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Issue: 36

May 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.

RIP: Children’s Services at Ealing Hospital

In just a few weeks time acute care for very sick Ealing children will no longer be available at Ealing Hospital. This will be the end of A&E services for children at the hospital after 36 years. As of 1 July 2016 there will be no specialist A&E Paediatric consultants and no beds for children. The Charlie Chaplin Ward for children will be closed.

93% of all sick children who arrive at Ealing Hospital do so in the arms of a parent and not by ambulance. 24,000 children self-presented at the hospital in 2014/15 and of these 4,500 needed A&E treatment. If you have a seriously physically or mentally ill child on 1 July 2016 or after do not take him or her to Ealing Hospital. Figure out which of the following hospital A&E units you can get to most quickly and take the child there:

West Middlesex, Hillingdon, Northwick Park, Chelsea and Westminster or St Mary’s.

Taking your very sick child to Ealing Hospital will delay the onset of treatment as there will be no Paediatric consultants there to diagnose and treat the child. The Urgent Care Centre (UCC) at Ealing Hospital will request transportation to one of the above remote hospital A&Es and you will have to wait for NHS Patient Transport Service (PTS) to take your child for treatment. Contractually, apparently, PTS will collect your sick child within one hour of being telephoned by the UCC. Apparently also your child will not be accompanied on the trip by a medically qualified paramedic/nurse/doctor.

The NHS North West London Collaboration of Clinical Commissioning Groups is producing a booklet called ‘Changes to Children’s Services at Ealing Hospital’. Draft  version 20 of this booklet shamefully tells parents and carers to continue to take sick Ealing children to Ealing Hospital after 1 July 2016. This cannot be in the best interests of the child. There’s no reference to PTS in the leaflet which will lead parents and carers to presume that NHS ambulances will transfer their child to a remote hospital A&E. I’m certain that this will prove an erroneous presumption. The booklet doesn’t even define the NHS upper age of a ‘child’. 16, 17, 18 years old maybe? Surely the adresses and postal codes of the remote hospital A&Es should be included in this booklet.

You might have thought that A&E waiting times will clearly increase significantly because of the waiting time for the PTS service and the travel time to the remote hospital A&E. But, oh no……NHS bosses say that the ‘clock’ will stop when the UCC calls the PTS. The clock will only re-start when the sick child arrives at the remote hospital A&E. This amounts to despicable manipulation of a performance metric. It is unethical and completely against the spirit of the 4 hour wait as a measurement of treatment performance. Why won’t the SaHF gurus have the guts to be honest about the fact that the closure of children’s A&E at Ealing Hospital will result in degraded treatment performance?

Finally as you can read in the next newsletter item, two of the remote hospital A&Es – Hilllingdon and Northwick Park – are performing dreadfully in treating very sick patients (so called Type 1 A&E patients) in a timely manner. Imagine how much worse the performance figures at these two A&Es will be when significant numbers of very sick Ealing Type 1 A&E children start arriving in July 2016.

Northwick Park Hospital’s A&E Service for the Seriously Ill Still Performing Poorly: Even Though A&E Attendance Levels  for the Seriously Ill are Unchanged for Three Years

Only 66.90% of Type 1 A&E patients (those most ill) were seen in four hours at Northwick Park Hospital at the end of January 2016. This is a disastrous performance as the target is 95%. The Type 1 A&E collapse is also evident at Hillingdon Hospital (61.3%) and at Charing Cross Hospital (69.1%) At Ealing Hospital the figure was substantially better at 87.49%. Type 1 A&E attendance figures for all north west London hospitals have remained the same since April 2013. The Northwick Park Hospital’s poor performance is in spite of a new A&E unit being installed there and repeated reports of ambulances being diverted away from the hospital.

NHS bosses refuse to acknowledge the Type1 A&E crisis in north west London.

However in the topsy-turvy world in which we live, it’s Ealing Hospital’s A&E that will close. And this closure begins in just a few weeks time when Ealing’s children will be deprived of A&E services at Ealing Hospital. Let’s hope none of them die because of this.

