Issue: 25

May 2015

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.

Ealing Save Our NHS (ESON)

For over three years this campaigning group has fought to save Ealing’s hospitals and our NHS from cuts, closures and privatisations. On 30 April 2015 ESON together with Hammersmith’s Save Our Hospitals campaigning group presented a 15,000 signature petition to Health Minister Jeremy Hunt at the Department of Health in Westminster. The signatories want the new Government to suspend plans to close Ealing Hospital Maternity unit, cut 600 beds from Ealing and Charing Cross Hospitals and take away their A&E units.

See https://www.facebook.com/ealingsaveournhs

Will NHS Still Be Centre Stage After the General Election?

Somehow I doubt it – whatever the result.

However, locally politically sensitive healthcare documents and decisions – no doubt many of them already written and made – may well enter the public domain after the election. They include:

+  The new ‘Shaping a Healthier Future’ Business Case

+  The date of the closure of Ealing Hospital’s Maternity Unit

+  The demolition and new build plans for the Ealing Hospital site

+  Sir Bruce Keogh’s new definition of a ‘Modern A&E Unit’ which no doubt will be the blue print of the yet to-be-built new not-really-an-A&E-unit –as-we-know-it on the Ealing Hospital site

+ The McKinsey report on the reasons for the A&E Type-1 chaos in NHS North West London post the September 2014 A&E closures

+ The final report of the North West London Commission on Health

+ The fate of Solace, the Bowman’s Close, West Ealing walk-in mental health centre.

Pressure on A&E Has Not Increased and Is Not Increasing

Colin Standfield of Save Our Hospitals continues quoting NHS statistics which refute the Coalition Government’s lie that there is increasing pressure on NHS hospital A&E units.

From November 2010 to March 2015 Type-1 A&E (the most seriously ill) attendances have remained steady – averaging at 273,388 per week. In fact recently they have dropped below this figure.

So the recent A&E chaos is not to do with what patients are doing to A&E, it is a result of hospital closures (5 in London alone, 2 of those here in NW London), bed cuts and savage culling of social care, meaning that people cannot be discharged from hospital.

North West London Commission on Health: Initial Report

This excellent report, published on 26 March 2015, contains the initial findings of the independent commission chaired by Michael Mansfield QC. The report was written by independent consultants Sean Boyle and Roger Steer. For those of you who may not have the time to read the 119 page report, I have tried below to summarise and highlight the findings which constitute a review of ‘Shaping a Healthier Future’ (SaHF).

1. SaHF HISTORY

A McKinsey and Company report to Government in 2009 put forward the view that the NHS spends too much money on acute care and that £billions could be saved by shifting care from acute hospital settings. NHS boss Nicholson demanded £20 billion savings on NHS costs across England during the period 2009 to 2015.

Out of this came the approach in NHS North West London to save one £billion by 2015 by downgrading four of the nine major hospitals, moving expensive acute hospital care into cheaper Out of Hospital (OOH) services and primary care, and centralising services at five major hospitals.

The decision to downgrade four major hospitals – and close four hospital A&E units – was taken before any public consultation was undertaken. The report is critical of the consultation as it simplistically asked residents which hospital they wanted downgraded.

2. ACCESS TO CARE

SaHF offers poor access to care especially for those living in deprived areas. A formal needs assessment for the 1.9 million population is missing from SaHF. What is evident is that SaHF supplied a set of assumptions about what reductions in demand were needed for all SaHF’s pre-determined capacity reductions to work.

A&E Capacity and Performance

SaHF claimed that North West London is overprovided with A&E units. The commission could find no data to back up this claim. Authoritative data from multiple sources shows that reducing A&Es from nine to five would create loadings on each of the surviving A&Es which would be 50% more than the national average.

In North West London over the last four years A&E attendance fell by 26.2 %. Urgent Care Centre usage seems to be the explanation here. A&E performance in North West London has deteriorated since the closure of the A&Es at Hammersmith and Central Middlesex hospitals in September 2014. Type-1 (the most ill patients) performance is the most concerning. For some weeks performance was the worst in England. SaHF is in denial about A&E closures being responsible for this disastrous performance. SaHF refused to release a report on the subject produced by McKinseys.

OOH Care

SaHF proposed to transform OOH care – spending up to £310 million over five years. All eight Clinical Commissioning Groups (CCGs) provided detailed plans on what they would achieve by March 2015. However there is very little to show what has been actually achieved by this date.

Beds

SaHF claims there is excess capacity, but it is unclear whether the growth in population has been sufficiently factored into calculations of the number of beds required.

3. QUALITY OF CARE

SaHF is all for specialisation and centralisation of services. It favours big hospitals. However the commission could find no recent evidence which supports the case for centralisation of acute services.

Maternity

SaHF’s reason for reducing the number of maternity units is difficulty in recruiting and retaining consultants and midwives at each of the seven sites. SaHF also claims it’s uneconomic to retain Ealing Hospital’s maternity unit. However SaHF has not provided a detailed financial analysis to back up this claim is not available from SaHF.

Emergency Services

Lots of published papers quoted in the report refute SaHF’s claims for centralisation of services and closure of four A&Es. The commission’s findings are that a much stronger case should have been put forward to justify the closure of one A&E unit – never mind four!

OOH

The evidence on the impact of OOH services on the demand for acute services does not support the conclusion that five acute units will be able to support the needs of 1.9 million people.

4. THE BUSINESS CASE

Financial considerations are the ultimate driver for SaHF. This section of the report examines the unproven results of OOH expansion, the affordability, risks, uncertainties and deliverability of the SaHF programme. It questions whether the SaHF costs are under control, whether double –counting is going on in SaHF, and whether too little is being spent on our healthcare anyway.

SaHF cost £62.9 million in 2013/14, yet NHS NW London enjoyed a cash surplus of £100.1 million. In 2014/15 figures are more difficult to source but an overall loss of £14.9 for NHS NWL is identified. (The overall cost of SaHF (2010/11 to 2017/18 ) is projected to be £235.5 million of which £35.43 million is for management consultancy.)

NHS NWL is apparently in overall balance so why were there two A&E closures in September 2014? This was at a time when it had not been proven that SaHF plans were affordable, deliverable or financed.

QIPP and SaHF Entanglement

Possible double counting of cost savings revolve around the NHS Quality, Innovation, Productivity and Prevention ( QIPP) programme and SaHF. QIPP may have already succeeded in making the savings needed without recourse to SaHF closures. The Commission thinks it unlikely that QIPP or SaHF programmes will meet the 44.5% savings required by 2020. SaHF’s refusal to release its latest business case makes it impossible to unravel SaHF (and QIPP) projections and savings.

Should More Be Spent on Healthcare?

Whether you choose money, nurses, doctors or beds as your yardstick the UK has lower numbers than Germany, France and the USA. But in 2009 McKinsey told the Government that the UK had high hospital costs and utilisation costs.

Financial Benefits of SaHF

In 2012 annual savings by implementing  SaHF of £135 million were stated. However the commission has been told that the capital costs have been significantly underestimated, as has population growth. Annual savings might be significantly lower that £135 and might render SaHF plans unaffordable.

Investment in OOH

The creation of new and enhanced OOH services should precede any reconfiguration of acute services. There is no evidence of these new or enhanced services. There is no evidence that there are large reductions in acute capacity as a result of extensions to OOH services.

Affordability

As well as investing £250 million in OOH services, SaHF needs £750 invested in acute services. Can NHS NWL afford this? Only a review of the latest SaHF business case might provide clues to this.

Risks

The report questions whether the SaHF is deliverable. It questions who owns the project – the NHS Commissioning Board, local CCGs or key local providers? The fact that the programme director has changed several times is not a positive sign. The report highlights many risks – service planning, safety, quality, business interruption, estates and construction, delay and adverse publicity.

The report proposes that SaHF develop a more conservative ‘Do Minimum’ option which would be easier to finance and easier to manage.

5. A FLAWED PROCESS

Framing the Problem

SaHF came into being during a period of great turbulence in the NHS nationally, regionally and locally. The North West London Strategic Health Authority and Primary Care Trusts were being abolished. CCGs were being created and many hospitals were wrestling with trying to attain Foundation Trust status. There was therefore no stable strategic platform to plan major changes in service delivery.

The report cites the failure of the ‘Better Services Better Value 2011’ project in South West London. With many similarities to SaHF the project was abandoned in the face of its unsustainability. The commissioners predict a similar fate for SaHF.

