Issue: 71

3 October 2018

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.

Ealing Out Of Hospital (OOH) Services Single Supplier Contract

Ealing CCG has, I think, admitted that it has received three ‘compliant’ bids for this 10 year contract.  Allegedly two of the bidders are:

+ Virgin Care, with some kind of association with Ealing Community Voluntary Service

+ West London NHS Trust (until very recently called West London Mental Health NHS Trust). The bid involves Central and North West NHS Foundation Trust and Hillingdon Hospitals NHS Foundation Trust.

ECCG has promised to make some formal announcement about the ‘outcome’ of the bidding process on 5 November 2018. The plan is that 36 OOH care services will be outsourced to one of these three suppliers beginning on 1 May 2019. The initial contract value is £450 million. Over the course of the contract an additional 24 OOH care services might be outsourced to this supplier and the final value of the contract could reach over £1.2 billion.      

ECCG has refused to place its business case for this contract into the public domain. With the bidding deadline having past there can now be no commercial confidentiality considerations. Has ECCG got something to hide?   

Virgin Care Terminates Elements of Single Supplier, £270 Million Healthcare Services Contract in East Staffordshire

‘Health Service Journal’ has reported that Virgin has terminated large parts of a controversial NHS healthcare contract in East Staffordshire. The contract was awarded in 2015. It was a seven year, fixed price contract. Termination notices have been served for all services for which Virgin is not the direct provider. These services include hospital services, 111 and Out-Of-Hours services. Virgin and the local CCG have been arguing for 18 months. Virgin had asked for £5 million extra funding.

Integrated Care Judicial Review Appeal – Financial Support Needed

On 18 August 2018, the campaigning group 999Callforthe NHS won the right to appeal the failed April 2018 Judicial Review (JR) about Integrated Care. The appeal will be heard before Christmas, but the campaigners need to raise money to cover their costs. Although the Court of Appeal has capped the cost liability, 999CallfortheNHS needs to raise £18,000 very quickly.

You can read the grounds for the appeal and donate money at:

https://www.crowdjustice.com/justice4nhs-stage5-courtofappeal/

If the appeal is successful it’s likely it will make a nonsense of the current public consultation about the Integrated Care Provider contract – as the contract under the microscope might be deemed illegal.

NHS North West London (NWL) Makes a Second Attempt at Extracting £100 Millions from H.M. Treasury for SaHF Building Work

In 2012 NHS NWL launched its ‘at least three year’ Shaping a Healthier Future (SaHF) plans. SaHF would cut costs annually by 4% and would close down four District General Hospitals (DGHs) and their A&E units. No cost savings have ever been announced. After just two of the DGHs and their A&Es were closed in September 2014, A&E performance across NWL immediately plummeted and has never recovered. The two further DGH/A&E closures failed to materialise.

There had been draft SaHF business cases in circulation for three years. The final SaHF ImBC SOC 1 business case finally emerged into the public domain in December 2016. It contained within it a cash-call for building work of £513 million. NHS NWL duly submitted this bid to NHS England and NHS Improvement. In September 2017 NHSE/NHSI (London) rejected the bid on the grounds that the large reduction in emergency admissions postulated were unrealistic. Fairly soon after this rejection the two NHS NWL Accountable Officers resigned.

It has recently emerged that an attempt to submit an updated version of ImBC SOC 1 is underway. Its patron is the new NHS NWL Accountable Officer Mark Easton. We don’t know yet whether as much as £513 million is being asked for again. A copy of this submission has not been offered, as yet, for public viewing. Mr Easton is quoted as saying he expects some response from NHSE/I by November 2018.

Let’s not forget either that in December 2016, yet another final SaHF business case was mentioned in dispatches – ImBC SOC 2. It was, apparently, a business case for SaHF building work in ‘inner’ NWL with a cash-call for £314 million. Here we are 22 months later and SOC 2 was apparently never submitted and has quietly disappeared.

