Issue: 65

16 April 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.

NHS North West London (NWL) Hire Management Consultants For £95,400 to Yet Again Re-write Business Case for the Stalled 2012 ‘Shaping a Healthier Future’ (SaHF)Project

The NHS NWL Clinical Commissioning Group cabal has revealed that in November 2017 it hired management consultants GE Healthcare Finnamore. The consultant’s task was/is to work on ‘Urgent & Emergency Care Strategy (Strategic Outline Case)’. The cost for completing the task was/is £95,400.

The work described here relates to the December 2016 NHS NWL SaHF ImBC SOC1 business case which was rejected by NHS England (London) and NHS Improvement England (London) on 28 September 2017. A major component of this business case was/is a request for £513 million for building work. NHSE/NHSI could find no evidence in the business case to support the assertion that 99,000 Non-Elective admissions could be eliminated annually at NWL Acute hospitals by 2025/26. A further claim was that implementing SaHF SOC1 would save 334 lives each year!

The SaHF, published in 2012, promised to ‘..improve care both in hospitals and the community and save many lives each year’. It also promised 4% cost savings every year. In September 2014 SaHF downgraded Central Middlesex and Hammersmith District General Hospitals with the consequent loss of two hospital A&E units. A&E performance in NWL immediately plummeted and has never recovered. No SaHF figures on lives saved or cost savings have ever been announced.

Apparently on 9 February 2018, NHS NWL bosses were going to have another go at persuading NHSE/NHSI on the merits of its revamped ImBC SOC1 business case. However this meeting was cancelled. Seemingly another such meeting was likely in March 2018, but if it happened and NHS NWL had succeeded, no doubt we would have heard about it by now.

NHS NWL has acknowledged in public numerous times that if ImBC SOC1 continues to be rejected and consequently the request for £513 million is refused, then the plan to close Ealing District General Hospital will be abandoned.

Sean Boyle and Roger Steer Deliver Another Compelling Critique of NHS North West London’s Plans and Performance in ‘Current Issues in the Delivery of Health Care in NW London’

Published on 19 March 2018, this 20 page report provides clear evidence that the 2012 NHS NWL’s ‘Shaping a Healthier Future’ (SaHF) plan was ill-conceived and its goals are not being met. The authors are both very experienced and this is the third report they have authored on this topic. They wrote up the findings of the ‘Independent Healthcare Commission for North West London’ in 2015 and along with John Lister authored the ‘Health and Social Care in North West London: a Review of SaHF and the NWL STP’ in 2016. This latest report was commissioned by the London Borough of  Hammersmith & Fulham (LBH&F) who have been consistently the leading West London Local Authority in researching and reporting on care planning and implementation realities in recent years.

Highlights of the report include:

+ Population Growth

SaHF underestimated this. The 2016 population was larger than SaHF estimated it would be for 2022 by some 800,000. ONS data quoted shows a 10.5% projected growth of population in NWL from 2016 to 2026.

+ Attendances at Acute A&E Units

This has fallen in NWL by 16.5% since 2011/12

+Attendances at non-Acute ‘minor A&Es’

This has risen drastically (at Urgent Care Centres and walk-in centres) since 2011/12. This pattern of attendance is very different in NWL compared with the rest of London and the rest of England. In 2011/12 in England, 65% of A&E activity was Acute, whereas in NWL it was 49%. By Q3 2017/18, A&E activity attendance at Acute units remained at 65% but in NWL it had fallen to 37%.

+ Admissions into Acute Hospitals

Risen by 8% in NWL since 2011/12. This figure includes a dramatic rise in the number of emergency admissions not via A&E. Direct admissions by GPs rose from 12,000 in 2011/12 to 29,000 in 2016/17.

+ Waiting Times at Acute A&E Units

Since September 2014, the proportion of people not treated within four hours has been consistently poorer in NWL than elsewhere in London and in England

+ Waiting Times to be Admitted to a Bed in Acute Hospitals

In Q3 2017, 5.3% waited for up to 12 hours for admission to NWL hospitals. For the rest of London it was 2.75% and the average for England was 4.1%.

+ Acute Bed Capacity

Between 2009/10 and 2017/18 this fell 270 beds in NWL.

+ Report Recommendation to LBH&F

Worth repeating in full:

‘The Council should continue to monitor NHS plans, and to insist that these are subject to the full scrutiny of the Council. Future demand projections and evidence for the success of out-of-hospital services and new models of care continue to be updated and although there is evidence that acute A&E attendances may have fallen across NW London, this has not resulted from SaHF plans presented now. In our view the introduction of minor A&E units has had the biggest influence. Moreover the level of emergency admissions has risen since 2012, not decreased as SaHF would have projected’.

The report makes for refreshing reading as it’s written largely in everyday language with a minimum of jargon. One does wonder just how many more times these experienced, expert healthcare researchers, observers and communicators have to document the continuing failure of the 2012 SaHF initiative. Surely it would be a mercy killing to stop attempting to resuscitate SaHF?

Read the report at:

www.lbhf.gov.uk/sites/default/files/section_attachments/current_issues_in_the_delivery_of_health_care_in_the_borough_final.pdf

LEGAL NEWS

+ 999callforNHS – Accountable Care Organisations, Whole Population Budgets: Judicial Review

In Court on 24 April 2018 in Leeds

www.999callfornhs.org/999-judicial-review/459383706

+ JR4NHS – Accountable Care Organisations, lack of public consultation and lack of Parliamentary scrutiny and legislation: Judicial Review

In Court on 23 and 24 May 2018

http://bit.ly/JR4NHS

+ Barnsley and Rotherham

Both Barnsley Save Our NHS and Rotherham Save Our NHS are seeking to raise funds to support a legal challenge to fight the planned closure of the emergency stroke services at both local hospitals in South Yorkshire.

Crowd funding has begun at:

www.crowdjustice.com/case/save-local-hospitals

+ Dorset

A patient, supported by Defend Dorset NHS and represented by Leigh Day solicitors, is seeking a Judicial Review of Dorset CCG’s plan to downgrade Poole A&E, close Poole Maternity, close Acute beds, and close Community beds in 5 of 13 Dorset locations.

A Full Hearing has been granted for 17 and 18 July 2018.

Crowd funding is underway to raise an initial £9,000 at:

www.crowdjustice.com/case/save-poole-ae-and-maternity-and-nhs-beds/

+ Huddersfield

The campaign to prevent the closure of Huddersfield Royal Infirmary received a boost on 15 March 2018 when Judge Mark Gosnall approved a full Judicial Review Hearing. This is expected to take place in June 2018.

www.officialhandsoffhri.org

+ Lancashire County Council (LCC)

A judge ruled against LCC in January 2018 that privatisation of one service threatens the whole local NHS. The judge’s written ruling in February 2018 stated that LCC paying damages to two NHS Trusts that had challenged LCC’s award of a £100 million children’s service contract to Virgin Care, would not make up for the disruption and damage to the provision of the whole range of healthcare.

The two NHS Foundation Trusts are claiming that their loss of the children’s contract would cost them £2 million and result in 160 job losses. A Final Hearing will take place in April 2018.

http://calderdaleandkirklees999callforthenhs.wordpress.com

Smartphone GP Consultation Services – the Good, the Bad and the Ugly

There is clearly a demand for ‘instant’ free Smartphone consultations with an NHS GP. For one thing it could eliminate waiting weeks for a face-to-face consultation. It could cut out that messy business of travelling to a GP surgery and having to sit in reception and actually meet your GP in person. The service might be available 24 hours/day and it might suit your busy life to ‘see’ a doctor on your Smartphone at 4am.

A trial of such a service was agreed by NHS bosses in 2017 using a ‘GP at Hand’’ service which uses a mobile app developed by Babylon Health. The GP surgery involved is Dr Jefferies & Partners in Fulham, West London. A Smartphone consultation is on offer at two hours notice round the clock. Within a year, 26,000 patients have used the service and new patients are registering at Dr Jefferies’ for this service at the rate of 4,000 each month. As soon as you register, you are immediately eliminated from your existing GP surgery list.

In November 2017, Local Medical Committee’s (LMC’s) national body voted not to introduce mobile GP consultation services until there is clear evidence that they are beneficial to patients.

The impact of the Fulham ‘GP at Hand’ experiment is yet to be fully evaluated, but Hammersmith & Fulham Clinical Commissioning Group (HFCCG) is in a bit of a financial pickle because of it. The HFCCG financial shortfall for its GPs is apparently now £5.4 million, but if ‘GP at Hand’ sign-ups continue at the current rate the annual HFCCG GP funding deficit could reach £10.6 million.

