Issue 75

5 March 2019

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. Increased financial funding is what is needed in our NHS – not financial cuts, closure of vital services or privatisation.

Government Attempts to ‘Sneak’ Through New Legislation Which Legitimises Integrated Care Systems – without Any Parliamentary Discussion or Vote

On 13 February 2019, the Department of Health announced ‘Statutory Instrument 248 – The Amendments Relating to the Provision of Integrated Care Regulations’. These amendments are aimed at changing existing secondary legislation to enable Integrated Care Providers (ICPs) to run a whole range of hospital, Primary Care, community health and social care services. It is due to take effect on 1 April 2019. The National Audit Office, the Nuffield Trust and the BMA have all expressed concerns that there is no evidence to suggest that these new ICPs will reduce costs or improve the quality of patient care.

MPs have not had the chance to debate these ‘amendments’. The Labour Party is attempting to have the Statutory Instrument (SI) annulled. The means to achieve this SI annulment is through ‘National Health Service Early Day Motion #2103’. The deadline for this so called ’Prayer Motion’ to be debated is 24 March 2019.

How this SI might affect any future Supreme Court appeal hearing on the 999callforNHS Judicial Review questioning the legitimacy of Accountable (Integrated) Care organisations is by no means clear. Somewhat inappropriately at the 31 January 2019 NHS England (NHSE) Board meeting it was stated ‘…the Supreme Court is unlikely to grant permission to appeal’. Does this suggest that NHSE has some inside track on how the highest Court in the land will perform?

I urge you all to email your MP and request he/she signs EDM #2103 as soon as possible.

NHS North West London (NWL) Has the Highest Hospital Urgent Repair Liabilities in England – Four Hospitals Alone Need £729 Million in Repairs

A ‘Sunday Times’ investigation published on 10 February 2019 has revealed a £3.06 billion NHS hospitals’ maintenance backlog of ‘high risk’ and ‘significant risk’ problems throughout England in 2017/18. This represents an increase of 102% in three years.

The biggest NHS urgent repair bill in England is at Charing Cross Hospital (£312 million). Following this are St Mary’s Hospital (£229m), Hammersmith Hospital (£108m) and Hillingdon Hospital (£80m). So, NHS NWL has the four biggest hospital repair liabilities in the whole of England.

Maybe one of the reasons for the now discredited NHS NWL 2012 ‘Shaping a Healthier Future’ plan to destroy Charing Cross District General Hospital was to avoid paying the huge (and no doubt growing) urgent repair bill. It’s also interesting to note that the current urgent repair bill for Ealing District General Hospital is less than £41 million.

NHS NWL has made two abortive attempts in recent years to gain capital grants for ‘transformation’ building work (£513m in 2016 and £260m in 2018). Isn’t it about time NHS NWL stopped wasting time and money on failing ‘transformation’ bids and submit some rather more utilitarian bids for urgent repairs to its crumbling hospitals?

NHS England (NHSE) Clears the Way for ‘GP at Hand’ Online/Video Consultations to Expand Out of London to Birmingham

On 13 February 2019 ‘Health Service Journal’ revealed that NHSE had agreed that the Babylon Health’s ‘GP at Hand’ (GPaH) service could be expanded out of London to Birmingham. NHSE had previously stopped the geographic expansion of the use of GP at Hand due to safety concerns. GPaH has been described as an Artificial Intelligence (AI) ‘solution’.

GaH is a digital GP practice, whose terrestrial base is Dr Jefferies’ GP surgery in Fulham. When you sign up to the service your name is added to Dr Jefferies’ list and your name is immediately deleted from your local GP surgery list. So far over 44,000 patients have joined up since the service was launched in 2017. In November 2017 there were some 4,000 patients using the service.

One of the major attractions of the digital service is that patients who are accepted can get an online/video 24/7 Smartphone consultation with a GP within two hours. However, if you are pregnant, have cancer or are mentally ill you are unlikely to be accepted.

NHSE agreed to a six month trial of GPaH in January 2018 in Camden, Islington, Enfield and Barnet. On 17 July 2018 Hammersmith & Fulham Clinical Commissioning Group (H&F CCG) formally objected to the expanded use of the service.  Patient safety was the CCG’s main concern. In 2018 NHSE and H&F CCG commissioned Ipsos Mori to carry out an independent evaluation of GPaH. The final report on the £250,000 evaluation is due in March 2019.

Strong objections to this GPaH expansion to Birmingham have been voiced by the British Medical Association and the Royal College of GPs. These objections include concerns over safety, effectiveness and the threat to ‘place-based’ care delivered by GP practices embedded in local communities.

H&F CCG is still hoping it will be bailed out by NHSE for the cost of funding 1,000s of new patients for Dr Jefferies (£11 million) never mind picking up the tab for new Birmingham based GPaH patients. However re-imbursement is by no means guaranteed.

The Secretary of State Matt Hancock MP has publicised the fact that he is an enthusiastic user of GPaH.  This seems at best a naive admission. Acting as a ‘poster boy’ for Babylon Health appears to be poor judgement. Agreeing to the geographic expansion of the service before the full results of the expensive Ipsos Mori evaluation are made public smacks of incompetence.

The idea that an AI application can of itself ‘replace’ face-to-face consultations with a GP is a dangerous one. AI can, at best, provide useful decision-support tools to support GPs diagnosing a patient’s physical, mental and social problems.

