of healthcare activists spent over an hour with David McVittie and Dr William Lynn. The former is Acting CEO and the latter Deputy CEO of the Ealing Hospital NHS Trust.

These managers are clearly responsible for providing a safe, predictable and well resourced set of medical services to anyone who walks through the doors of Ealing Hospital. This is in spite of a continuum of waves of essentially non-clinical challenges forever attempting to disrupt their best endeavours. There’s the marketisation of healthcare, the Foundation Trust imperative, the destruction of the local PCT, the embryonic ECCG, the must-have Trusts’ merger, the Shaping a Healthier Future  hospital downsizing saga, the Francis Inquiry and now the Keogh A&E recommendations.

Some Headlines:

At the earliest Ealing Hospital A&E – as we all know it – will disappear at the end of 2016

Ealing Hospital Maternity Service – as we know it – will disappear in 2/3 years time and probably before A&E is ‘downsized’

Paediatrics – as we know it – will disappear at Ealing Hospital soon after Maternity is ‘reconfigured’

No Ealing Hospital services will be closed down until alternative, accessible services are available elsewhere

David McVittie is an Accountant who cut his management teeth at BT. In the past he ran Hillingdon Hospital and he currently runs, and is based at, Northwick Park Hospital (as CEO of the NW London Hospitals Trust) and is also responsible for Ealing Hospital. William Lynn is a practicing clinician (Tuberculosis expert) who has worked at St George’s, Hillingdon and Hammersmith Hospitals rising to Medical Director level.

Irrespective of what Jeremy Hunt MP said in Parliament on 31 October 2013 and what the NHS NW London Independent Review Panel report says, McVittie says that at some point blue light flashing ambulances will no longer deliver patients to Ealing Hospital. Ealing Hospital will at some point not run an Intensive Care Unit. There will be no surgical in-patient beds and no operations carried out using general anaesthetic.

What is likely to emerge, he says, is some sort of added value Ealing Hospital Urgent Care Centre, with additional ‘bits’ such as X-Ray and scanning. If there is sufficient expected volume then there might also be day surgical facilities.

Central Middlesex Hospital A&E (open 7:00am to 7:00pm) will not close down immediately following the end of this winter.

Post natal and ante natal services will be retained at Ealing Hospital – but no babies will actually be born there under the impending reconfiguration. Viable volumes of births to justify birthing services are 5,600 births/year. Last year just 2,400 births took place at Ealing Hospital. The logic is that skill sets are high with high volumes of work and low with low volumes of work. (However the Royal College of Midwives stated that 28% of Maternity Wards in England turned away mums-to-be because of lack of space or shortage of midwives between April and September last year).

There is currently inadequate capacity at Northwick Park Hospital to take the volume of A&E patients who are currently being treated at Ealing Hospital.

We asked about referrals to private companies e.g. InHealth scanning service in central West Ealing. Not an Ealing Hospital referral practice but an ECCG one. We asked about referrals to other hospitals for certain complaints. McVittie said that for quite a while local hospitals had worked together to maintain sustainable specialist services at one/two hospital e.g. Urology services at Northwick Park Hospital. Haematology was a shared service provided by Ealing and Hillingdon Hospitals. Kidney services were provided by Charing Cross and Northwick Park. The key factors were safety, quality standards and economics.

The merger of Ealing Hospital NHS Trust and NW London NHS Trust was essential for the survival of Ealing Hospital. There is no Plan B.

Ealing Hospital A&E performs well. The additional £3million given by Government/NHS to bolster Ealing Hospital A&E this winter has been used to source additional beds.

Clayponds Hospital will remain operational till the end of 2015. The local PCT wanted to retain it but the new ECCG does not support its retention.

Morale is a problem. Staff retention and attracting high quality staff is challenging with so much uncertainty and confusion surrounding the future of Ealing Hospital.

Ealing Hospital Day Surgery, Brunel Ward 3N, 26 November 2013

My 35 year old son had surgery involving a general anaesthetic. The staff were well organised, welcoming, helpful and flexible. His recovery from the anaesthetic was amazingly rapid.

Thank you and well done Ealing Hospital.

Impressive NHS North West London Peoples’ Inquiry in Ealing Town Hall: 8 November 2013

The People’s Inquiry for London NHS is a massive research exercise being conducted by informed, specialist healthcare practitioners, journalists and policy analysts. Over a six week period it will collect oral and written evidence from over 100 clinicians, patients, carers, activists and expert commentators and researchers. Seven evidence gathering sessions throughout London have been organised from 23 October to 6 December 2013. The Inquiry is funded by the union Unite.

On 8 November 2013, sixteen people gave evidence to an expert, independent panel on their local experiences in the NHS and their views on the NHS  NW London ‘Shaping a Healthier Future’ (SAHF) downsizing experiment. Dr John Lister of London Health Emergency, ‘Guardian’ journalist Polly Toynbee and Dr Louise Irvine GP of Save Lewisham Hospital were amongst those on the panel.

Of the politicians John McDonnell MP Hayes & Harlington and Andy Slaughter MP Hammersmith & Fulham were the most authoritative. Dr Gurkinder Sandhu, a consultant at Ealing Hospital, gave a stunning address on how West London healthcare was slipping into Third World status. Colin Standfield, Chair of Ealing Hospital SOS, presented damning and worrying evidence of Dr Mark Spencer’s economy with the truth. (Dr Spencer is the main ‘poster boy’ for SAHF).  

This five hour inquiry went over much old ground, but some new ground was covered as well. The national and local depth and width of feeling about the breakdown of NHS healthcare is the greatest I have experienced in my adult life. This beats the Iraq War, the Miners’ Strike, the three day week, Arcadia and the Tram.

Of course it’s not impossible that SAHF will be a great success. But suppose it isn’t. Is there a Plan B? Seemingly there is not.

NHS NW London People’s Inquiry in Westminster on Reveals Stark NHS Dysfunctions and Worrying Future Prospects: 15 November 2013

More evidence giving with some interesting facts and views.

Lynn Struthers of City of London Healthwatch presented evidence on unreceptive NHS reception staff, aggressive staff and rushed staff. Inappropriate handling of deaf and elderly patients was highlighted as were referrals to Social Services without discussion with or informing the service user.

She pleaded that patients should not be judged on date of birth. Relocating services was all well and good but new bus services – including night services – must be provided.

The physical pains of people with dementia and Alzheimer’s were routinely being missed e.g. anguish caused by undiagnosed tooth ache.

Over the years the changing landscape of organisations representing patients – Community Health Committees, LINK and now Healthwatch – has not helped in terms of continuity of messaging and reporting protocols.

Does Healthwatch actually have any statutory power? Probably not. Maybe its most useful roles are in advocacy, acting as a consumer voice and as a disseminator of NHS information.

Michael Gold told us that admin costs in the Dutch healthcare service were 3% of total costs in the 1950s. Thatcher in the 1980s raised NHS England admin costs to 10/11%. Today they are 20% and in the USA 30%+.