Diagnosing the Problem

SaHF is based on assertions. These assertions include that only five major hospitals are affordable in North West London and that the need to improve quality of primary care implies there should be a reduction in acute capacity. However the SaHF strategy should have been based on local needs’ assessments, a deep analysis of the nature of the problems and detailed research on costs in the current system.

SaHF Objectives

Not  clearly stated or followed. Why choose A&E services for reconfiguration-based quality improvement? A&E represents a small percentage of healthcare spending. Quality improvements could be made which would not involve a major reconfiguration and a capital spend of £1 billion.

The Options Appraisal Process

The commissioners believe too few options were considered by SaHF. Critically a ‘Do Minimum’ option was not considered. This breaks Treasury guidelines and its absence could lead to SaHF failing to gain Treasury approval.

Public Consultation

The public in 2012 were not presented with an approved business case. (In fact an approved business case still does not exist). Current plans are much more expensive and the benefits much less that those initially proposed to the public in 2012.

Local Authorities Ignored

Local authorities have been starved of information and involvement. It’s clear that they have developed doubts as to whether SaHF can deliver what it has promised.

RECOMMENDATIONS

The commissioners want the whole SaHF programme to be halted and independent reviews to take place on the September 2014 A&E closures and the planned A&E closures at Charing Cross and Ealing Hospitals. They want the assertion that OOH services can effectively substitute for acute capacity and save money to be reviewed. When the new business case emerges if it is significantly different from the one presented to the public in 2012, then a new public consultation exercise must be mounted.

More on the Healthcare Commission

The fourth public hearing of evidence by the commission will take place at Brent Civic Centre on Saturday 9 May 2015 from 9:30am to 4:30pm. Representatives of SaHF have promised to attend and be interviewed at this event.

Health Commission witness statements, hearings, transcripts etc can be viewed at:

http://www.bpv.org.uk/the-independent-healthcare-commission/

How Seamless and Effective is integrated Healthcare and Social Care in England?

Not very might well be the answer.

In 2014/15 there was a 23% annual increase in ‘delayed transfer of care’ – 306,581 incidents in 2013/14 and 375,700 incidents in 2014/15. These transfers are from acute to non-acute (including community and mental health) care and occur when a hospital patient is ready to be transferred but can’t be for one reason or another and is still occupying a hospital bed. These figures suggest that patients’ length of stay in hospitals is rising – however the most recent data on this is not yet available.

For patients to be transferred back to their homes engagement with family and friend carers is necessary, as can be nursing and social care staff who can visit the patient at home. NHS district nurses often provide or manage the healthcare needs of those at home. However, during the period 2003 to 2013 there was a 47% reduction in qualified district nurses in England. In 2014 the Royal College of Nursing called for the number of district nurses in England to rise to 10,000 (what it was in 2009). In 2013 there were only 6,700 district nurses and more than a third of them were over 50 years old.

As for social care provision, this is a Local Authority service. According to the Association of Adult Social Services (ADASS) Government funding for adult social services has dropped by 12% since 2010, whilst demand had risen by 14%. Age UK reported in January 2015 that the number of people receiving meals on wheels had declined by 64% between 2010/11 and 2013/14. During the same period those receiving home help for washing and dressing fell by a third and the number of day care places dropped by two-thirds.

Only the vulnerable poor who are assessed as having ‘substantial’ or ‘critical’ needs get free social care from Local Authorities. The rest have to pay for social care. Most Local Authorities have sold off the care homes they once owned. In fact of the 430,000 elderly and disabled people who live in care homes only 10% live in those still owned by the NHS or a Local Authority.

It seems to me that many thousands of care co-ordinators are needed across England to knit together community healthcare and social care. Logic says that they should be employed by the state. However looking at job advertisements for care co-ordinators they have all been placed by private care companies. None of them seem to be NHS vacancies. If elderly people are blocking beds surely pro-active initiatives (research/co-ordination) by hospital co-ordinators with close family/friends, the Local Authority, Age UK, District Nurses and care homes might just unblock beds somewhat faster? Or maybe GP surgeries should employ care co-ordinators for their vulnerable, disabled and elderly patients. However Local Authorities, NHS hospitals and GP surgeries will all claim that they cannot afford to employ care co-ordinators.

Which brings us to the £5.3 billion Better Care Fund (BCF) which went ‘live’ on 1 April 2015. BCF’s original reason for existence was to transform local health and social care services by pooling resources. However it’s still mired in conflict. Local government wants the funds to be used to support adult care services. The NHS wants it to be spent on healthcare. National Government wants it spent on reducing hospital admissions and making £1 billion NHS savings by 31 March 2016.

For the first time in our history there are over 10 million over 65 year olds in the UK and of these 1.4 million are over 85. The ONS predicts that these figures will rise to 15 million and 4.2 million by 2035. Improving the quantity and quality of healthcare and social care and their integration for the elderly is going to be an even bigger challenge in the future than it is now.

Issue: 24

April 2015

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.

Over 500 Attend Evening Save the NHS Rally in London on 10 March 2015.

Patients, clinical staff and politicians  from all over London came together for a lively rally at Hammersmith Town Hall on Tuesday 10 March 2015. It was a show of force by those who are worried and unhappy with the actual and planned NHS cuts, closures and privatisations. Many of the attendees were members of NHS campaigning groups throughout London.

The mood amongst speakers and audience members was one of optimism that the Government’s assault on the NHS could be challenged and defeated. Everyone was encouraged to vote at May’s General Election for candidates and political parties who would defend the NHS. A vote for the Conservative Party was universally viewed as a vote for the death of the NHS.

One of the most impressive platform speakers was Ealing Hospital consultant Gurjinder Sandhu. He caught the mood of the meeting perfectly when he asked ‘…we bailed out the banks in 2008 so why can’t we bail out the hospitals in 2015?’

Read Rally Chair Anne Drinkell’s report on the event at:

www.saveourhospitals.blogspot.co.uk

Ealing Hospital A&E Outperforms Northwick Park A&E in February 2015

NHS figures show that Ealing Hospital A&E outperformed Northwick Park A&E and London and national average A&E performances in February 2015. These figures relate to waiting times for the most seriously ill patients (so called Type-1).

This poor performance by Northwick Park comes 12 weeks after the opening of its new £21 million A&E unit.. Many local ambulance, GP and CCG initiatives are also in place to stop A&E patients being taken to Northwick Park, presumably to take the pressure off Northwick Park A&E.

And so the questions must be asked again and again:

+ Why plan to close Ealing Hospital A&E unit?

+ What more can be done to improve the performance of Northwick Park A&E unit?

(From information supplied by Colin Standfield of Save Our Hospitals)

NHS Resorts to Untruths in Defending its ‘Shaping a Healthier Future’ (SaHF) Strategy

The NHS NW London SaHF Winter 2015  newsletter states ‘…while performance nationally dipped, the North West sector was the highest performing in London in the last few months of 2014 – at 92.87% – for all types of A&E performance and was above both the London and the national average performance for the quarter’.

However, NHS official data reveals that at no time in the last quarter of 2014 was the North West London figure above the London average and in only 4 weeks did it creep above the England average. If you take ‘Type-1’ performance rather than ‘All Attendees’ the figures were,  and continue to be, even worse.

NHS NW London SaHF continue to state publicly that ‘there were increases in demand in A&E services across the country during the winter period’. However the NHS’s own data clearly shows that there was no significant winter pressure on A&E demand, anywhere. For example in November 2014 the NHS huffed and puffed about a ‘surge’ in A&E demand reaching 417,000 in England in one week. Given that the nation’s A&Es in June 2014 had coped with 460,000 attendances/week, highlighting this November figure was disingenuous to say the least.

So just what are we to make of these untruths? Is it merely incompetent reading and interpreting of the NHS data or does it amount to attempted deception by NHS NW London SaHF?

(Information again supplied by Colin Standfield of Save Our Hospitals)

No More A&E Closures – NHS NW London SaHF Bombshell

The SaHF newsletter tells us this as well as that there will be no ‘further changes to local A&E services in the next three years’. All this makes a mockery of the SaHF Option allegedly chosen by residents in 2012. Within three years the four A&E units at Central Middlesex, Hammersmith, Charing Cross and Ealing Hospital would be closed. Well the first two were closed – in September 2014. And now Charing Cross and Ealing A&Es will not close at all. The Independent Reconfiguration Panel pronounced in September 2013 that it was unconvinced by proposals to close Charing Cross and Ealing A&Es. The hospitals (Trusts) were told to maintain A&E services until more convincing plans had been drawn up and alternative services put in place. Here we are 19 months later and such plans and alternative services are clearly not in place.