Concerns have been expressed by GPs and by others that the ‘GP at Hand ‘ consultation service is not available for all medical conditions and perhaps not available for certain types of patients. ‘GP at Hand’ does publicise a list of medical conditions it deals with. The words ‘mental health’, ‘cancer’ and ‘dementia’ are not on the list. However on the list are ‘colds and flu’ and ‘tennis elbow’.

NHS England (NHSE) has blown hot and cold on Smartphone GP consultations. In November 2017 it launched a £45 million funding pot for a limited number of GP surgeries to implement online consultation programmes over a three year period. However in January 2018, NHSE lodged a formal objection to a significant further roll-out of Babylon Health’s ‘GP at Hand’ service.

Now, just few months later, NHSE has decided to pay someone £250,000 for an independent evaluation of ‘GP at Hand’. However this won’t deliver its findings till May 2019. It might have been prudent for NHSE to have carried out a thorough evaluation of this service before launching this trial, which is causing disruption to GP surgery patient lists and some funding carnage in HFCCG.  

In January 2018, the Department of Health announced that there would be a public consultation on online GP services. It also announced that the Care Quality Commission (CQC) would be allowed to evaluate online GP services. Babylon Health said it doubted CQC’s inspecting powers were adequate with regard to digital health services.

Babylon Health is the brainchild of a Dr Ali Parsa. He has an eclectic background in civil engineering, ‘relationship services’ and investment banking. His doctorate is in the physics of fluids. In 2004 he set up Circle which became Europe’s largest clinician partnership. He left in 2012 and in 2013 he launched Babylon Health.

In the First Seven Weeks of 2018, the Death Rate in England and Wales was 12.4% Higher Than in Previous Years

The British Medical Journal (BMJ) has reported that in the first seven weeks of  2018 93,990 people died in England and Wales. The average number of deaths in the comparable period over the last five years was 83,615 deaths. This rise in deaths of 10,375 is a rise of 12.4%.

The BMJ think it unlikely that flu or an aging population can explain this large change in mortality. The BMJ suggest that it’s a clear pattern of worsening health outcomes. Keep Our NHS Public is more forthright and says that it’s obvious that the 10,000+ extra deaths are a direct result of the Government austerity cuts to public services.

‘Our NHS in Crisis’ Newsletter Archive

Now available at www.ealingsaveournhs.org.uk

This archive stretches back over 60 issues of the newsletter since May 2013. I’m working on an index of issues which will be added soon to this excellent web site. I’ve been active in Ealing Save Our NHS (ESON) for over five years and I’m currently ESON Vice Chair.

You can now read online our latest newsletter.

Shocking Plans for huge “sell off” of community services:

On a scale unlike anywhere else, Ealing’s health bosses intend to contract out most of the services they run. The Contract will last for 10 years and is worth half a billion pounds but possibly increasing up to £1.2 billion of our NHS money. It’s under offer to private health companies or any NHS management team. Whoever wins, it’s a type of privatisation on a massive scale.Ealing Clinical Commissioning Group ( Ealing’s health bosses) want to award this 10-year contract to a single provider, who would run all community health services, and some social care too. Community nursing, palliative care, diabetes, mental health and specialist children’s nursing, are just a few of the services up for grabs. The contractor would be expected to develop these services so that they can somehow ‘substitute’ for hospital beds – something that has never worked anywhere in the world.
You can read more on this story on our website here– https://ealingsaveournhs.org.uk/2018/04/shocking-plans-for-a-huge-sell-off-of-ealings-nhs-services/

Questions for candidates in the Election on our NHS:

We believe our NHS should be an issue in the local elections and that our Councillors should be campaigning against the plans to cut and downgrade Ealing Hospital. They should also be opposed to the big sell off of our community services.
On our website we now have some ‘Questions to Candidates’ which aim to find out where candidates and their parties stand on the Big ‘sell off’ of Ealing’s NHS and on the Future of Ealing Hospital. We hope you can use them when you next meet any candidates or in other places –
https://ealingsaveournhs.org.uk/2018/04/questions-to-candidates-in-the-ealing-council-elections-3rd-may-2018/

A poster for your window or a car sticker:

Lots of people replying to our Survey said they would like a poster for their window so here it is below and a copy is attached. If you would like us to drop off a poster please send us your address.

Every car in Ealing should have one!

As well as showing your support it also makes it easier to find your car in a car park! If you want to brighten up your car with our sticker and fly the flag please get in touch.

Ealing Street Stall Saturday 28th April:

We will be in Ealing Broadway (Marks & Spencers) on the 28th from 11.00-1.00pm with leaflets, petitions and our Questions for Candidates. If you can spare a little bit of time to help it would be lovely to see you.

CAMPAIGN MEETING TUESDAY 17TH APRIL- All welcome
This month we are delighted to be joined by Merril Hammer & Jim Grearly from our sister campaign, Save Our Hospitals (Hammersmith & Charing Cross) who will be giving us an update on the campaign to save the A&E and beds at Charing X Hospital.
We would love to see more people get involved, so new people are very welcome to our friendly meeting on the 17th at 7.30pm, Northfields Community Centre, 71a Northcroft Road, Ealing W13 9SS. Tea and Coffee provided

Some other worthwhile reading:

Current Issues for the delivery of health care in Hammersmith & Fulham:

Save Our Hospitals have circulated this well researched summary of the situation in North West London by two of the authors who wrote the Mansfield Report, Sean Boyle and Roger Steer. – definitely worth a read.

https://www.lbhf.gov.uk/sites/default/files/section_attachments/current_issues_in_the_delivery_of_health_care_in_the_borough_final.pdf

Exploiting Maternity Closure to make a profit:
A new article by Sarah Boston exposing ‘Window to the Womb’ a private company out to make big bucks flogging ante natal scans.
https://ealingsaveournhs.org.uk/2018/04/private-healthcare-companies-are-looking-for-business-and-profit/

‘NHS in Crisis’ now on our website:Eric Leach, Researcher and Ealing Save Our NHS Vice Chair produces an excellent Newsletter with in-depth analysis and information on the NHS Crisis and social care. This can now can now be found in our website ‘Library’ including all back copies. The latest issue has some great facts and figures on the Single Contract and more…

https://ealingsaveournhs.org.uk/category/our-nhs-in-crisis/

Thanks for reading our Newsletter and you can also find us on Facebook and Twitter.

Subscribe to our Newsletter!

[wysija_form id=”1″]

Window to the Womb Ealing

PRIVATE COMPANY  LOOKING FOR BUSINESS AND PROFIT.

If you Google – ‘Antenatal Scans at Ealing Hospital’  two sites top the search. Ealing Hospital which offers antenatal care. and  the private company Window to the Womb Ealing, which claims to be ‘Specialists in Well-being, Gender & 4D Baby Scans’

It is hardly surprising that with  the closure of the Maternity Unit at Ealing  Hospital the private company, Window to Womb, has moved into Ealing and is leafleting the area offering  ante natal scans. They offer a dazzling number of scans for women throughout their pregnancy – costs for a scan start at £55.

One of the scans on offer is for gender.  Their website trumpets that 

We offer our  99.9% accurate  Well-Being & Gender Scan from 16-22 weeks for just £59, you can visit us a full 4 weeks before the NHS scans for gender.

Screening specifically for gender is controversial and many NHS hospitals do not offer it unless it is for genetic abnormalities that only one sex inherits.  

Window To The Womb  Ealing website does not tell expectant women  who are enticed to use their services what happens if a scan reveals possible problems or abnormalities.  On inquiring about this possibility expectant mothers are told they will be quickly referred to ‘a doctor’. For most without private health insurance or very large bank accounts that will be an NHS doctor. Once again private companies take the profit and the NHS  is left to deal with the problem.

Window to the Womb registered with the Care Quality Commission  on the 10th March 2015  however as of  the 22nd March 2018  the Care Quality Commission report that  “We have not inspected this service yet.”

On a scale unlike anywhere else, Ealing’s health bosses intend to contract out most of the services they run.  The Contract will last for 10 years and is under offer to private health companies or any NHS management team. Whoever wins, it’s a type of privatisation on a massive scale.

Ealing Clinical Commissioning Group (the CCG, Ealing’s NHS bosses) have issued figures showing this ten year contract will be worth initially half a billion pounds but possibly reaching 1.2 billion of our NHS money.  We believe this is an outrage – there is no public support for NHS privatisation, yet Ealing seems to be in the front line.

There is no explanation of how the running of such a huge contract would be accountable to the public or how there would be any transparency on spending or running of services, nor is there any   evidence of experience in monitoring such a huge contract. Questions to the CCG on any of this are met with silence or evasion.

