Issue: 39

August 2016

This occasional newsletter is researched, written and edited by a group of concerned residents in Ealing, West London who want to preserve our NHS. We view the wholesale engagement of private, for-profit healthcare service suppliers as unnecessary, profligate and dangerous. Process improvement is what is needed in our NHS – not revolution.

The Secret Planning of Healthcare and Social Care Services:

The Sustainability and Transformation Plan (STP):

An Update

At the 6 July 2016 Ealing Clinical Commissioning Group (ECCG) public meeting hard copies of nine NW London STP slides were handed out. In December 2015 NHS England announced that England would be divided up into 44 ‘Footprints’. Each Footprint (let’s call them regions) would create a five year plan (an STP) for delivering cost cutting in the provision of healthcare services and social care services. Each region would pull together a supergroup of all its Local Authorities, NHS CCGs and NHS Trusts to work together collectively to create the plan. These supergroups meet in secret and have no Parliamentary mandate.

As well as massive cost cutting, each of the 44 STPs must deliver healthcare services seven days a week. The number of Acute hospital beds must be reduced and more Acute care delivered in the home and in the community. All historic healthcare debts must be eliminated and healthcare services and social care services must be integrated. A fundamental flaw in trying to integrate healthcare and social care in England is that the former is free at the point of use and the latter is means tested.

The deadline for submitting the first draft of the 44 STPs was 30 June 2016. However in typical NHS style this deadline was slipped in early June to October /November 2016.

Our region is North West London. Our STP supergroup numbers over 30 public bodies. On 5 April 2016 a summary version of our STP was created. An early draft dribbled out into the public domain in June. In April the debt target was £1.1 billion. Now the debt to be cleared appears to be £1.3 billion. On a pro rata basis this would mean an annual reduction in healthcare and social care spend in Ealing of £160 million. In order to comprehend the difficulty of meeting this cost cutting target, let’s look not for the first time at the 2012 NHS NW London ‘Shaping a Healthier Future’ plan (SaHF). SaHF’s cost saving target was 4% per year. So by now SaHF should have a saved over £400 million on the NHS NW London costs. Not once over the last three years has the SaHF brotherhood announced any savings achieved whatsoever.

I can find no reference in any of the April or July NW London STP drafts about the projected population increase and how this has been factored into the plan. ONS/GLA figures calculate a current population of 2,093,972. By 2022 they predict it will have risen to 2,206,451 – a rise of 112, 479 people. This equates to adding the population of a city the size of Carlisle or Worcester to our regional population. The population increase for Ealing alone is just under 20,000.

Bed Losses: Changing Numbers

Bed losses are on the agenda. In a 15 April 2016 STP document it states the target bed loss is 500 Acute beds. In a 27 May 2016 STP document it states a bed loss of 592. However on 1 June 2016 Carolyn Downs boss of Brent Council and one of the NW London STP hotshots said that the closure of 500 beds target had been dropped.

Carolyn Downs is the Local Authority (LA) STP lead for all the eight LAs in NW London. She also said that the three guiding principles of the NW London STP were 1) prevention 2) integration of health and social care and 3) innovation via technology. She voiced LA concerns about closure of Acute beds when alternative community provision was not in place. Also LAs are worried about funding the social care aspects of the STP mandated requirements.

Net savings apparently total £328 million This presumably must be annual savings for year one. Apparently £208.9 million will be saved by ‘improving consistency in patient outcomes and experiences regardless of the day of the week that services are accessed’. This clearly is where seven day working is implemented. But seven day working means employing more staff at the weekend and overnight or reducing service levels Monday through Friday. How over £200 million can be saved in this scenario – without massive service deterioration – is beyond my comprehension.

Outsourcing Mental Health?

Are the STPs being set up to fail so that the private health companies (‘the cavalry’) can then charge in and rescue our healthcare and social care services? Well, perhaps not. The small print shows us that the cavalry are actually being planned into the STP. Nestling inside ‘Delivery Area 4: Improving outcomes for children and adults with mental health needs’ (net savings of £11.8 million) is ‘implement accountable care partnerships’(ACPs). The ACP idea has been around for a while in the NHS. It is England’s version of the American Accountable Care Organisation which first emerged 10 years ago. (ACO) ACPs are a vehicle for introducing private care companies into the delivery of public care services.  A contract is drawn up with often private care providers, Primary, Acute and social care providers to provide all care for a given population for a defined (long!) period of time. Very often there are tight performance parameters and financial incentives in place when targets are met. The jury is still out in America as to whether ACOs are effective or even cost-effective. Critics of the ACO/ACP approach see them as a means of destroying single payer national care systems. .

There are yet again scant details on social care savings or initiatives. Nothing on social workers, personal care, protection or social support services to children and adults with needs arising from illness, old age or poverty. There are clearly planned changes on how the total spend cake will be sliced in 2020/21 compared with 2015/16. However even if, for example the slice for ‘Community’ rises from 9% to 13% there may well be less cash This is because  the total cake is just over £4 billion now but will be less than £3 billion in 2020/21. Astonishingly there is no slice of the total spend cake labeled ‘Social Care’ or even ‘Social Care and Healthcare Integration’.