The newsletter goes on to say that (as from 2018) Charing Cross and Ealing A&Es will continue to operate ‘from new buildings’. One does wonder where these new buildings will be built on the Ealing Hospital site and which current buildings will be demolished to make way for them. But these post-2018 A&Es will be ‘modern A&Es’ – a term yet to be defined by the NHS. Many of us are certain that no blue light ambulances will deliver patients to these modern A&Es and that they will have no intensive care beds or consultants. Put crudely these ‘modern A&Es’ will not be A&Es at all. Yet another NHS untruth raises its ugly head.  

Ealing Hospital Maternity Unit Closure Date is Still a Mystery

At the ECCG meeting held in Ealing Town Hall on 18 March 2015 it was announced that there was still no confirmed date for the closure of the maternity unit. Ealing mothers-to-be, 120 Ealing Hospital midwives and local NHS activists are variously anxious, angered and bemused by this continuing management failure.

SaHF plans in February 2013 included the closure of Ealing Hospital Maternity Unit. This was confirmed in October 2013 by the Secretary of State. In October 2014 ECCG stated that closure would be ‘as soon as possible’. March 2015 was suggested as a likely date for closure.

Here we are 17 months on from when the Secretary of State decided on the closure and NHS NW London is still unable to organise future childbirth provision alternatives to Ealing Hospital. Surely this is incompetence. Is this a failure of the SaHF strategy? Is this a failure by ECCG and/or NHS NW London? Is it all about the money and space not being available to expand other maternity units in north west London?

This is no way to run a public healthcare service.

NW London Hospital Health Commission

Chaired by Michael Mansfield QC, this is an independent investigation on the impact of the ‘Shaping a Healthier Future’ (SaHF) programme. The programme includes the closure of 4 of our 9 hospital A&E units, two of which closed in September 2014. The Commission is funded by Brent, Ealing, Hammersmith & Fulham and Hounslow Councils.

After three of the four public hearings – in Hammersmith on 14 March, Ealing on 21 March and Hounslow on 28 March – a distinct pattern is emerging:

+ SaHF is about cost savings and generating capital receipts by land disposal

+ Hospital A&E services have been reduced before any out-of-hospital alternative services have been established in the community

+ 90%+ of witnesses cannot see how longer journey times and fewer hospital beds and services will give us all a healthier future

+ SaHF strategy completely ignores current population growth as well as future London Plan residential growth

+ No high level engagement between SaHF and senior Local Authorities’ staff at any time – 2011 to 2015

+ No local senior NHS /SaHF staff have accepted invitations to give verbal evidence. Why won’t Dr Spencer, Dr Spicer, Dr Parmar and Thirza Sawnett defend the SaHF strategy in public?

+ The management consultants who conceived SaHF (notably McKinsey & Co) have failed to participate in these hearings

+ Healthwatch sees itself as a ‘friend of CCGs’ – not surprising in a way as it was set up and is funded by the Department of Health

+ The SaHF transformation seems to have casually expanded from taking ‘at least three years’ in 2012 to now in 2015 being a five year project ‘ending’ in perhaps 2018

+ Magnificent and courageous verbal evidence delivered by practising clinicians

For reports and YouTube coverage of the Commission see: www.saveourhospitals.blogspot

Keep Our NHS Public (KONP) in North Central London To Take Five CCGs to Court for Failure to Consult on Privatisation Plans

Five Clinical Commissioning Groups (CCGs) – in Camden, Islington, Haringey, Brent and Enfield – have decided to combine Out Of Hours (OOH) GP service and the 111 telephone helpline and put it out to tender. This decision was taken without any consultation with the one million patients who use these services. KONP in north central London wants these services to be run by NHS staff and is taking these CCGs to Court for their failure to consult. More at www.camdenkeepournhspublic.org.uk  

NHS NW London Spent Over £13 Million on Management Consultancy Since 1 April 2014

A Freedom of Information request has revealed that NHS NW London has spent over £13 million on management consultancy over the last 11 months. The money was spent to support the NHS NW London ‘Shaping a Healthier Future’ (SaHF) strategy.

Three companies received the bulk of our money – McKinsey (and McKinsey-led consortia) £7, 237,600, PA Consulting £3,366,336 and PWC £1,528,06.

NHS NW London is just one of 27 NHS area teams in England. If all of them have spent similar amounts on ‘strategy and transformation’ then the total national spend on management consultancy over the last 11 months could be over £350 million. In London alone if the other two area teams spent as much as NW London then the total London management consultancy spend would be almost £40 million.

Let’s hope that the independent NW London Mansfield Healthcare Commission reveals just how well or badly our £13+ million has been recently spent on the SaHF ‘strategy and transformation’.

REPORTS ON LONDON’S NHS

Two reports were published in March 2015 on this topic. The larger report is ‘London’s NHS Into the Unknown’ which is the second report by The People’s Inquiry into NHS London. ‘Critical Condition: London’s NHS’ is a smaller report from the London Assembly Labour group.

‘London’s NHS Into the Unknown’

This 47 page report is an updated version of the original March 2014 report. A deepening divide is identified between Clinical Commissioning Groups (CCGs) and the hospitals, mental health and community health service trusts which deliver front line services.

The report reveals increasing concerns about the lack of strategic overview of healthcare in London. It is very critical of the operation of a number of healthcare initiatives. It finds no grounds for optimism that anything substantial will be achieved by the Better Care Fund. It finds no evidence of the work of the local Health and Wellbeing Boards and Health Watch organisations and little evidence of local engagement.

The report finds that the London Ambulance Service performance has weakened. It also finds little improvement in mental health resourcing or funding. On the Primary Care front there is frightening evidence that community nursing services don’t exist.

A new recommendation is to tackle system failure and integrate care in and outside hospital. A repeated now urgent recommendation is an independent review of the clinical case for reconfiguration.

The people’s Inquiry is chaired by Roy Lilley and sponsored by Unite, the Union. The report can be downloaded at www.peoplesinquiry.org.uk

‘Critical Condition: London’s NHS’

Dr Onkar Sahota AM, Chair of the GLA Health Committee, has authored this interesting 22 page report on behalf of the Greater London Assembly/London Assembly Labour. The report highlights problems with GP services and the provision of emergency care throughout London. It is packed with useful, well presented data.

The report calls on the London Mayor to halt any further closures of A&E and Maternity wards and to prohibit the reduction in hospital beds until a full comprehensive review has been carried out across London. A London-wide strategic approach to providing health and social care in London is proposed – along the same lines of the one recently announced for Greater Manchester.

Read the report at http://ow.ly/KbNL5

Child Mental Health Crisis

Government research in 2004 revealed that one in ten children in England have a diagnosable mental health problem. Government figures released in March 2015 reveal sharp increases in the number of children being admitted to hospital for self-harm, eating disorders, depression and other psychological disorders. 17,278 under 18 year olds attended hospital A&E units with psychological problems in 2014. In 2010 the number was 9,328. Also over a ten year period the number of children treated on wards for anorexia (2,965 in 2014) has doubled.

However only 6% of the total mental health budget is spent on services for children and teenagers – totalling £50 million in cuts. Allied to this the overall spend on mental health services has fallen every year since 2010.

However a little help is on the way. In the 18 March 2015 Budget an additional £250 million each year for five years was promised to improve mental health services for children. This LibDem initiative is aimed at helping some 100,000 young people.

NHS Election Promises Given by Political Parties

+ Conservative

The NHS is not one of its six key themes. It says ‘not a penny’ is to be cut from the NHS budget. It plans to spend £2 billion more annually on the NHS. Recently Mr Cameron has talked about creating a ‘truly seven-day-a-week NHS’.

+ Labour

It will add 8,000 more GPs, 20,000 more nurses, integrate health care and social care, guarantee 48 hour GP appointments, and cancer tests within one week. It will invest an extra 2.5 billion each year in the NHS. It will repeal the Health & Care Act and Section 75 in First Queens Speech. It plans to cap at 5% the profit that private companies can make providing NHS services. Will take the NHS out of TTIP.

+ LibDem

Is pledged to protect the NHS from cuts. It will add £8 billion in NHS funding by 2020. It is committed to improving the NHS mental health service.

+ Green

It wants to protect the NHS, end NHS privatisation, repeal the Health and Social Care Act, support the NHS Reinstatement Bill and give a higher priority to mental health.

+ UKIP

Says it is the party of the NHS. Invest £3 billion in NHS frontline services, £130 million in dementia services, £1 billion in social care for the elderly and merge health care and social care. It would abolish the CQC and scrap hospital car parking charges. Nigel Farage, UKIP’s leader, advocates moving to an insurance-based system of healthcare.