Ealing Hospital Bosses Try to Schedule the Hospital’s Future in the Context of Healthcare and Social Care Integration

The LNWH NHS Trust, which runs Ealing and Northwick Park Hospitals, has published details of the Sustainability and Transformation Plan (STP) for the North West London ‘footprint’. STP is the latest of a number of State initiatives to cuts care costs whilst miraculously and simultaneously integrating healthcare and social care. The Trust is one of 11 Trusts, eight Local Authorities and eight CCGs who have been thrown together in this footprint to save money. A new body has been formed to run this footprint – the NWL Strategic Planning Group (SPG).

The SPG must produce an STP which must specify how:

+ existing local NHS debts are eliminated

+ 7-day NHS working is implemented

+ hospital beds will be replaced by care at home

+ A&E units will be replaced by Urgent Care Centres

+ healthcare and social care provision will be integrated.

The first worrying thing about the LNWH Trust document is that the phrase ‘social care’ does not appear anywhere. What this suggests to me is that the senior NHS folks see STP   as being exclusively about healthcare.

By April 2017, the Trust expects the ‘Shaping a Healthier Future’ project (SaHF) Ealing Hospital Implementation Business Case to actually exist. SaHF is a 2012 NHS healthcare cost cutting initiative which, amongst other things, aspires to demolish Ealing Hospital. By April 2018 the Trust expects the existence of an ‘Ealing Hospital A&E/UCC model’. This little gem is all about post demolition creation of a First Aid post on the site staffed by GPs and nurses.

‘It is anticipated that much of this work will be overseen by (Local Authority) Health and Wellbeing Boards’. How this marking of its own homework will be accomplished is unclear – given that the eight Local Authorities will be jointly authoring and jointly implementing the STP in the SPG.

A new bureaucratic layer will be added in 2018/19. This will be the Accountable Care Partnership (ACP). The ACP is apparently all about mental health as its constituents will be Local Authorities, mental health service providers and the voluntary sector.

Finally it’s stated that ‘…the aim is for the eight CCGs in North West London to work within a single financial control total with the NHS service providers’. Surely what this means is that there will exist, in effect, a regional health authority. It also means that GP led control of local NHS spending will disappear completely – given that it ever existed since CCGs were forced upon us in 2012.

Ealing One of Just Eight Local Authorities in England Not to Raise Council Tax to Help Pay for Social Care

Chancellor George Osborne announced a precept in November 2015 which would allow Local Authorities to raise Council Taxes by 2% without facing any punishment or the need for a local referendum. 144 Local Authorities in England took advantage of this. Ealing Council was not one of them. Had Ealing followed the vast majority of other authorities it would have raised at least an extra £2 million for social care.

I for one would have supported this Council Tax rise, and I suspect so would many other local tax payers. Ealing Council’s reasons for not raising Council Tax seem to be purely political. I know of one single unemployed mother with a four year old child who upon being evicted in April 2016 could not be re-housed in Ealing. The best Ealing Council could do was put her and her daughter in a B&B room with a single bed and a fridge outside the borough of Ealing.

To compound Ealing Council’s hubris, they decided that even the registered disabled would pay something towards their Council Tax this year. In previous years the disabled were exempt from paying Council Tax. Who would have thought a Labour administration would favour taxing the poor instead of taxing the rich?

Healthcare and Social Care Integration: A Muddle of Mutually Exclusive Initiatives?

First we had the NHS Better Care Fund. Then we had NHS Vanguard projects. We also now have devolved integrated healthcare and social care eg Manchester. And recently we have had the NHS Sustainability and Transformation Plan.

All these four initiatives variously throw Local Authorities, NHS CCGs and NHS Trusts together and effectively say to them ‘sort this integration stuff out between you and at the same time make major cost savings’.

Of course the Emperor’s New Clothes factor here is that we have an ever decreasing number of hospital and care home beds. Between 2010 and 2015, 10,000 hospital beds in England were lost. For the year up to September 2015, 1,500 care home beds in England were lost. In March 2016 AgeUK estimated that three million hospital bed days were lost between June 2010 and January 2016, due to lack of social care provision.

All this is about money – of course:

+  If you are in a hospital bed the State pays for it. The average weekly cost per bed is £2,121

+ If you are in a care home bed in most cases you will pay something towards the average weekly cost of £563. Only 37% of care home beds receive Local Authority funding. 90% of all care homes in England are privately owned.

+  For social care at home you will be means tested. If you receive three hours care each day the average weekly cost is £356.58.