Our GP Workforce is Shrinking – and Future Predictions Suggest Much Worse to Come

A recent survey of 929 GPs in Hampshire and Dorset carried out by ‘BMJ Open’ has revealed that 42.1% of GPs are looking to quit or retire early within the next five years. This figure has risen by a third since 2014. Over 50 % of the GPs said they were working more hours than two years ago, with work intensity and amount the main reason for planning earlier retirement.

According to the Royal College of Nursing (RCN) research about 2.5 million patients are at risk of their local GP practices closing because many rely on GPs close to retirement. 762 GP practices could close within the next five years.

The Government planned to increase the GP workforce by 5,000 by 2020 but the latest NHS figures show that the GP workforce has actually decreased by 1,000. The current national, annual waiting time to see a GP is in excess of two weeks.

Can’t Meet Performance Targets? Oh Well – Let’s Just Scrap Them…..

NHS England (NHSE) has announced it is to scrap the four hour A&E waiting time standard. Introduced in 2004, the target of 95% has not been met by any NHS hospital since July 2015. It has been known for years that hospitals have ‘gamed’ the system by prioritising those patients who have been waiting to close to four hours, rather than those in the greatest need for care. It’s truly ironic that NHSE should be announcing this target scrapping at a time when Type 1 (seriously ill) waiting times across England are the worst ever at 76.1%.

NHSE has itself tinkered with the performance reporting system when it stopped reporting weekly figures and replaced this with monthly figures. NHSE also allowed some hospitals to present A&E performance data in a form inconsistent with most other hospitals. For example Chelsea & Westminster Hospital’s A&E data has for years been concocted in a dissimilar way to all the other six Acute District General Hospitals in North West London.

NHSE says it will investigate other methods of measuring A&E performance. Let’s hope whatever option is selected is one which can’t be ‘gamed’ and one that is consistently implemented and ‘policed’ effectively.

Sign and share our petition

Why are there More Than Double the Number of Non-Elective Admissions to Hospitals of Ealing Patients than Westminster Patients?

Issue: 74

1 February 2019

In the ‘Financial Times’ on 31 December 2018, the article ‘Poor have worse access to GP services’ quoted research that Emergency admissions to hospital were nearly 30% higher in the most deprived areas in England compared with the least deprived areas. The research data was complied by the think tank Nuffield Trust.

The Department of Health and Social Care has just published the Annual Report by the Chief Medical Officer (CMO). In it she reveals that the most deprived children and young people are 60% – 70% more likely to go to A&E than the least deprived. Also a recent report by Dr Foster reports that 70% of High Intensity Users (HIUs) of A&E live in more deprived areas. It states the proportion of HIUs that live in areas in the most deprived decile is around 21.9% compared with around 12.9% for other users of A&E.

Research by retired Medical Physicist Tony Brewer has revealed that big inequalities in hospital Non-Elective admissions are to be found in NHS North West London. (Non-Elective admissions (NELs) are those which have not been arranged in advance. NELs may be Emergency admissions, maternity admissions or transfers from hospital beds in other health care providers).

In 2015/16 there were more than twice the number of Ealing patient NELs compared to Westminster patients. Of the 426,086 patients registered with Ealing’s 79 GP surgeries, 31,726 of them were NEL admissions to hospitals. Of the 177,950 patients registered with 25 Westminster GP surgeries, there were 6,286 NEL admissions.

NHS England employs a technique of ‘Weighted’ GP patient list numbers using the Carr Hill Formula. This weighting takes into consideration patients’ age, gender and health conditions and calculates a weighted count of patients according to need.

Calculated as NELs per 1,000 weighted registered patients, Ealing scored 74.46 whilst Westminster scored 35.32. Admittedly there are only 25 GP surgeries (out of a total of 35) in Westminster included, because there were fewer than 50 NELs or less than 500 registered patients at 10 surgeries.

Further research is underway to expose the inequalities of NELs which occur across Ealing. All this research is using NHS data obtained through Freedom of Information requests.

It would be helpful to discover why these inequalities exist. Possible reasons include:

+ Availability of /access to GPs

+ Differing rates and consequences of Do Not Attend (DNA)

+ Levels of Deprivation

+ Ethnicity

+ Public health factors, including diet

+ Are rich people healthier than poor people?

+ Proximity to Heathrow Airport

+ Use of private hospitals.

London North West University Healthcare NHS Trust (LNWUHT) Attracts Publicity For All the Wrong Reasons

The NHS Trust which runs Ealing Hospital – LNWUHT – scored very poorly in three recent national research surveys:

100% Bed Occupancy

In December 2018, the Trust was one of only two in England which recorded 100% bed occupancy. 95% bed occupancy is the generally accepted safe level.

Did Not Attend

Patients using the Trust hospitals were the worst in England for not turning up for appointments.

Junior Doctors

‘Health Service Journal’ recently published the results of the first national survey of Junior Doctors, following the introduction of the controversial Junior Doctors contract. Junior Doctors are allowed to file a report when they work beyond their contracted hours or work without breaks, as well as other contract breaches. NHS Trusts can be fined for such breaches. The reports are called ‘Exception Reports’. LNWUHT reported the highest number of Exception Reports submitted in England – 25,690 of them by 440 Junior Doctors since 2016.

West London NHS Trust is Amongst 29 NHS Mental Health Trusts Failing to Publish 18 Week Refer To Treatment (RTT) Performance Data

When a GP refers a patient to an NHS Trust consultant-led service for diagnosis, the legal maximum waiting time for the first appointment – as stated in the NHS Constitution – is 18 weeks. This applies to non-urgent referrals for all physical or mental health conditions. All NHS Trusts and all independent providers who provide services by contract with the NHS are legally obliged to record ‘Referral-to-Treatment (RTT) statistics, so that compliance with the 18 week target, and zero tolerance of RTT waiting times over 52 weeks, can be monitored.