+ National Health Action Party

Supports local A&E and maternity provision, removal of a health care market, and stopping privatisation. It wants to reverse government cuts. It is anti TTIP and wants to renegotiate PFIs.

‘NHS For Sale: Myths, Lies and Deception’

This is a new book written by Jacky Davis, John Lister and David Wrigley. Jacky is a consultant radiologist and David a GP. Jacky co-authored the 2013 book ‘NHS SOS’. Jacky and David are both members of the BMA UK Council. John is a founder member of KONP and a respected health researcher, speaker and writer.

The book details forensically what has happened since Oliver Letwin first floated the concept of privatising the NHS in his book ‘Privatising the World’ published in1988. It tracks the emergence and implementation of the 2012 Health and Social Care Act and sets out what needs to be done to protect the NHS from corporate greed. ‘NHS For Sale’ provides a veritable arsenal of information to be used in the war against those who seemingly want to undermine the future of the NHS.

Book royalties will go to KONP.

ISBN.978-0-85036-627-3

To order a copy go to www.merlinpress.co.uk

Issue: 23

March 2015

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.

‘Shaping a Healthier Future’ Strategy in Tatters as ‘Care Closer to Home’ Fails to Materialise

Colin Standfield of Save Our Hospitals (saveourhospitals.blospot.co.uk) continues to forensically analyse NHS NW London’s performance in implementing its 2012 ‘Shaping a Healthier Future’ strategy.

The central plank of this 2012 – 2015 strategy is ‘shifting more investment into Primary Care and other local healthcare, providing more proactive services in the community closer to patients’ homes’. However no evidence has ever been presented that ‘care closer to home’ results in better care outcomes. There is also no evidence that there actually are any improvements in Primary Care and community care. There is no NHS data available to measure this.

As Colin points out, the budget for ‘care closer to home’ is various pitched at £120 million, £138 million and £190 million. It’s impossible to figure out how much of this money has actually been spent by CCGs on ‘care closer to home’ and there’s certainly no evidence of any cost/benefit analysis of any such expenditure.

If in fact there is no local improvement, then the consequences for residents in north west London will be quite devastating. Closing A&E units and reducing the number of intensive care beds and consultants in hospitals, whilst apparently providing no replacement capabilities in local communities, must result in more pain, anxiety and death.

NHS Suggests More ‘Less Well’ Patients in North West London are the Cause of A&E Meltdown

NHS NW London bosses are suggesting that an independent review has found ‘no direct link’ between closures of A&E units and poor A&E performance in north west London. They are suggesting that an increase in acuity (with people less well leading to increased length of stay and bed occupancy) is the main contributory factor. The publication of this report was due in January 2015 but as of 27 February 2015 it has not appeared.

The performance of A&E units across London generally is above the national trend. It’s only in north west London (where two A&E units were closed in September 2014) that A&Es are performing so badly. It seems incredible that so many of these ‘less well’ patients only live in north west London and not in other parts of London. In fact if this demographic feature is real and sustained, then this is surely a reason for expanding hospital A&Es not contracting them.

23% More NHS Operations Cancelled in October, November and December 2014 in England

At 19,473 cancelled operations this was the worst figure recorded since 2001-02. These last minute cancellations were for non-clinical reasons. Most Trusts were forced to call off planned procedures at short notice because they ran out of beds. Shortage of beds is thought to be caused by the surge in demand for care and the demands of A&E admissions.

However here in north west London the 2012 NHS plan was for the total number of beds to be reduced from 3,268 to 2,470 by 2015. No doubt this plan is being implemented and no doubt it is having a major impact on the number of cancelled operations.

Hospital News

Ealing Hospital

Retiring Ealing Hospital Chief Executive David McVitie made two interesting statements in public in February. He stated that Ealing Hospital Maternity Unit would close in July 2015. (However Ealing CCG is now saying that it might make a decision on the closure date at a meeting on 18 March 2015). Mr McVitie stated that Type-1 (the most ill) A&E patients would still be being admitted to the hospital for the next five years time.

CQC Criticises Hillingdon Hospital

The Care Quality Commission (CQC) states that improvements are needed in maternity. A&E, critical care, family planning and children’s care. It noted an incidence when one nurse was caring for 20 patients. CQC also criticised the state of the hospital buildings.

The problems in maternity are particularly worrying for would-be mothers in Ealing. Hillingdon Hospital Maternity Unit is one of the designated units for pregnant Ealing women when Ealing Hospital Maternity Unit is closed down.

The hospital is to receive £12.3 million Department of Health funding to build a new Urgent Care Centre and improve facilities for A&E, emergency paediatrics, acute medical admissions and endoscopy.

Chelsea & Westminster and West Middlesex Hospitals to Merge

It’s not exactly clear how this merger will improve patient care. It’s also not clear how this merger will improve the finances of these two financially troubled hospitals. It’s also only four months ago that CQC stated that Chelsea & Westminster Hospital needed to improve in A&E, medical care, surgery, children’s services, end of life care and outpatients.

90 Ealing Hospital Midwives Warn that Pregnant Women in Ealing are At Risk

In a long letter to Ealing CCG and to the ‘Shaping a Healthier Future’ (SaHF) team Ealing Hospital midwives describe how their top performing Maternity Unit is ‘rotting away in front of our eyes’. They compare the likely dangerous consequences of closing their unit with the A&E carnage being caused by the closure of Central Middlesex and Hammersmith Hospital A&Es.

Ealing CCG has been telling Ealing GPs not to refer pregnant women to Ealing Hospital. Consequently birthing admissions are down. This action by Ealing CCG is completely contrary to what was agreed in order to keep Ealing open and a safe ‘going concern’ until the point of planned and carefully considered closure.

There has been considerable uncertainty about the closure date for the Ealing unit. In sheer frustration some Ealing Hospital midwives have already quit their jobs. The Ealing Hospital boss is now saying that the Maternity Unit will close in July 2015. However Ealing CCG and SaHF apparently refuse to commit to a closure date, but hint that they might decide on 18 March 2015.

Ealing CCG and NHS NW London has formally responded to the Ealing Hospital midwives. It blames the uncertainty and delays on concerns about patient safety. This is all well and good until we reach the statement ‘The A&E changes have not impaired care or service provision for patients…’. Well blow me down with a feather – this statement is an outrageous distortion of the truth. NHS NW London has for many weeks been the worst performing A&E segment in the whole of London. Ealing Hospital A&E has consistently been one of the six worst performing A&Es in the whole of England. Ealing CCG deny instructing Ealing GPs not to refer mums-to-be to Ealing Hospital. Ealing Hospital midwives dispute this and given the ECCG’s economy with the truth on A&E performance I’m minded to side with the midwives.

One has to ask the question here – who is in charge of and responsible for this chaos?

West London Mental Health Trust (WLMHT) Responds To £4 Million Overspend Allegations in ‘Independent on Sunday’

On 3 February 2015, WLMHT responded to the ‘Independent on Sunday’ 25 January 2015 allegations of financial impropriety at WLMHT. The Trust emphasised that there was no financial overspend at Broadmoor Hospital or for the Trust’s financial year as a whole. It stated that the reason the Lammas Centre Recovery House project (in Mattock Lane, W5) was abandoned was one of building unsuitability and was not related to finance. The Trust did confirm that an independent investigation was underway relating to other projects mentioned in the press article.

Greater Manchester to Get Control of a £6 Billion Health and Social Care Budget in April 2016

This will be a huge reorganisation impacting over 2.6 million residents. It will involve 10 Local Authorities, 12 Clinical Commissioning Groups (CCGs), 14 NHS partners, NHS England and National Government. There will also be a newly elected Mayor for Greater Manchester in 2017 who will control this budget.

On the face of it Manchester CCGs will lose power, as Councillors will decide priorities. Monitor presumably becomes redundant. Some might see this Greater Manchester experiment as a logical development of the national Better Care Fund (BCF). BCF will attempt to integrate social care and health care via local pooled budgets spent jointly by a CCG and a Local Authority. BCF commences in April 2015. It has had a rocky gestation period with accusations of poor planning. There has been little ‘gelling’ of cost cutting aspirations of the NHS and the revenue searching zeal of Local Authorities. BCF is untested.  It may fail and the Greater Manchester plan may similarly fail. However if the latter is seen to succeed we might see other cities being given similar devolved powers.