On the mental health front the slice of the cake will stay at the current 8% of total spend in 2020/21. This will represent a serious annual drop in real cash terms of some £80 million. On a pro rata basis that would cut the annual mental health spend in Ealing by £10 million. There is a quite incredible projection about how there will be a 1% fall in serious and long term mental health needs over the next five years. I can find no clinical or research data to back up this claim.

The plan for addressing social isolation is amazingly ‘Address Social Isolation’. This really is pathetic. In ‘Socially Excluded Groups’ the only data – and partial data at that -concerns rough sleepers. If the STP creators think rough sleepers are the only socially excluded people they are the wrong folks to be creating my STP.

In the plan delivery section it states ‘…delivery to ensure it (the STP) sustains investment on the things that keep people healthy and out of hospital’. Well blow me down with a feather …isn’t that what the NHS was created for in 1948? Also in this section we find that at least 178 NHS and Local Authority staff in north west London are working on our STP. However the number could be over 200. Nationally there might well be over 8,000 paid public servants working on the 44 STPs as well as many £millions being spent on management consultants.

There’s reference to ‘joint governance’ and ‘joint accountability’. This is so much nonsense. I keep meeting STP /SaHF staff who tell me that they are being paid and employed by both the Local Authority and the NHS. This sends me berserk. You can only have one boss. You can only be accountable to one bunch of shareholders and one organisation.

Multi-Speciality Community Provider: The Outsourcing Vehicle

On 22 July another public NW London STP event took place. Labelled as a workshop so many residents asked questions that the workshop format was abandoned. Allegedly a NW London STP public event will take place in Ealing Town Hall in September or October 2016. There are no explicit plans to involve the local Healthwatch organisations in any NW London STP plan making or public engagement. More emerged on ACPs (see above) and on them being ‘delivered through Multi-Speciality Community Providers (MCPs). I first referred to these MCPs in May 2016 when discussing Devo-Manc Health (in Manchester). The scary idea emerging from the jargon littered verbiage is that traditional GP surgeries might well be closed down. They would be replaced by MCPs /’superhubs’/’networks with shared infrastructure’ which will – using the GP surgery patient lists – ‘provide…the full breadth of services ….including primary medicine and community services’. How this will threaten or destroy the traditional GP surgery is unclear. However in Brent, all the GPs have joined a newly created limited company. It’s no surprise that the directors of that company are GPs who serve on the Brent CCG Governing Body.

NW London STP, following the lead of the monster STPs in Manchester and Liverpool, wants a devolved budget. A recent Localis survey says 78% of NHS and Local Authority bosses want this. New London Mayor Sadiq Khan says he wants it for a London STP. However devolving health and social care could create a patchwork quilt of differing approaches and arrangements. It could wreck the NHS as a consistent, universal healthcare service. To give, as some have suggested, tax raising powers to the 44 unelected STP cabals – even with the blessing of Parliament – would destroy this country as a representative democracy.

Believe me STP will end in tears – in fact it’s starting in tears. Rumours abound that in my region two of the Local Authorities (LAs) have refused to ‘sign off’ on the latest draft STP. They were recently given a two page STP summary to sign their names to. The two LA bosses refused, saying no-one had showed them the latest full draft. They were then shown the 51 pages of draft version 39 and given just three hours to peruse and sign. Again they refused. NW London STP bosses then told the two LAs that they would ‘take money away from community health services for local people’. The two LAs are the London Borough of Hammersmith & Fulham and the London Borough of Ealing – the areas still most threatened by Major Hospital closures under the 2012 SaHF declaration.

The Judicial Review Option

Thanks to research by Peter Latham of Brent Patient Voice it’s clear that Ealing CCG  has a statutory duty under S.14Z2 of the National Health Act 2006 (as amended by Section 26 of the Health and Social Care Act 2012) to involve and consult its publics as to proposals for healthcare commissioning and changes to healthcare commissioning that affects patients. This is clearly not happening with NW London’s STP. ECCG is at risk of the procurement of or changes to commissioned healthcare affecting patients without full statutory patient/public involvement and consultation of being challenged by Judicial Review proceedings in the High Court This will, of course, apply to all 211 CCGs in England.

A Government Inspection Reveals Serious Failings at Northwick Park Hospital Maternity Unit: Ealing Mothers Victims of Inadequate Service

Since Ealing Hospital Maternity Birthing Unit closed down at the end of June 2015, mums to be in Ealing have had nowhere to go to in Ealing to have their babies. Some have chosen Northwick Park Hospital Maternity Unit in Harrow.

In October/November 2015 the Government’s Care Quality Commission (CQC) carried out an inspection on Northwick Park Hospital. Incredibly it took seven months before the CQC report was published at www.cqc.org.uk. The report contains much criticism generally about hospital services and specifically about the maternity services. These criticisms about maternity are summarised below:

Requiring Improvement:

+ Safety arrangements

+ Early Pregnancy Unit cleanliness

+ Medicines sometimes in unlocked cabinets and sometimes stored at the wrong temperature

+ Foetal Heart Rate checks

+ Low Midwife staffing levels

+ Minimum standards of consultant presence per week not met

+ Shortage of Health Visitors

+ Too many non-elective Caesareans

+ No Consent, Mental Capacity Act and Deprivation of Liberty training

+ No documented birth plans

+ Delays in Caesareans, induction of Labour and in Discharge

+ Poor maternity and gynaecology governance.