The Health Bosses want to award this 10-year contract to a single provider, who would run all community health services, and some social care too. Community nursing,  palliative care, diabetes, specialist children’s nursing, older peoples services, mental health, physiotherapy, wards at Clayponds Hospital and much more will be included.  The contractor would then be expected to develop these services so that they can somehow ‘substitute’ for hospital beds – something that has never worked anywhere in the world.

As we write this, nine NHS Trusts and eight private NHS providers have already shown some interest, including Virgin Care!

This is a disaster – we won’t Stay Silent!  Please support Ealing Save Our NHS campaign to keep our NHS truly public.  Contact your MP and ask them to highlight and publicly oppose what’s happening.  Council elections are coming up – what do the candidates say – put them on the spot :  Questions to Candidates in the Ealing Council Elections

As the saying goes – you don’t know what you’ve got ‘till it’s gone!

Does Privatisation make a Difference?  – Here are some recent examples

The Health & Social Care Act 2012 opened the doors to private companies to bid to run any NHS service and they have grasped the opportunity to win billions of pounds worth of contracts by undercutting the NHS and worsening the quality of care.

The healthcare market that has been created is a huge waste of public money costing us somewhere between £5 and £10 Billion – part of this cost comes from the management & legal costs of the contracting out process and the growing list of failures.

It’s a 10 year contract so no going back for more money and a lot can happen in 10 years. So if the single provider is a private company and isn’t making enough money for their shareholders, or if it is a NHS Trust or Consortium and they just can’t afford to run the contract anymore, then they can just pull out and the local NHS has to pick up the bill.  There is plenty of evidence that this can happen but here are a few examples –

Collapse of Private Transport Service – NW London:

The ‘Private Transport Service’ which ran patient transport for London North West University Healthcare NHS Trust (which includes Ealing Hospital) ceased trading in October 2017. The Trust was given only two days’ notice of the loss of this service causing additional costs for the NHS and considerable distress for patients needing to use the Service to get to and from hospital appointments.

Cambridgeshire and Peterborough Older Peoples Services Contract:

This was an extremely high profile contract due to its considerable value, worth £700 – £800 million over five years for the provision of older people’s services for Cambridgeshire and Peterborough CCG.  The Contract was eventually won by a consortium of NHS providers called ‘Uniting Care Partnership’ after all private bidders withdrew as there was not enough profit. However Uniting Care Partnership terminated the contract early as it wasn’t financially viable and the NHS was left with unfunded costs of £16 Million which had to be shared by the CCG and the Trusts involved!

Hinchingbrooke and Circle:

In January 2015, Circle the private company running Hinchingbrooke Hospital pulled out of the contract after just two years of a ten year contract. The company announcement came just before the publication of a damning report on the hospital from the Care Quality Commission (CQC) however Circle cited financial reasons for pulling out. The contract allowed Circle to withdraw if it had to invest more than £5 million of its own money in the hospital, which looked extremely likely.   

Staffordshire Cancer Care Contract:

This was a ten year contract worth over £690million. The CCGs were seeking a single provider to co-ordinate and contract providers for cancer care in Staffordshire. After the problems with the Cambridge & Peterborough Older Persons Contract it was put on hold and restarted in 2017 with only 1 private consortium left led by Interserve whose bid was found not to be financially viable. Although the contract failed to begin it managed to cost the NHS around £840,000.

The West Sussex MSK contract

This £235 million contract for provision of musculoskeletal services in West Sussex with Coastal West Sussex CCG was awarded to BUPA and social enterprise CSH Surrey in September 2014. However it never begun once it was determined just how much damage the contract would do to other NHS services in the region. BUPA and CSH Surrey withdrew in Jan 2015 before the contract was signed.

Our Hospitals Trust Could be at Risk.

Currently most of the community health services are run by our local NHS Trust, London North West University Healthcare NHS Trust. If they lost the contract they would also lose about 7% of their income and other services could be at risk. Our NHS staff should be spending their time focusing on patient care instead many hours will have to be spent restructuring services, pouring over spreadsheets and drawing up bids to try and win this contract.

As you can see It’s no wonder that Ealing Save Our NHS is worried and opposed to these plans.

Please check out our website for more updates as the picture unfolds and our Campaign develops.

Question 1  The Big “Sell Off” of Ealing’s NHS

Ealing Clinical Commissioning Group is advertising for a single contractor to run “out of Hospital” services for 10 years.  This contract, tendering out Ealing’s NHS services is worth over half a billion pounds of public money.

Do you support or oppose this tendering out and possible privatisation of huge amounts of NHS services in Ealing?  Have the local meetings of your Party discussed this proposal and if so what are their views?

If your Party supports this tender of NHS services, how do you believe those who won such a huge contract would be accountable to us, the public?

Or, if your party opposes this tendering out of public services, just what has it done about it?

Question 2  The Future of Ealing Hospital

The plans to cut the blue light A&E and hundreds of beds at Ealing hospital have not substantially changed since they were made 6 years ago?  Do you support those plans, as laid out in “Shaping a Healthier Future”?

If your Party supports the plans to somehow replace hundreds of hospital beds with health care in the community, please explain how on earth this this could work as there are so far no examples in the UK or abroad.

If your Party opposes the plans, can you specify what your party has done about it?

Issue: 62

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.

NHS ECCG OOH Services, 10 Year, Single Supplier Contract ITT Issued: Contract Value Between £450 Million and £1.2 Billion

On 22 March 2018 the NHS Ealing Clinical Commissioning Group (ECCG) advertised an Invitation to Tender (ITT) for a 10 year, single supplier Out Of Hospital (OOH) services contract for Ealing The deadline for responding to the ITT is 21 June 2018.

The basic value of the contract is £450.2 million and it will run from 1 April 2019 to 31 March 2029. But that isn’t the end of the potential value of the contract. ‘Transitional’ funding of £47.4 million might be available as might the possibility of adding to ‘the contract scope by annual value of £79.9 million’. Add this lot up for 10 years and we arrive at a potential contract value of some £1.2 billion.

Of note is that Dr Mohini Parmar Chair of ECCG wrote on 8 September 2017 that the 2017/18 OOH services spend in Ealing would be £121.794 million. Over 10 years that would cost (excluding inflation) £1.2794 billion. If the basic cost of the contract (£450.2 million) is all that is spent over 10 years then there would have to be massive reductions in the quantity and quality of OOH services managed and delivered. Maybe if potential bidders think this might be the case, they will not bid.

Why No NELs Reduction Target?

ECCG Managing Director Tessa Sandell recently confirmed in public that no cost reductions would be targeted in the future management and delivery of OOH services in Ealing. The cost reductions would be achieved by reductions in Non-Elective hospital admissions (NELs). So, why one might ask is there no NELs reduction target for Ealing specified in the OOH ITT or in the supporting documents? By 2025/26 and beyond annually for Ealing there should be (pro rata) an annual reduction of 12,375 NELs.

If the NHS SaHF IMBC SOC1 Business Case Continues To Be Rejected, Is This OOH Services Single Supplier Contract a Non-Starter?

In 2012 NHS North West London (NWL) launched its ‘Shaping a Healthier Future’ (SaHF) project. Part of the SaHF plan was the closure of Ealing District General Hospital and the enabling of OOH services via the creation of Ealing community health ‘hubs’ and the expansion of some Ealing GP surgeries. The final SaHF business case for these OOH services changes was published in December 2016. In it (IMBC SOC1) was a request for £513 million for OOH services building work. In September 2017 this business case was rejected by NHSE/NHSI (London). Surely without this £513 million capital grant the OOH services contract is a non-starter?

Where are the OOH Social Care Services and the OOH Integrated Healthcare and Social Care Services in this ITT?

I’ve had a good look at the 36 OOH services listed in the OOH Contract Prospectus, and at all of the ITT supporting documents. The phrase ‘social care’ is hardly mentioned at all. The Government launched the programme to integrate health care services and social care services way back in 2010. We now even have a single Healthcare and Social Care Ministry. The 2014 NHSE Five Year Forward View and the 2016 NHS NWL Sustainability and Transformation Plan (STP) require integrated healthcare and social care services. In the supporting documents we have a paper on Clinical Standards, but no equivalent paper on Social Care Standards. This ECCG OOH services ITT is almost exclusively about NHS healthcare services. As such it’s a complete dinosaur.