There are some worrying technology and governance issues being raised. For example there is no common identifier of a citizen shared by health and local government. Tracking patients through the care cycle will be a big challenge in successfully integrating health and social care. There will be IT problems to overcome due to the lack of interoperability between disparate health and social care IT systems. There is also a future worry that cities may devise their own, different ways of integrating health and social care. We could finish up with a ‘patchwork quilt’ of IT approaches to integrating health and social care. This will make life complicated for those patients who move from one city to another or between cities and rural areas.

Sadly there is no indication that the Manchester initiative is some kind of city ‘pilot’ scheme. And anyway if one were choosing a pilot conurbation one would not pick one so large with so many residents, Local Authorities and CCGs.

It’s important to appreciate that none of the £6 billion will be ‘new’ money. The acid test will be to try and deduce whether this regional devolution of integrated health and social care results in improved health and social outcomes. We are unlikely to see any metrics on this before 2017.

NHS England Concedes GP Advice Must be Provided by the 111 Telephone Service at Peak Times

In a policy climb down, NHS England has conceded that its 2013 111 launch policy of just using non-medically trained call handlers is inadequate – certainly during peak periods. A GP presence in call centres or a GP available to provide clinical advice must be put in place as soon as possible.

Major Study Finds the Sustainability of Clinical Involvement in Commissioning (CCGs) of Primary Care Is At Risk

The King’s Fund and the Nuffield Trust have just published a study of six Clinical Commissioning Groups (CCGs) in order to monitor the changing role of CCGs in General Practice.

The risk to clinical involvement is due to waning levels of GP leader engagement in CCGs, potential problems in the recruitment and retention of leaders, and significant pressures on GPs’ time and capacity.

The research suggests that the benefits provided by the shift towards CCGs co-commissioning Primary Care could be compromised by potential conflicts of interest, reductions in running cost budgets and strained relationships with fellow GPs and NHS England.

Issue: 22

February 2015

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.

A&E Waiting Times for the Seriously Ill at Ealing Hospital Worst Ever Recorded in England

A new NHS low was reached in the week of 14 to 21 December 2014. At Ealing and Northwick Park Hospitals only 53.7% of Type-1 A&E patients (the most seriously ill) were treated within four hours. This is the lowest number ever recorded in England. All this is against a backdrop of no increase in Type-1 demand.

We should all sympathise with the heroic staff in Ealing Hospital A&E who are working to their limit with too few beds, too many temporary staff and an uncertain future ahead for all of them.

All this is at a time when the NHS’s own figures show no increase in A&E attendances.

Surely now is the time for the NHS ‘Shaping a Healthier Future’ plans to close Ealing Hospital and Charing Cross Hospital A&E units to be dropped. More acute beds and permanent acute staff must be acquired at these units.

The Solace Mental Health Centre Closure Plans – Linked to Death by Suicide – Are To Be Reviewed

The London Borough of Ealing’s (LBE’s) Solace Mental Health Centre in Bowmans Close, West Ealing has been a 365 day/year walk-in centre for mental health service users for over 22 years. Recently LBE announced plans to discontinue funding the centre as from April 2015. Without the LBE annual grant of £104,000 the centre will have to close.

The likely closure of the centre has caused great anxiety and anguish amongst the 85 regular service users. Two have recently attempted suicide and tragically one of them died under a train at Ealing Broadway Station on 7 January 2015.

On the face of it if the centre is providing a valuable cost effective service.  Why can’t it be funded by the NHS West London Mental Heath Trust (WLMHT)? WLMHT currently provides £47,000 annual funding which pays for the centre to be open at weekends.

Alternatively why can’t funds be found from Ealing’s £29+ million 2015/16 Better Care Fund (BCF)? This pooled fund is operated by LBE and the Ealing Clinical Commissioning Group. BCF exists in order to facilitate the integration of health care and social care. The budget has not been finalised but this should happen in February 2015.

Perhaps WLMHT and the Ealing BCF could jointly fund the £151,000 annual running cost of Solace?

However, with a financial scandal beginning to engulf WLMHT (see below) it seems highly unlikely that it will be in any position to inject funds to save Solace.

On 13 January 2015 ‘Ealing Today’ reported that the LBE Councillor responsible for health – Hitesh Tailor – had said that LBE somehow wants to ‘continue the service’ at Solace. LBE has delayed a Cabinet decision on Solace and LBE Officers are now ‘developing proposals’.  

It appears that Mencap might commit £40,000 annually to renting out space at the centre. At an LBE meeting on 27 January it emerged that a final decision could be made before the middle of February 2015.

More on Solace and to sign the Save Our Solace Centre petition see www.saveoursolace.co.uk

Now Ealing Hospital Maternity Unit Closure Date Has Slipped Again

Midwives at Ealing Hospital are mired in uncertainty as to when they might transfer to another hospital maternity unit and when exactly birthing will cease at Ealing Hospital. The likely date for closure of the Ealing Hospital maternity unit was originally 31 March 2015, but the NHS has failed to confirm this. Ealing CCG has told Ealing GPs not to refer expectant mothers to Ealing Hospital any more and currently referrals are down by 50%. Once referrals drop by another 25% the service will be unsustainable. There seems to be uncertainty about when and if extra capacity will exist at other maternity units when/if Ealing Hospital’s unit is closed. An excellent, well established service for diabetic mothers in Southall is now falling apart – as is one for HIV+ mothers in Southall.

When Ealing Hospital maternity unit closes Ealing mothers will be referred to Hillingdon, St Mary’s, Hammersmith, Northwick Park, West Middlesex and Westminster & Chelsea Hospitals. However rumour has it that Hillingdon Hospital will refuse to admit Ealing mothers. After closure of the Ealing Hospital birthing unit and the neo-natal unit, the ante-natal and scanning units will be retained.

Although a relocation process is in place, the 120 staff apparently have no formal job offers or formal start dates. All of the staff have issues which include very low morale, general uncertainty, school drop-off and pick-up arrangements for their children, travel to work and car parking at work. Midwives will soon begin to leave and the birthing service will have to close as it will be deemed ‘unsafe’.

A rethink on the fate of the Ealing Hospital Paediatrics unit has resulted in its retention for a year.

NHS Lammas House Repurposing as Mental Health Residential Recovery House Bites the Dust – As Financial Scandal Engulfs WLMHT

Plans for converting Lammas House on Mattock Lane into a 12 bedded residential mental health Recovery House have clearly gone all wrong, as we hear the building has been sold by the NHS West London Mental Health Trust (WLMHT) for £2.9 million.

‘The Independent on Sunday’ of 25 January 2015 suggested that the Recovery House project was scrapped because of financial turbulence at WLHMT. Anti-fraud specialists Mazars are currently investigating a £4 million overspend on unfunded or unapproved projects at WLMHT.

I understand that alternative facilities have been acquired on a 5 year lease at Amadeus House, 18 Corfton Road, W5. This house has 17 bedrooms and was until recently a care home for 11 mentally ill residents.

The Independent Health Commission Inquiry (IHCI)

The Councils of Brent, Ealing , Hammersmith & Fulham and Hounslow have set up the IHCI in order to investigate the impact of the proposed and actual changes to healthcare services brought about by the NHS North West London  ‘Shaping a Healthier Future’ (‘SAHF’) strategy. The inquiry is chaired by Michael Mansfield QC.

Issues in Ealing include:

+ Demolition of Ealing Hospital and its replacement with a smaller, non-major hospital

+ Closure of A&E and Maternity Units at Ealing Hospital

+ Out-of-hospital provision prior to demolition and closures.

The Royal College of Nursing (RCN) has already submitted written evidence. The RCN wants the SAHF programme halted. It wants no A&E closures at Ealing and Charing Cross Hospitals until adequate out-of-hospital provisions are in place.

If you want to submit evidence you can contact Peter Smith at peter.smith@lbhf.gov.uk or at Clerk to the Commission, Room 39, Hammersmith Town Hall, London W6 9JU. The public hearing in Ealing will take place at Ealing Town Hall on Saturday 21 March 2015.

Labour Party Pledges 10 Year Campaign to Merge Health and Care Services

Labour is promising, if elected, to recruit 20,000 nurses, 8,000 GPs, 5,000 care workers and 3,000 midwives. It plans to end the ‘Tory market experiment’ and repeal the Health and Social  Care Act.

Patients Who Opted Out of Medical Records’ Sharing (care.data) Have Been Ignored and Could be ‘Punished’. Another care.data Shambles

The Health and Social Care Information Centre (HSCIC), which collects patient medical records, has admitted that ‘none of the objections requested by patients …have been enacted’. It is understood that tens of thousands of patients have objected to their personal medical data being shared or sold off.