Looking logically at the integration of healthcare and social care we clearly need more care home beds. However the private care home sector is failing to expand care homes or build new ones. Reasons quoted include:

+ The April 2017 introduction of the National Living Wage will threaten the viability of their businesses

+ Local Authorities are receiving less money for social care from national government. In response they have reduced the rates of remuneration paid to private care homes.

It’s obvious that the only way to increase the number of social care beds is for the State to build new care homes and run them.

Devo-Manc Health Up and Running With Only £6 Billion Each Year to Improve on the Current £10 Billion Spent on Healthcare and Social Care Across Greater Manchester

I spent the first 19 years of my life living in North Manchester. I have visited friends in Manchester regularly since 1992. The healthcare/social care experiment taking place there is of more than just a passing interest for me. It’s also probably the clue to what’s going to happen in London.

I have read the 60 page December 2015 ‘Taking charge of our health and social care in Greater Manchester’ plan published jointly by the NHS and the Greater Manchester Combined Authority (GMCA).

Greater Manchester (GM) is the pioneer in England for attempting integrated healthcare and social care services on a grand scale. Here are some relevant dates and numbers on this bold (or reckless) initiative:

+ GMCA and National Government agreement signed on 3 November 2014

+  Formal start date of the project was 1 April 2016

+  2.8 million people’s lives will be affected

+  By 2021 £2 billion saving must be achieved

+  37 statutory bodies are attempting to work together – 10 Local Authorities, 12 NHS CCGs and 15 NHS Trusts

+  Current official figures for the current annual spend on healthcare and social care in GM is £7.7 billion. Oldham and Saddleworth (Greater Manchester) MP Debbie Abrahams calculates it to be £10 billion

+  Currently paid healthcare and social care staff in GM number 100,000

+  563 care homes (the vast majority of all care homes) not owned by Local Authorities in GM – none of them are represented on the GM Board which decides how the annual £6 billion budget is spent.

Themes very similar to those in the ailing 2012 NHS NW London ‘Shaping a Healthier Future’ project can be found in the plan. Although the plan contains admirable aspirations and laudable goals it is also riddled with cost cutting initiatives. These include reducing the number of acute beds, fewer visits to hospitals, more out-of–hospital/community care, increased use of technology to reduce face-to-face transaction times, more home care and more self care.

A new raft of bureaucracy is planned. New ‘models’ will be created. These include:

+  LCOs (Local Care Organisations)

+  MSCPs (Multi-Speciality Community Providers)

+  PACs (Primary and Acute Care Systems)

+  ICAs (Integrated Care Organisations)

+  ACOs (Accountable Care Organisations)

+ AHMOs (Accountable Healthcare Management Organisations)

The so called Financial Plan is absurd. Instead of detailing just how the £6 billion will be spent it lists savings to be made. There’s no overview on projected income and expenditure. This leads me to believe that those leading this experiment are unsure of its costs and its income. This is very worrying.

Given £billions will be spent over the next 11 months it’s odd that there are no stated integration performance goals and consequently no details on how integration performance will be measured. So there will be no way of making quantitative or probably qualitative assessments of services’ success – or failure.

It’s also not encouraging that the boss of the project has just left a year into his job. On 31 March 2016 a new Chief Officer was appointed. He’s Jon Rouse. At least he does have relevant senior management experience in local government, healthcare and social care. However I suspect he’s never run a three ring circus before.

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 the physically ill 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 2016/2017 NHS NW London Sustainability and Transformation Plan (STP). This draft STP has been hatched in secret by representatives of 31 public bodies which include 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 website 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.

A fantastic turnout at Ealing Hospital on both days!
More doctors than ever kept turning up and consultants popped along to show their support.
Car horns were going all the time – there’s clearly massive public support for the docs and the NHS.

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All over England public bodies are meeting together in secret to come up with plans to cut £2.3 billion off the annual NHS budget by 30 March 2017. For example here in north west London a Strategic Planning Group (SPG) has been formed to produce a Sustainability and Transformation Plan (STP). Members of the SPG include representatives from eight Local Authorities, eight NHS CCGs and 11 NHS Trusts. The STP has to be completed by 30 June 2016.