Integrated Care Provider (ICP) Contract Public Consultation

Accountable Care Organisations (ACOs) first caught my eye in 2016. ACOs, an American ‘invention’, involve long term, fixed price care contracts held by a single supplier. The supplier could be a private company. They were touted as the future vehicles for delivering integrated healthcare and social care services. 32 of the 44 STPs published in October 2016 referred vaguely to Accountable Care Organisations/Partnerships as implementation engines for parts of the STPs.  

Nothing much happened with ACOs during 2017 except that two Judicial Reviews (JRs) were initiated challenging ACOs. In January 2018, the JR4NHS JR forced the Government/NHS England to commit to a 12 week ACO public consultation. In February 2018 the Government/NHSE decided to rename Accountable Care as Integrated Care. Integrated Care Systems (ICSs) became the new STP implementation vehicles. The two JRs ended in failure, but the 999CallfortheNHS JR was granted leave to appeal on 18 August 2018 and this appeal is yet to be heard in Court (see above).

In spite of the legal uncertainty surrounding the JR Appeal, the public consultation promised in January 2018 began on 3 August 2018 and will end on 26 October 2018. Of course, we have had another name change and the consultation is entitled ‘Integrated Care Provider contract’.

NHSE has made little attempt to list and explain the issues involved or the likely impact on healthcare patients and social care users under Integrated Care Provider (ICP) regimes.

The massive consultation paperwork is only available online at:

www.engage.england.nhs.uk/consultation/proposed-contracting-arrangements-for-icps/user_uploads/integrated-care-providers-consultation-document.pdf

Health Campaigns Together has assembled a very informative web page which contains lots of background information on ACO/ICS/ICP. It has also created a well considered set of summary answers to the consultation questions. See:

https://healthcampaignstogether.com/ACOmonitor.php

My consultation response also contains the following points:

+  ICPs will be 10 year, single supplier  contracts which will undermine the NHS as the provider of healthcare services and Local Authorities (LAs) as providers of social care services. ICPs will ‘sit above’ NHS Trusts and LAs and will, in effect, commission all care services

+ ICPs will make CCGs redundant – but there are no plans to eliminate CCGs

+ There is no compelling evidence that supports the notion that the integration of healthcare services and social care services leads to better care outcomes

+ No evidence is provided that supports the notion that the single supplier approach results in better healthcare and social care outcomes than employing multiple suppliers

+ The notion that GPs can either work or not work with an ICP is fragile and dangerous .

+ The elephant in the room is that we need to spend more on healthcare services and social care services. The ICP initiative only serves as an unwelcome distraction to these financial deficiencies.

Integrated Care Provider (ICP) London-wide Public Consultation Meeting: Only 12 Members of the Public Attend

On 11 September 2018 in Newington, East London, NHS England mounted a London-wide public consultation event on Integrated Care Provider (ICP) contracts. ICPs are the preferred NHSE vehicles for providing future Primary, Secondary and Out of Hospital healthcare and social care services throughout England. This event was part of the 12 week ICP public consultation which ends on 26 October 2018.

Only 12 members of the public attended this London event. This is out of an adult population in London of over five million. How NHSE can seriously consider this attendance level acceptable is almost beyond belief. When challenged about this clear attendance failure, NHSE’s main speaker Ed Waller pointed out that the event was one of four to be held in England.