Before the closure of Ealing Hospital Maternity Unit the NHS Ealing Clinical Commissioning Group (ECCG) stated ‘….it has been able to improve maternity care for mothers across North West London’. For many new mums in both Ealing and Harrow this statement has been shown to be patently untrue.

The CQC criticised the standard of cleanliness in the whole hospital. There was savage criticism of the London North West Healthcare NHS Trust – the legal entity running Northwick Park Hospital. CQC stated that the Trust had failed to communicate its strategy and vision, it had failed to communicate with staff and it had failed to support staff and make them feel valued.

NHS North West London CCGs Spent £5.1 Million on Management Consultants in FY 2015/16

£5,188,001 was spent by the eight NHS NW London Clinical Commissioning Groups on management consultants from June 2015 to March 2016. These contracts concerned work for the 2012 ‘Shaping a Healthier Future’ (SaHF) project and the Sustainability and Transformation Plan (STP). Over £1.8 million alone was paid to McKinsey and Company.

The fact that one of the STP contracts was signed in August 2015 leads me to believe that the STP project was up and running secretly for months before it was announced to the public just before Christmas 2015.

It defies belief that the CCGs are still paying consultants to write/rewrite SaHF business cases for the SaHF which was conceived four years ago. But sure enough, six consultancies were paid over £1.8 million to work on these business cases in 2015/16. And still there are no final, published business cases. Surely the whole idea of a business case is that you get an approved business case signed off before you start a project – not four years into the project!

If you thought that NHS England had put a cap on the size of individual management consultancy contracts – think again. In December 2015, for example, Deloittes was awarded a £585,000 SaHF business case support contract.

Presumably the hundreds of staff employed by the CCGs are deemed not competent to carry out this work. But surely public money would have been better spent last year and in the last three years if the NHS had hired bright people onto its payroll to do this work? At £80,000 per year (salary plus overheads) it would have cost £3.2 million to have 10 people on board for four years to do this work. Instead the NHS NW London management consultants’ bill for 2013 to 2016 was over £38 million. Truly scandalous.

After Spending £50 Million on the care.data Patient Health Records Sharing Scheme, NHS Bosses/Government Scrap It

On 6 July 2016 – the day The Chilcot Report  condemning Tony Blair’s invasion of Iraq was finally published and filled our newspaers and TV screens – the  Government quietly announced that care.data was being scrapped. Launched in 2013 the care.data scheme was an attempt by the NHS to collect patient data from GPs, anonymise it and use it internally and sell it externally. care.data has consistently attracted criticism about  the anonymity and security of patient data.

In February 2014, 47 million NHS patient records were sold to insurers. In February 2015, 700,000 NHS patient records were shared with insurance companies without patients being consulted.

Tim Kelsey the genius responsible for initiating and running the care.data shambles ran away from it, the NHS and the UK in September 2015 and was last heard of in Australia. However Kelsey clearly does have a sense of humour as he’s recently published a book on the role of transparency in government and business surveillance. To misquote an old adage ‘Nothing succeeds like failure’. Also in September 2015 the care.data pilot trials were halted.

Data campaigners are still concerned that the NHS and the Government will continue to sell off confidential patient data – including data from NHS patients, like me, who opted out of the care.data scheme. However the Government has now, apparently, decided that patients can no longer opt out of their medical records being loaded onto a central NHS database.

Yet more £millions wasted by NHS/Government and still more erosion of trust between citizens and the State.

Issue: 38

July 2016

This occasional newsletter is researched, written and edited by a group of concerned residents in Ealing, West London who want to preserve our NHS. We view the wholesale engagement of private, for-profit healthcare service suppliers as unnecessary, profligate and dangerous. Process improvement is what is needed in our NHS – not revolution.

The NHS Is Not In Debt – But In Surplus: Nationally To The Tune of £600 Million and £72 Million in NW London

Roger Steer is a healthcare audit consultant who has been studying NHS financial data for ten years. On 9 June 2016 he published a bombshell paper which analysed NHS commissioning financial reports for 2015/16. He revealed the following surpluses (what one might call profits) for 2015/16:

+ NHS England – £600 million

+ NHS London – £26.5 million

+ NHS North West London – £72 million

In fact the NHS in England has been in surplus at the end of the last five financial years – in 2013/14 as low as £1 million and in 2010/11 as high as £1.1 billion.

These figures make a nonsense of the scary reports of NHS 2015/16 losses of £2.4 billion. They make no sense in the context of the blanket requirement of the Stevens /NHSE Five Year View/Sustainability and Transitional Plan (STP) imperative of clearing NHS debts – if in fact at a gross level no such debts exist.

One wonders whether the Government’s seemingly erroneous debt message is simply scare mongering to somehow justify the STP cost cutting without Parliamentary scrutiny or any public consultation.