The STP must specify how existing local NHS debts are eliminated, how 7-day NHS working is implemented, how hospital beds will be replaced by care at home, how A&E units will be replaced by Urgent Care Centres, and how healthcare and social care will be integrated. The failing 2012 ‘Shaping a Healthier Future’ cost–cutting project is being ‘folded’ into the STP.

If the plan is not produced or is rejected, access to new NHS funding will be denied and a new SPG leader appointed by national NHS bosses.

Creating these public bodies’ ‘supergroups’ has not been the subject of an Act of Parliament. There has been no public consultation. No-one has produced any evidence to indicate that this radical STP initiative will or might improve healthcare and social care services – or in fact will or might achieve the targeted cost savings.

Over the last 10 years 10,000 hospital beds have been lost across the country. In the 12 months up to September 2015, 1,500 care home beds have been lost. Care at home has become discredited by constant stories of under paid care workers only being able to spend 15 minutes per patient.

Far from spending less in healthcare we should be spending much more. The UK spends 6.8% of GDP on its healthcare. In Germany  it’s 10.3% of GDP. In the UK we have 3 hospital beds per 1,000 people – in Germany it’s 8.3 hospital beds per 1,000 people.
The UK is one of the richest countries in the world. We ‘invented’ publicly funded  healthcare and social care services. Why can’t we collectively look after our citizens’ health especially those unable to look after themselves? After all a healthy population is a happier one and a more productive one.

Angry health protesters gathered today outside Greenford Hall as Ealing CCG was considering ongoing cuts to Hospital services.
The CCG (Clinical Commissioning Group) is pressing ahead with plans to close the Charlie Chaplin Children’s Ward at Ealing Hospital, which would also mean children would no longer be accepted at the hospital A&E department.
Eve Turner, from Ealing Save Our NHS, said “If this cut goes ahead the CCG will be responsible for serious delays in seriously injured or ill children getting treatment. No amount of PR waffle or abuse of statistics will change that. It’s dangerous and has no public support.

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Issue: 35

April 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 Failing NHS NW London Shaping a Healthier Future Project is Being Buried in the Shiny New Sustainability and Transformation Plan for Integrating Healthcare and Social Care Services

Massive changes are afoot in the creation of new organisations (consortias of public bodies) throughout England which are the vehicle for making massive financial cuts in NHS spending. These new organisations will design and deliver new models of integrated healthcare and social care. The national media and activists on the ground have seemingly not yet woken up to these changes, their inherent risks and implications.

The change agents for all this are Sustainability and Transformation Plans (STPs). STPs are part of NHS England’s Five Year Forward View (FYFV). STPs have a five year budget of £8.4 billion. England has already been carved up into 44 so called ‘footprint’ areas. In each of these footprints NHS CCGs, Local Authorities and NHS Trusts will work together to formulate and deliver an STP. London has five footprints. Our local one is NHS NW London which includes eight CCGs, eight Local Authorities and 11 NHS Trusts. NW London Footprint boss is Ealing’s own Dr Mohini Parmar. She now has four roles/jobs – Footprint boss, SaHF cheer leader, ECCG Chair and local GP. The bosses identified so far are almost all senior CCG types or NHS Trust bosses. None of them are from the social care community. Each footprint has to create its first STP by 30 June 2016.

The prospect of NHS and Local Authority bureaucrats working successfully together and amicably resolving the competing resource demands of healthcare and social care takes quite a lot of believing. It also seems incredible that apparently none of the thousands of care homes in England are represented in these footprints. I now understand one of the reasons why the eight CCGs in NW London have been working together for so long.

Each STP must balance the financial books of local NHS finances by end of March 2017 and achieve this by implementing new models of care set out in the FYFV. The new models include reducing hospital beds and ‘replacing’ them with digital monitoring and home visits. Another new model is for Urgent Care Centres to effectively replace A&E units in hospitals. STPs will also spell out the sale of surplus land and buildings. The STP presents private healthcare providers with huge opportunities.

Apparently NHS London North West Trust (which includes Ealing Hospital) expects to receive £21.5 million for 2016/2017 from the STP. This seems quite high as £2.1 billion nationally for 2016/2017 STP shared by 44 footprints comes to just over £47 million each.