It also emerged that patients who opt out of this data sharing will be ‘punished’ by not being approached for direct care services. These services include bowel screening and cancer screening.

The persistently stalling care.data scheme is a hugely ambitious programme which aims to link GP, social care and hospital records. A previous abortive attempt to do something similar – NPfIT – was started in 2002 and abandoned in 2011. It wasted some £10 billion of our money.

No Air Ambulances in the Whole of London for Much of January

Only one air ambulance normally operates in London.  It is run by a charity and funded by businesses. However it did not operate for much of January as its annual three week maintenance was carried out.  It seems barely credible that our state run healthcare service does not fund a fleet of air ambulances to serve the eight million residents of London.

Chronic Hospital Bed Shortage in England

The number of hospital beds /1,000 population in England is 2.7. The EU average is 4.2. In Germany it’s 8.2 and in France it’s 6.6. England is seriously ‘under-bedded’ in its NHS hospitals.

‘The Observer’ Reveals Soaring Stress Levels Amongst Nurses. Should We Be Surprised?

A Freedom of Information request has revealed that the incidence of stress, anxiety and depression is rising amongst our 400,000 NHS nurses in England. Since 2012 the number of working days lost due to stress has risen by 48%. NHS Employers estimates that 30% of all NHS sick leave is caused by stress.

Outsourcing NHS Scanning and Pathology Services Leads to ‘Loss’ of Data

Opendemocracy.net/ournhs quotes an anonymous NHS worker bemoaning fragmentation of healthcare caused by outsourcing NHS services to private companies. Often these days X-ray, ultra-sound, blood tests and other pathology and microbiology tests are outsourced to private companies. The results however reside on the private companies’ computers, not on NHS computers. So when NHS clinicians want to check/review these results they can’t find them. Just how this amounts to progress is beyond me.  

One does also wonder who actually owns these images of you and your test results?

What Do NHS Services Cost?

Some recent cost estimates from The Kings Fund:

+ £26: Visit to a GP

+ £44: Visit to a family planning clinic

+ £111: Accident and emergency visit

+ £250: Hospital admission overnight stay

+ £344: Ambulance journey from accident scene

Issue: 21

January 2015

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.

Ealing Hospital A&E Performance – Now a National Scandal

Only 62.6% of patients attending Ealing Hospital A&E were seen within 4 hours during the week of 15 December 2014. This figure is worse than 139 other NHS hospital A&Es in England. In fact it’s the poorest performance of any NHS hospital in England. 951 people waited over 4 hours to be admitted. The national average was 315 people. As for ambulances queuing outside the hospital there were 227. The average across England was 60.5.

Just what is being done to improve this terrible performance? Who is to blame for this awful service?

According to Lewisham GP Dr Louise Irvine the real problem is the reduction in the number of acute beds. This leads to many more patients queuing on trolleys in hospital – for up to 12 hours in some cases. Delayed discharge of patients also adds to the problem. Social service cuts largely explain the delay in discharges.

We all know that the plan is to demolish Ealing Hospital including its A&E unit. How will this improve performance? This will leave the 338,000 Ealing residents with no major hospital and no A&E unit within the borough’s 21 square miles. This seems like criminal negligence to me.

New Northwick Park Hospital A&E Finally Opens on 10 December 2014

At a cost of £21million this new facility offers 40 individual treatment bays. The number of qualified nurses on each shift has been increased from 24 to 27. No numbers are provided by the NHS on the number of consultants on each shift – which is a concern. No information is provided as to whether additional Intensive Care/Acute beds have been created.

At 40 beds this new facility offers the same capacity as the one it is replacing. Why spent £21 million on a new facility which provides no extra capacity? Apparently a further 66 medical beds are promised for autumn 2015 – but in pre-fab modular units.

Senior staff at the Trust are quoted in the ‘London Evening Standard’ saying ‘…You don’t need a bigger A&E’ and ‘…the needs of the patients are not being met in the community’. Just what these statements mean is unclear to me. Are queues in ambulances, in A&E and on trolleys in hospital going to be reduced by more treatment/care in the community? If so,where, how, when and on whose budget?

Is the NHS Deliberately Confusing Us by Mixing Up Data on A&E Admissions and A&E attendances?

Excellent research by Colin Standfield of Save Our Hospitals has confirmed that there is no increase in patients visiting our local hospital A&Es. However, there is a painful increase in the number of patients waiting more than four hours to be treated in the A&Es. NHS managers are claiming that both the number of A&E admissions and the number of A&E visitors have increased, when it’s only the admissions numbers which have increased. The NHS target of treating 95% of visitors to A&E within four hours is being consistently breached. For the week ending 30 November 2014 NHS North West London Healthcare was the worst performing Trust in the country for Type-1 (most sick) patients at 65.7% waiting over 4 hours.

‘Arrest Drunks Clogging up A&E’ Trumpets National A&E Leader in ‘The Observer’

Dr Cliff Mann, President of the College of Emergency Medicine wants fewer drunks clogging up hospital A&E units. He says threatening drunks with arrest will stop them drinking alcohol.

What a load of nonsense.

For starters not everyone who presents at A&E as being drunk is actually just drunk. They may have other physical illnesses or injuries which require treatment and which may require admission to hospital.

The Police Federation sees little merit in arresting drunks. The charity Alcohol Concern thinks we are not getting ‘to the heart of the problem’.

The heart of the problem, and what is missing in the article, is the direct connection between mental illness and alcohol abuse. For Dr Mann and ‘The Observer’ not to refer to this in the article is gross negligence. The National Bureau of Economic Research (NBER) reports that there is a ’definite connection between mental illness and the use of addictive substances’. NBER research reveals that people who have been diagnosed with a mental health condition at some time in their lives consume 69% of all alcohol consumed.

So what is clearly needed is more money and resource invested in training and employing more therapists in the treatment of those patients whose mental illness symptoms include substance abuse.

More on the links between mental illness and substance abuse at www.dualdiagnosis.org

Some Young Adults Preferring A&E Walk-In Attendance Rather Than GP Appointments System

Citizens Advice researched 900,000 people across England and found that 18 – 34 year olds are more than twice as unlikely to be able to secure a suitable appointment with their GP as those 55 years old and over.  Similarly these young people were twice as likely as 55+ olds to use their local hospital A&E walk-in service rather than their GP. So…even more pressure on A&E units.

‘Sell Off’- A 60 Minute Film Featuring Doctors and Healthcare Researchers Describing the Destruction of Our NHS

This excellent film covers a wide range of NHS issue including:

+ inappropriate and expensive internal market

+ PFI hospitals creating huge public debts and huge private profits

+ Government lies

+ Health and Social Care Act 2012 – fatally flawed

+ Foundation Trusts/mergers – about profits, not patients

+ planned NHS service downgrading as a trigger to introducing private service suppliers

+ politicians joining the boards of private healthcare providers and consultancies

+ CCGs as instruments to bring in privatised insurance based healthcare

+ massive fees paid to management consultancies, especially to McKinsey & Co

+ TTIP – granting power to US corporates on a par with nation states

+ intimidation of whistle-blowing NHS staff

One of the key narrators in the film is the famous healthcare researcher Professor Allyson Pollock. The film is produced by Peter Bach.

http://youtu.be/ultKvnw2h3Q

A must watch.

A GP Surgery Attempts to Refuse to Treat Mental Health Patients and NHS England Puts a Stop to It

A GP surgery in Newton Abbot in Devon emailed its 10,000 patients recommending they should not seek help from the surgery for a range of conditions, which included ‘mental wellbeing concerns’. Instead these troubled people should contact local NHS mental health services. On 2 December 2014 NHS England intervened to say that the surgery’s recommendations were unacceptable. The Department of Health stated that the surgery’s approach flouted the GP contract and that it is unacceptable for surgeries to turn away patients in need.

Four West London Councils Collaborate and Set Up an Independent Commission to Investigate Deteriorating Local Hospital Services

Brent, Ealing, Hammersmith & Fulham and Hounslow Councils are to work together and impartially study the impact on patient services caused by local hospital closures. The commission will take evidence from the NHS and from other organisations and individuals. Chairing the commission is the human rights specialist Michael Mansfield QC. Other members of the commission include renowned NHS researcher Dr John Lister and retired Chiswick GP Dr Stephen Hirst.

London Mental Health Strategic Network

This new London initiative involving 22 organisations is working on a set of recommendations for commissioning mental health crisis services across London. Recommendations include a round-the-clock telephone help line, 24-hour psychiatric services in accident & emergency departments across London and mental health crisis training for GPs, practice nurses and community staff. The organisations involved include Mind, the Metropolitan Police, NHS, social care, housing and local Councillors.