North West London’s Sustainability and Transformation Plan (STP) Finally Enters the Public Domain on 16 June 2016

NW London’s 15 April 2016 initial draft STP submission can be viewed at:

www.bpv.org.uk/nw-london-sustainability-transformation-plan-15-april/

STPs are the latest device being foisted on us by Government in an attempt to eliminate alleged historic NHS debts, reduce future healthcare and social care costs and extend healthcare and social care services. Simon Stevens, boss of NHS England, published a national Five Year View care strategy in late 2015. In it he created 44 care regions (weirdly called ‘Footprints’). Each Footprint threw together all the Local Authorities, NHS CCGs and NHS Trusts in that region. Each of these footprints has this year to produce a first year STP and submit it to NHS England for review. All STPs have to indicate how current NHS ‘debts’ would be paid off, 7 day working would be implemented, hospital A&Es would be replaced by Urgent Care Centres, Acute hospital care reduced and replaced by care at home or in the community, and healthcare integrated with social care. The STP must also supply details of the sale of surplus land and buildings.

Our footprint is North West London with over 2 million people and a Government estimate of over £4 billion spent last year on NHS healthcare and Local Authority social care.

Before I make any comments on the 18 page NW London draft STP I think it’s worth exploring the attempts in recent years to cut healthcare and social care costs nationally and regionally. This exploration will help to answer the question (or question the question): why STP?

Healthcare Cost Cutting

+  In 2010 the Government announced that annual NHS costs would be reduced by $20 billion by 2015. However annual healthcare expenditure (according to Roger Steer – see above) rose over five years from £97.5 billion to £101 billion in 2015/16.

+  The Health and Social Act 2012 created a market for healthcare which separated healthcare professionals into buyers and service providers. Profit and loss accounts were created for hospitals. However mystery and confusion surrounds the NHS accounts for 2015/16. All but seven of the 138 NHS Hospital Trusts supposedly made a loss in 2015/16. NHS England says the NHS losses for the year were at least £2.4 billion. However the recent Roger Steer report (see above) has added up the NHS figures and he states that in 2015/16 the NHS in England made a profit/surplus of £600 million.

+  In 2012 NHS NW London launched its ‘Shaping a Healthier Future’ (SaHF) strategy. NHS expenditure in NW London was then stated to be £3.6 billion. The target for annual cost savings was 4%. By now over £400 million should have been saved. As SaHF has not trumpeted details of any savings one can presume that none have accrued from SaHF. However Roger Steer has analysed all eight NW London CCG accounts and calculates a £72 million profit (or surplus in NHS speak) was achieved in 2015/16.

+  In June 2013 the Government’s Better Care Fund (BCF) was introduced to oil the wheels of reducing costs by integrating NHS healthcare and Local Authority social care services. £3.8 billion was to be invested with the target of saving £1 billion by 2015/16. In November 2014 the Government’s National Audit Office produced a report stating that in its first year BCF savings of just £55 million were realised. Since that announcement we’ve heard little more about BCF.

Social Care Cost Cutting

+  What is social care? It’s the provision of social work, personal care, protection or social support services to children or adults in need or at risk or adults with needs arising from illness, old age or poverty.

+  Since 2010/11 annual social care expenditure in England has decreased by over 10% to £13.3 billion. The expenditure on children in care in England in 2013/14 was £2.5 billion. Try as I might I can’t find any other meaningful historic or current expenditure details on children’s social care in England, London or NW London.

NW London STP 15 April 2016 Submission

So against a backdrop of austerity, population increase and people living longer 31 regional public bodies were thrown together and told to come up with a plan to both cut costs and improve healthcare and social care services across North West London. There clearly is some logic in trying to integrate the service supply of physical health, mental health and social health. To make this work would almost certainly involve the creation of a single business model and a single organisation to provide all these services. But we have the NHS, Local Authorities and private care homes each with different mission statements and different reporting structures.

I can only sympathise with the plan makers as what they are being asked to do is impossible. They must surely know this.

There are very few relevant, understandable numbers in the plan. Two are:

+ Over £1 billion annual savings by year 5 (2021/22?)

+ Lose 500 Acute beds.  

There are seven ‘Emerging Priorities’, which bizarrely are not the Stevens/NHE Five Year View goals. They are really seven aspirations as opposed to priorities. There are no real, tangible clues as to how these aspirations will be met. Quite simply these aspirations might be summarised as wanting better healthcare and social care services for everyone in NW London. As such they represent what citizens have thought the NHS and Local Authorities have aspired to deliver for decades.

On the financial side on page 11 there is an impenetrable table of financial numbers and unexplained acronyms. The table doesn’t even has a title –  which if it existed might help the reader to gain some understanding. However what stands out like a sore thumb are the entries associated with ‘NW London social care’ financial figures. The entries state ‘not available’.

Returning to the Stevens/NHE Five Year View goals the STP gives very little detail on how they might be met. For example there is little explicit detail on how 7 day working will be achieved or how healthcare and social care will be integrated.

Apparently there is some kind of risk register. Number 1 risk is ‘Access to capital for estates and IT investment’. SaHF (which is included in the STP) has wanted up to £1billion for capital projects for quite some time now. However there are no signs or hints anywhere that the Treasury will stump up the cash.

What’s missing from the STP?

There very little in it concerning GP services, social care services generally and care homes specifically. There is nothing on the sale of surplus land and buildings. None of the statutory Healthwatch organisations have been given a role in the formulation or implementation of the plan. And of course there is nothing in the STP about residents and patients being involved in the plan making process.