Multiple Confusions About Accountable Care/Integrated Care Organisations

The ITT describes the OOH Services contract as’…a building block in the development of integrated care systems for Ealing in the support of the NW London Health and Care Partnership ambition for an integrated care system for NWL’. Now this is all over the place. The October 2016 NHS NWL STP makes no reference to integrated care systems (or their progenitor Accountable Care Partnerships (ACPs)) in Ealing. In fact the only ACP reference in the NHS NWL STP is for Delivery Area DA3 ‘Achieving better outcomes and experiences for older people’.

Where is the Evidence that a Single Supplier OOH Service in Ealing Will Be Any Better Than What We Have Now?

I understand that a business case exists to support this outsourcing move, but this is being kept hidden from the public. Surely the contents can’t be commercially sensitive and anyway public money is involved here and how and why it is planned to be spent should be publicly accountable.

NHS North West London (NWL) 2012 ‘Shaping a Healthier Future’ (SaHF) Still in The Doldrums

It’s now six months since NHS England (London) and NHS Improvement (London) said ‘no’ to the NHS NWL SaHF ImBC SOC1 business case, which asked for £513 million for building work. According to the London North West University Healthcare NHS Trust (LNWUHT) Strategy Committee meeting Minutes, the SaHF Programme Management Office team, the NHSI SOC1 Oversight Group, NWL Trusts and NWL CCGs are all attempting to justify the unjustifiable. SaHF predicts that if we do nothing there will be some 250,000 Non-Elective (NEL) annual NWL hospital admissions annually by 2025/26. ImBC SOC1 requires an annual reduction of 99,000 NELs by 2025/26. NHSE/NHSI state that no evidence has been presented by SaHF which justifies such a massive reduction in annual NELs.

But those pesky NELs keep on rising. LNWUHT Deputy Chief Finance Officer Bimar Patel stated recently that NEL activity rose every month between October 2017 and January 2018. It’s no better with social care and mental health bed blockers either. Delayed Transfers of Care (DTOCs) are not reducing significantly, and in fact beds are being opened rather than closed. In March 2018, LNWUHT Chief Financial Officer Jon Bell confirmed the Trust had planned for 40 (extra) beds for April 2018.

And there was no joy for NHS NWL in the 28 March 2018 Government announcement of NHS capital grants. Out of £760 million awarded nationally, NHS NWL will receive just £4.2 million. You have to ask yourself just how realistic is NHS NWL SaHF’s request for a capital grant of £513 million in the context of these recent awards.

NHS NWL Trusts Fighting Each Other or Working with Each Other to Try to Win the Ealing Out Of Hospital 10 Year, Single Provider Contract

LNWUHT, West London Mental Health NHS Trust (WLMHT) and Hillingdon Hospitals NHS Foundation Trust are all seemingly working on bidding for this contract which was  advertised on 22 March 2018. WLMHT is seemingly pursuing discussions with Central and North West London NHS Foundation Trust and Central London Community Healthcare NHS Trust.

It seems extraordinary that WLMHT, which last year was found wanting by CQC in 9 of its 11 core areas of operation, should be considering taking on running over 30 primarily physical care services in Ealing. This would be on top of improving its mental health services in Ealing, Hounslow, Hammersmith and Fulham, and at Broadmoor.

I can just about remember a time when we had hospitals which just provided care for patients – and that was all they did.

NHSE/NHSI is Making Impossible Demands on Overworked NHS Hospital Doctors

An NHSE/NHSI letter dated 9 March 2018 to NHS hospital doctors instructs that every patient should be medically assessed each morning and evening by a senior doctor. The letter also tells hospitals to ‘boost essential services such as diagnostics and pharmacy at weekends to maximise Non-Elective (NEL) patient flows’. These orders are all about moving patients out of (expensive) hospital beds as soon as possible.

The 2014 NHS Five Year Forward View (FYFV) and all 2016 44 NHS Sustainability and Transformation Plans (STPs) require the NHS in England to collectively improve care services, achieve annual cost savings of £33 billion and a 3% improvement in efficiency – all by 2020/21.

In January 2018 the BMA reported that seven out of ten hospital doctors said there were gaps in the shift rotas in their departments. NHS Providers in March 2018 stated that 9,600 doctor posts in England were vacant. One does wonder whether pressurising and hectoring clinically under resourced NHS hospitals is an effective approach to help the NHS attain its challenging performance, financial and efficiency goals.

A House of Commons Library Paper Attempts to Describe and Explain the Accountable Care Organisation (ACO) Saga

Just as NHS England (NHSE) decides to ‘retire’ the term ‘Accountable Care’ and replace it with ‘Integrated Care’ the House of Commons (HoC) Library issues a paper entitled ‘Accountable Care Organisations’.

This 5 March 2018, CBP 8190, 16 page paper provides an interesting audit trail of decisions, opinions and facts about ACOs in England. However I find it thin on the ground in identifying ACO challenges. It does not get to grips with the enormity of integrating healthcare services with social care services. It does refer to IT, culture and mindset challenges, but it fails to mention the considerable dichotomies of  business models and patient databases in NHS healthcare and Local Authority social care.

ACO Cavalcade Has Been Halted

The whole ACO cavalcade has had to be halted because of Government legislative

‘gaps’ being attacked by Judicial Review (JR) initiatives. On 25 January 2018 we were promised a 12 week public consultation on ACO, but none has been forthcoming. The Government said it wanted to introduce ACO enabling legislation in February 2018 – and this has just not happened. The Department of Health’s (DoH’s) edict that 20% of England’s population should be covered by ACOs/ICOs/MCPs/PACS in 2017/18 has also not been realised. The DoH call for this to be 50% coverage by 2020 is truly risible.

The August 2017 draft ACO contract is alluded to. The contract concepts of ‘full’, ‘partial’, and ‘virtual’ integration are repeated. I can’t help being reminded that it’s hard to be partially or virtually pregnant – and I suggest this also applies to integration.

All the eight grant-aided Accountable Care Systems ACSs (now ICSs) announced in June 2017 have been halted – no reason given, but the two JRs and missing legislation must be clues here. The grant aid for these ACS/ICS experiments is £450 million over four years.

The paper alludes to the riddles of ACSs/ICSs involving CCGs, whilst ACOs/ICOs do not; and ACSs/ICSs broadly relating to STP areas and ACOs/ICOs relating to (smaller) CCG areas.   

Will ACOs Be the Death-knell for CCGs?

In ‘2. Role of CCGs’ we enter a surreal world of ‘children’ supposedly supervising their ‘parents’. If an ACO is awarded a 10/15 year, fixed price contract to provide integrated healthcare and social care to a defined population then, for this to make any sense at all, this ACO must be the commissioning body for all the care services. The CCGs and Local Authorities – sitting ‘below’ the ACO – cannot themselves commission these services as well. You can only have one ‘big boss’ and that clearly will be the ACO.

Jeremy Hunt MP is quoted as saying in 2014 that the 211 CCGs would be turned into ACOs. I see this as highly unlikely and what is more likely is that ACOs will make CCGs irrelevant and they will atrophy.

In ‘3. Legal Challenges’ the 999callforNHS JR will be in court on 24 April 2018 and the JR4NHS JR will be in court on 23 and 24 May 2018.

In ‘4.2 Role of GPs’ both ‘GP Online’ and the BMA are quoted raising concerns about the future role and status of GPs. Both worry about GPs losing their independent contractor status. NHSE envisions ‘multiple models of GP participation’ including partial and virtual integration. This sounds like twaddle to me.

‘4.3 Rationing of Service’ gets to the heart of the ACO raison d’etre – cutting costs. From my 21 years of running my own business I have never experienced a cost cutting initiative resulting in improved quality or quantity of service.

Issue: 61

Plans to Transform NHS North West London’s Care Services Still in Disarray

NHS North West London (NWL) is possibly unique in England in having not one, but two major different care transformation programmes in play at the same time. The 2012 ‘Shaping a Healthier Future’ (SaHF) project is still attempting to implement ‘changes that will improve (health) care both in hospitals and the community and save many lives each year’. The 2016 NHS NWL Sustainability and Transformation Plan (STP) attempts to improve health and wellbeing, improve (and integrate) healthcare services and social care services, improve productivity and close the financial gap. Both the SaHF and the STP postulate major financial saving accruing for massively reducing annual Non-Elective hospital admissions (NELs). The ‘replacement’ for NELs will be treatment at home, in community healthcare day centres (‘hubs’) and in some expanded GP services. This latter treatment modality is often called Out Of Hospital (OOH) services

NHS NWL SaHF and the STP were effectively halted in November 2017 when the SaHF business case (IMBC SOC1) was rejected by NHS England (London) and NHS Improvement (London). The rejection was on the basis of lack of evidence to support an annual reduction of Non-Elective hospital admissions (NELs) by 99,000 by 2025/26. On 9 February 2018 NHS NWL bosses were scheduled to meet with NHSI/NHSE (London) at which they hoped to supply the missing evidence. On 13 March 2018 we discovered that the 9 February 2018  meeting had been cancelled by NHSE/NHSI.