Acton based researcher Victor Leser has examined the reported RTT figures for the last complete year. For the month of March 2018, there appear to be 37 NHS Trusts which did not supply/publish the RTT statistics that are legally required. Of the Trusts, 29 mainly provide mental health services, 6 mainly Acute services and 2 are health and care Trusts.

One of the mental health Trusts failing to publish RTT data is West London NHS Trust, which provides mental health services for Ealing residents. Anecdotally Ealing mental health service users and carers were told in 2018 that RTT waiting times would be measured in months or even years. This on the face of it is as scandalous as is the Trust not documenting these RTT waiting times.

Accountable Care Organisation (ACO) Contract Judicial Review  Appeal is Turned Down – but Campaigners Will Fight On to The Supreme Court.

The Court of Appeal ruled in November 2018 against the ‘999callforNHS’ Judicial Review (JR) claim that the Government’s ACO contract is illegal. The campaigning group’s JR was initially unsuccessful in the High Court in April 2018. The group now intends to pursue the case in the Supreme Court. For more details see:

www.999callfornhs.org.uk

Collaboration of NHS North West London (NWL) CCGs

The Collaboration of the eight NHS NWL Clinical Commissioning Groups (CCGs) is a non-statutory body which acts as a cheer leader for the ailing 2012 NHS NWL ‘Shaping a Healthier Future’ (SaHF) project. Rumours abound about financial problems afflicting three of these collaborating CCGs. Harrow CCG is, apparently, soon to enter ‘Special Measures’. Hammersmith & Fulham CCG is suffering a £28 million shortfall largely because of one GP surgery adding 30,000 + new on-line ‘GP at Hand’ patients. Ealing CCG’s £4.8 million A&E costs’ shortfall have just come to light.

The Collaboration’s attempts to gain £millions to implement the NHS NWL 2012 SaHF plan and destroy Ealing Hospital as a District General/Major Hospital seem to have come to an end. The Collaboration’s supremo Mark Easton told the public on 24 January 2019 that any cash it might receive for building work would be for maintenance not for ‘transformation’.

The NHS is very much in the news again with the publication of the Government’s ‘NHS Long Term Plan’, which sets out how the much publicised £20.5 billion will be spent over the next 10 years. There will be some further analysis from Keep Our NHS Public and Health Campaigns Together but their initial thoughts and comments suggest we can expect more bed cuts, rationing and privatisation. –  More on this later. 

First Street Stalls of 2019 – Saturday 19th January:

We are back on the streets, with two simultaneous Stalls from 11.00 – 1.00pm in Pitshanger Lane (near the Co-op) and in Greenford Broadway (near the Wishing Well Bar). Hopefully it won’t be too cold! We will have plenty of leaflets, stickers and ‘Save Ealing Hospital’ posters to give out.  If you can spare an hour or so to help, it would be lovely to see you.

Half of CCGS ‘require improvement’ or ‘inadequate’ and many are in financial trouble!

The National Audit Office has published a really interesting report on the role and costs of Clinical Commissioning Groups (CCGs). These local health bosses, in our case Ealing CCG, commission, monitor and pay for local health services such as Ealing Hospital and community health services (out of hospital services)

They are monitored by NHS England and frankly they are not doing too well. Of the 195 CCGs; 42% are rated ‘requires improvement’; 48% rated ‘good’ and only 10% rated ‘outstanding’. 50% of the criteria are financial sustainability and quality of leadership. It is quite alarming to read that 24 CCGs are reported to be ‘failing’ or ‘at risk of failing’ and one of these is likely to be Harrow, who are commissioners for Northwick Park Hospital.  We have also heard that other North West London CCGs are in financial difficulties including Hammersmith & Fulham and Ealing, which we shall certainly be following up.

The Report can be read here –

Leading NHS campaigners say Government’s ‘NHS Long Term Plans’ spells danger.

Overall the key feature of the 10 year Plan is to keep people out of hospital by whatever means they can, and open the doors to even greater privatisation – all of which spells danger for the NHS.  Plans to cut beds, ‘reduce demand’ through care in the community and ‘self – care’ may sound all too familiar. Well it should, as that’s what North West London’s bosses ‘Shaping a Health Future’ plan has been trying to do in Ealing, and now they are rolling it out around the country.

As well as ‘treating more people’ in the community, the government wants virtual consultation and online diagnostic tools to increasingly replace face to face consultations with GPs.  Greater emphasis is to be placed on telling patients to look after themselves (’empowering us to take more care of our health’) through health prevention schemes and so-called ‘social prescribing’ of dance classes and the like. 

Big plans are also afoot to change the way GPs operate with huge primary care networks servicing up to 50,000 patients and cash incentives for GPs to avoid referring patients to hospital.  

And as for the much publicised  ‘extra’ £20.5 billion, I think Roy Lilley, one time NHS Trust Chair and health policy analyst sums it up rather well – “ After nearly 10 years of flat line funding if anyone says to you the ‘NHS has had a bonanza bung’, they are either fools, liars or can’t add up!  