Finally the North West London Footprint wants a ‘Devolution Deal’. This  would mean that the self appointed healthcare and social care bosses would have direct control of over £4 billion annually to spend as they thought fit. A scary prospect.

Ealing CCG Hosts Vacuous STP Public Meeting on 13 June 2016: Announces STP Deadline Slip to October/November 2016

Ealing Clinical Commissioning Group (ECCG) announced at a rare public STP meeting on 13 June 2016 that NHS England had cancelled its 30 June 2016 deadline for submitting draft STPs. Now the deadline date is a vague October/November 2016.

Fewer than 20 residents attended this poorly advertised Ealing STP public meeting. I asked why the meetings of the 31 public bodies over the last four months concocting our STP were held in secret and why we couldn’t see a copy of the latest STP for North West London. ECCG said that NHS England had told them to exclude the public from involvement in the plan making exercise.

So, how do you run a public meeting on a plan the details of which can’t be revealed to the public? What you do is split the audience up into little groups and ask them to discuss huge societal and political issues like ‘how do we reduce social isolation’ and ‘how do we improve children’s mental and physical health and well-being’? I’m surprised in a way we weren’t asked how to reverse climate change and eliminate world poverty. This is so unbelievably patronising and belittling to citizens. Some people got angry and raged about the UK’s low % of GDP spent on care, the impossibility of improving care services when hospital and care home beds were being lost and how is it that healthcare in Cuba is better than it is in England. The thorny issue of STP legitimacy was raised, as no Act of Parliament supports STPs’ existence.

I lobbied hard with a senior ECCG person on the need for NHS staff and Ealing Council officers to work in tandem with informed volunteers to provide, for example, mental health caring services. NHS England’s approach of shutting out and antagonising volunteers was very unhelpful. I told her I thought it was unlikely that more paid staff would enter the fray and deploying significant numbers of well managed volunteers integrated with paid staff offered some hope of ‘doing more with less’. Her elliptical response was ‘we are working with partners’.

No details emerged from the meeting about how the alleged enormous NHS debts would be paid off, how 7 day working would be implemented, how Acute hospital care would be reduced (rumours of 500 bed losses) and replaced by care at home/in the local community and how healthcare and social care would be integrated.

Apart from losing 90 minutes of my life I will never get back, my overriding impression was that the STP project is doomed. The no doubt well paid public servants in the room tried hard to show enthusiasm for the STP project but this was not entirely convincing as they shut down responses to difficult questions. No Ealing GPs, Ealing Hospital staff or anyone working for an Ealing care home bothered to attend the meeting. No-one mentioned SaHF and the usual SaHF cheer leaders were absent. Ealing Council’s presence was minimal and very low key.

The reality is that if NHS England do not like submitted plans they will send them back to footprints who will have to re-do them. And Thatcher-like, if NHS England finally does not like the re-worked STP the threat is that no new money will be sent to that footprint.

Opposition to Inadequate Funding and Resourcing for Care Grows Locally, Regionally and Nationally

Locally here in Ealing the Ealing Save Our NHS (ESONHS) group remains strong and new blood and new leadership is maybe coming onto the Board of Healthwatch Ealing (HE). HE so far has been largely ineffective. A Judicial Review on the paediatric closures in Ealing is being mounted by a local parent.

Regionally there has been a first meeting of North West London Health Matters. The organisation was inspired and organised by activists in Hammersmith and Fulham. It aims to co-ordinate opposition to closures and cuts throughout NW London.

Nationally, Keep our NHS Public (KONP) seems to have stopped arguing with itself so much and its newish, knowledgeable leaders John Lister and Tony O’Sullivan are making their mark. Health Campaigns Together offers the prospect of an entity supporting and representing all healthcare activist groups nationally.

Inspiration for all care activists has come from Shropshire where a CCG voted against the closure of a hospital A&E department. Rumour has it that the CCG and the Local Authority in Bedford are at loggerheads over reviewing services. News came, initially from Yorkshire, that the deadline for creating Sustainability and Transformation Plans (STPs) has been/will be extended. We now know from Ealing CCG that the submission deadline has been delayed. Sometimes delays in state programmes are precursors to programme change or programme deletion. One suspects that the competing goals of Local Authorities and NHS CCGs and Trusts have resulted in acrimonious and protracted rows about how big financial cuts should be ‘shared’ across  social care and healthcare.

A Government Inspection Reveals Serious Failings at Northwick Park Hospital Maternity Unit: Ealing Mothers Victims of Inadequate Service

Since Ealing Hospital Maternity Birthing Unit closed down at the end of June 2015, mums to be in Ealing have had nowhere to go to in Ealing to have their babies. Some have chosen Northwick Park Hospital Maternity Unit in Harrow.

In October/November 2015 the Government’s Care Quality Commission (CQC) carried out an inspection on Northwick Park Hospital. Incredibly it took seven months before the CQC report was published at www.cqc.org.uk. The report contains much criticism generally about hospital services and specifically about the maternity services. These hospital maternity services criticisms are summarised below:

Requiring Improvement:

+ Safety arrangements

+ Early Pregnancy Unit cleanliness

+ Medicines sometimes in unlocked cabinets and sometimes stored at the wrong temperature

+ Fetal Heart Rate checks

+ Low Midwife staffing levels

+ Minimum standards of consultant presence per week not met

+ Shortage of Health Visitors

+ Too many non-elective Caesareans

+ No consent, Mental Capacity Act and Deprivation of Liberty training

+ No documented birth plans

+ Delays in Caesareans, induction of Labour and in Discharge

+ Poor maternity and gynaecology governance.