This initiative is attempting to meet the needs of the Crisis Care Concordat launched in February 2014. The concordat is a national agreement between services and agencies involved in the care and support of people in crisis. It is supported by 22 national organisations.

More on the network and the concordat at www.crisiscareconcordat.org.uk

NHS Spent £640 Million on Management Consultants in 2014

Professor David Oliver writing in the British Medical Journal has slated the NHS for spending so much on management consultants. He quotes day rates of between £3,000 and £4,000. Professor Oliver, a prominent advisor to the Department of Health, believes  adequate management skills exist in the NHS which could be used instead of consultants.. He regards money spent on consultants as wasteful and unnecessary.

Project to Share Patient Data Held by GPs Delayed Yet Again

The Government’s care.data project, which aims to extract and use patient data held in GP records, has suffered yet another set back. This time a report by National Data Guardian Dame Fiona Caldicot and the independent Information Governance Oversight Panel has reported significant questions, concerns and recommendations for the project. Jeremy Hunt wants these issues to be resolved by NHS England before care.data can go ahead.

care.data was initially put on hold in February 2014 after widespread concerns were expressed. Many GPs expressed the wish in May 2014 that the scheme should only go ahead with patients explicitly consenting by opting in.

Issue: 20

December 2014

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.

NHS Funds 23 NHS NW London Staff, GPs and ‘Patient Representatives’ to Visit USA for a Week at a Cost of £120,000

Mystery still surrounds this trip which began on Saturday 29 November 2014. The trip itinerary apparently takes them to Boston, New York, Baltimore and Richmond. Details leaked out a few days before and were reported in the ‘London Evening Standard’. Save our Hospitals Hammersmith complained bitterly about the trip and Imperial NHS Health Trust boss Dr Tracey Batten pulled out of the trip at the last minute. We haven’t discovered who from Ealing is on the trip, but ‘Shaping a Healthier Future’ supremo Dr Mark Spencer is thought to be participating.

The organisers of the trip are management consultants, McKinsey & Company. McKinsey has earned many millions of fees from NHS NW London and is well known to favour marketised, insurance based healthcare. Ex-McKinsey consultants occupy a number of senior positions in the NHS.

+  In view of the well publicised crisis in A&E in NW London right now the timing of this covert junket is appalling.

+  A number of us attend public Ealing Clinical Commissioning Group (ECCG) meetings. The existence of this trip has never been mentioned in these meetings. Why was this?

+  Healthwatch Ealing is supposed to represent NHS patient interests. Why didn’t Healthwatch Ealing publicise this trip? Is Healthwatch Ealing participating in the trip?

Reflecting on the Local NHS Crisis

It does seem quite extraordinary that the Coalition Government and NHS top management can continue saying ‘..A&E units will remain open long term at both Charing Cross and Ealing Hospitals’. Over the last two years I have come to appreciate that when intensive care beds, consultants and services are removed, then A&E services can no longer be provided. We all know that the removal of intensive care at Ealing Hospital is planned for sometime after March 2015, so why can’t the bosses and politicians just be honest about what is inevitably going to happen? It’s common knowledge that it is planned to demolish Ealing Hospital. Most of the land will be re-used for residential development. On a small part of the land a large GP surgery will be built. This new facility will operate as an Urgent Care Centre.

On 11 November 2014 I drove past Ealing Hospital and 12 ambulances were queuing on the road and ramp services at the A&E entrance. I have never seen so many ambulances there before. One has to surmise that most of them were carrying patients queuing for A&E.  Backing this up is an NHS report which placed London North West Hospital Trust (which includes Ealing Hospital) as one of the four worst performing Trusts in England for week ending 19 October 2014. Overall the Trust failed to see 32.32% of A&E patients within four hours. For the week ending 9 November 2014 only 69.2% of Type-1 A&E patients (the most seriously ill) were dealt with in 4 hours.

A&E waiting times have also rocketed at West Middlesex Hospital since the closure of Central Middlesex and Hammersmith Hospital A&Es in September 2014.

Colin Standfield of Save our Hospitals (saveourhospitals.blogspot) made the point recently that we were all promised Community and Primary Care enhancements to take 80% of the A&E load that didn’t need to be in hospital. But, he asks, where are these enhancements? In reality they still do not exist.

On 16 November 2014 Colin Standfield wrote to all our local MPs emphasising that there is no substantial extra A&E demand locally. There is though a crisis in local A&E  services caused by the elimination in September 2014 of Central Middlesex and Hammersmith Hospital A&E units. As well as the increase in pain and possible mortality caused by longer A&E waiting times, there are other disturbing knock-on effects. These include early discharge problems, record rates of day case cancellations and the shuttling of patients around north west London to find admission beds.

The ‘Daily Mail Online’ reported on 22 November 2014 that NHS NW London had launched an inquiry about poor A&E performance at Northwick Park and Ealing Hospitals. This inquiry, amongst other things, will look at death rates at both hospitals. The article strongly suggests that re-organisation supremo Dr Mark Spencer wants to blame our local A&E chaos on poor A&E performance at Northwick Park and Ealing Hospitals, rather than attributing it to the closure of A&Es at Central Middlesex and Hammersmith Hospitals

As for ‘changing settings of care’ it’s clear that what is being pushed is for greater use of pharmacists, paramedics in ambulances and more treatment in existing and new local GP staffed facilities, and at home. For me the acid test will be how this works for the millions of mentally ill patients throughout England.

‘Your Healthcare in Ealing’

On 27 November 2014 a 20 page NHS booklet called ‘Your Healthcare Services in Ealing’ arrived in my letter-box at home. It aim is clearly to tell Ealing residents about local healthcare services. It also gives some information on future local healthcare facilities. On the face of it, the booklet is quite useful.

The booklet’s tragic flaw however is that its content is totally devoted to physical healthcare services. The term ‘mental health’ is not even mentioned once. There are no details on primary or secondary mental health services. There are no details of mental health facilities. One in five Ealing adults are suffering from mental health problems at any one time. Expenditure on mental health services is the single highest item of healthcare service expenditure in Ealing. This absence of mental health service information is disgraceful and totally irresponsible.

In the ‘Improving hospitals’ section it says that there are ‘plans for a redeveloped local hospital with A&E’ at Ealing Hospital. I just don’t believe this. We all know that most of Ealing Hospital will be demolished and that a ‘traditional’ A&E with intensive care consultants and beds will not be retained on the site. It is simply impossible to describe what is planned for the Ealing Hospital (demolishing a major hospital) under a heading ‘Improving hospitals’.

In ‘Improving GP services in Ealing’ we are told that at least 3 GP practices are open every weekend spread across the borough. This is all well and good, but where is the web site address, email address or phone number we can all access to find out which GP surgeries are open on any one weekend?

Closure Date Decision on Ealing Hospital Maternity Unit Delayed at Last Minute

The Ealing Clinical Commissioning Group (ECCG) had planned to discuss(?) and decide/confirm the date for the closure of the Ealing Hospital Maternity Unit at a meeting on 26 November 2014. However on 18 November 2014 we learnt that that meeting had been postponed till January 2015. Later in November this postponement was described by the ECCG as till the New Year. Reasons given for this delay were issues related to Paediatric training. A hospital clinician I spoke to found these reasons not very credible.

Could it be that someone has done the sensible thing and has researched spare maternity capacity accessible to Ealing mothers? If they have, they may have discovered that there is no spare capacity. NHS NW London may be loath to repeat the current chaos being caused by closing two local hospital A&E units in September 2014.

Solace Mental Health Centre to Close

London Borough of Ealing’s (LBE’s) cuts for 2015/16 sadly include the closure of the Solace mental health walk-in centre in Bowmans Close W5. The centre is jointly funded by LBE and the West London Mental Health Trust (WLMHT). It’s unfortunate that WLMHT can’t step in and pay the LBE grant to keep Solace open.

Surely reducing the number of local, mental health facilities is not the way forward? Some 80 patients use the centre – some of them for over 10 years.

However it seems as if mental health service users who use the centre will be offered personal budgets which allegedly will result in £187,000 savings. My experience of mental health service users being able to assemble and manage a ‘personal budget’ is that this is often unsuccessful. LBE says that all eligible users will be able to spend their personal budgets ‘…to buy alternative services in the voluntary sector’. This might prove problematic, as I’m not aware that these alternative services actually exist.