NHS PFI debts are £60 billion on build cost of £11 billion. The London Hospital PFI debt is the largest in NHS England totalling £115 million every year.

European Competition Law was beginning to slow the process of NHS changes in England. The merger of hospitals/Trusts in Bournemouth and Poole (10 miles apart) was thrown out by a judge as it would have taken away choice for patients.

An even bigger catastrophe awaits us if the EU/US Trade Agreement – being endlessly negotiated – is signed in 2014 on the basis of US companies having a statutory right to be invited to tender for all NHS contracts.

Where is the evidence that ,with rising need, cutting £20 billion off the annual national NHS budget is prudent? Common sense would conclude that the annual budget should be increased to meet this increased need.

Malcolm Alexander warned about paramedics leaving because of the pressurised nature of the job. Paramedics have not been given mobile phones to use in their jobs as their bosses felt they could not trust them not to use them for personal use.

He also quoted very worrying ambulance queuing at hospital statistics. The worst example was 180 patients waiting more than 30 minutes to get into West Middlesex Hospital.

The use of private ambulances is growing within the NHS. There is an issue of consistent performance standards using a fragmented service.

Government’s Plan  to Introduce a ‘Duty of Candour’ into the NHS is Ironic Given the Government’s Lack of It.

‘Sincerity’ and ‘frankness’ are but two synonyms for the word and concept of ‘candour’. Jeremy Hunt MP, the multi-millionaire Secretary of State for Health, wants a statutory duty of candour forcing hospitals to disclose all harm caused to NHS patients. However this sincerity will only be required when patients have died or have been severely harmed or permanently injured. So insincerity will be fine if NHS staff inflict just minor injuries on patients.

In reality compliance with the Health and Safety at Work Act 1974 might have saved about 20,000 preventable deaths during NHS treatment. However apparently the Act has not been promoted, complied with nor regulated.

And Hunt is calling for statutory candour is ironic indeed given his lack of candour at the Dispatch Box in the House of Commons on 31 October 2013. His weasel words on keeping Ealing Hospital A&E open bore no real resemblance to the actual planned destruction of Ealing Hospital A&E over the next few years.

Ealing Clinical Commission Group (ECCG) ‘Divorces’ one set of Partner CCGs and ‘Marries’ another set

At a cold, three hour ECCG Board Meeting in the bleak setting of Greenford Town Hall on 20 November 2013 worrying but incomplete details of ‘reconfigurations’ emanated from Chair Dr Mohini Parmar. Barely eight months old ECCG is walking away from its ‘current’ CCG chums in Brent, Harrow and Hillingdon (the BEHH CCGs) and getting into bed with CCG chums in Hounslow, Central London and Hammersmith & Fulham CCGs’ ‘Federation’. This is the first many of us have heard about this. As the wedding is on 1 December 2013 one wonders whether it is a shot gun wedding.

At a time when local provider Ealing Hospital is trying to merge with Northwick Park Hospital our local commissioner is ‘running away from’ Northwick Park Hospital.

With just one microphone amongst  up to 30 people in the room it was sometimes hard to hear what was happening. Could it be that ECCG/BEHH Chief Officer Rob Larkman has lost his job? ECCG’s launch COO has disappeared and there is now an Interim COO – Kathryn Megson. Is the Chief Financial Officer Jonathan Wise departing? And why are new people such as Bal Kaur, David Archibald and Ursula Gallagher joining the ECCG?

We asked for clarification on what was happening at Clayponds Hospital. The ECCG clearly began to wind it down and staff left. Then Ealing Hospital said it would pay for beds there to cope with the expected winter crisis. No doubt this was part of the £3 million given by Government to help with the impending winter crisis. However the long term solution is to demolish Clayponds and to source these addition beds on a permanent basis by using the SINGLE TENDER WAIVER option. This latter ‘legal’ approach just gives the contact to seemingly the only possible (private of course) provider. None of us had the bad manners to ask who the lucky supplier was/is.

I asked how many of the 79 Ealing GP surgeries have signed contracts to provide Mental Health Primary Care. The answer was none as contracts had only just been sent out. I pointed out that at a public meeting in July ECCG said that Ealing GPs would have mental health training in summer 2013 and that those who had signed contracts would provide Primary Care Mental Health services in autumn 2013. Dr Parmar said ‘Oh, the NHS is always late’. I wasn’t comforted by this.

Dr Parmar seemed irritated by our questions. I still have not had answers to questions I asked her in writing in August 2013.

The meeting finished for us with the ECCG telling us that they had another hour’s confidential business to transact. One can only imagine what this was about and why secrecy was needed in deciding how to spend our money.

Private Patient Use  and PFI Developments Drive England’s NHS Bed Shortage

Hospital beds per 1,000 population in England is 3.3 – whereas in France it’s 6.6 and in Germany it’s 8.2. Income from private patients in the NHS grew by 12% over the last 12 months and a further 10% rise is forecast for the next 12 months.

PFI expert Allison Pollock estimates that each wave of PFI developments has led to a 30% reduction in bed numbers and A&E and community services’ closures.

Why Do I Care?

Staying alive and maintaining our health are major priorities for all of us. I guess being safe, having a roof over our heads and food in our bellies must also rank highly. If for no other reason than the survival of the human race, good education for all our children is clearly essential.

A growing body of opinion demands that these needs are met, as a priority, from the public purse. More money needs to go into the public purse from the very rich. Vanity projects like HS2 need to be dumped. We have to find a better way of measuring human happiness than calculating Gross Domestic Product (GDP).

Eric Leach

Mental Health in Ealing

The budget for mental health is the biggest item in the NHS budget, consuming more than cancer or cardiac services.

There were periods in September 2013 when there were ‘no inpatient beds in the public or private sector available in the whole of England.’ So said Professor Dinesh Bhugra Co-Chair of the Mental Health Foundation.

Severe mental illness levels – the incidence of psychosis – are above the national average in Ealing. Spending in Ealing on severe mental health is higher in Ealing than in most NW London boroughs.

However mental health spending across NW London last year was cut by £20 million (6%). The overall three year cuts (2012 to 2015) will be between £43 million and £54 million.

The severely mentally ill in Ealing who are ‘Sectioned’ under the Mental Health Act are often accommodated outside Ealing as there are too few places available in Ealing.

Hounslow Police tell us that the Lakeside Mental Health Unit at West Middlesex Hospital – just one of the venues for Ealing Sectioned patients – is an ‘Open’ facility and most of the facility is not secure. Patients abscond on a regular basis. I currently visit the assessment section of the facility  on a frequent basis and it is bleak and unwelcoming. This cannot be a pleasant place to work, and caring for people who might self harm or harm others would not be most people’s choice of profession, vocation or job. The communication skills of many of the staff are poor.