Please read the initial thoughts from leading campaigners, Tony O’Sullivan, KONP Chair, and John Lister, Editor of Health Campaigns Together here – 

You might also be interested in this article on the dangers of privatisation from GP, Youssef El Gingihy

‘NHS Plan Unfit’ – Protest Thursday 31st January

NHS England, the architects of the 10 year plan have their Board Meeting on 31st January. Keep Our NHS Public wants to give them a clear message from campaigners – ‘NO TO CUTS, RATIONING AND PRIVATISATION’.  There will be a Rally outside the meeting on 31st January from 10.00 onwards at Skipton House, 80 London Road, SE1 6LH.  Our Ealing Save Our NHS banner will be there from 10.30 to 12.00.

Ealing Save Our NHS  AGM & Campaign Meeting – Tuesday 15th January:

It’s the time of the year when we review developments, what we have achieved over the past year and discuss our campaigning priorities for 2019.  It is a good opportunity to find out what we have been doing and help us plan our campaigning for the next few months. Why not come along?

The meeting starts at 7.30pm Northfields Community Centre, 71a Northcroft Road, Ealing W13 9SS (Come a few minutes early if you want tea and coffee)

Ealing Save Our NHS campaigners were out in force on 8th December to spread our Christmas message – “All we want for Xmas is our A&E”, and of course the beds and all the services that back that up too!  

Around 26 people joined in to help give out leaflets and stickers in Ealing, Southall and West Ealing shopping centres, whilst our colourful car and PA toured the street with our message.  

The demand for leaflets was amazing with a whopping 2500 given out in a few hours. The support for our local hospital is just as strong as when we first started campaigning 6 years ago and so very heartening.

It was also very encouraging to hear this week that Ealing’s NHS bosses plan to cut Ealing Hospital have had yet another setback as vital money to extend other hospitals and community services has been refused for a second time by national NHS bosses.

They clearly don’t believe that the closure are viable so why don’t our local NHS bosses just accept it. In the meantime with your support we will keep on fighting till we win.

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1. Time to Dump the failed plan called ‘Shaping a Healthier Future’.

 We now know that once again the NHS nationally have refused financial support for the North West London NHS re-configuration plans.  The capital bid for £260 million, which has been rejected, was intended to expand and develop services in several hospitals in North West London and in the local community to pave the way for downgrading Ealing Hospital from a major to a local hospital.

 It means the discredited ‘Shaping a Healthier Future’ still has no money for their plans to replace hospital beds. This “five-year” plan was adopted in 2012 although as we enter 2019, most of it has yet to be implemented.  The plan involved reducing emergency admissions and the need for hospital beds by caring for patients in the community.  Both Ealing Save Our NHS and Ealing Council have been clear this was wrong and unworkable.  Not surprisingly, the hoped-for reduction in bed use and emergency admissions (called non-elective admissions) has not come about – in fact all the statistics show that emergency admissions are actually rising.

 Nevertheless, in anticipation of the reduction in demand for hospital services, North West London NHS bosses went ahead and closed two much-needed A&Es as well as Maternity and Acute Children’s Services at Ealing Hospital. They have also, as reported in the national media, spent £66 million pounds on 41 different management consultancies.

The main area for expansion has been the development of new layers of NHS bosses including the North West London STP (Sustainability and Transformation Partnership), which overlaps with the ‘Shaping a Healthier Future’ team based in Marylebone, which both overlap with the North West London ‘Configuration of Clinical Commissioning Groups’.

 Oliver New from Ealing Save Our NHS said “Apparently there’s millions to spend on highly paid management consultants and NHS senior management projects, while at the same time front line services are desperate for funding.  It’s time our well-paid health bosses finally faced up to the fact ‘Shaping a Healthier Future’ isn’t working, won’t work and can’t work.  The resources should instead be put into Ealing Hospital, where long suffering staff have been working under a shadow.  Ealing should continue as a proper District General Hospital, not a so-called local hospital”

2. Contracting Out of Ealing NHS Services needs to stop

On Friday 13^th December, Ealing Save Our NHS will hand in a petition to the CCG Health Bosses opposing contracting out of vital services.

 The petition, which has been signed by over 1100 local people, rejects the plans to put district nursing and other community health services into a market-style “single contract”. It also rejects the notion that community care can replace 100’s of hospital beds at Ealing Hospital.

Eve Turner, Secretary of Ealing Save Our NHS said “Contracting out of services is completely the wrong medicine.  Instead of turning our health services into a market place with contracts and fixed budgets, The CCG should be spending our NHS money on urgently needed front line care. This contract made NHS Trusts bid against each other at a cost of millions. ESON also believes the unusual 10-year contract worth up to £1.3 billion is highly risky in the current economic climate.  Written into the contract is an aspiration to replace hospital beds with community services, which we also believe is both wrong and unworkable.”

 Petition wording:

STOP THE OUTSOURCING OF EALING NHS SERVICES

We call on Ealing Clinical Commissioning Group and NHS England to suspend the plan to give all Ealing community-based  NHS Services to a contractor for 10 years.*

Such a plan has never been tried before and includes proposals to replace Ealing Hospital beds with care in the community – which has never been shown to work.

We are opposed to the privatisation and marketisation of NHS services.  Running services to a fixed budget could mean that Ealing patients don’t get treatment which is now available.

*Services that would go out to contact include; district nurses, specialist children’s services, physiotherapy, mental health services, dementia support, audiology, occupational therapy, and more.

Although we are now in the season of goodwill, there is precious little of that coming from North West London NHS bosses, who as you will read below won’t give up their plans to cut our Hospital. Nevertheless we are determined to keep on fighting and we hope you will continue to support us. This Saturday we will be out on the streets for our Xmas Day of Action – so please come and join us, the more the merrier.