Some ICP facts, challenges and omissions thrown up by this event included:

+  10 year contracts only (the 2016 quoted option of 15 years has been dropped)

+  Not fixed price contracts any more (a change from what we were told in 2016) – budgets will be set annually

+  Single supplier ICPs with potentially lots of sub-contractors

+  GP surgeries could be ICP contractors if they wished – but they don’t have to be

+  No clarity of guidance on VAT issues

+  No evidence was presented which supported the view that the integration of healthcare services and social care services resulted in better outcomes for patients and service users

+  Mental healthcare and mental social care services were never mentioned

+  STPs were never mentioned

+  There was no clarity as to how many ICPs might ultimately exist in England -apparently ICP creation is all done locally by CCGs

+ The population of an ICP will be aggregations of GP lists but there will be geographic limits imposed

+  Local Authorities will buy services from ICPs

+  If the ICP is a private company (and not an NHS one) it will not be subject to Freedom of  Information legislation

+  There are potential data sharing problems for ICPs yet to be resolved   

+  No hard copy of the consultation paperwork was given to attendees

+  Dudley is clearly the flagship ICP

Latest news on who will run our community health services & more

The Summer is over but it has certainly was a busy one for Ealing Save Our NHS (ESON). Some of our worst fears about local health bosses (Ealing CCG) plans to get a single provider to run our Out of Hospital services (community health services), have been realised. Our local NHS Trust, who provide community nursing and many other services decided not to bid – definitely bad news.  On the bright side though we managed to give Virgin Care, who want to get their hands on our NHS, a bit of an upset when they came to Ealing last month – please read on….  

Who might run our local community health services?

The whole process of choosing who will win the 10 year, 1.3bn, contract to run our Out of Hospital services (community health services) is shrouded in secrecy but, we now know that at least two NHS Trusts felt unable to bid. These are:-

London North West University Healthcare NHS Trust (our local Trust) who did not submit a bid because there was ‘a significant difference between the cost of the quality of care required and the amount that the tender allows us to spend’. 

And Central London Community Health Trust (CLCH) who pulled out ‘because they can’t provide any decent safe service for the money the CCG was willing to pay’.

The fact that two Trusts felt unable to bid confirms our worst fears that the Contract is not safe, not financially viable and likely to fail as a similar one did in Cambridgeshire. And of course our local Trust is likely to face huge financial problems. Not only will they lose around £45 million in income, but have lost the benefits of sharing costs and staff across both the hospital and community health services. Ealing Hospital could well be a big loser in all this as we have pointed out in Letters to both Ealing CCG and national NHS regulators NHS Improvement. 

We have now asked Ealing Council to join us in pressurising Ealing CCG to commission an independent impact assessment of the single contract on our local Trust and Ealing Hospital as soon as possible.

Virgin Care not welcome here say protesters:

Despite having less than a week to mobilise people, ESON managed to get over 50 people, to join our Protest against profiteers Virgin Care, who came to Ealing Town Hall to sell their wares on 17th August. We were joined by Keep Our NHS Public campaigners from London, West London Unite Community members, Julian Bell, Leader of Ealing Council and Rupa Huq MP.  

Some of us went in to the Virgin Care Meeting, which exposed Virgin’s poor understanding of Ealing’s Community Health Services. They also didn’t seem to understand that they would be expected, if they won the single contract, to deliver a ‘transformation’ so that people would stop needing hospital beds or the A&E! And not surprisingly Virgin told lies about how good they were and tried to deny they had sued the NHS when they lost a contract in Surrey, which is well known!

NHS regulator says we will scrutinise Ealing Contract plans: 

In 2015, an £800 million, 5 year Older Peoples and Adult Social Care Contract in Cambridgeshire collapsed when the Uniting Care Partnership, an NHS Consortium terminated the contract as it was ‘no longer financially viable’.

After this debacle NHS England and regulator NHS Improvement set up strict guidelines to ensure this did not happen again. We wrote to NHS Improvement and NHS England and asked them if they would be scrutinising the Ealing Out of Hospital Contract tendering process and were assured they would. In their own words:-  

“We (NHSI and NHS England) shall collectively consider whether the Ealing CCG governing body and the preferred bidder, when identified, can demonstrate that: …. .. the commissioner (ECCG) and preferred provider have the capacity and capability to deliver the contract.

I think our readers know that we don’t think either the CCG or whoever wins the Contract can deliver but it’s good to know they are being scrutinised.