The NHS plan for Ealing is to demolish existing ‘first point of contact’ mental health services and for GP surgeries to provide these services. However, if GP surgeries don’t want to do this, the NHS can’t make them as the GPs are private contractors and not NHS employees. To be quite specific about this, top West London Mental Health NHS Trust (WLMHT) psychiatrist Dr Christopher Bench told a public meeting on 24 July 2013:

‘…the care of people with common mental illness or stable severe and enduring mental illness will be transferred from mental health services into Primary Care’.

The sub text of all this is of course saving money by reducing hospital admissions, reducing the time sufferers occupy hospital beds and moving ‘Settings of Care’ out of Ealing Hospital into your GP surgery or even into your own bedroom.

Will it work? Has your GP surgery decided to opt in or opt out of this arrangement for treating the mentally ill? How many of the 79 Ealing GP surgeries have opted out? Dr Serena Foo, Mental Health Lead, Ealing Clinical Commissioning Group (ECCG) told the public meeting in July that co-operating Ealing GPs are being trained in providing mental health services ‘this summer’. GPs, apparently, will begin offering these services in ‘autumn 2013’ in one NHS leaflet and ‘this summer’ in another NHS leaflet.

The Ealing mental health assessment service, based at Cherington House in Hanwell, now no longer operates a ‘walk-in’ service. Sufferers in Ealing are now offered just a 24 hour helpline on 03300 1234 244. Or they could ask their GP – if in fact their GP is signed up to the new mental health Primary Care arrangement. Or, of course, go to Ealing Hospital A&E – for as long as that still exists.

Two amazing figures that emerged at the July public meeting were  ‘700’ and ‘10’. According to ECCG and the West London Mental Health T rust (WLMHT) 700 is the number of mental health patients in Ealing who will be affected by these changes. Out of an Ealing population of 338,000?  That 700 figure takes some believing. The 10 figure is the average ‘less than’ number of mental health patients transferring from Secondary Care (i.e. hospital care) to a GP. And if your GP is opting out of these new arrangements……

If you have concerns about these new arrangements for yourself or your loved ones, ECCG, WLMHT and Ealing Council urge you to contact Sarah McInnes on 020 3313  9257 or at sarah.mcinnes@nhs.net. And good luck in getting a response from Sarah. I telephoned her on 5, 6, 11 and 17 September. There was no human response but I was asked to leave a message. I did this and asked Sarah to call me back. It’s now 29 September and she still hasn’t called me back.

WLMHT seems to want to turn itself into a Foundation Trust. Cynics will argue that WLMHT wants this status so it can earn revenue from offering mental health services to non-NHS patients i.e. to private patients. Cynics might also argue that WLMHT does not have adequate human and facility resources to provide a resilient service to NHS patients, never mind adding non-NHS patients to the workload. I have met some very talented, caring and hard working WLMHT staff. My suspicion and concern is that there are just not enough of them to deal with  today’s workload. – never mind tomorrow’s.

Is Jeremy Hunt Attempting to Micromanage the NHS?

Jeremy thinks that GPs should proactively monitor and manage the care of the frail and elderly when they are in hospital, at home and in care homes. This surely is cloud cuckoo land. He also thinks that all A&E staff should have to have flu jabs. More flexible work hours for carers is another of his big ideas. Not enough on site consultants in A&E departments overnight is another one of his top gripes.

And he also wants to breed NHS super managers by spending £10 million on sending them to Harvard Business School. Clearly world ranked London Business School is just not up to it as far as Hunt is concerned. He’ll also top up these selected managers’ two month jollies in Massachusetts with a stint at the convicted criminal monopoly maintainer Microsoft. Oh dear…

However, if you thought Government ministers were appointed to propose policy, think again with Mr Hunt. With regard to NHS nurses covering their faces (with burkas, for example) he is ducking the issue and passing the buck onto the GMC. Just 17 hospitals in England have banned front line staff wearing the veil. Balancing the issues of effective service delivery, hygiene and religious beliefs and practices can’t be easy – but that’s why Hunt gets paid the big bucks to fashion policy, not to do a Pontius Pilate on it.

Pocket Money for Ealing Hospital Won’t Shore Up A&E this Winter

And he’s dipping into the NHS petty cash to the tune of £55 million to attempt to stave off winter time A&E collapses in Ealing and West Middlesex Hospitals and in eight other London hospitals. So, yet again the Government/NHS takes money away from funding local healthcare services and with the other hand gives some of it back. And just how can that money-at-short-notice be spent? Probably on hiring private sector nurses, doctors, consultants and healthcare service suppliers on very expensive short term contracts.

But we won’t get much extra help at Ealing Hospital according to the Ealing Gazette. The extra cash for Ealing is only £3 million – much less than the NHS paid McKinsey & Company management consultants to come up with the ‘Shaping A Healthier Future’ plan which will destroy Ealing Hospital. The Gazette also quoted an August 2013 report sizing Ealing Hospital’s A&E staff count at 76 – way below its full complement of 106 staff. According to a BBC5 FOI request A&E understaffing is on average 10% – so Ealing Hospital A&E staffing is worse than most.

However at the Ealing Hospital Trust Board Meeting on 26 September the HR Director assured Ealing Trades Council Save Our NHS Campaign observers that there were no problems in recruiting staff to Ealing Hospital. Campaigners also raised issues of patient safety, merger, service and equipment removal and lack of community engagement. Active Chief Executive David McVittie  agreed to meet the campaigners at a separate meeting to answer all of our questions.

Ealing Council Reject or Ignore Any Assistance Offered by Local Activist Groups and Expert Clinicians in Fight to Save Ealing Hospital

Just what is it about Ealing Council that seemingly makes it unable to work in collaboration with local activists, NHS experts and concerned and knowledgeable clinicians?

I have read over 10 excellent Independent Review Panel submissions written by activists, NHS experts and clinicians. On 31 August 2013 Ealing TUC Save Our Hospitals group sent many of these IRP submissions to the Ealing Council Cabinet Healthcare portfolio holder, Councillor Patricia Walker. Not so much as an acknowledgement has yet been forthcoming.

A local clinician has compiled some very compelling treatment inequality data – for which he is an acknowledged practising expert.  However hard he tries, Ealing Council’s in-house and external experts do not even want to discuss this ‘new’ avenue of approach to save Ealing Hospital.

ECCG’s Dr Parmar is Again a No Show as 100+ Turn Up to Hear and Question Her at Ealing Town Hall

Seniors Action Group Ealing organised an event on 11 September 2013 to discuss changes in our health services. 100+ turned up to quiz Ealing Clinical Commissioning Group (ECCG) Chair Dr Mohini Parmar but she failed to show up – much like she failed to turn up at organised public events in 2012 on 26 September and on 11 October.

Ursula Gallagher, Borough Director NHS, Ealing filled in. She boldly announced that she did not know much about the current healthcare situation in Ealing as she had been away from Ealing for a year. We also had a weak presentation about the toothless Healthwatch Ealing body.