Ealing Save Our NHS Xmas Day of Action – Sat 8th December:

This is now an annual feature in our campaigning diary. It’s always good fun and we get a great response from shoppers as we tour round the local shopping centres. We will have our colourful leaflets and stickers to give out and a megaphone to draw attention. Adding to the impact in a big way is our poster- covered Car with P.A system spreading the ‘word’ with maybe a bit of singing “All we want for Xmas is our A&E”. 

We start off leafleting in Southall from 11.00 – 12 .00 noon in Southall, opposite the Town Hall while our PA car tours round. Then from 12.30- 1.30pm we will do the same again in West Ealing near Sainsbury’s before heading off for lunch in Pret a Manger in Ealing Broadway to have a sociable and well-earned chat and sandwich break. Our final session will be from 2.45 – 3.45pm in Ealing Broadway (M&S) where there should be lots of Xmas Shoppers.  If you can join us at any point that would be lovely (contact number on the day 07960 309457)

Threat to Ealing Hospital beds still present!!

In our last Newsletter we were pleased to inform supporters that NHS North West London bosses had been forced to admit that their projections for future bed numbers, made in ‘Shaping a Healthy Future’ in 2012 were wrong and that bed numbers were in fact going up, Following a ‘review’ (ha) they now expected bed numbers in North West London to remain the same for the next 5 years. Since the 500+ planned beds cuts were at Ealing & Charing X Hospitals this sounded like good news.

BUT, the trouble with our NHS bosses is that they are doggedly committed to the ‘Shaping a Healthy Future’ (sic) plans to downgrade our hospitals. So when we asked Mark Easton, boss of NHS NW London whether they would now disband their plans for Ealing Hospital, he said that whilst bed numbers in North West London would not be cut, the location and type of beds could still change in the next 5 years. In other words Ealing’s acute beds are still at risk.

One of the big factors is whether NHS NW London can get the capital from national NHS bosses, to create alternative beds. They are hoping that NHS Improvement will say yes to their second request for half a billion capital.  The first request was turned down last year (with a little nudge from ESON researchers) as their projections for reducing emergency hospital admissions were unbelievable. Nothing has changed in the last year, except emergency admissions are going up not down!  Of course they could try and cook the books and there is evidence for thinking they just might be doing that.

Campaign for Free, Publicly Run Social Care takes first steps:

Over a hundred people, including 6 from Ealing attended a hugely informative ‘Reclaim our Social Care’ Conference organised by Health Campaigns Together in Birmingham last month.

The state of social care and in particular the appalling conditions that care workers have to endure is shocking. For example around 1 million older people who need care don’t get it. Nearly half of the 1.3million people working in the care sector earn less that the real living wage of £9 an hour and one in four are on zero-hours contracts. Our social care system is definitely working well for private care providers who make a whopping 13% profits whilst at the same time local authorities are making 20% cuts!

Moving people more quickly out of NHS hospitals into social care not only transfers the financial burden but also means that people have to pay, unlike for NHS treatment. No wonder the Government is so keen on so-called integrated care. We look forward to supporting this national campaign as it develops and working with the newly founded Ealing Social Care Action Group.

National ‘NHS Safe for All’ Campaign to be launched:  

We all know our NHS staff work hard to get us well and keep us safe. Yet 8 years of under-funding, NHS pay falling behind and rising staff shortages have all taken their toll. Inevitably things go horribly wrong and we usually hear about it in the media. Of course the real culprits don’t get the blame as the media loves a good scapegoat, usually a doctor or nurse or both when the real problem is a failure of the system.

This should be a really exciting campaign uniting, patients, families, NHS staff, campaigners and the wider public.

You can read more here in the Health Campaigns Together newsletter. –

Link to https://www.healthcampaignstogether.com/

Save the NHS money and have a little dance or go to the library!

In a recent speech Health Secretary Matt Hancock set out his ideas for ‘social prescribing’ asserting that “prevention is better than cure”. ‘Social Prescribing’ has existed in the NHS since the 1990s and allows a clinician to refer to or suggest, activities such as dance lessons or art classes to aid a patient’s recovery in certain circumstances.  Mr Hancock said that social prescribing can ‘help us combat over-medicalising people’ and help the NHS to save money.

To this end he is setting up a new Academy for Social Prescribing as a resource for GPs and others. Libraries are to play an important part in social prescribing “ If correctly trained on social prescribing referrals, librarians can play an important role in keeping people well in their communities, encouraging them to take dance classes, join choirs to tackle loneliness or become part of mental health reading groups, Mr Hancock said. So it seems GPs and Librarians are to become social workers too!

It would almost be laughable if it wasn’t the case that the Government’s austerity policies have led to library closures and drastic cuts in preventive health services such as substance misuse services.

More on this story here –

https://keepournhspublic.com/news/social-prescribing-fraudulent-fantasy/

Get Involved – come to our Campaign Meeting Tuesday 11th December:

It’s our last Meeting of the year so mince pies are on the Agenda as will a bit of a review of recent news and events. We always welcome new people to helping with campaigning and our campaign meetings are a good place to start so it would be great to see you.

Please come if you can: 7.30pm, Tuesday 11th Dec in Northfields Community Centre.

You can subscribe to our newsletter here

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It has certainly been an interesting couple of weeks. Our local health bosses, Ealing CCG, have picked the bidder who they want to run our community health services in a massive contract.  It’s a consortium of West London NHS Trust & several other partners using a “corporate structure”. Plus this week, we heard NW London health bosses have confirmed that Ealing & Charing Cross Hospitals were unlikely to lose any beds before 2023.  