SAGE Public Meeting ‘Who is taking over our NHS’, Thurs 27th Sept 

Seniors Action Group Ealing (SAGE) is holding this very welcome Public Meeting to discuss how the care of older people will be affected by putting community health services out to tender and how it might impact on specialist services, care homes etc. Initially, the CCG Chair, Dr Mohini Parmar and Managing Director, Tessa Sandall agreed to speak but then withdrew saying it might prejudice the procurement process and therefore they wouldn’t be able to answer all of peoples questions. Perhaps they didn’t like the look of the other speakers?

There is still a very good line-up of speakers with Dr Louise Irvine for Keep Our NHS Public, Julian Bell Leader of Ealing Council, Steve Pound MP and Eve Turner for Ealing Save Our NHS. Please spread the word and come along.

The Meeting is at 5.30pm on 27th September in Ealing Town Hall.

AND another Consultation on restricting 17 treatments

Stories abound now of patients being denied treatment, long delays and alternatives being offered that worsen your condition. Here is yet another rationing of treatment right across England. This time there are 17 treatments/ procedures up for the chop. These include knee arthroscopies for osteoarthritis, injections for non-specific back pain, varicose vein surgery and haemorrhoid surgery. Although it’s ‘claimed’ many of these treatments don’t work, they also aim to save £200 million despite all the extra money that was supposedly given to the NHS.

NHS England are now consulting on their plans, which closes on 28th September via an online Survey, easy to fill in. You can register your views here–

News story with the full list –  here

Please come to our Campaign Meeting – Tuesday 18th September

We meet every third Tuesday in Northfields Community Centre to discuss and update ourselves on what’s happening in Ealing Hospital and our NHS, exchange ideas and thoughts and plan our campaign activities. We very much welcome new people and new ideas for things we can do.

Our friendly and informative meeting is at 7.30pm in Northfields Community Centre, 71a Northcroft Road, Ealing W13 9SS. Tea and Coffee also provided. It would be lovely to see some of you then. 

Street Stall this Saturday in Ealing

This Saturday 15th September we will be leafleting and running a Stall outside Marks & Spencer in in Ealing Broadway from 11.00 – 1.00pm. Why not drop by and help or just say hello. Our latest leaflet is attached for a read.

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Issue: 70

1 September 2018

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.

Ealing Out Of Hospital (OOH) Services Single Supplier 2019 – 2028

The bidding process for a minimum of £450 millions’ worth of work formally ended on 23 August 2018. We are now in the bid evaluation phase with the outcome to be announced at the end of October 2018. There are currently lots of rumours flying around about Virgin Care bidding and then not bidding. If Virgin Care decided not to bid it does seem strange that it should showcase its OOH credentials at a public meeting in Ealing Town Hall on 17 August 2018 (see below).

One organisation we know will not be awarded the contract is NHS LNWUHT, our local Trust which runs Ealing Hospital. On 29 August 2018 ‘The Pulse’ magazine quoted from a letter sent to 800 LNWUHT staff which stated that the money on offer in the Invitation To Tender would not allow the Trust to provide ‘the required quality of care’. So LNWUHT declined to submit a bid.

The question must be asked if one NHS Trust evaluates that there’s not enough money of offer to do the job properly, how could any other Trust come up with a different evaluation?

Accountable/Integrated Care Public Consultation is Underway – But Predictably It’s Not Straightforward

We all have until 26 October 2018 to comment on the draft Integrated Care Provider (ICP) contract. There are three draft Integrated Care Provider contract documents to review. In total there are 227 legal pages to peruse. These are legal draft contracts. It is virtually impossible for a lay person to figure out what these pages actually mean. This is way too much for the general public to deal with. This is an absurd public consultation. It is akin to asking end users of a new computer system to review it by giving them the machine code of the software programmes. Over and above this there is a plethora of supporting documents numbering up to 316 pages. In total there are 543 pages of material to review.