Dr Kaur, Interim Director Public Health, Ealing spoke about stroke and heart attack care service improvements brought about by centralisation of care. Impressive – but these attacks are only 3% of the A&E inflow. So it’s somewhat irrelevant to the audience’s main issue which was Ealing Hospital decimation of A&E, Maternity and Paediatrics.

The quality of the event came from the angry patients and carers in the audience. Questions there were many, but factual answers there were few. The NHS representative was clearly not aware of NHS’s Dr Mark Spencer’s public statements of demolition and home building plans on the Ealing Hospital site.

There was real emotion and anger from the floor concerning the proposed closure of the successful and well liked Clayponds Hospital.

I asked for details on how many of the 79 Ealing GP surgeries had signed up to provide mental health primary care services. I asked how many of the 207 GPs in Ealing had received mental health primary care training this summer as promised to us in July. The ever smiling Ms Gallagher supplied no answers.

ECCG Refuses to Answer Questions

On 12 August 2013 I sent the letter detailed below to the Chair of ECCG. Over six weeks later and no answer has been forthcoming:

“Dear Dr Parmar,

Belated thanks for your letter to me dated 11 March 2013. I have enclosed a copy of your letter.

1. In 2.in your reply the fact that ECCG/NHS England allows Governing Body members to have shares in Harmoni/Care UK and in other private healthcare suppliers is deplorable. Still with 70 MPs and 120 Peers in the House of Lords having direct or indirect financial interests in the private healthcare industry I suppose you are in good (bad) company.

2. In 3. in your letter you say that ‘the majority of Ealing GPs supported clinical change’. Where is the evidence for this? How many of the 208 Ealing GPs voted for the SAHF proposals?

3. In 4. you talk about ‘an Out of Hospital Strategy’ that we have shared with you’. I am really not aware that you have shared that with me. Please resend it to me.

4. I note that ECCG has now been a statutory organisation responsible for commissioning some 60% of NHS healthcare in Ealing for over three months. I have attended one ECCG Governing Body (GB) meeting and studied the documentation provided at this and other GB meetings. For the absolute lay people these documents are mostly unintelligible. This is unhelpful and does nothing to promote understanding and transparency with regards to the activities and performance of ECCG. Might I suggest that ECCG creates and maintains a glossary of the many acronyms used in the reports. Also the average person in the street cannot understand terms like ‘underspend’, ‘overspend’, ‘adverse’, ‘favourable’, up arrows, down arrows and horizontal arrows. Graphs are fine but  when it’s not obvious what downward travel or upward travel actually means then no universal ‘communication’ is taking place.

5. Can you explain what the £77,000 budget is for ‘Chair and Lay Members’. Is it fees and expenses? In which case what fees and expenses?

6. How can ‘Shaping A Healthier Future’ be ‘making progress’ when four of the hospitals being proposed for downsizing are subject to IRP examination and Ealing Council is pursuing a Judicial Review of the SAHF process and proposals.?

7. In an age of financial austerity how can the ECCG possibly justify an annual spend of £105,000 on ‘Communications and Public Relations’? To rub salt into the wound Month 3 figures show an overspend/deficit of £10,000.

8. Which clinical contracts were transferred to ECCG under Section 300-302 of the Health & Social Care Act 2012?

9. Which services are coming to an end over the next six months? What process does ECCG intend to follow to re-commission these service?

10. Is ECCG considering alternatives to competition, including:

+  a ‘single tender action’ on the basis that there is only one provider ‘capable’ of delivering the service

+ adjusting an existing contract with a provider

Yours sincerely,

Eric Leach”

Dr Spencer, Now a NHS England Big Wig, Attacks Resident ‘Inaccuracies’ on Ealing Gazette’s Letter Page

Here’s my reply:

Dear Sir/Madam,

“Dr Spencer was the medical architect of the ‘Shaping A Healthier Future’ (SAHF) plan. He no longer works locally as he recently became Associate Medical Director for Service Design and Quality, NHS England. The SAHF plan, which cost £7 million, will eliminate A&E, Maternity and Paediatrics at Ealing Hospital. His 13 September 2013 letter published by you attacks my 6 September published letter on the basis of ‘inaccuracies’. Oh dear….

Why is it that Dr Spencer appears to be the lone voice praising SAHF on these pages? No local residents, consultants, nurses, GPs or surgeons seem moved to write in support of SAHF. Five Ealing residents have recently graced these pages with SAHF criticisms.

Dr Spencer has himself said at public meetings that there will be closure and demolition on the Ealing Hospital site.

Engagement by local stakeholders during the formative stage of plan making is what was and is needed. This did not happen with SAHF. I have interviewed attendees at two if the early NHS NW London SAHF gatherings at Lords and at Wembley. Ealing residents at these meetings offered to work with the SAHF zealots to produce a plan. One of them suggested that scientific rigour required running a small pilot. He even offered to give up huge amounts of time to help SAHF. All his and every other Ealing residents’ views and suggestions at these meetings were completely ignored. This is not community engagement. It’s not even public consultation. It’s sales and marketing!

Dr Spencer writes he is proposing to ‘move Ealing Hospital A&E’ not to destroy it. Trying to fit Ealing Hospital into Hounslow (West Middlesex Hospital) or into Harrow (Northwick Park Hospital) or into Hillingdon Hospital does indeed destroy local A&E services in Ealing. One wonders whether Dr Spencer passed his Geography O Level or indeed whether he possesses and can interpret a map of West London.

Yours, in sickness and in health,

Eric Leach”

Nurse/Patient Ratios At Dangerous Levels

3,000 nurses surveyed by King’s College London revealed that in 43% of hospital wards nurses had more than eight patients to care for. A series of studies have shown that in wards with this nurse/patient ratio there was an increased risk of patients dying in hospital.

NHS Trusts are desperately trying to recruit more nurses especially abroad as there are no spare indigenous nurses. Nurses from Spain, Portugal and Ireland are being wooed abroad to try and get them to come here and fill up some of the hole left by 5,000 nurses who have lost their jobs since 2010.

The Chartered Institute of Personnel Development recently noted, however, that recruiting more nurses won’t be sufficient if poor management leads to high levels of stress, absence and staff turnover. A lack of investment in training and development is needed along with better use of qualitative anecdotal data from staff.

NHS Salary Differentials Dominated by 13% Rise in Senior Managers’ Pay Since 2009

 The Health and Social Care Information Centre (HSCIC) has announced that the average full time NHS worker was paid on average £29,543 this year. Senior NHS managers were paid on average £75,759 this year. Other average salaries were nurses £30,619, doctors £58,813 and hospital consultants £87,584.

The Guardian has also revealed that a total of 291 NHS staff employed by NHS England earn over £100,000 per year. 62% of these very highly paid individuals are managers. NHS England employs a staggering 6,115 staff to run the NHS. NHS England, an unelected body, has replaced a Government Secretary of State as the body responsible for the day-to-day running of hospital trusts and clinical commissioning groups. It has an annual budget of £96 billion.