Before the closure of Ealing Hospital Maternity Unit the NHS Ealing Clinical Commissioning Group (ECCG) stated ‘….it has been able to improve maternity care for mothers across North West London’. For many new mums in both Ealing and Harrow this statement has been shown to be patently untrue.

The CQC criticised the standard of cleanliness in the whole hospital. There was savage criticism of the London North West Healthcare NHS Trust – the legal entity running Northwick Park Hospital. CQC stated that the Trust had failed to communicate its strategy and vision, it had failed to communicate with staff and it had failed to support staff and make them feel valued.

Ealing Save our NHS Childrens Ward Closes, We Need A Hospital from Ealing Save Our NHS on Vimeo.

Ealing Save our NHS Childrens Ward Closes, Bring Services Back from Ealing Save Our NHS on Vimeo.

Ealing Save our NHS Childrens Ward Closes, Fight Goes On from Ealing Save Our NHS on Vimeo.

[gmedia id=20]

£5,188,001 was spent by the eight NHS NW London Clinical Commissioning Groups on management consultants from June 2015 to March 2016. These contracts concerned work for the 2012 ‘Shaping a Healthier Future’ (SaHF) project and the Sustainability and Transformation Plan (STP). Over £1.8 million alone was paid to McKinsey and Company.

SaHF is a 2012 NHS NW London strategy to cut costs. Two full hospital A&Es, a children’s hospital A&E and a hospital Maternity unit have already been closed, but no financial savings have been announced. SPT is a national cost cutting scheme whereby Local Authorities, NHS Trusts and NHS Clinical Commissioning Groups ( CCGs) try to thrash out regional five year plans for delivering less expensive healthcare and social care services. In NW London the goal is to save £1.3 billion by 2020/21.   

The fact that one of the STP contracts was signed in August 2015 leads me to believe that the STP project was up and running secretly for months before it was announced to the public just before Christmas 2015.

It defies belief that the CCGs are still paying consultants to write/rewrite SaHF business cases for the SaHF which was conceived four years ago. But sure enough, six consultancies were paid over £1.8 million to work on these business cases in 2015/16.

If you thought that NHS England had put a cap on the size of individual management consultancy contracts – think again. In December 2015, for example, Deloittes was awarded a £585,000 SaHF business case support contract.

Presumably the hundreds of staff employed by the CCGs are deemed not competent to carry out this work. But surely public money would have been better spent last year and in the last three years if the NHS had hired bright people onto its payroll to do this work. At £80,000 per year (salary plus overheads) it would have cost £3.2 million to have 10 people on board for four years to do this work. Instead the NHS NW London management consultants’ bill for 2013 to 2016 was over £38 million. Truly scandalous.

The new Care Quality Commission report for the London North West Healthcare NHS Trust is out.

Link to the report

Eric Leach, a researcher and campaigner for Ealing Save Our NHS, added:  ‘It’s sad that overall ‘Requires Improvement’ is a common theme. However we do note that CQC states that Northwick Park Hospital (NPH) requires more improvement than Ealing Hospital (EH).

[pdf-embedder url=”https://ealingsaveournhs.org.uk/wp-content/uploads/2016/06/Joint-campaigns-response-Final-28th-May-2016.pdf”]

Issue: 37

June 2016

This occasional newsletter is researched, written and edited by a group of concerned residents in Ealing, West London who want to preserve our NHS. We view the wholesale engagement of private, for-profit healthcare service suppliers as unnecessary, profligate and dangerous. Process improvement is what is needed in our NHS – not revolution.

500 Acute NHS Beds To Be Axed in North West London Over the Next Four Years

It took an article in the 10 May 2016 issue of the ‘Evening Standard’ to inform us all about the projected butchering of our local hospitals. The so called debt of £1 billion in NHS NW London is apparently to be dealt with by axing 500 Acute beds in our local hospitals by 2020. The beds to be lost would have been for use by both the physically and the mentally ill.

The trio who told the newspaper are the bosses of the NHS Ealing Clinical Commissioning Group, Brent Council and the NHS Imperial Healthcare Trust.

Digging deeper into this bombshell we find that the figures came from the draft  NHS NW London Sustainability and Transformation Plan (STP). This draft STP has been hatched in secret by representatives of 31 public bodies including eight NHS CCGs, eight Local Authorities and all the NW London NHS Trusts. The failing 2012 cost cutting ‘Shaping a Healthier Future’ (SaHF) programme does not get any mention whatsoever. Obviously SaHF as a cost cutting vehicle has now been replaced by STP.

The body which created this STP calls itself the NWL Strategic Planning Group (SPG). The SPG has no statutory authority and is not the creation of any Act of Parliament. No public consultation was carried out on the STP or the SPG. I can’t find any evidence of SPG meeting minutes or the draft STP. You might have thought that these documents might exist on the Ealing CCG web site, the Ealing Council web site or the web site of the ‘North West London Collaboration of Clinical Commissioning Groups’,  but you would be wrong.