NHS England has provided us all with a set of consultation questions to answer, which could hardly be described as being unbiased. There’s also a questionnaire to fill in which again is ‘directed’ and is really quite long.

View this massive consultation library at:

www.engage.england.nhs.uk/consultation/proposed-contracting-arrangements-for-icps

There are consultation events in London, but you have to register to attend them, and we currently don’t know the venues:

11 September, 10:30am to 12:30pm.

www.events.england.nhs.uk/events/consultation-on-contracting-arrangements-for-integrated-care-providers-icps-34140

11 September, 2:00pm to 4:00pm

www.events.england.nhs.uk/events/consultation-on-contracting-arrangements-for-integrated-care-providers-icps-34144

Court of Appeal Grants Permission to Appeal Against Judicial Review Decision Legitimising NHSE’s New Integrated Care Provider Contract

In April 2018 The High Court ruled against a Judicial Review (JR) application by 999 Save the NHS which sought to question the legality of  NHSE’s Accountable Care (subsequently renamed Integrated Care) contracts and so-called ‘Whole Population Budgets’. 999 Save the NHS decided to appeal against this ruling. On 18 August 2018 it was announced that the Court of Appeal had granted 999 Save the NHS leave to appeal the April judgement. Apparently all seven JR grounds will be reviewed.

This is an enormous embarrassment for the Government. Success in the Court of Appeal could completely invalidate the public consultation on the Integrated Care Providers contract – as the contract itself may not be legally valid.

Over 60 People Demonstrate Against Virgin Care Outside Virgin’s Out of Hospital Services Sales Presentation

On 17 August 2018 Virgin Care presented its Out of Hospital services credentials at a public meeting in Ealing Town Hall. Outside the Town Hall some 60 people noisily protested about the possibility of Virgin Care providing any NHS services in Ealing. Speakers at the demo included Central Ealing and Acton MP Rupa Huq and Ealing Council Leader Julian Bell. The demo was organised by Ealing Save Our NHS. Virgin Care is one of the organisations rumoured to be bidding to run initially 36 care services in Ealing, commencing in May 2019. It’s a 10 year contract which is worth between £450 million and £1.2 billion – with ultimately up to 60 care services to be run by a single supplier.

It did seem odd that Virgin would do this presentation during the bidding process. Even odder was the fact that the presentation was ‘hosted’ by Ealing Community Voluntary Service (ECVS). Incompetently Virgin Care attempted to run this ECVS hosted event initially on 31 July 2018. Virgin Care pulled out of the event at 3 hours notice, but failed to tell all those people registered to attend. Those who turned up to find the event cancelled were none too pleased. I do find it hard to think that a company which can’t even run (and cancel) a sales pitch to the public in a competent fashion could be trusted to run over £1 billion OOH Services for 360,000 people for 10 years.

Ealing GP Federation Isn’t Keen to Discuss Local, Regional and National Care Transformations with Ealing Save Our NHS

Ealing GP Federation, formed in 2014, describes itself as ‘representing all 76 practices’. (There are some 200 GPs operating in Ealing). Since the launch of  NHS North West London’s (NWL’s) ‘Shaping a Healthier Future’ (SaHF) programme in 2012, there have been many care service changes proposed and implemented which directly affect Ealing residents. NHS NWL’s 2016 Sustainability and Transformation Plan (STP) and more recently Ealing CCG’s plans for a single supplier of Out of Hospital Services are having and will have profound impacts on care services.

On 9 July and on 13 August 2018, Ealing Save Our NHS (ESON) wrote to the federation requesting a meeting to discuss the issues raised by SaHF, STP and the Ealing OOH contract. The federation failed to reply to either of these letters until 21 August. Even though I’d spelt out in detail who we were and why we wanted to meet, the federation asked me to repeat all this. It’s inconceivable that the federation does not have opinions and policies relating to these transformation issues. Why would it not want to share its views with ESON or in fact with Ealing patients? The federation’s web site provides no information on its stance on these issues. The federation is not a statutory body and is a private company. It would be fruitless to submit Freedom of Information requests as the federation would have no legal liability to respond.