The Guardian yet again quotes HSCIC telling us that  in 2012 700 GPs earned more than £200,00/year, with 160 earning over £250,000/year. These figures include income from the NHS and from private practice. Interestingly enough the number of high earning GPs has gone down somewhat compared to 2011. The BMA is saying that falling pay, increased bureaucracy and growing workloads are all contributing to GP shortages. The average salary in the UK in 2012 was £26,500 (ONS).

706 GP Surgeries in England ‘Need to Make Major Improvements’

So says Professor Steve Field the NHS’s first Chief Inspector of Primary Care. He says that too many of the 7,607 GP surgeries in England are not responsive enough to patients’ needs. He’s going to push for seven days a week GP services. Clare Gerada of the Royal College of General Practitioners  was quick to respond to Field’s plans. She branded them as ‘unrealistic’. GPs get just 10% of the total NHS budget and an additional 10,000 more GPs are needed now to cope with current workloads. She wants NHS bosses to employ more carrot and less stick when dealing with GPs

Independent Review Panel (IRP) A&E Closure at Ealing Hospital is Delayed ‘,..until further work has been completed…’

On 30 October 2013 the IRP report on changes to NHS Services in North West London delayed the destruction of Ealing Hospital A&E using these weasel words:

‘The A&E departments at Ealing and Charing Cross hospitals must be sustained until further work to inform a final decision on the future of these two local hospitals has been completed and the alternative services that will provide a safe, high quality urgent emergency care system for local residents are in place’.

So it’s not ‘if’, but ‘when’.

Jeremy Hunt MP, Secretary of State for Health, did not have the bottle to spell this out in Parliament as Ealing MPs Bray, Sharma and Pound successively battered him and demanded clarity.

Appeal Court Overrules the Department of Heath – Lewisham Hospital Wins Yet Again

On 29 October 2013, an Appeal Court Judge rejected the DoH’s appeal against a Judicial Review decision that halted the downgrade of Lewisham Hospital. This was a slap in the face for Health Secretary Jeremy Hunt MP and an expensive waste of tax payers’ money.

Ealing Council Loses Ealing Hospital Judicial Review in the High Court

On 9 October 2013 Mr Justice Mitting in the High Court would not give his permission for Ealing Council to pursue a Judicial Review  against Ealing Hospital downsizing (part of NHS Shaping A Healthier Future – SAHF).

Ealing Council admits that the judge pointed out that alternative proposals to SAHF had been invited, but none had been given by Ealing Council. The judge cited the approval of SAHF by Ealing clinicians, and that the public consultation was not flawed. These two latter statements are just plain wrong and this leads us to believe that this legal judgement was politically driven.

Maybe this outcome was inevitable or maybe Ealing Council argued the wrong case. We will probably never know, as Ealing Council has consistently refrained from open, collaborative working with activist groups or Ealing Hospital staff to fight the destruction of our local hospital.

The decision seems to be one of approving the SAHF process, rather than approving the NHS NW London closures’ decision. This should worry us all very much as many activists have over and over again highlighted multiple flaws in the public consultation process, not to mention the complete absence of any community engagement during the formative phase of plan making.

We now have the ‘verdict’ of the Independent Reconfiguration Panel (IRP). The IRP Chair, Lord Ribeiro, has never voted against his Tory Party’s wishes. When I was giving evidence to the IRP, the questions from and discussions with panel members almost resembled community engagement. How ironic to have community engagement after the SAHF process has finished, rather than before the plan was formulated! I’m reminded of the Queen’s comment during the trial in ‘Alice’s Adventures in Wonderland’ – ‘sentence first – verdict afterwards’.

Now we know that the IRP and Hunt now back the SAHF, we can look forward to the complete demolition of Ealing Hospital. Somewhere amongst the blocks of private flats some kind of new medical facility will be assembled occupying just 4% of the site that for 34 years housed Ealing Hospital.

Ealing Hospital

Four Ealing residents and patients attended the Ealing Hospital Trust (EHT) Board Meeting on 26 September 2013 as observers. There is no permanent Ealing Hospital boss. However the Acting Chief Executive Officer, David McVittie, attempted to answer some of our questions in public and then offered us a separate meeting with him. Unfortunately, because of his holiday arrangements, this meeting will not take place until 7 November 2013.

The questions and issues we will be quizzing him on include those concerning privatisation, staffing, the attempted merger of the Ealing Hospital NHS Trust with the North West London Hospitals Trust (which includes Northwick Park Hospital), out of hospital services, risk analysis, Foundation Trust aspirations and finance. Mr McVittie is apparently in a difficult conflict of interest position with regard to the merger machinations, as he is the CEO of Northwick Park Hospital, as well as the Acting CEO of Ealing Hospital.

Ealing Hospital NHS Trust is forecasting a £8.9 million deficit for this financial year. Monitor, the NHS regulator, will only grant Foundation Trust status to those Trusts which the Care Quality Commission say are providing good quality care. Foundation Trust status allows NHS staff and facilities to be used by private patients to generate income for the Trust.

All these confusing references to ‘Trust’ are ironic as it’s trust in the future of the NHS which millions of us in England no longer have.

I, like thousands of other Ealing residents and patients, want the retention of District Hospital status for our local hospital – Ealing Hospital.

Dr Mark Spencer Promises What He Can’t Deliver, Reshapes Local NHS Healthcare On the Fly and Voices Unsupported Opinions  

On 24 September 2012 Dr Spencer, at a public meeting in West Ealing chaired by Eric Leach, promised to identify two West Ealing GPs who supported the SAHF proposals. Some eight months later after lots of chasing no such individuals have been named.

Dr Spencer emailed Colin Standfield on 25 October 2013 in connection to loss of Obstetric services at Ealing Hospital ‘…Chelsea and Westminster (Hospital) are online to open their expanded maternity services in December.’ This will be of little comfort to pregnant women in Southall when Obstetrics at Ealing Hospital is destroyed. Colin also points out that the CQC rates Chelsea and Westminster Hospital as overall a riskier hospital to attend than Ealing Hospital.

On BBC London News on 30 October 2013, Spencer said ‘there will be smaller A&Es at Ealing and Charing Cross, (but) they’re unlikely to take blue flashing lights’. A ‘smaller A&E has no defined existence anywhere in the NHS. Did Spencer just make this up on the spur of the moment?

Spencer also comes up with opinions unsupported by any evidence. He states   ‘We know that maternal deaths are most common in the early hours and at weekends.’ Standfield is Chair of Ealing SOS campaign and an established and respected medical research analyst. He spent five days searching for data to back up Spencer’s claims. He looked at data collected in the UK, Guyana, India, Canada, New Zealand as well as in worldwide UN studies. He found no supportive data. The key research report/body in the UK CEMACH/CMACE also failed to support the Spencer assertion.