There are just 12 weeks to go to finalise our STP. Ealing CCG’s web site provides details of the NW London Footprint. Apparently a first draft of the local STP was created at the beginning of February 2016. A mind boggling 31 public organisations are represented.  The footprint is led by something called the NW London Strategic Planning Group (NWLSPG). All CCGs, all Local Authorities, all NHS Trusts and The London Ambulance Service are represented, and there are just two patient representatives. I wonder who they are and just how they were selected or possibly elected.

The ailing ‘Shaping a Healthier Future’ (SaHF) project finally gets buried and subsumed into the NWLSPG’s STP initiative. This could well explain Ealing Council’s ‘quietness’ on the subject of SaHF. The Council must be finding it difficult to publicly criticise  SaHF as now it is one of the (admittedly many) organisations now responsible for SaHF. Surely Hammersmith & Fulham Council can no longer seriously pursue a Judicial Review about SaHF when it is now part of the consortium responsible for SaHF. I now also understand why references to SaHF have been curiously disappearing over recent months.

Other existing NHS ‘transformations’ which will be brought into the STP regime include Whole Systems Integrated Care, Like Minded, Primary Care Transformation and Seven Day Services.

On a day to day basis Ealing Council’s Scrutiny is attempting to hold Ealing CCG to account. Surely this becomes mission impossible if the Council and the CCG are getting into a very large STP bed together to design and deliver integrated health care and social care services. Now I understand one of the reasons why ECCG moved into the same building as Ealing Council.

The STP project could learn from some of the missteps of its progenitor – the £5.3 billion NHS Better Care Fund launched in 2013. BCF aimed at ‘…transforming local health and social care by pooling (Local Authority and NHS) resources’. BCF failed to meet its operational and cost cutting goals in 2014. It’s a bit odd that it is not being absorbed into STP.

There is a link here somewhere, somehow with the Accountable Care Organisation (ACO) concept. ACO is a 2006 American idea which became mandated in the US Patient Protection and Affordable Care Act of 2010. The ACO approach is that of a consortium of public and private healthcare and social care organisations delivering services to a defined population for a defined period. Reimbursement is often tied to ACO’s meeting quality and cost targets. Surely these 44 STP footprint consortia are ACOs?

The ACO concept is being trialled in one of the NHS Vanguard projects in Barking & Dagenham, Havering and Redbridge. Other ACOs under consideration include those in Northumbria and Morecambe Bay. Worryingly studies of ACOs in the US showed that projected savings by ACOs in 2011 – 2014 of $320 million were not achieved. In fact a loss of $3 million was sustained.

All these STP activities, costing £millions and requiring extensive organisational engineering, are not mandated by any Act of Parliament and have not been the subject of any public consultation.

When David Cameron said in 2009 and in 2010 that a Tory Government would not bring about a new top down re-organisation of the NHS, he was right. He’s now initiated not one – but two of them.

Hunt Threatens to Remove and Replace NHS Boards for Those Trusts in Deficit on 1 April 2016

Secretary of State Jeremy Hunt MP is going to be very busy this month replacing the Boards of 138 NHS Trusts throughout England. London Health Emergency’s research published in early February 2016 revealed that 138 of the 150 NHS Trusts were in the red. The combined deficit of these 138 Trusts amounted to £2.2 billion. – and it was still rising.

‘…Children Will Die…’ Says Experienced Consultant Paediatrician

This prediction by Tony O’Sullivan, Consultant Paediatrician at Lewisham Hospital, was made to over 100 people at the Ealing Save Our NHS rally in the centre of Ealing on Saturday 12 March 2016. He made it in response to Ealing Clinical Commissioning Group’s (ECCG) ‘Shaping a Healthier Future’ (SaHF) plans to severely downgrade (in fact remove) Ealing Hospital’s Paediatric services. On 16 March 2016 ECCG confirmed to the press that the children’s in-patient ward and the children’s A&E service at Ealing Hospital would close on 30 June 2016.

Tony’s nightmare scenario is that in 12 weeks time  a very sick child may arrivie at the doors of Ealing Hospital being carried by a parent. With no A&E facilities available for children, the Urgent Care Centre (UCC) – devoid of Paediatric Consultants and Paediatric Nurses – will likely have difficulty in accurately diagnosing and adequately stabilioasing such a sick child.