The IMBC SOC1 business case asks for £513 million for building work. However waiting in the wings is IMBC SOC2 which will ask for another £314 million for building work in ‘inner’ NWL. If this amount of cash for the builders in NWL is typical, then in London the cash for builders for NHS STPs will be £4.1 billion and nationally it would be £36.3 billion. Surely this is all pie in the sky?

The Curious Case of MCAP, Finnamore, NHS Bosses, Freedom of Information and The Truth

In 2012 NHS North West London (NWL) launched its ‘Shaping a Healthier Future’ (SaHF) project. Central to this project was improving healthcare services and reducing health care costs. The project mandated reducing the number of hospital admissions, District General Hospitals, hospital A&E units and hospital beds. Many more patients would be treated in their own homes, in community healthcare day centres (‘hubs’), and in some expanded GP surgeries. Our health would also be improved and cost savings achieved by measures which would somehow persuade us all to live healthier lives. These out of hospital services are variously referred to within the NHS as Community Services, Intermediate Services and Out of Hospital (OOH) Services.

A core component of this project was the theory, promulgated by American management consultants McKinsey & Co in 2009 and 2012, that 40% of patients in Acute care in hospitals should not be there. These 40% of patients should be successfully and less expensively treated using OOH services. In NHS NWL’s SaHF project there was clearly an aspiration to provide a proof of this theory.  On 7 March 2013, an Invitation To Tender (ITT) was created by NHS NWL to find an organisation who could provide this ‘proof’ . It’s not clear how many suppliers responded to this ITT, but one supplier who did respond was Finnamore/Oak. Finnamore/Oak’s ITT response was reviewed and accepted – seemingly within just eight days. The Finnamore/Oak vehicle for providing this proof was called ‘Making Care Appropriate for Patients’ – MCAP. A one year contract to implement MCAP for £249,000 was signed on 12 April 2013. Surprisingly the project appears to have been curtailed in September 2013 after four months. Even more surprising was that Finnamore/Oak was paid even more money (£95,200) for ‘MCAP Implementation support – Extension’ in December 2013.

In November  2017 medical researcher Colin Standfield issued a Freedom of Information (FOI) request to NHS  NWL about MCAP. After receiving no content bearing response, he issued a number of FOI requests about MCAP to NHS NWL. But no-one wanted to talk about MCAP. Why/how were Finnamore/ Oak chosen so quickly and were they the only ITT responder? What value for money was achieved in spending £344,200 on MCAP? What were the results/output from the four months of operating the Finnamore/ Oak  MCAP programme? Does the abandonment of the MCAP project represent a failure to ‘prove’ that 40% of so called Non-Elective hospital admissions (NELs) can be ‘replaced’ by OOH services?

Seven senior NHS NWL executives chose MCAP in 2013. Three of them have left NHS NWL. One of those three – Kevin Atkins – left to join Finnamore/ Oak, then called GE Healthcare Finnamore  In 2014, GE Healthcare Finnamore ‘sold’ him back to NHS NWL for a year at a cost of £98,000. One of the MCAP decision makers still in post at NHS NWL is Dr Mohini Parmar, who is the NHS NWL lead for its 2016 Sustainability and Transformation Plan (STP), as well as being the Chair of the Ealing Clinical Commissioning Group (ECCG). Her silence on the matter of MCAP is particularly deafening.

NHS Failings Caused 271 Deaths of Mental Health Patients 2011 to 2017

An investigation by ‘The Guardian’ has revealed these shocking statistics. Factors attributable to these deaths include:

+ Not following protocols

+ Treatment delays

+ Medication mistakes

+ Insufficient risk assessments.

Avon and Wiltshire Mental Health Partnership NHS Trust and Camden and Islington NHS Foundation Trust recorded the most deaths attributable to NHS failings.

Ealing Clinical Commissioning Group ECCG) Wants Ealing Residents to Help in Shaping Local Healthcare Services

Please tell ECCG what you want and what you don’t want at:

www.surveymonkey.co.uk/r/VC5DTTV

Is Parliament Fit for Purpose in Determining Healthcare and Social Care Policy and Legislation?

On 27 February 2018 a House of Commons Select Committee on Health and Social Care questioned three groups of expert witnesses on the subject of ‘Integrated Care: organisations, partnerships and systems, HC 650’. .

The first group of expert witnesses were impressive as they have between them over 100 years of NHS management, clinical and analytical experience. They were Professor Allyson Pollock, a renowned public health expert, Tony O’Sullivan, a retired Paediatrician and Co-Chair of ‘Keep Our NHS Publi’, Dr Graham Winyard, ex-Chief Medical Officer, NHSE and Dr Colin Hutchinson, Chair of ‘Doctors for the NHS’.

The MPs revealed a shocking level of ignorance, arrogance and disingenuousness. The Chair made repeated attempts to tease out of the experts answers that she clearly wanted. She went on and on about how difficult it is to get new legislation enacted through a hung parliament and described Integrated Care Partnerships as a ‘workaround’ existing legislation. I could hardly believe my ears!

One MP suggested that the leading ACOs/ICSs had been halted, so why all the fuss. The experts quoted Simon Stephens/NHSE statements (which strongly suggest the ACO/ICS pause was purely tactical). Another MP tried to claim that as private companies only had small percentage of NHS contracts, they then did not pose a threat to the public nature of the NHS. This is breathtakingly irrelevant because private healthcare companies are bidding for contracts all over England. Another waxed on about a trip they had made to Yorkshire where care professionals were all working together. He and other MPs deduced from this one visit that integrated healthcare and social care was alive and well. Pathetic.

All four experts told the MPs that they believed in care integration. However, they said that there is no evidence to support implementing this by creating unaccountable, non-public (ACO/ICS) bodies with 10/15 year, fixed price contracts. It might well be illegal anyway. An MP again suggested one might work around current legislation to make this work. One MP said that legal advice had been obtained to support this workaround. As some of the experts were involved in a Judicial Review which questions the legitimacy of ACO/ICS a meaningful dialogue on this was not possible.

Professor Pollock explained to the MPs about the significant differences in healthcare and social care patient databases. It was unclear whether the MPs actually understood what she was talking about. One MP said again that it would be difficult to get new care legislation through Parliament. Dr Hutchison pointed out that as it would just apply to England the chances of new legislation being introduced were much improved.

The King’s Fund opinions were thrown at the experts. The experts threw them back wrapped up in comments which to this writer at least seemed to imply that what the King’s Fund is proposing is possibly illegal.  

To summarise the contents of this session – what the MPs were saying is that we have a square peg which we want to fit into a round hole. Can you work with us to shave bits off the corners of the peg so that it might fit? The experts, calmly and politely, wiped the floor with these uninformed, ill-equipped MPs who clearly did not want to listen to facts or engage in intelligent debate. It was like men against boys.

The following session of MPs v experts involved the BMA, the Royal College of Nursing (RCN) and Unite. There was more of how can STPs/ACOs/ICSs be ‘bent’ to make them work. Issues raised include balancing the NHS financial books by 2021, nursing standards and workforce engagement. The MPs’ trip to Yorkshire was brought up yet again. The wonderful nurses in Doncaster and that fabulous GP practice in Worksop. However, ‘one swallow does not a summer make’. The BMA made the point that a universal national ‘Worksop GP’ service would take new funding, more staff, improved infrastructure and technology. The BMA and the RCN  were firmly against ACO/ICS and gave their reasons.

Unite’s concerns included cuts in NHS staff and capital spending, lack of information about a future NHS, terms and conditions of employment when working ‘across boundaries’, lack of information about non-clinical staff and repealing the Section 75 regulations enforcing market competition rules.

In the final MPs and ‘experts’ session, Healthwatch England (the largely ineffective State sponsored healthcare watchdog), Ipsos MORI (the polling agency) and two healthcare charities took their seats but did not gain my attention. Surely some of the local and regional healthcare activist groups should have occupied these seats? Ealing Save Our NHS, Defend Our NHS York and Sussex Defend the NHS are just a few of the tens of likely candidates.

View the proceedings at https://goo.gl/dvncKT

The National Audit Office Documents Only Failure in its ‘Reducing Emergency Admissions’ Report: NHS STP/ICS Plans in Tatters

On 1 March 2018, the National Audit Office (NAO) published a damning report on successive failed initiatives to reduce emergency admissions at NHS hospitals in England. The NAO scrutinises public spending and holds Parliament to account and to improve public services.