On the OOH Services front, the federation’s web site ( www.ealinggp.com) contains an undated news story stating that it has been ‘commissioned’ to take on 18 OOH services’. How this relates to the ECCG’s beauty contest to find a single supplier of 36 OOH Services is by no means clear.

ESON finally received a letter from the federation on 29 August 2018 in which it declined to meet ESON. The federation’s CEO stated that they were ‘an organization that wants to work collaboratively with partner organizations to try and facilitate excellence in local healthcare, but can’t directly influence commissioner’s decisions’. It does seem odd to refer to ‘commissioning’ as the federation is not ‘commissioned’ by any statutory body (i.e. not NHSE, ECCG or the Local Authority). It’s a private company whose shareholders are the 76 GP practices in Ealing. The federation clearly does not want to work with ESON.

Greater Manchester (GM) Care Devolution Stalling – Non-Elective Admissions Rising Not Falling

Greater Manchester’s efforts to reduce demand for Acute services (especially Non-Elective Admissions – NELs) are failing. According to ‘Health Service Journal’ in August 2018 NELs have consistently risen since the GM care devolution deal in 2016/17. The £450 million ‘transformation fund’ financial support doesn’t seem to have been much help.

The increase in NELs is a national and regional trend. In NHS North West London (NWL) increases in NELs have consistently frustrated any attempts to breathe life into the 2012 NHS NWL’s ‘Shaping a Healthier Future’ programme and the 2016 NHS NWL Sustainability and Transformation Plan.

Ealing Save Our NHS calls for a halt to outsourcing OOH services & a bit of a protest

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Issue: 69

1 August 2018

Who Might Have Bid for the Single Supplier Up to £1.2 Billion Ealing Out Of Hospital (OOH) Services Contract?

Rumour has it that the bidders will have included:

+ Central London Community NHS Healthcare Trust

+ Hillingdon Hospitals NHS Foundation Trust

+ London North West University Healthcare NHS Trust

+ West London Mental Health NHS Trust

+ Virgin Care

Deadline for submitting an intention to bid was 19 July 2018.

All Attempts to Improve Access to Treatment for the Seriously Ill and Critically Injured (Type 1) in North West London (NWL) Have Failed

In April 2014 healthcare researcher Colin Standfield began collecting and collating A&E performance data at the NWL hospitals. In that month the performance for Type1 A&E patients against the 4 hour target was 88%. Clearly below the 95% target. The latest NWL A&E performance figures (June 2018) are at 80% – so no improvement in over four years. At no time since August 2014 has that figure exceeded 90%. Hillingdon Hospital continues to have the worst performing A&E unit in England at 59%.

In summer 2012, NHS NWL’s ‘Shaping a Healthier Future’ (SaHF) programme promised us ‘improved care, both in hospitals and in the community’. Some six years later this promise to the seriously ill and critically injured has not been kept. The original SaHF Medical Director has been long gone from the project. Of the eight CCG Chairs who signed their name to the SaHF programme, five are still in post. It’s surely time for them to publicly apologise for the failure of SaHF and perhaps consider their positions.

In October 2016, NHS NWL published its Sustainability and Transformation Plan (STP). It promised ‘to improve the health and wellbeing of our residents’. This promise to the seriously ill and critically injured has not been met. Of the five STP sponsors, three have already resigned. Maybe it’s time for the other two to remove themselves as well.