NHS bosses forced to admit beds cuts at Ealing & Charing Cross Hospital can’t be done:

North West London health bosses have been forced to acknowledge that their plans to cut hundreds of beds at Ealing & Charing Cross have to be postponed yet again and that no bed cuts will be taking place in the next 5 years.  

In their statement on 18th October, NWL NHS said –  

“We have always been committed to revising our initial projections for future hospital bed numbers in line with actual activity. Our latest analysis suggests that the number of beds in NW London has gone up slightly since 2012 and we expect the number of bed numbers to stay more or less constant for the next five years at least.”  

Of course this is good news as far as it goes BUT these health bosses have STILL NOT CHANGED their plans to downgrade our hospitals merely delayed them until they think it’s safe. They have two problems – local opposition which has been very strong, combined with the fact that their plans would only work if they can reduce hospital admissions, which hasn’t been happening.

This obviously shows how right Ealing Save Our NHS, Ealing Council, health workers and the people of Ealing have been, and how wrong the management consultants and Health bosses have been.

Sadly, Ealing Hospital has been and continues to be deliberately starved of support in the meantime and has lost a number of services. Now more than ever our Hospital needs a big boost of funding and commitment if it is to survive. But there’s light at the end of the tunnel so let’s keep on fighting to save it!

The whole story has been reported in Get West London, which is the online Ealing Gazette.

Here’s how Ealing Council reported it to the public in a recent press release –

If you want to read it from the NHS bosses it’s here

Consortium of NHS trusts to ‘run’ our community health services

Ealing’s health bosses (Ealing CCG) have put our community health services on to the market place.  They asked for bidders to run these NHS services in a 10 year, £1.3 billion contract, claiming that Ealing community health services would be more integrated and co-ordinated if they were run by a so-called ‘single provider’. This is nonsense as most of our community health services are already provided by London North West University Healthcare NHS Trust (London North West Trust), who also manage Ealing Hospital.  There will probably be less integration, not more.

The latest announcement from Ealing CCG is that the contract has been won by a ‘consortium’ of NHS Trusts led by West London NHS Trust (previously – Mental Health Trust).  There may well be a single contract, but it is laughable to call it a ‘single provider’. The winning consortium consists of three NHS Trusts (Central & North West London, Hillingdon and West London) plus at least 2 charities and inevitably many sub- contractors.  On top of that the integration of Ealing Hospital and community health services has been broken, and the London North West Trust will be deprived of considerable finances.

Cuts to our community services seem inevitable as the winning consortium has to deliver a greater amount of community health services within a very tight budget. No wonder that both London North West and Central London Community Health NHS Trust pulled out of the bidding as they felt they couldn’t provide safe, quality services for the money.

Of course we are pleased that a private company didn’t win but this rotten contract system has pitted NHS Trust against NHS Trust, wasting millions of pounds of scarce NHS money in preparing rival bids.  It forces NHS Trusts to behave more and more like private businesses. In fact the contracting system probably wastes between £4 -10 billion pounds of NHS money a year – outrageous!

As the saying goes ‘it’s not over until the fat lady sings’.  This contract still has to be approved by the NHS at a national level and Ealing Save Our NHS has submitted a long list of objections so watch this space to see what happens. We have also requested that Ealing Council use its powers to scrutinise the contract and the impact on the local NHS including Ealing Hospital.

More NHS bureaucracy and name changes

One thing you can be sure of these days is that money can always be found for more NHS bureaucrats. Health bosses in North West London have set up yet another body, catchily called – ‘NHS North West London Collaboration of CCGs’, with a raft of highly paid officers to run it. This new body will be commissioning services across NW London, including acute services, so what we ask, will be the role of local health bosses, Ealing CCG, and any possibility of local accountability- none or next to none we think.

The NHS seems very keen on name changes these days, particularly when they become a bit unpopular, so the North West London STP (the mechanism set up to implement cuts under the guise of integrating health and social care) has now become the ‘North West London Health & Care Partnership’. It is a funny kind of partnership given that two local authorities, Ealing and Hammersmith & Fulham, didn’t sign up to the STP because it meant supporting the closures at Ealing & Charing Cross hospitals.  Since they didn’t toe the line they have been told they can’t be on the Partnership Committee!!

Get Involved – come to our Campaign Meeting Tuesday 20th November:

Ealing Save Our NHS always welcomes new people to helping with campaigning and our campaign meetings are a good place to start.  The latest announcements on the future of Ealing & Charing Cross and the Community Health Services contract will certainly be one of the main discussions. We will also be making plans for a Day of Action in local shopping centres before Christmas. We would love to see you on the 20th.

Please come if you can: 7.30pm, Tuesday 20th November in Northfields Community Centre.

Health tourism – fact or fiction?

A weeny part of the NHS budget is spent on ‘health tourism’, but it’s a great excuse for the Government to pretend we have no money.  What are the facts? Check out this excellent leaflet hot off the press from Keep Our NHS Public.

Reclaim Social Care Conference –  Birmingham Saturday 17 November

This very welcome conference organised by Health Campaigns Together, aims to kick start a much needed major national campaign to reverse privatisation and demand decent publicly funded and accountable social care services for all.