Apparently the Department of Health (DoH) wants elective and emergency admissions to be reduced to 1.5% (whatever that means). The NHS England (NHSE) mandate is however extremely weak in the admissions arena. – ‘…to achieve a measurable reduction in emergency admissions by 2020’.

Cost is a big issue here and reducing mortality and patient pain and suffering makes no appearance in the 54 page report. The current annual cost of emergency hospital admissions is £13.7 billion. This cost has remained static over recent years. Between 2015/16 and 2016/17 emergency admissions increased by 2.1%. So all attempts over recent years to reduce emergency admissions have failed.

No Proof Yet of the Theory that 40% of Those in Hospital Should Not be There

The elephant in the room here is the oft quoted 2009 McKinsey & Co ‘theory’ that 40% of patients admitted to hospital should not be there. The theory continues with the notion that Out of Hospital (OOH)/community care/intermediate services could ‘replace’ these hospital admissions. NHSE states that currently 24% of emergency admissions could be avoided. No ‘proof’ or evidence seemingly exists to ‘prove’ the 40% theory or even the 24% theory.

79% of the growth in emergency admissions from 2013/14 to 2016/17 was by people who did not stay overnight in hospital. Reducing beds (bed use) is clearly a key factor as staying overnight in hospital is expensive. The emergency admissions’ increase is mostly of older people.

It’s pretty clear that NHSE and partners attempts to reduce the impact of emergency admissions has failed. These funded  reduction programmes include the urgent and emergency care programme, the new care models, the Better Care Fund, RightCare and Getting It Right First Time.

Re-admittance rates rose by 22.8% between 2012/13 and 2016/17. However, NHS Digital is planning to stop collecting, recording and publishing re-admittance rates!

Grant Funded Community Care Services Programmes have ‘Stalled’

In October 2017 the DoH admitted that £10 billion spent on community care ‘could have been better used’ and that ‘programmes to focus on community care had stalled’.

The DoH, NHSE and NHS Improvement (NHSI) all admit that they have no idea why there are local variations in hospital emergency admissions. NHSE is not happy with emergency admission data, and the lack of linked data across healthcare and social care.

On page 10 of the report we find ‘…the challenge of managing emergency admissions is far from being under control’.

There are enormous amounts of data analysis on performance, beds and intermediate care.

The number of days that beds are used by people admitted as emergency admissions has increased from 32.4 million in 2013/14 to 33.59 million in 2016/17 – an increase of 3.6%. The majority of bed days (96% in 2016/17) are used by people who stay for two days or more after being admitted as an emergency admission.

The recommendations in the report are stunning and include:

+ Establish an evidence base

+ Disseminate learning on new care models effectively

+ Link primary, community health and social care data

+ Figure out why there are local variations in emergency admissions

+ Figure out how community services will support reductions in emergency admissions

+ Introduce an Emergency Data Care Set to improve data on daycase emergency care

+ Publish data on re-admissions.

Are STP/ACO/ICS Initiatives Dead in the Water?

All this pours cold water on all 44 Sustainability and Transformation Plans (STPs), Accountable Care Organisations (ACOs) and Integrated Care Systems (ICSs) as they all postulate cost savings based on reduced hospital admissions, leading to closure of District General Hospitals and hospital A&E units. They all also postulate Out of Hospital/Community/Intermediate healthcare services as cost saving ‘replacements’ for Acute hospital care – and this is still an unproven theory. Finally the integration of healthcare services and social care services is talked about, but anecdotally on the ground it has not happened. Under current arrangements the dichotomy of business models, finances, patient databases, service access and cultures makes genuine integration an impossibility. Clearly the STP/ACO/ICS dream of balancing the NHS financial books and cutting NHS annual costs by £22 billion – all by 2021 – is now a nightmare.

On 1 March 2018, the National Audit Office (NAO) published a damning report on successive failed initiatives to reduce emergency admissions at NHS hospitals in England. The NAO scrutinises public spending and holds Parliament to account and improve public services.

Apparently the Department of Health (DoH) wants elective and emergency admissions to be reduced to 1.5% (whatever that means). The NHS England (NHSE) mandate is however extremely weak in the admissions arena. – ‘…to achieve a measurable reduction in emergency admissions by 2020’.

Cost is a big issue here and reducing mortality and patient pain and suffering makes no appearance in the 54 page report. The current annual cost of emergency hospital admissions is £13.7 billion. This cost has remained static over recent years. Between 2015/16 and 2016/.17 emergency admissions increased by 2.1 %. So all attempts over recent years to reduce emergency admissions have failed.

The elephant in the room here is the oft quoted 2009 McKinsey & Co theory that 40% of patients admitted to hospital should not be there. The theory continues with the notion that Out of Hospital (OOH)/community care/intermediate services could ‘replace’ these hospital admissions.

NHSE states that currently 24% of emergency admissions could be avoided.

79% of the growth in emergency admissions form 2013/14 to 2016/17 was by people who did not stay overnight in hospital. Reducing beds (bed use) is clearly a key factor as staying overnight in hospital is expensive. The emergency admissions’ increase is mostly of older people.

It’s pretty clear that NHSE and partners attempts to reduce the impact of emergency admissions has failed. These reduction programmes include the urgent and emergency care programme, the new care models, the Better Care Fund, RightCare and Getting It Right First Time.

Re-admittance rates rose by 22.8% between 2012/13 and 2016/17.

In October 2017 the DoH admitted that £10 billion spent on community care ‘could have been better used’ and that ‘programmes to focus on community care had stalled’.

The DoH, NHSE and NHS Improvement (NHSI) all admit that they have no idea why there are local variations in hospital emergency admissions. NHSE is not happy with emergency admission data, and the lack of linked data across healthcare and social care.

On page 10 of the report we find ‘…the challenge of managing emergency admissions is far from being under control’.

There are enormous amounts of data analysis on performance, beds and intermediate care.

The number of days that beds are used by people admitted as emergency admissions has increased form 32.4 million in 2013/14 to 33.59 million in 2016/17 – an increase of 3.6%. The majority of bed days (96% in 2016/17) are used by people who stay for two days or more after being admitted as an emergency admission.

The recommendations in the report are stunning and include:

+ Establish an evidence base

+ Disseminate learning on new care models effectively

+ Link primary, community health and social care data

+ Figure out why there are local variations in emergency admissions

+ Figure out how community services will support reductions in emergency admissions

+ Introduce an Emergency Data Care Set to improve data on daycase emergency care

+ Publish data on re-admissions.

View the NAO report can be found here

Chapter 5. Social Infrastructure

The prevailing theory underpinning improvements to healthcare services and cost savings in the NHS London STPs is that 40% of those in hospital beds should not be there. The proposed STP ‘replacement’ treatment venues include community health day care centres, enlarged GP surgeries and in bed at home. Proofs to ‘prove’ this theory do not exist.

The number of Emergency admissions to hospital (so called Non-Elective admissions – NELs) continues to rise throughout London. The current programme of planned hospital A&E unit closures and District General Hospital (DGH) closures in London has been delayed. In North West London (NWL), for example, two hospital A&Es were closed in September 2014 and A&E performance throughout the region fell dramatically and has never recovered. Plans to fund the closure of another NWL DGH and its A&E unit were rejected by NHS London regulators in November 2017.

16 November 2017 Mayor Khan announced devolved care in London. He stated that London’s population would rise by 1.3 million by 2024. At 2.1 million the eight London boroughs which make up NWL contain over 20% of London’s population. This suggest a population growth in NWL of over 260,000 by 2024.

In the Mayor’s new draft London Plan, the eight NWL boroughs are expected to build 139,950 new homes between 2019 and 2028. In addition to this the OPDC, situated in Brent, Ealing, Hammersmith and Fulham, is required to build 13,670 new homes during this period. This would give us an increase in population in NWL of 461, 982 people by 2028.

In order to successfully treat all these residents in NWL, NHS DGHs, hospital A&E units, community health day care centres and GP surgeries will have to be retained and expanded. By 2028 it’s likely that a new DGH will need to be established in the region.

S1 E ‘new facilities should be easily accessible by public transport, cycling and walking’.
This statement excludes those who are challenged in an ambulatory fashion who will need easy access by private transport. ‘Private transport’ needs to be added to the list.

5. 1. 1 The social infrastructure listing should include ‘social care provision’

5.1. 7 Add ‘including social housing’ after ‘affordable housing’.