Currently 93% of all sick children arriving at Ealing Hospital are brought by their parents and carers and not by ambulance. Around 6,000 children annually attend Ealing Hospital A&E. Just under 2,000 children annually are admitted as patients to the hospital.

So what will happen to the thousands of sick children who the Ealing Hospital UCC determine need A&E services? The plan is that the NHS Patient Transport Service (PTS)  – not the London Ambulance Service – will transfer them variously to hospital A&E units at remote locations including those in Harrow, Hillingdon and Isleworth. The NHS PTS has a poor reputation. A comprehensive report on PTS in London by Transport for All in October 2014 discovered many patients facing long waits for transport to hospital appointments. It’s unclear (and almost certainly unlikely) whether a Paediatric nurse or doctor would accompany each sick child on his or her trip out of Ealing. Distraught parents and carers will have to make their own way to these remote hospitals to be re-united with their sick child.

It is an absolute certainty that the time to expert diagnosis and commencement of treatment will be increased by these closures. This will inevitably introduce the risk of increased physical and mental pain, condition deterioration and death.

ECCG presented a paper on its Paediatric reconfiguration aspirations at Ealing Council’s Health and Social Care Scrutiny Panel on 8 March 2016. The paper was almost completely bereft of Paediatric patient numbers, explanations and analyses. Scandalously the paper makes no mention at all about how the specific emergency needs of children arriving at Ealing Hospital suffering from severe mental health episodes and conditions will be diagnosed and treated.

The MindEd Trust has recently publicised the fact that just 0.7% of the NHS budget is spent on the mental health needs of children and adolescents. The ECCG’s apparent ‘blindness’ with regard to mentally ill children presenting themselves at Ealing Hospital is symptomatic of the empty senior NHS rhetoric of ‘parity of esteem between physical and mental health’. Still the ECCG approach is horribly consistent with the 2012 SaHF proposals which contain no mention of mental health services whatsoever.

If  A Child Dies As a Result of  Removing Accident, Emergency and Acute Services for Children at Ealing Hospital – Whose Fault Will It Be?

The answer to this one is quite simple. It’s the Ealing Clinical Commissioning Group (ECCG). We should hold the ECCG Governors personally and collectively responsible. I have attended quite a few public meetings of the ECCG Governing Body. They are very strange meetings. No-one ever argues. There is very little discussion or debate. I have never witnessed a vote on any issue or policy choice. Surely a few of these Governors must have had their doubts about closing Maternity or downgrading children’s services at Ealing Hospital. Why have none of them put their hands up and said something like ‘you know, I’m not entirely convinced that this will work/that we’ve thought this through properly/that this is the right thing to do…’.

And who are these people anyway?

Let’s identify them:

+  Dr Mohini Parmar, NHS ECCG Chair and newly appointed boss of the NHS NW London Footprint (Sustainability and Transformation Fund).

She signed her name on the 2012 ‘Shaping a Healthier Future’ Consultation document. GP working at the Barnabas Medical Centre, Ealing.

+  Dr Raj Chandok, NHS ECCG Vice Chair

GP working outside Ealing

+  Dr Mohhammad Alzarrad

Southall GP

+  Dr Arjun Dhillon

West Ealing GP

+ Dr Vijar Tailor

GP at Hillcrest Surgery, Acton

+ Dr Shanker Vijayadeva

GP working with Dr Parmar at the Barnabas Medical Centre, Ealing

+ Fionnula O’Donnell

Ealing GP Practice Manager

+ John McNeill

Healthwatch Ealing Chair

+  Jonathan Webster

Qualified nurse now in nursing management in NHS North West London

+  Ben Westmancott

NHS North West London manager and administrator

+  Dr Jackie Chin

Ex-Director of Public Health, London Borough of Ealing

+  Keith Edmunds

Chief Finance Officer

+ Sally Armstrong

Hanwell GP Practice Nurse

+ Philip Young

Accountant and management consultant. Has experience as Trustee of a respected local care home

+ Philip Portwood

Ex-Acton Councillor

+ David Archibald

Ex-social worker and ex-Executive Director for Children and Adults, London Borough of Ealing

+ Clare Parker

NHS ECCG Chief Officer and qualified accountant

+ Tessa Sandall

NHS ECCG Managing Director

+ Carmel Cahill

Ex-Healthwatch Ealing Chair

This line-up does not tally exactly with the ECCG web site, which sadly is not up to date.