It’s open to all – just register in advance. There will be speakers from Health Campaigns Together, MPs, Care Unions, Disabled People against the Cuts, National Pensioners Convention, Relatives and Residents Association, leading social care policy experts and more with plenty of time for discussion and debate.

More details here

Health Campaigners to get day in court to stop dangerous NHS reorganisation

NHS England is planning a new model of health and social care provision that could see multi billion pound contracts handed over to the private sector. These new contracts called ‘Integrated Care Provider (ICP) contracts will be enormous, covering up to half a million people for 10-15 years.

Health Campaign group, ‘999 Call for the NHS’ have challenged the legality of these plans on 7 grounds.  The protracted legal case is up at the Court of Appeal, probably on Tuesday 20-21 November (confirmation due any time soon) Once again – watch this space.

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Issue: 72

2 November 2018

NHS North West London’s ‘Transformation’ Strategy Crashes and Burns as it Finally Admits to Cancelling the Closure of 500 Beds

On 1 November 2018 NHS bosses in North West London (NWL) finally conceded defeat in their 2012 ‘Shaping a Healthier Future’ (SaHF) strategy. Reducing the number of ‘Major Hospitals’ from nine to five was the major plank of SaHF. In six years they managed to get it down to seven, but now concede (ostensibly till 2023) that the Acute hospitals at Ealing and Charing Cross will not have their Acute beds removed. In fact the number of beds at both sites are being increased.

Surely this is the last straw for SaHF. A list of previous SaHF failures can be found in my missing business case piece below.

NHS NWL is Still Confident it Will Soon Win Approval For its Re-Request for £513 Million for Building Work

Also on 1 November 2018, NHS NWL boss Mark Easton publicly stated that he expected the resubmitted SaHF ImBC SOC1 business case for £513 million for capital projects to be approved ‘soon’. With just months to go until the UK leaves the EU, with tens of £billions at risk, the idea that H.M. Treasury would agree to give NHS NWL £0.5 billion for building work is beyond ludicrous.

Ealing Out Of Hospital Services Contract Not Awarded to a Single Supplier

Our local NHS mental healthcare service supplier is the first company named in a list of five companies announced on 30 October 2018 by Ealing CCG as the winner of the 10 year, £450 million contract. This lead winner received poor CQC reviews in both 2016 and 2017.

The five organisations named in the press release are:

+ West London NHS Trust (was until very recently called West London Mental Health NHS Trust)

+ Central & North West London NHS Foundation Trust (the only other NHS mental healthcare service supplier in North West London)

+ Hillingdon Hospitals NHS Foundation Trust (which runs Hillingdon Hospital – regularly one of  the worst performing Acute hospitals in England since 2015)

+ Marie Curie (‘Care and Support through terminal illness’ charity)

+ Mind (mental health charity)

Also mentioned are ‘other local organisations’ (the number of which and their names are not identified).

There is no single supplier here. Surely this makes the whole procurement process flawed. There has been no overt attempt to create a consortium of the seven (maybe 10, 15…) organisations. What is even more bizarre is that the current supplier of 25 of the 36 OOH Services covered by the contract is our local Trust here in Ealing – the London North West University Healthcare NHS Trust (LNWUH). LNWUH, by the way, was one of two London Trusts which refused to bid for the contract on the grounds that the money on offer was insufficient to provide quality services.

I’m certainly glad that Virgin Care didn’t win the contract. But rumour has that they did submit a bid. If they did, they may well claim compensation – a stroke they have pulled before. I wonder whether we will ever discover, officially, which organisations – single supplier or a group of organisations – actually submitted bids. However, the ever secretive ECCG is unlikely to tell us.

Finally with our local mental health NHS Trust (‘West London’) taking the lead on this contract how might these new responsibilities affect its faltering core mental health services? In 2017, CQC rated nine of its eleven core mental health services as ‘Requires Improvement’. In another bizarre twist on secondary mental health services, it appears that all eight NHS NWL CCGs have delegated ‘upwards’ the commissioning role for this to the non-Statutory NHS NWL Collaboration of CCGs. How this will work is unclear as this collaboration appears on the face of it to be just a set of meetings. However as is the way seemingly in the NHS maybe the Collaboration now employs staff.

Maybe Jam Tomorrow for Mental Health Services According To Hammond’s Budget

On 29 October 2018, Chancellor Hammond announced an additional £2 billion for NHS mental health services in England. Was this new money? No it wasn’t – it’s part of the £20 billion for the NHS announced by Prime Minister May in July 2018. Allegedly ‘the increase’ will begin in 2019/20 but will not be ‘completed’ till 2023

The announcement says little specifically about increasing the number of mental health beds, recruitment and training of more psychologists and other mental health staff. The idea of mental health teams in schools seems helpful on the face of it. But who will staff these teams? Do schools have room for a mental health team? Will teachers be trained as mental help workers? Promising to add specialist mental health support to A&E departments shocks me as I naively thought such support was already universally in place across England.

There’s also no commitment to ring fence this money for mental health use. Both NHS Trusts in North West London which supply mental health services are no longer dedicated just to mental health. In future Integrated Care Providers will ultimately decide how or if this money is spent on mental healthcare and mental social care.

However the caveat to all this is that if Brexit goes pear shaped the NHS budget increase will just not take place at all.

Why Are Business Cases for NHS Transformations Being Withheld From the Public?

I’ve been tracking NHS ‘Transformations’ now for over six years. The NHS intentions for transformations are better outcomes for patients and cost reductions. In a conventional business you would probably borrow money from the bank in order to transform your business. You would write a business plan/business case which would which would have projections of costs and profits. For a private business this business case would only be shown to investors and the bank. For public businesses the investors would be the general public and the business case should be shown to them.