S2 C Add ‘private transport pick-up and drop-off’ to the list

5.2.1 London’s social care population is excluded for this planning guideline. (With 1.5 million social care workers in England as opposed to 1.3 million healthcare workers, London’s social care staff population is almost certainly larger than that of London’s healthcare population).

5.2.2 For ‘healthcare’ replace with ‘care’.

In 5.2 a whole new section is required on social care infrastructure provision which should ‘mirror’ the healthcare infrastructure guidelines at 5.2.3, 5.2. 4 and 5.2.5.

5.2 7 Add ‘social care’ references

2 March 2018

NHSI (London) and NHSE (London) Directors of Finance Write to Ealing Save Our NHS (ESON)

In November 2017 NHS Improvement (London) and NHS England (London) Directors of Finance wrote to NHS North West London (NWL) rejecting the NHS NWL ‘Shaping a Healthier Future’ (SaHF) business case ImBC SOC1. This business case requested £513 million for building work connected with plans to close down Ealing District General Hospital. On 6 February 2018 the ESON Research Team wrote to the NHSI/NHSE Directors expressing concerns about the lack of evidence to support the SaHF changes. Specifically ESON found no proof to support the theory that annual Non-Elective hospital admissions (so called NELs) across the eight boroughs in North West London could be reduced by 40% (i.e. by 99,000) by 2025/26.

On 21 February 2018 the Directors wrote to ESON noting the contents of the ESON letter and stating:

‘We would like to assure you therefore, that proposals for significant changes to the provision of health services will need to meet a high assurance bar and be deliverable’.

Hammersmith & Fulham GP Federation and Four NHS Trusts on Track for ‘£200 Million to £300 Million’ for an ‘Accountable Care System’ (ACS)

‘Pulse’ has revealed this deal which is shocking in so many ways. Dr John Sanfey, Medical Director of Hammersmith & Fulham GP Federation, is the mouth piece in the article. For starters the federation is not a statutory body. Why the wild variation in the budget? Will the ACS ‘commission’ physical health, mental health and social care for 212,000 residents? Dr Sanfey is aiming for ‘partial integration’ in 2019. What does that mean? Where is the NHS CCG in all this? Where is the London Borough of Hammersmith & Fulham in all this? Where is the public engagement in all this? Dr Sanfey says that an ‘alliance agreement’ will be signed in April 2018.

Dr Sanfey MB BA BAO BCh DCCH FRCGP appears to be a freelance GP. He is a member of Pallant Medical Chambers based in Chichester. Pallant appears to be a GP locum agency. Pallant employs 125 people and has offices in Southampton and Twickenham.

Hammersmith & Fulham GP Federation is a rather secretive, private limited company (H&FGPF Ltd). It does not have a web site. CQC data reveals that it runs the Brook Green Medical Centre. H&FGPF Ltd’s registered address is 20 Dawes Road, Fulham, SW6 7EN. According to Companies House Dr Sanfey is not an Officer of H&FGPF Ltd.

ECCG OOH Services Single Supplier

A prospectus on this has been published.

What the document is not is an Invitation to Tender (ITT). It’s more of an ‘engagement’ document at the formative stage of contract writing. What the prospectus says, in effect, is that the Ealing Clinical Commissioning Group (ECCG) is thinking about outsourcing the delivery and management of 36 care services. However the ECCG reserves the right to vary the range of services and the nature in which it might outsource them. One assumes that the prospectus might stimulate the nine NHS Trusts and the eight private care providers that ECCG variously entertained on 19 September 2017 and 2 October 2017 to some kind of response of continuing interest.

The contract will be for 10 years and will be in excess of £1 billion. The scheduled start date is April 2019. The prospectus was briefly presented in public on 28 February 2018. 24 members of the ECCG Governing Body approved it at this briefing. Public questioning revealed that no cost saving were envisioned. Cost savings would accrue, allegedly, from reduced Emergency hospital admissions (so called Non-Elective admissions or NELs).  

The care flavour of the decade (along with privatisation) is integrated healthcare and social care services delivery. If you are looking for lots of this in the prospectus you will be disappointed. The prospectus is clearly written from a healthcare perspective and its integration with social care is never consistently referenced.

No Simple numeric Performance Metrics

There are no references to any performance metrics. However adhering to the, as yet unapproved, 2012 NHS NWL ‘Shaping a Healthier Future’ (SaHF) business case no doubt the single supplier will have to deliver Ealing’s share of reductions in NELs (Non-Elective admissions to hospitals). Out of the regional total of an annual reduction of 99,000 NELs by 2025/26 Ealing will have to pro rata ‘deliver’ a total of 12,375 of them. On page 41 under ‘Non-Elective Requirements’ we have an ominous phrase ‘Table to be inserted’. At the ECCG meeting in public on 28 February 2018, ECCG said that NELs reduction targets would be inserted on 22 March 2018 in the next public OOH Single Supplier document.

There’s also no reference to how the 10 year contract might relate to the OOH component of the NHS NWL Integrated Care System (ICS) – previously called the Accountable Care System – which no doubt will become a reality before 2029.

No Financial Details

There are no financial details in the prospectus. Trying to find out historic annual OOH service spends in Ealing is far from straightforward. Dr Parmar of ECCG wrote to an Ealing resident on 8 September 2017 and told him that the OOH services spend for Ealing in 2017/18 would be £121.794 million. 10 times that results in a £1.2+ billion contract.

Now some detailed comments:

+ Page 3:

It says the underpinning business case is not for public release. I wonder why that is. It can hardly be commercial in confidence.

It says that OOH services have been fragmented, complex and difficult to navigate for the service user and health and social care staff. (How it would know this about social care services is hard to fathom as they are commissioned by the London Borough of Ealing (LBE)).

Telephone Triage

The triage for all OOH services will be on the phone via the Single Point of Access (now re-named the Community Single Point of Access). The current SPA for mental health service users is not clinically supported 24/7. I know this from direct experience and from other carers. For a Community SPA to operate successfully 24/7 for physical health, mental health, social care and their integration with expert support would be a difficult and expensive service to create and maintain.

The sharing of care plans makes an appearance here as does ‘IT functionality of the Community SPA’. The idea of all 434,000 patients registered at the 76 Ealing GP surgeries all having care plans is hard to imagine. NHS and Local Authorities sharing care plans (the former with healthcare plans, the latter with social care plans) is again quite a leap of faith.  Of course the social care service users are part of a different database of 349,000 Ealing residents. No explanation or even description of the challenges of the dichotomy and legality of the healthcare and social care database sharing is even entered into.

Underestimated Population Growth

+ Page 5:  

There is a description of Ealing’s current and future population. The future population figures are understated. Mayor Khan’s new 2018 draft London Plan requires LBE to build 28,000 new homes in Ealing 2019 to 2029. This will add some 84,000 new residents. So the social care database will rise to 433,000 and the healthcare database to 518,000.

There is a discussion here about nursing homes, but care homes and domiciliary staff are not mentioned. Yet another integrated healthcare and social care omission.

+ Page 9:

SaHF makes an appearance here. Its business case requires the closure of Ealing District General Hospital (EDGH) by 2021. £513 million for building works is requested to create Ealing healthcare hubs and extend Ealing GP surgeries – all to enable Ealing OOH services to ‘replace’ Acute hospital care in Ealing.  But in November 2017, NHS Improvement (London) and NHS England (London) both rejected the SaHF business case.

Although there are explicit sections on ‘Community Care’ and ‘Adult Care’ here, there are no explicit sections on ‘Child Care’, ‘Mental Health’, ‘Social Care’ and ‘Integrated Healthcare and Social Care’. This is worrying.

(Social care is described later in the prospectus under ‘Local Authority’ suggesting that integration of the two care services is not in place).

+ Page 10:

Here we find aspirational stuff including the phrases ‘advance towards’, ‘decisive steps’, and ‘a new deal’. They add little value to the prospectus.

The Manchester and Dudley Vanguard Multispeciality Providers (MCPs) ICSs are mentioned in a positive light. Surprising this, as all three of these grant funded projects have been halted.

‘…(Current) improvements to OOH services throughout the borough’. The only measureable, tangible OOH services’ improvement in Ealing mentioned by Dr Parmar in her letter of  8 September 2017 was ‘(Home Ward) service apparently helping to avoid 1,400 hospital admissions over an eight month period’. This is tiny reduction compared with the hospital admissions reduction goal.

Performance Aspirations

+ Page 12:

A goal for the single supplier approach is ‘increased consistency and reducing variation in quality (of access to) services’. There’s some shallow thinking here, as there’s no guarantee that such benefits accrue for a single supplier. I might get great service from Thames Water, but a chum down the road might get awful service from them.