Number of Arrivals at NHS Hospital A&Es is FALLING: Shortage of Beds and Staff is Causing the A&E Treatment Crisis

A&E waiting times in many areas of England are missing performance targets. Patients in NW London are amongst those suffering because of this. Closure of hospital A&Es across England, including closures at Hammersmith and Central Middlesex Hospitals in September 2014, is clearly the recent historic driver for this local service deterioration.

The NHS figures extracted and presented by Colin Standfield of Save Our Hospitals show unequivocally that there has been no increase in A&E arrivals since April 2013. His figures and graphs show this to be the case for England, London, NW London, London excluding NW London, and Ealing and Northwick Park Hospitals. In fact the number of attendances nationally actually dropped in recent months. According to a King’s Fund report of 6 March 2016 ‘…so far this year, total A&E attendances for the first three quarters are slightly down on the same period last year’.

However the Department of Heath and NHS England is consistently lying about the numbers of A&E arrivals. They keep saying that ‘demand’ is increasing. But they won’t quote real data and NHS England’s refusal to publish weekly A&E performance data any more looks like a pathetic attempt to hide the actual data. Also even monthly data is not made publicly available on a timely basis. No such data has as yet been released for January and February 2016.

The ever worsening crisis in A&E is being caused by shortage of staff and shortage of Acute beds. Dr Cliff Mann, President of the College of Emergency Medicine says the crisis in A&Es is ‘unprecedented’. With the future of many NHS hospitals uncertain (eg Ealing and Charing Cross) and high levels of pressure and overcrowding in A&Es it’s not surprising that doctors are not signing up for permanent A&E positions.  Just one quarter of new A&E consultant posts in England were not filled this year. The recent caps on rates of pay for locums has lowered pay levels three times – in November 2015, February 2016 and March 2016. So vacancies are either unfilled – permanently or temporarily – or Trusts are risking censure or worse by breaking the temporary pay rate rules. Dr Mann says that hospitals are drafting non-A&E hospital staff into A&E. With finite and perhaps reducing medical staff resources, hospitals are having to delay or cancel elective and non-emergency treatment.

I went to the Ealing Hospital rally in support of junior Drs, which was brilliantly organised by local campaign group, Ealing Save Our NHS. It was a very powerful event and I felt quite emotional standing together with over 100 people – junior and senior Drs, nurses, relatives of patients from within the hospital, union representatives, parents of young children and elected politicians – to protest loudly against the unfair and unsafe contract for Junior Drs.
The speakers were varied and inspirational. Although, at times, the crowd had to strain to hear over the continuous noise of drivers on Uxbridge Road tooting their horns in support of the junior doctors picket. A few things that the speakers said stood out. Firstly, Dr Ravi Ganepola was quite emotional when he said that ever single striking doctor in the country would much rather be working on the ward, helping their patients, than picketing outside the hospital in the rain. These Drs are very reluctant activists who are simply desperate for the Government to listen to their fears about what this contract will do to patient care. He is very worried there will an exodus of junior Drs when the contract is imposed.

Meanwhile, local celebrity, Shappi Khorsandi echoed the concerns of parents from across the community. I have a one year old and a three year old, and I am worried that the children’s A&E that is currently closest to my home will be shut. And finally, there was a call to action from virtually all speakers to tell friends, families and colleagues about what the Government is actually doing to our NHS. It’s starving our hospital of funds, selling of chunks of the NHS to private companies who are running them for profit and stretching every single member Dr, nurse, radiologist and ambulance driver to breaking point.

Jeremy Hunt is desperately hoping that we won’t notice and that we won’t protest the destruction of our health service. Judging by the strength of feeling at yesterday’s rally, and at public demonstrations across the country, Mr Hunt is out of luck.
I feel lucky that we have such a strong local group in Ealing Save Our NHS, which supports our local hospitals and is leading efforts to protect our local hospital and support NHS staff.

As you probably know on 16 March 2016 the local CCG confirmed that the children’s in-patient ward and the children’s A&E service at Ealing Hospital will close on 30 June 2016.

Please consider writing or speaking to your GP and local councillors.  Your GP or Councillor might not know or understand everything that’s going on….