What happens in the NHS?

+ NHS North West London (NWL) ‘Shaping a Healthier Future’ (SaHF)

A ‘final’ business case for this project launched in 2012 appeared in the public domain in December 2016. In September 2017, NHS England (London) and NHS Improvement (London) both rejected the business case. This business case was entitled ImBC SOC1 and it requested £513 million for building work. The cash was intended for GP Surgeries and Acute facilities expansion and the creation of healthcare ‘hubs’. Deploying capital in this way would apparently justify the closure of Ealing and Charing Cross as Acute hospitals.

We have been led to believe that a revised version of SOC1 has been drawn up by NHS NWL bosses and submitted for approval to NHSE/I. NHS NWL has refused to place this new business case into the public domain. However it now appears that the original SOC1 has been resubmitted on a new, different set of forms. Wow! Maybe the new forms will make all the difference….

One of the ‘fragile’ elements of the original SOC1 was ambitious targets for reducing annual Non-Elective Admissions to Acute hospitals by 99,000 by 2015/26. These so called NELs are largely emergency admissions. A recent Freedom of Information (FOI) request to NHS NWL has revealed that NELs continue to rise (not fall) across NWL:

2013/14: 167,222

2014/15: 170,271

2015/16: 175,502

2016/17: 172,142

2017/18: 181,632

In fact the latest data for April, May and June 2018 show that for each month NELs were higher than each of the same months for the previous five years. So the trajectory is upwards not downwards.

On the cost saving front, the original 2012 SaHF public consultation document projected annual cost reductions of  4%. In the first year alone this would have amounted to £144 million in savings. However NHS NWL SaHF has yet to announce any cost savings at all.

In a quite distasteful fashion current SaHF /NHS NWLbosses have just published their own review of SaHF 2012 to 2018. There are few performance metrics in the 11 pages and there are some shocking errors and omissions, which include:

+ The SaHF benefits statement in the review is completely at odds with the 2012 SaHF benefits statement. In 2012 the benefits are localising , centralising and integrated. In the 2018  SaHF review they are personalised, localised, coordinated and specialised. More to the point the 2012 SaHF mission statement says ‘….changes that will improve care both in hospitals and the community and will save many lives each year’

+ Getting a GP appointment takes much longer in 2018 than it ever did in 2012

+ There are no estimates of lives saved by SaHF

+ The 2012 SaHF is purely about NHS physical healthcare transformation and as such is at odds with the 2016 STP and the 2018 Integrated Care Provider contract as the latter two also involve Local Authority social care services transformation and its integration with physical and mental healthcare services

+ The 2012 SaHF changes were to take ‘at least three years to put in place’. Six years on, the SaHF changes are still not in place

+ It was planned in 2012 to close four hospital A&Es, but only two have been closed.

+ After the two A&Es were closed in September 2014, A&E performance deteriorated massively across the whole of  NWL, often being the worst in England. Whilst A&E demand has remained steady it’s only recently that there has been a modest recovery in performance

+ No reference to cost savings

+ So far SaHF has cost over £100 million

+ The 2016 SaHF ImBC SOC 1 business case requesting £513 for building work is still not approved

+ The SaHF ImBC SOC 2 business case requesting £314 million for building work has never appeared in public and little has been heard of it in recent years.

(+ Bed reduction strategy was dumped on 1 November 2018, and this really closes the book on SaHF).

When I ran my own business I performed performance reviews on my staff and on their projects. At school I was never allowed to mark my own homework – this was done by my teacher. It’s high time we had an independent review of SaHF. The last people who should be considered to review SaHF are past and present SaHF bosses.

You can view this partial view of SaHF history at:

www.healthiernorthwestlondon.nhs.uk/sites/nhslondon/files/documents/8._nhs_in_nw_london_-_overview_of_strategic_developments_since_2012.pdf

+ Ealing Out Of Hospital (OOH) Services Contract

Ealing CCG refuses to release the business case supporting this single supplier, 10 year, £450 million minimum contract. ECCG’s reason for withholding this document is that it is commercially sensitive. Well this might have been the case prior to bids being submitted. All bids were submitted by 23 August 2018, so why not release the business case now? What has ECCG got to hide?

ECCG has stated publicly that the single supplier OOH Services contract will not reduce costs. It said cost reductions would be achieved by reductions in NELs. FOI data tells us the ECCG NELs in 2013/14 were 31,335 but by 2017/18 they had risen to 32,561. So the trajectory is upwards not downwards.

As of 30 October 2018 we now know that at least seven organisations have been awarded this ‘single supplier’ contract. Bonkers or what?

+ Integrated Care Provider (ICP) Contract

ICP contracts could, when signed and implemented nationally across the coming decade, amount to £100s billions in value. But, where is the ICP business case? Where in fact is the Integrated Care business case? I can’t find them.

All that seems to exist are various papers written by McKinsey & Co from 2009 onwards containing the dogma that 40% of patients occupying Acute hospital beds shouldn’t be there. Along with this are somewhat dated performance metrics from some of the 50 NHS Vanguards, showing some reduction in the growth rate of NELs. Launched in 2015, these are grant funded experiments, whose results may not emerge till 2020/21. £389 million has already been spent on them but the National Audit Office (NAO) said in June 2018 that it could find no evidence of cost savings. In a stunning NAO statement it noted that ‘NHS England does not intend to continue measuring savings’.