Dr Spencer MBBS, FRCGP, DRCOG, is the Medical Director, Quality and Service Design, NHS England (London). Worrying isn’t it?

Hospitals and Clinical Units with Insufficient Staff Should be Closed Down Says Robert Francis QC

Robert Francis, the author of the hugely damning NHS Mid Staffordshire Hospital scandal report, believes there is an intimate link between staff numbers and care standards. So much so that units with too few nurses and doctors should be closed down. On that basis Ealing Hosptial A&E in August 2013 with only 76 out of 106 staff should almost certainly have been closed down.

Further, Mr Francis believes that the arguments for legally mandated ‘safe staffing’ ratios, supported by Labour and the Royal College of Nursing – but rejected by Jeremy Hunt MP – are persuasive.

He has also re-iterated his concern that Mr Hunt seems unwilling to introduce some of Francis’ far reaching proposal, such as introducing a duty of candour on individual NHS staff.

After looking at the NHS for three and a half years he has found that  willing staff often lack the support to do their job and feel under valued in what they can do. (‘The Guardian’ 9 October 2013). The Department of Health’s final response to the Francis Report is due later this month.

Jeremy Hunt Wants GPs To Break The Law and Work More Than 48 Hours per Week

The working convention in England for many decades has been to work five days a week and not to work at weekends. The current European Working Time Directive (EWTD) allows GPs to work over nine hours per day Monday to Friday. Those really are quite long days and where some GPs are seeing 60 patients per day even most fit GPs will be tired come Saturday each week. One of the legal solutions to these long hours is the hiring of more GPs. Mr Hunt’s solution is apparently looking at ways the EWTD can be circumvented or in fact changed.

NHS Regulator Mouths Off About The Wonders of Cheap Mexican and Indian Healthcare Services Such As Cataract Surgery and Orthopaedic Services

‘The Guardian’ of 10 October 2013 quotes David Bennett, Monitor’s Chief Executive, as saying that NHS services could be provided at much lower cost by the NHS employing Mexican and Indian private healthcare companies.

These comments seem inappropriate from the person running a body which is the health services ‘referee’ existing to make sure all participants play by the rules and act fairly.

Most of his other comments were about costs and not about how enforcing the ‘rules’ would bring about better clinical outcomes for more and more people. Reducing the number of hospital beds, closing hospitals, introducing private healthcare companies, shifting patients into their community (and into their bedrooms) seem to be Monitor’s raison d’etre.

Is Serco Fit For Purpose? Are Some NHS Contracts Fit for Purpose?

Why, oh why, should Serco be allowed to subcontract an NHS  service contract to another organisation? Serco won a contract in Devon to provide out-of-hours GP services, but now (for whatever reason) it wants to subcontract this service to another organisation. For starters, private contractors should not be allowed to subcontract at all. Accountability goes out of the window and service fragmentation is almost inevitable.

And why Serco anyway? Serco was found by ‘The Guardian’ to have falsified its GP out-of-hours performance data when reporting to an NHS Trust in Cornwall. Serco won this contract on cost. However it was caught out as unsafe and, on one occasion, had only one GP on duty over night to cover the whole of Cornwall.

GP Surgeries ‘Open All Hours’ is Pie In The Sky

One does wonder sometimes whether David Cameron was actually listening in his basic arithmetic classes at Eton College. The Royal College of GPs (RCGP) tells us we need 10,000 more GPs to cope with rising demands. RCGP also informs us that GPs as well as working in their surgeries are also looking after patients in Urgent Care Centres and walk-in clinics and through 111, NHS Direct and out-of-hours providers. So how exactly can any surgery provide an 8am to 8pm service seven days a week as Cameron trumpeted at the Tory Party Conference in Manchester? An even more extraordinary trick would be for the 18 one person GP Surgeries in Ealing to provide this 12 hour every day Primary Care service!

Of the 9,305 GP Surgeries in England only 100 are open on Saturdays and Sundays. 1,439 are open on Saturdays.

The £50 million Cameron pledged to pay for nine 12 hour/7 days a week GP Surgery pilots has been stolen from another part of the healthcare budget and is not ‘new’ money.

We rate very poorly worldwide on our patient-doctor ratio in England. It’s 440:1, and that places us 37th in the world. In Cuba it’s 170:1, in the US it’s 390:1 and in Ireland it’s 360:1. Our medical schools are full to bursting with 10 students applying for every place.

The Government/NHS seems to revel in beating up GPs. How this helps to persuade medical students to go into general practice in England, rather than into hospitals here and abroad, is hard to fathom.

What Do We Want from Our NHS?

When we feel unwell we need rapid access to free expert triage, advice, diagnosis, prognosis, treatment and after-care. Face to face is better than telephone, email, texting or Internet. Using legacy NHS structures this means access to a GP close by and access to a local District General Hospital. It also means access to responsive telephone, email and texting services staffed by clinicians.

It’s not rocket science is it?

NHS England London Region Plans for £4 Billion Additional Cuts

This new regional body, which has replaced NHS London, is already talking about present NHS services in London being ‘unsustainable’. It is proposing future additional cuts of £4 Billion throughout London by 2020. More on this at www.peoplesinquiry.org

The Two Faces of Hunt

‘Stop rejecting complaints by patients…’ says Hunt:

+ Over 60,000 patients complain in writing about plans to close Ealing Hospital A&E, Maternity and Paediatric units. So what does TwoFace do? He’s closing down these hospital units

+ Over 20,000 complain in the streets of Lewisham about plans to close Lewisham Hospital’s A&E, Intensive Care and Maternity units. What does TwoFace do? He’s changing the law so he can close down these units at Lewisham Hospital.

+ ‘Ealing Hospital A&E will not close’ says TwoFace in the House of Commons on 30 October 2013. IRP report of 30 October 2013 accepted by Hunt states, in effect, that after ‘further work’ including setting up ‘alternative services’ – A&E will close.

£22.7 Billion Set Aside by NHS to Cover Medical Negligence Lawsuits

The NHS 2013/14 budget provision for medical negligence is a staggering 22% of the whole NHS budget for England. With this money over one million nurses could be hired. Some individual payouts are over £1 million.

Competition Champion To Take Over NHS England

Simon Stevens, currently President of the largest US healthcare company UnitedHealth in Minneapolis, will replace David Nicholson as NHS England supremo in April 2014. He’s 47 years old, born in Birmingham and a former Labour Councillor

Stevens, a former advisor to Tony Blair from 1997 to 2001, is a fan of Free School zealot Michael Gove MP. Ominously he drove the introduction of independent private sector healthcare suppliers into the NHS under New Labour.

UnitedHealth must be heart broken to lose him. Maybe he will find some way to connect with his former senior executive chums in his new role…..

CQC Rates NHS Northwick Park, Central Middlesex  and West Middlesex Hospitals as At Risk of Poor Quality Care

The Care Quality Commission (CQC) exists ‘..to make sure hospitals, care homes, dental and GP services and all other care services in England provide effective, compassionate and high quality care’.