Expansion of ‘GP at Hand’ Online Service Blocked by CCGs

On 17 July 2018, Hammersmith & Fulham Clinical Commissioning Group (CCG) formally objected to the expanded use of the ‘GP at Hand’ Smartphone consultation service. Patient safety was the CCG’s concern. This service, launched in 2017 by Babylon, allows for Smartphone based 24/7 consultation services. One of the conditions to signing up to the services is that you immediately transfer to the GP surgery hosting the service. The launch GP surgery was Dr Jeffries in Fulham. Over 30,000 have signed up for the service which now boasts five London GP surgery sites.

Attempts to expand the service to Birmingham have been thwarted. Birmingham & Solihull CCG has raised concerns about Birmingham GP patients being registered at a GP surgery outside of Birmingham. NHS England (NHSE) also raised concerns in November 2017 when the service expanded to five sites across London. Ipsos Mori is currently conducting an independent evaluation of GP at Hand, which has been commissioned by Hammersmith & Fulham CCG and NHSE.

As ‘Private Eye’ recently pointed out, GP at Hand’s privacy policy clearly states that it may take users’ data to share with third parties. This smacks more of being a transparency policy.

Referral Facilitation Services – the Future for Healthcare ‘Demand Management’?

A member of my family, who has had countless ear infections over many years, recently asked his GP to see a consultant. Weeks later he received a letter from the ‘Ealing Referral Facilitation Service’ (ERFS) granting him an appointment with a consultant on 25 February 2019. This is completely unsatisfactory. The letter itself is a strange beast as it does not bear an NHS logo on it.

Another family member received an ERFS letter telling her that if her referral were to be accepted by West Middlesex Hospital the hospital would contact her. If the hospital did not contact her after a period she should contact them .All attempts to get through on the phone to the hospital have so far failed. Months later she gets a letter from the hospital giving her an appointment date.

My surgery’s Patient Participation Group has attempted to explain how the ERFS works in its current newsletter to patients. The description makes no mention that the ERFS might turn down the GP’s request for a consultant appointment. It also states that a hospital will contact the patient with appointment details. My family knows that this contact might takes weeks or months to be made.

It’s clear from anecdotal evidence that there is no consistency in the way the ERFS works. For some patients, the ERFS does not make it easy for them to exercise ‘patient choice’ as to which hospital they want to be referred.

It almost beggars belief that two GP members of the Ealing CCG Governing Body are also paid Clinical Assessors for the ERFS. So not only do these two receive fees from Ealing CCG as Ealing GPs they also get paid for double guessing their GP peers in Ealing on GP patient referrals to consultants. This is conflict of interest on steroids!

I can find no description of ERFS on any NHS web site. Google can’t find one either. Apparently the ERFS is an outsourced operation run by a private company. Ealing CCG accounts state it cost £849,000 to run ERFS last year.

What’s Happening on the Accountable Care/Integrated Care Front?

When Secretary of State Hunt was confronted with the JR4NHS legal challenge on Accountable Care Organisations in February 2018, he conceded that there had been no public consultation on the issue of Accountable Care Organisations. He said no Accountable Care Systems’ (ICSs’) contracts would be signed until after a 12 week public consultation. Well, the JR4NHS Judicial Review has been and gone but there is no sign of any ACS (now ICS) public consultation. Could it be that as the JR judge found  the Health & Social Care Act 2012 gave very broad discretion to CCGs when commissioning services? Maybe this means no new ACO/ICS Government legislation is needed and perhaps no consultation. It could be that as the other major ACO JR – 999 Call For NHS – is appealing its rejection, the way is still blocked for ICS progress.

It’s clear that ICS contracts for front-runner ICSs in Dudley and Greater Manchester have not been signed. NHS England web pages on ICSs have been unchanged since May 2018.

The High Court Overturns £104 Million Virgin Care Contract for Public Health Services in Lancashire

‘Health Service Journal’ has reported that on 22 June 2018 the High Court found in favour of two NHS Trusts in their action against Lancashire County Council. (LCC). Lancashire Care and Blackpool Teaching Hospital Foundation Trusts took LCC to court after LCC awarded a five year contract for school nursing and health visiting to Virgin Care. The Trusts claimed that LCC’s bid evaluation process was deficient. The judge found LCC’s records of moderation processes fell short of standards required to evidence reasons for the scores awarded to the bidders.