Of course the ‘Evening Standard’ quotes some anonymous NHS spokesperson shoveling out the usual claptrap about not axing beds before alternative services are in place. Well, this never happened when Acute beds were axed from Central Middlesex and Hammersmith Hospitals in September 2014. And I don’t expect it will happen with the new ‘Axe 500 beds’ project.

Are Clinicians the Best People to Make Decisions That Could Put in Danger  the Lives and Health of Our Children?

On 25 April 2016 eight senior NW London Paediatricians wrote a letter in support of closing Ealing Hospital’s Acute care for children. On 18 May 2016 Ealing CCG duly endorsed the experts’ view and confirmed closure of all Acute services for children at Ealing Hospital on 30 June 2016.

The first glaring omission in the experts’ letter is the complete lack of any reference to caring for mentally ill children. So much for the parity of esteem for physical and mental health. This unforgivable slight on emergency care for seriously mentally ill children almost invalidates the letter completely. A second glaring omission is that the authors don’t even have the guts to explicitly endorse the closure of A&E facilities for children at Ealing Hospital.

No doubt senior clinicians endorsed or even mandated the closure of the A&E units at Central Middlesex and Hammersmith Hospitals in September 2014. These closures led to an immediate, unprecedented and massive drop in A&E performance across the whole of north west London. And even now, some 18 months since the A&E closures, the A&E waiting times at Charing Cross and St Mary’s Hospitals are amongst the worst in England.

The reality of better clinical care for children in Ealing is rapid access to appropriate physical and mental health competencies for seriously ill children. 4,500 seriously ill children are brought to Ealing Hospital A&E each year. Last year 4,185 of these arrived in the arms of a parent, carer or loved one and not by ambulance. Under the new July 2016 regime these sick children will be triaged by the Urgent Care Centre at Ealing Hospital and then subject to an up to one hour wait for Patient Transport Services (PTS) to take them to a remote hospital A&E outside Ealing. The other option being proposed is the Children’s Acute Transport Service (CATS). CATS median response time is 75 minutes. Only when the child reaches this out of borough hospital will the possibility of expert treatment become a reality. It’s not clear how the parent/carer/loved one will get to the remote hospital, especially if it’s 4am for example. None of this is clear in the letter from the senior medics or any NHS patient literature in print or in draft.

No doubt the senior medics who admit to designing these new children’s Acute services  and who signed the letter are experts in their fields and have impeccable motives. However do we as a society allow nuclear scientists to push the nuclear weapon button? To use another analogy – from my own career – when you are designing a computer system you start off with discovering the users’ requirements. The users’ requirements in this case are quite clear. The 68,000 Ealing children and their parents/carers/loved ones require a complete children’s care service in Ealing providing 24 hour A&E, in-patient beds and specialist Peadiatric and mental health services. The obvious location for this across the 21 square miles of the borough is within the existing facility at Ealing Hospital in Southall.

Dr Anne Davies, Dr Michele Cruwys, Dr John Hutchins, Dr Hermione Lyall, Dr Kingi Aminu, Kay Larkin, Katrina Warkcup and Nathan Askew – I do hope all your service design efforts for our local children work out well. I do realise it would have been very difficult for you all to say explicitly ‘…we had to save money and what we’ve come up with is the least worst option’. However you didn’t. No doubt you might have gained citizens’ respect if you had said that. If children’s Acute services for Ealing children take a turn for the worse at least we’ll know at whose doors to lay the blame.

‘A Hospital is Not Always the Best Place to Treat People’

We have heard and read this somewhat asinine assertion a number of times emanating from some anonymous NHS spokesperson. In response to this a few questions come to mind. They include:

+ So what?

+ What has it to do with the number of hospital beds we need?

+ Is the statement in actual fact a gutless replacement statement for ‘hospital beds are very expensive and we have to close 100s/1,000s of them because the Government refuses to pay for them’?

Allied to the ‘not always the best place’ assertion is another claim that hospital beds can be replaced by out-of-hospital treatment at home or close to home in the community. However there is little or no evidence that this out-of-hospital approach provides significant cost savings. For example the 2012 ‘Shaping a Healthier Future’ (SaHF) programme has apparently been implementing this bed loss/out-of-hospital replacement approach for over three years in NW London. However the SaHF mavens have yet to claim anywhere, anytime that there have been any resultant cost savings.

With people living longer more elderly people will need treatment/care/surgery that only hospitals can provide.

The number of people in England detained under the 1983 Mental Health Act is rising. It has risen by 30% over 10 years. 58,400 Sectioned patients needed hospital beds in 2014/15 – up 10% on 2013/14.

Government figures in September 2015 stated that 68,560 households in England were living in bed and breakfast, hostels, refuges, supported lodgings and self-contained annexes. The number of families with children in bed and breakfast accommodation has risen by 45% in just one year. Secondary/hospital-type care and treatment for all these people is impossible ‘at home’.

The number of care home beds declined by 1,500 in the year ending September 2015.

Ealing Council’s 2012 plans for building new homes will add 12,407 new homes and 30,000 new residents in Ealing by 2026. Residential development at one site alone in Southall will house some 9,000 new residents.