CQC in October 2013 rated NHS Trusts from 1 to 6. 1 = high risk of poor quality care and 6 = very low risk of poor quality care. Northwick Park, Central Middlesex and West Middlesex Hospitals are rated at 2 i.e  at risk of poor quality care. Hillingdon Hospital is rated at 6 i.e with a very low risk of poor quality care. Ealing Hospital is rated as neither high nor low risk at 3.

BMI Hospitals Is Over £2.2 Billion In Debt and Unhappy with  Competition Commission’s Assertions of Exercising Market Power and Making Excess Profits at Patients’ Expense

‘The Times’ of 19 August 2013 reported on the financial and regulatory ‘health’ of BMI Hospitals, which owns and manages 69 private British hospitals. BMI’s property company has debts of over £2.1 billion on properties which have dropped in value to £1.45 billion from £1.8 billion. BMI’s operating company has debts of £145 million.

BMI was also investigated by the Competition Commission for allegedly carving up the country into local monopolies. The other companies also investigated were Spire, Ramsey, HCA and Nuffield. The investigation was sparked off, in part, by new private healthcare ‘player’ Circle Healthcare in effect complaining that established private healthcare ‘players’ were making it difficult for Circle to join the game.

The Commission published its report on 28 August 2013 and found that most patients in UK private hospitals are paying more than they should for treatment because of a lack of local competition. BMI, Spire and HCA have been ‘earning substantially and persistently in excess of the cost of capital’. 20 hospitals in 11 locations owned by these three private hospital groups will have to be sold by them. The Commission estimates patients were  being overcharged by these three companies by up to £193 each year between 2009 and 2011.

BMI Hospitals is the trading name of General Healthcare Group, itself owned by Netcare and private equity group Apax Partners. Netcare is an investment holding company which manages the largest private health hospital network in South Africa.

Government Takes £20 Billion Out of NHS – and Puts Back £0.5 Billion

Ostensibly to help A&Es which might still exist in the winters of 2013/4 and 2014/5, the Coalition Government – ever aware of the upcoming 2015 General Election – is boasting of giving £0.5 billion to the NHS. As the Coalition Government/NHS is in the process of taking £20 billion out of the NHS this PR farce is pure electioneering.

NHS has Spent £1.4 Billion on Redundancies Since 2010

‘The Daily Mail’ of 28 August 2013 revealed this staggering figure. Other jaw dropping figures are 2,299 staff have been handed six figure ‘golden goodbyes’ with some of them receiving more than £600,000. 20% percent of those made redundant walked straight back into the NHS to take up new positions! Altogether 32,000 managers have been made redundant since 2010. This data was obtained from the Department of Health and the National Audit Office.

With around 4,500 posts in the shiny new world of brand new NHS organisations yet to be filled many, many more millions will be paid out in redundances and recruitment costs.

Jeremy Hunt MP – No Longer Responsible for Supplying a Universal Healthcare Service – Wants GPs to be Responsible for Life and Health

Quoted in ‘The Sunday Times’ of 11 August 2013, Jeremy Hunt says he wants GPs to go back to the days when they checked on vulnerable patients. He clearly means a return to home visits. He also talks about transforming out-of-hospital care. I can’t imagine many existing GPs want the former and it’s unclear certainly in Ealing how and where the latter might be implemented.

GPs are private contractors and are clearly not all ‘biddable’ by the Government/NHS. In fact that has been the case since the NHS was founded 65 years ago.

I can’t find anyone who thinks this is a viable strategy. It will hardly persuade students at medical school to choose to be a General Practitioner in England.

As for hospital services, Hunt wants Consultants to work at night and at weekends. Again this won’t be popular at medical school and as private contractors (again for 65 years) many Consultants will plump for private practice in England or elsewhere. This consequence is probably what Hunt’s ‘handlers’ want anyway.

Hunt also bangs on about sustainability. There is rich irony in this here in West London when it’s his hand which is pushing for the closure of four major hospital A&E departments. Of all these A&E closures, the one at Ealing Hospital in densely populated, expanding and highly deprived Southall is the most unsustainable.

The old chestnut of electronic patient records is on his dance card too. Bill Gates persuaded Tony Blair in 2001 to begin the world’s largest IT screw-up to have online patient records in England by 2005.  This vastly overambitious project (‘NHS Connect’), costed at £12+ billion, was littered with very poor decisions and it petered into oblivion in 2011 having squandered and still squandering around £13 billion. McKinsey, Microsoft, Accenture, BT, CSC and Fujitsu all variously made and lost money in the fiasco. No doubt Hunt wants some other global players to have another go at this search for the unattainable Holy Grail of anywhere, anytime, access to 53.5 million patient records. His deadline for reaching this nirvana is 2018.

Hunt’s comments and ideas on the NHS are about as useful and credible as alleged war criminal Tony Blair’s comments and ideas about peace in the Middle East.

Ealing Council’s Request for a Judicial Review (JR) of NHS NW London’s Proposed Downsizing of Ealing Hospital is Denied

No details are seemingly available on why the JR was refused. Of course Justice Secretary Grayling said in April 2013 that many JRs were  ‘…needlessly holding up building projects’. So maybe it’s a political decision and the Government wants to crack on and demolish Ealing Hospital and get some luxury flats built on the site.

Independent Reconfiguration Panel Evidence Gathering Ends as Developer Announces Plans To Increase Southall’s Official Population by Some 10,000 Residents.

Clearly the biggest losers in the downgrading of Ealing Hospital will be Southall residents. And in the great big wonderful joined up world we live in Berkeley Group is trumpeting building 3,750 new homes in Southall. This development alone (on the old Gas Works site) will raise the official population in Southall by some 10,000 within 15 years. The 2011 population projections estimated that Southall’s population in 2015 would be 84,000. Add maybe 5,000 illegal residents living in sheds in Southall then a population in 2015 of 89,000 emerges. If we then add the new Gas Works site residents we begin to approach 100,000.

Parts of Southall are in the top 5% deprived areas in England in terms of income deprivation, crime and access to housing and services. The incidence of Chronic Heart Disease, Diabetes and Tuberculosis in Southall is very high.

For Ealing generally the semi-destruction of Ealing Hospital is a real backward step. Birth rate in Ealing in 2012 was 81.8 births/1,000 women (15 – 44 years of age) – well above the national average of 65.4 births/1,000. In 2012 there were 28,200 under fives. The loss of well performing Maternity and Paediatric units at Ealing Hospital will seriously adversely affect expectant mothers, babies, toddlers and nursery children in our town.

On the independence front I recently discovered that Chair of the Independent Reconfiguration Panel Lord Ribeiro is an advisor on hospital reorganisation to PriceWaterhouseCoopers. You just couldn’t make this stuff up.