If we work together we can put some pressure on the people who make these decisions.

This prediction by Tony O’Sullivan, Consultant Paediatrician at Lewisham Hospital, was made to over 100 people at the Ealing Save Our NHS rally in the centre of Ealing on Saturday 12 March 2016. He made it in response to Ealing Clinical Commissioning Group’s (ECCG) ‘Shaping a Healthier Future’ (SaHF) plans to severely downgrade Ealing Hospital’s Paediatric services. On 16 March 2016 ECCG confirmed to the press that the children’s in-patient ward and the children’s A&E service at Ealing Hospital would close on 30 June 2016.

Tony’s nightmare scenario is of a very sick child arriving at the doors of Ealing Hospital being carried by a parent in 12 weeks time. With no A&E facilities available for children, the Urgent Care Centre (UCC) – devoid of Paediatric Consultants and Paediatric Nurses – will likely have difficulty in accurately diagnosing and adequately treating a very sick child.

Currently 93% of all sick children arriving at Ealing Hospital are brought by their parents and carers and not by ambulance. Around 6,000 children annually attend Ealing Hospital A&E. Just under 2,000 children annually are admitted as patients to the hospital.

So what will happen to the thousands of sick children who the Ealing Hospital UCC determine need A&E services? The plan is that the NHS Patient Transport Service (PTS)  – not the London Ambulance Service – will transfer them variously to hospital A&E units at remote locations including those in Harrow, Hillingdon and Isleworth. The NHS PTS has a poor reputation. A comprehensive report on PTS in London by Transport for All in October 2014 discovered many patients facing long waits for transport to hospital appointments. It’s unclear (and almost certainly unlikely) whether a Paediatric nurse or doctor would accompany each sick child on his or her trip out of Ealing. Distraught parents and carers will have to make their own way to these remote hospitals to be re-united with their sick child.

It is an absolute certainty that the time to expert diagnosis and commencement of treatment will be increased by these closures. This will inevitably introduce the risk of increased physical and mental pain, condition deterioration and death.

ECCG presented a paper on its Paediatric reconfiguration aspirations at Ealing Council’s Health and Social Care Scrutiny Panel on 8 March 2016. The paper is almost completely bereft of Paediatric patient numbers, explanations and analyses. Scandalously the paper makes no mention at all about how the specific emergency needs of children arriving at Ealing Hospital suffering from severe mental health episodes and conditions will be diagnosed and treated.

The MindEd Trust has recently publicized the fact that just 0.7% of the NHS budget is spent on the mental health needs of children and adolescents. The ECCG apparent ‘blindness’ with regards mentally ill children presenting themselves at Ealing Hospital is symptomatic of the empty senior NHS rhetoric of ‘parity of esteem between physical and mental health’. Still the ECCG approach is horribly consistent with the 2012 SaHF proposals which contain no mention of mental health services whatsoever.

Julia Farrington from Shropshire Defend our NHS wrote to Ealing Save our NHS:

[dropshadowbox align=”none” effect=”lifted-both” width=”auto” height=”” background_color=”#f0e9c3″ border_width=”1″ border_color=”#dddddd” ]Hello from a fellow campaign. Our Womens and Childrens Department was closed a few years ago at the Royal Shrewsbury Hospital and it has caused chaos.   The Royal Shrewsbury has an A&E department, which is due for closure too but it is still the trauma centre and has to accept paediatric patients, it a farce and dangerous. The sister hospital is the Princess Royal Hospital in Telford some 15 minutes away on a blue light…if there’s an ambulance available, if the roads are clear, no road works, no rtcs. The management team were repeatedly warned by senior staff in Paediatrics and the Emergency Department, they now regret ‘ the hasty decision to move Women and Childrens Department’
to one site. I am a mother with a child who has been in resuscitation area of the Emergency Department with a hospital minutes away that we now cannot access, it is frightening! I wish you all the best and please have a look at our website, Shropshire Defend Our NHS but we are a rural campaign with different dangers but we are all trying to do the same thing, I just wish we were listened to![/dropshadowbox]

While we have “Shaping a Healthier Future”, in Shropshire they have “Future Fit” but have a look at their website, it all sounds very much the same. You can also find Shropshire Defend Our NHS on Facebook.