In conclusion, England lags behind many countries in the number of hospital beds per head of population. Locally the population continues to grow. The number of people requiring hospital beds is rising. The number of care home beds is declining and this will do nothing to reduce bed blocking levels in hospitals. There is no convincing evidence that there are any significant cost savings achieved by replacing hospital care with home care or care in the community (whatever that might be).

‘Home is Not Always the Best Place to Treat People.’

Exploring NHS Myths

+  Priority of esteem for the physically ill and the mentally ill.

NOT  TRUE

13% of the NHS annual national budget is spent on mental health treatment. Mental health needs make up 28% of the NHS burden of illness.

+  There are increased attendance levels at hospital A&Es.

NOT  TRUE

NHS figure show that nationally in the 119 week up to 31 July 2015 all hospital A&E attendance levels variously varied from the median by 13.5% below to 7.1% above.

+  The best way to measure A&E performance is to lump together all A&E patient treatment performance data and Urgent Care Centre treatment performance data.

NOT  TRUE

Of greatest interest and relevance to all of us is the treatment of those who are rushed to hospital with serious injuries or illnesses. The NHS labels these patients as A&E Type1s.

In north west London although Type1 attendance levels have remained the same for over three years, rapid treatment has been elusive. Waiting times for Type1s extended dramatically immediately following the closure of two A&Es in September 2014. It has never really improved since then. In January 2016 attempts to treat  95% of Type1s within four hours (the national target) failed miserably. At Hillingdon, Northwick Park and Charing Cross hospital A&E Type1 performance was below 70%.

Colin Standfield of Save Our Hospitals digs out this Type1 data which is collected but not trumpeted by the NHS. What the NHS trumpets is treatment performance figures for A&E Type1, Type2, Type3 and Urgent Care Centre patients – all lumped together. The implication is that the NHS has the same interest in how fast patients with indigestion are treated as it has with patients with life threatening injuries or illnesses. However a cynic or realist might observe that NHS bosses just don’t want us all to know how it is failing the seriously ill in the provision of hospital A&E services.

This letter was sent to all the Doctors sitting on the Ealing Clinical Commissioning Group (CCG) board. They all appeared to have agreed to close Maternity & the Children’s ward as well as accepting that there will be no paediatrically trained staff in the Urgent Care Centre (UCC) or A&E at Ealing hospital. A Rapid Access Clinic has been set up but this is only available to GPs not the staff of either the UCC or A&E.

1.6.2016.

Dear Dr.

I am writing to you as you are on the Ealing CCG representing our profession as well as determining the Health services available to the Ealing community.

The Ealing CCG voted last year to close the maternity department of Ealing Hospital unanimously. I assume therefore you agreed with the received wisdom that as 24 hour in patient consultant cover was not available, the care was therefore not safe. This was the reason given for closing the department. Dr Parmar said that this was evidence based. The evidence was not available as no unit in England had at that time 24 hour cover.

Birmingham tested this employing additional consultants at a cost of ¾ of a £ million and found after one year there was no change in outcome. A further review published in the BMJ (copy enclosed) came to the same conclusion. The out of Borough hospital maternity units do not provide 168 hour Consultant in patient cover and on evidence & the shortage of funds employing the extra staff will not contribute to Shaping a Healthier Future and is a waste of money

Although the Independent Healthcare Commission lead by Michael Mansfield QC recommended the reopening the Ealing Hospital maternity department, this is no longer a possibility because the real reason for closing maternity was to save money.

You are about to close the in patient paediatric beds. Children admitted to the out of Borough Hospitals will be given a choice for their follow up. Most will probably wish to have continuity of care thus reducing slowly out patient numbers at Ealing.

In summary you are strangling Ealing hospital by degrees in order to close it as outlined in the original consultation document, ‘Shaping a Healthier Future’.

You are all working GPs do you really think that the Ealing community will receive a better NHS as a result of your past unanimous actions? May I suggest you vote to postpone the closure of the IP paediatric beds at Ealing Hospital?

Yours sincerely,

Clara Lowy MD, MSc, FRCP

Arthur Breens wrote  this letter that was published in the Ealing Gazette on 27/05/2016.

Well done the Gazette for reporting last week’s meeting at which NHS managers decided to close the children’s ward and children’s A&E at Ealing Hospital on 30 June 2016. Minor injuries only will be treated at the Urgent Care Centre. A&E child specialist staff will work at other sites.

The story around Samantha Phelps Schmidt (same issue) confirmed the doubts from the floor expressed by Ealing Healthwatch and Ealing Save Our NHS. Otherwise this meeting was tightly orchestrated by the chair and these 50 NHS managers (Ealing Clinical Commissioning Group) looked both uncomfortable and sheep-like.

Don’t trust this organisation to honestly and publicly monitor its own performance. Its level of self-interest and self-importance is high and its record poor. Remember it took a TV documentary to expose the inadequate monitoring of Ealing’s Urgent Care Centre by the CCG. The poor performance of A&E in our wider area after the closure of A&E s at Hammersmith and Central Middlesex has been well documented by Mansfield and a Hanwell resident but denied and spun by the chair of this group.

If whistleblowers still face problems in the NHS then we must demand rigorous independent performance monitoring of these major changes to Ealing children’s services and the promise to reverse these “bridge too far” cuts if required.  

Arthur Breens