Patricia Hewitt Wants the NHS to Operate in India

Australian born ex-MP Patricia Hewitt is Chair of the UK India Business Council. She told ‘Health Service Journal’ in August 2013 that she wanted many UK NHS, private health companies and charities to operate in India.  

As I understand it, Indian hospitals suffer from staff shortages. So….Indian students come to the highly rated UK medical schools to get qualified. (They have a good chance to gain entry as they pay higher fees than indigenous students). Once qualified some of them return home and treat UK patients who are flown over to India for treatment. It does sound nuts doesn’t it?

Dr Kailish Chard of the BMA told the ‘Daily Mirror’ that he thought the plans were ‘..a huge scandal’. He went on to say that the plans ‘..would mean losing manpower here – which could pose a serious threat to patient safety’.

Ms Hewitt had just a two year spell as Health Secretary but gained fame by being suspended from Parliament when caught asking for £5,000/day to advance commercial clients’ interests at Westminster. Her health sector clients include BUPA, Boots and Cinven the healthcare industry buyout specialists.

Anti-Depressant Prescriptions Reach New High in England in 2012 – Over 50 Million Issued

The Health and Social Care Information Centre has reported that anti-depressant prescription issuing was up 7.5% in 2012. In some towns and cities one adult in six was prescribed anti-depressants in an average month. The North features strongly in those places where medication for depression and anxiety was highest – namely Barnsley, Redcar, Durham, Middlesbrough, Salford and Sunderland.

Dr Mark Spencer of NHS England Attempts and Fails to Rubbish Residents’ Views on Closing Ealing Hospital

Ealing Gazette 16 August printed a letter from Dr Mark Spencer who is one of the leading Ealing Hospital closure protagonists. Dr Spencer attempted to belittle local residents’ letters in the previous week’s issue. Here’s the letter I wrote in response to this:

“Dr Mark Spencer of NHS NW London ‘Shaping a Healthier Future’ (SAHF) fame is somewhat selective with his facts in his 16 August 2013 Ealing Gazette letter.

What is beyond dispute is that A&E, Maternity and Paediatrics units at Ealing Hospital will be closed as part of SAHF. 104 beds will be eliminated 2012 – 2015. The Unite Union publicised the NHS NW London Ealing Hospital tower and three level podium demolition cost of £3 million and land sale value of £9.9 million in August 2012. The major hospital that is Ealing Hospital as we have known it since 1979 will soon close and be demolished.

Dr Spencer does not refute Arthur Breens’ 6,000 job losses – he just passes it off as not part of his bit of the NHS! He also writes about ‘employing more GPs. There are no GP employees in the NHS – they are all private contractors. And the additional weight that healthcare ‘promoter’ Jeremy Hunt MP wants GPs to carry – including night time and weekend working – is unlikely to persuade medical students to plump for General Practice in England.

What NHS NW London never did was engage with the local community. Engagement involves sitting down with residents/patients at the formative stage of plan making. Tell us that money has to be saved and discuss with us ways in which sustainable services can still be provided which will inflict the least damage on the vulnerable, sick, injured and disabled.

‘Ealing GPs are developing plans….’ No they are not. It’s clear from attending Ealing Clinical Commissioning Group public meetings that very few Ealing GPs are involved in local health service policy making or planning. A ‘….£83 million new hospital at Ealing…’ . This is a new figure. The new hospital at Barts in London cost £1 billion and the rebuilt and quite small West Middlesex Hospital cost £125 million in 2002. So £83 million won’t build us very much at all in terms of a major hospital.”

.

Shortage of High Quality Doctors

NHS Consultant Surgeon J. Meirion Thomas writing in ‘The Spectator’ on 17 August 2013 pinpoints the shortage of British trained doctors as an urgent problem to be solved. Each year the General Medical Council registers some 13,000 new doctors.

Of these doctors only 6,071 will come from British medical schools in 2013/14. The other new doctors come from medical schools both inside and outside the EU. Recently many of our new doctors are arriving from Greece, Spain, Italy, Portugal and especially Eastern Europe.

The quality of British medical schools is recognised as being higher than those in many other countries. The advantages of native language skills allied to knowledge of British culture and the NHS itself really do matter. Foreign trained doctors, for example, are up to four times more likely to be suspended or struck off here rather than their UK colleagues.

Most applicants to UK medical schools are rejected despite having the required A Level grades. This is because we don’t have sufficient training places in British medical schools.

So stop spending £billions on complex IT health systems which will probably never work. Stop the planned spending of £billions on HS2 to get folks from Birmingham to London 35 minutes quicker and spend all these £billions on TRAINING MORE BRITISH DOCTORS HERE IN BRITAIN.

Some GPs Are seeing Up to 60 Patients in a Single Day

A poll of GPs carried out by the Royal College of General Practitioners (RCGP) revealed that 80% of GPs said that they had ‘insufficient resources’ to provide high quality patient care. 70% were concerned that patients could face longer waiting times. 47% admitted that they had cut back on the range of services they provide for patients.

Patients/Tax Payers Say ‘Raise Taxes to Fund NHS’

‘The Independent’ of 13 August 2013 reported that global tax and audit giant KPMG had carried out a survey of UK patients about the funding of long-term healthcare. 87% said that Government should pay for long-term healthcare. 82% said that social care should also be funded from the public purse. 54% said they were willing to pay more in tax to meet the cost of care. More than 50% said they had ‘no means of supporting’ their own long-term care.

It will be interesting to see if this issue becomes a battleground for votes in the 2015 General Election.

Facts and Statistics You Won’t Like

+ Number of Cancelled Operations

1998:  12,389

2013:  15,443

+ Number of General and Acute Hospital Beds in England

1997:  138,047

2012:  104,858

+Visits to A&E Lasting Over 4 Hours

Q2 2003:  87.3%

Q2 2011:  95.5%

+ Total Number of Visits to A&E

Q2 2003:  3.21 million

Q2 2011:  3.58 million

+ Shortage of Midwives

May 2010:   Cameron pledges to recruit 3,000 new midwives

April 2013:  Only 1,278 new midwives recruited

+ Shortage of at least 47,000 Nurses and Maybe up to 190,000 Nurses by 2016. (Government Report August 2013)

+ Shortage of 650 A&E consultants (College of Emergency Medicine)

+ Peers and MPs with Financial Interests in Private Healthcare

73 MPs and 147 Peers

(May 2013: www.socialinvestigations.blogspot.co.uk)

+ Since May 2010

4,000 fewer nurses in the NHS.

£2.6 billion taken out of adult social care spending.

£3 billion of NHS funds have been spent on ‘reconfigurations’ under the auspices of the Health & Social Care Act 2012.

500 GP practices have stopped opening in the evening and at weekends.

25% of all NHS Walk-in centres have been closed.

25% of Doctors in New Zealand were trained in the UK.

(Much of the above data has been sourced from ‘Hansard’ and ‘The Spectator’).