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.

In this article Professor Clara Lowy considers the changes in the urology service affecting services in Ealing Hospital.   

A recent decision has been made to remove Urological surgery from Ealing Hospital – further undermining the Hospital

In 2012 the ‘Shaping a Healthier Future’ plan was born following a very limited public consultation claiming that care could be carried out better in the community rather tha in hospitals. The plan did include reassurance that provisions would be in the community before hospital bed closures.

The two hospitals marked for major downsizing were Ealing & Charing Cross. By 2014 Hammersmith & Central Middlesex had lost their A&E departments – but the promised alternative community services were not in place.  As a result the A&E departments at Ealing, Northwick Park and elsewhere filled to overflow.

Despite this, the Ealing Clinical Commissioning Group and The London North West University Healthcare NHS Trust set about downsizing Ealing Hospital.  First they closed the Maternity Department, then Urological Cancer Treatment, then closure of in patient Paediatric Care and A&E Paediatric Care and now in 2018 Urological Services. The reason given primarily was staffing recruitment and shortages, leading to possible unsafe practises.

A review of the proposed urological service change was presented to the Ealing Council Health & Adult Social Scrutiny Panel after the changes had been ‘enacted’ in June.

I provide here a summary of the outline of the current urological services presented to the Ealing Scrutiny Panel now available to Ealing residents.

The changes started in 2012/13 when the Urological Cancer Service ceased at Ealing Hospital.  This resulted in reduced volume and diversity procedures so Health England withdrew clinical training posts. The department had a high turnover of staff, relying on temporary staff.

The options were to consolidate services on two rather than three sites, Northwick Park and Central Middlesex Hospital (CMH) were chosen. So why was Central Middlesex chosen as the second site when Ealing Hospital would have been the much more appropriate since it almost still has a full complement of services including an A&E?

8000 new urological patients attend the 3 sites, of this a quarter are Ealing residents (2000) and a fifth of these (400) are emergency admissions.  The number of emergency admissions is rising by 10% per year.

This reflects the aging population in the Borough. This group also have more co morbidities and therefore should have access to an A&E and a hospital where disciplines are well integrated not only for patients with presenting urological problems but also Ealing in-patients who develop urological emergencies.

Questions and problems

As this reorganisation has already taken place Ealing patients are now being triaged in A&E at Ealing Hospital & transferred if needing admission to Northwick Park. It is envisaged that some patients will not be suitable for transfer. An on-call urologist from Northwick Park will travel to Ealing Hospital to perform the necessary operation. He or she will be operating in non-urological equipped theatre and without designated training junior staff.  Is this good practice?

Ealing Hospital will continue to provide Out Patient, a One Stop Clinic and Enhanced Out Patients Procedures but as Ealing Hospital is no longer recognised for training it is not clear who will be qualified to carry out the outpatient procedures?

A statement is made that Outpatient and onsite specialist cover will be maintained.

How can this be true when an on-call Urologist has to be summoned from Northwick Park Hospital to operate on patients that cannot be transferred?

It is claimed that there will be better continuity of care. If so where is the evidence to support this claim?

Is there sufficient capacity on the NWP site to absorb the emergency urological patients arriving from the Ealing A&E?

Unless there are clear answers to these questions, we can be forgiven for concluding that the changes are driven not by clinical reasons but as part of the unsuccessful ‘Shaping a Healthier Future’  plan for North West London.

Clara Lowy is a local resident and Emeritus Professor of Medicine

Thursday 5 July was seventy years to the day since the introduction of free health care and the founding of the NHS.

Ealing Save our NHS – 70th Birthday Party Outside Ealing Hospital, 5/7/18 from Martin Woodford on Vimeo.

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