Waiting times will not magically reduce by hiring a single supplier. Hiring more staff, opening more hospital beds and expanding and opening more treatment centres might just achieve this.

Expecting a single supplier provider to be the key to keeping ‘all parties informed and involved in the tailored care using appropriate clinical IT systems’ is a statement of faith. Notice no mention here of integration with social care IT systems.

How a single supplier per se might reduce hospital bed-blocking (Delayed Transfers of Care – DTOCs) is not explained. Reducing DTOCs on a sustainable basis with a rising and aging population must require more nursing home beds, more care home beds and more mental health beds, along with more staff.

+ Page 14:

‘Vision for OOH care’. This is about healthcare and not integrated healthcare and social care.

‘The aim is for the single supplier to be clinically led and co-ordinated through a single point of contact to oversee, clinically triage and book all services in scope’. This presumably means the use of the Community SLA. 1,000s of people will be calling this telephone number. And where is the reference to social care triage and integrated healthcare and social care triage?

‘High quality care as close to home as possible and where appropriate’. Well, after EDGH closes, none of the 434,000 Ealing residents will find any high quality care in Ealing if they are critically ill or seriously injured.

Unreal Expectations

+ Pages 15/16:

Some of the expectations of what a single supplier must deliver seem almost certainly to be unachievable:

‘Joined up care across a person’s life from child to adult in the community responding to patient need, and delivering care to address the changing needs of an individual’.

Surely the GP has the primary role here – not the OOH service single provider?

‘The provider will deliver seamless proactive planned care’. What? For 518,000 Ealing residents in 2029?

‘Principles underlying the Clinical Model’

What about the integrated healthcare/ social care model?

The six principles are exemplary aspirational ones. Adhering to these principles and cutting costs significantly will take a genius of a single supplier. There’s reference here to Multi-Discipline Teams (MDT). Anecdotally employing MDTs has proved a little value in Ealing or throughout NHS NWL.

The rest of the document covers NHS healthcare service specifications and separate Local Authority social care specifications.

NHS Recruitment Crisis: EU Nurses Registering to Work in the UK Last Year Dropped by 96% – from 1,304 to 46

These July 2016 to April 2017 figures are very worrying. 34,000 vacancies for nurses and midwives were advertised in January 2018. The January 2018 minimum salary to qualify for a Skilled Work Visa was £46,000/year. In the Thames Valley only one nurse was recruited for the 400 posts advertised.

One in 11 NHS posts are unfilled. The 234 NHS Trusts, who employ 1.1 million ‘whole-time-equivalent’ staff, have 100,000 vacancies. 12% of mental health doctor roles are unfilled.

NHS North West London (NWL) Marks its Own Homework – October 2016 to February 2018

In a quite appalling waste of money NHS NWL has produced a coloured 16 pager entitled ‘The North West London health and care partnership – Progress update February 2018’. It pats itself on the back on each page. It’s probable that management consultants wrote this – thereby adding to the £36 million spend by the eight NHS NWL Clinical Commissioning Groups (CCGs) on management consultants since 2013. However you’ve got to give credit to these NHS regional bosses for having the brass neck to churn this stuff out.

Acute care performance is consistently amongst the worst in England. NHS NWL’s attempts to reduce beds and emergency hospital admissions (largely so called Non-Elective admissions – NELs) has been almost totally unsuccessful. Its many and different attempts at providing sustainable and cost effective Out of Hospital (OOH) services are largely unsuccessful. The well publicised dream of reducing annual NELs by 40% (by 99,000) by 2025/26 and ‘replacing’ the Acute functionality with OOH services must look like a nightmare to NHS NWL bosses.

The older peoples’ service suffers from a chronic shortage of geriatricians. On the mental health front from personal and anecdotal experience there is no ‘real time’ clinical support at the Single Point of Access. The service is still just a ‘go to your GP or A&E’ response service – as it has been for years. Chronically understaffed, the NHS West London Mental Health Trust (WLMHT) still bears the Care Quality Commission 2016 label for 9 of its 11 core services as ‘Requires Improvement’. Waiting times for psychological therapy programmes are measured in months and years. Also WLMHT apparently continues to consider bidding to gain other contracts e.g. the 10 year Ealing Out of Hospital services single supplier contract. How adding more /different service responsibilities will help to improve mental health services for our two million residents in quite beyond me.

At last some real data on page 12.’Agency staff bill reduced by £69 million’. It’s still in £millions but this data is not shared. In ‘Resilience’  it’s a bit distasteful to go on about the Westminster Bridge, London Bridge and Grenfell tragedies. In contemporary London there are going to be ‘unprecedented events’. The NHS NWL Grenfell Tower response metric of ‘4,514 contacts with our outreach team’ tells us very little about successful outcomes and treatment programmes for victims.

Quite incredibly there are virtually no references to updates on social care services and integrated health care and social care services. At least the ailing 2012 ‘Shaping a Healthier Future’ (SaHF) project is completely ignored in the glossy brochure. Surprisingly though, there are no ‘updates’ on the NWL Sustainability and Transformation  Plan, the NWL Sustainability and Transformation Partnership, the NWL Accountable Care Systems(s) (now apparently re-named and the NWL Integrated Care System(s)). Work on all of these have consumed lots of public money collectively by the 8 CCGs and individually by the each of the 8 CCGs.

Have a browse yourself, see what success looks like, and make up your own mind:

www.healthiernorthwestlondon.nhs.uk/news/2018/02/15/north-west-health-and-care-partnership-%E2%80%93-progress-update-february-2018

NHS Ealing District General Hospital (EDGH) Closure Plans Come to Light

A Freedom of Information (FOI) reply has revealed plans to create a 50 bed frailty/elderly unit within refurbished parts of a closed down EDGH. The FOI reply document arrived on 21 February 2018. The FOI revealed planning document is dated 16 June 2017. This document has the snappy title of ‘Client section (call-off) of a PSCP from the Procure 22 Framework: Information Pack for SaHF/STP Implementation Programme for London North West Healthcare NHS Trust’. Some eight months later I can’t believe there isn’t a more recent version of the document.

Rather confusingly the frailty/elderly residential unit for 50 people is called ‘Ealing Local Hospital’ (ELH). The 2012 NHS North West London ‘Shaping a Healthier Future’ (SaHF) changes never envisioned a ‘Local Hospital’ offering in-patient beds. Apparently the writing of the detailed/full business case for closing the 327 bedded EDGH and creating the 50 bedded ELH will commence in March 2018. ‘External approval’ of this business case is not expected until December 2019. These dates should be taken with a pinch of salt as they are eight months old, the overall SaHF business case was rejected by NHS Improvement and NHS England in November 2017 and NHS bosses are famous for creating schedule dates that are never met.

What will be housed in this ELH is still not set in stone. However what is clear is that there will be no ‘traditional’ A&E services, no intensive care services, no operating theatres and no ambulances will ever deliver seriously injured or chronically sick Ealing residents to the ELH. One of the two 25 bed ‘Intermediate Care’ wards at Clayponds in South Ealing will close and effectively move to ELH.

Seemingly there will be no new build on the EDGH site. So any grandiose plans that might once have existed for a new ELH are no more. It’s all now about ‘refurbishment’ of the ‘light’, ‘heavy’ or ‘major’ flavour. London Borough of Ealing (LBE) planning permission may not be needed for this re-purposing.

There’s only one explicit mention of demolition on the EDGH site, with no spatial details provided. If it’s going to be all refurbishing and repurposing, this may result in no or limited land release for housing. LBE may be disappointed by this and may lose some interest in the site as it careers headlong into meeting Mayor Khan’s target of 28,000 new homes in Ealing by 2029.

The date for the closure of EDGH is by no means clear. The opening date of the ELH is also far from clear. It’s December 2023 on page 3 and June 2025 on page 9.

21,000 Mentally Ill Prison Inmates Competing for Just 3,600 Mental Health Prison Beds

The Criminal Justice Alliance recently released these shocking figures. The British Medical Association recently stated that the average life expectancy of a prisoner in a gaol in England and Wales was 56 years. Self-harm in prison rose 12% last year (October 2016 to September 2017) and totalled 42,837 incidents. We have the highest imprisonment rate in Western Europe with 84,255 prisoners. In 1993 this figure was 44,552. The frontline prison staff population was reduced by over 7,000 from 2012 to 2016. Plans exist to recruit 2,500 new prison officers. These are clearly big problems for the government to solve and surely the NHS has a key role in diagnosing and treating all these 21,000 mentally ill patients.