WLMHT Mental Health Lammas Centre Recovery House Project is Scrapped

In July 2014 WLHMT boss Steve Shrubb waxed lyrical about the repurposing of the NHS Lammas Centre in Mattock Lane W5 into a 12 bedded mental health Recovery House. Local Councillors told me on 29 November 2014 that WLMHT had now cancelled this project.

2,100 Mental Health Beds Closed in England Since April 2011

An investigation by ‘Community Care’ magazine and the BBC has revealed mental health bed shortages linked to seven suicides and one homicide in England since 2012. 2,100 mental health beds have been lost since 2011. 468 mental health beds were closed during last year.

Jeremy Hunt and NHS England were warned by a senior Coroner in December 2013 about the dangers of mental health beds not being available in preventing future deaths. Hunt replied that ‘acute beds must always be available for people who need them’. However this investigation reveals that this is just not the case.

The recommended average monthly mental health bed occupancy level is 85%. However this occupancy level has stood at 101% for the past two years. Some Mental Health Trusts have occupancy rates of 120%+ for months.

The investigation has also revealed that a Chief Executive of a major Mental Health Trust wrote to NHS England during the summer informing them that there were no mental health beds available in London in either the NHS or the private sector.

Is Online Healthcare Now the NHS ‘Holy Grail’?

A November 2014 report by the National Information Board (NIB) offers the promise of more ‘digital support’ for patients. NIB claims that in future viewing test results and booking appointments online will make healthcare as simple as online banking.

Part of this nirvana is that by the end of 2015 everyone will have online access to their GP records. After a 47 year career in IT, I just don’t believe this will happen. Even more grandiose is the aspiration that emergency, urgent and primary care patients will be digitally monitored in real time by 2018 and all patients by 2020.

A big plug is given to University Hospitals of Leicester NHS Trusts whose nurses have been given iPads and iPhones to record and share patients’ vital signs. This has seemingly lifted staff morale, cut down on paperwork and allowed nurses more bedside time.

Mental health apps will also become available including one offering Cognitive Behavioural Therapy (CBT). It is, however, hard to imagine that CBT could be successfully delivered without considerable expert human counselling.

By 2020 there will be over six million people in the UK of 75 years old or older. I wouldn’t have thought many of these folks will be willing or able to use these new online healthcare initiatives.

Agency Nurses Now Cost NHS £5.5 Billion a Year

On 2 November 2014 ‘The Observer’ reported this figure and added that the cost had risen each year over the last four years. In 2009 the annual agency nurses’ salary bill was £734 million. Agency nurses are now costing the NHS up to £1,800 per head per day.

I suppose this is a predictable development when many hospitals are under threat of closure and constant change seems to be the order of the day.

Better Care Fund (BCF) Appears on Brink of Collapse. Hillingdon Just Refuses to Entertain BCF

In November 2014 ‘The Guardian Online’ reviewed the National Audit Office’s (NAO’s) unflattering review of the Government’s Better Care Fund (BCF) initiative. BCF, announced in autumn 2013, aims to integrate NHS healthcare services with Local Authority social care services. The plan is for BCF to go live in April 2015.

The BCF business case is about saving money and reducing admissions to hospitals. The NAO is clearly unconvinced that the latest savings estimate of £523 million is a credible one. NAO states that the BCF plans contain ‘bold assumptions’ about savings next year. It views planned reductions in emergency admissions to be based ‘on optimism rather than evidence’.

The NAO blames the Department of Health, the Department of Communities and Local Government and the Treasury for:

+ failure to agree financial and service objectives

+ failure to put in management resources, time and contingency planning appropriate for the scale of the project

+ failure to set out who was responsible for what

+ failure to look at the evidence of what works.

The London Borough of Hillingdon is so unimpressed with the BCF that it has refused to implement it.

Issue: 19

November 2014

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.

Delays at North West London Hospital A&Es Follow September 2014 Closure of Central Middlesex and Hammersmith Hospital A&Es

Entirely predictable but lamentable increased delays are being reported at Chelsea and Westminster and Northwick Park Hospital A&Es. The reports come from CQC and the Department of Health respectively. At Northwick Park Hospital a quarter of ‘Type-1’ (highest need) patients are waiting over four hours for A&E treatment.

The obvious conclusion to be drawn from these deteriorating A&E services is that the promises of the provision of alternative A&E facilities before the two A&E units in Park Royal and East Acton were closed have not been met.

400,000 NHS Staff Strike for Four Hours on 13 October 2014

After three years with no pay rise, 400,000 NHS staff have had to strike to gain the nation’s attention. It’s the first such strike for over 30 years. For midwives it’s their first strike ever. Ealing midwives joined the picket line outside Ealing Hospital. On 20 October NHS radiographers also went on strike.

According to Unite one in five NHS staff have second jobs as this is the only way they can make ends meet.

Senior Tories Admit ‘Huge Strategic Error’ in Implementing Controversial NHS Reforms

On 13 October 2014 ‘The Times’ revealed what many of us had suspected – that senior Tories had failed to grasp the explosive content of Andrew Lansley’s NHS plans. And now they regret allowing his ‘revolution’ to take place. No doubt with a General Election just six months away, senior Tories are worried that electors’ unhappiness with NHS performance will cost them votes. Most recent polls are showing that the NHS is the leading national issue amongst electors.

The Tory led Coalition Government spent £3 billion on an unpopular and potentially unproductive re-organisation when this money, and more, was needed to treat a growing, aging population.

Nuffield Trust Report Confirms that NHS Performance is Deteriorating

The highly respected Nuffield Trust along with the Heath Foundation recently revealed the results of its research into NHS performance. Some of the findings:

+ Four hour+ ‘trolley wait’ rose by 79% from 2010/11to 2013/14

+ One in ten patients waited longer than the prescribed 18 week maximum for planned treatment

+ Mental health assessment waiting times have risen by one third.

+ The psychiatric hospital nurse workforce in mental health fell by 13%, whilst mentally ill patients detained rose by 17%.

These figures make a nonsense of the Government’s and NHS bosses’ claims that the massive changes and financial cuts in the NHS are making it more efficient. Many of us would welcome some honesty along the lines of – we know the NHS needs more money; we won’t find this money; and so service levels will inevitably deteriorate.

London Ambulance Service (LAS) Admits Patient Demand is Up and Staff Recruitment , Retention and Morale is Down

LAS reported in September 2014 that demand for its services is up 11% over last year. 238 staff left LAS in 2013/14. Only 80 staff left in 2011/12. A fully staffed LAS should have 3,000 front-line staff, but this year it is short of 320 paramedics and 130 emergency medical technicians. The results of a recent LAS staff survey are not encouraging either. 71% of respondents would not recommend LAS as a place of work. Only 46% said that they would recommend LAS care to friends and relatives.

Meanwhile NHS spending in London on private ambulances rose 1,000% between 2011 and 2013. In 2011 the spend was £795,000 and in 2013 that had ballooned to £8.84 million.

Campaign of the NHS Reinstatement Bill 2015

Launched on 4 October 2015, the campaign aims to reverse the failings of the Health and Social Care Act 2012 and fully restore the NHS in England as an acceptable public service. More information at www.nhsbill2015.org

care.data Rears its Head Again – But This Time it’s as the Accredited Safe Havens (ASH) Scheme

care.data is/was a national Government scheme for collecting, storing and using confidential NHS patient information. It stalled earlier this year when GPs and patients expressed concerns about privacy and the requirement for patients to actively opt out if they didn’t want their personal medical records involved.

The scheme has seemingly risen from the dead under a new guise as the Accepted Safe Havens (ASH) scheme. Instead of personal medical data being stored nationally it will be stored regionally in an ASH. The same worries still exist of course about whether the planned ‘pseudonymisation’ of our records will indeed render them completely anonymous. care.data still lives on in a 265 GP pilot scheme.

Ealing Better Care Fund (BCF) Proposals for 2015/16 are Approved by Government

The Government BCF is a pooled fund for Clinical Commissioning Groups and Local Authorities to spend on integrating health care and social care. The 2015/16 budget for Ealing is over £29 million. Ealing Clinical Commissioning Group (ECCG) and the London Borough of Ealing (LBE) submitted their BCF plan in early October. The plan has been approved, but there are some parts of it unresolved. Final proposals are due on 18 November 2014, but further refinements are expected in mid February 2015.

The plan is very complex and at 112 pages very long. The key defining principle apparently is for patients and care users to direct their own care in their homes and in the community. Reducing unplanned hospital admissions is an investment priority. Given there will soon be no hospitals at all in Ealing, this does seem to be a prudent approach.

In BCF GPs will be at the centre of the system and co-ordinate delivery of integrated care. In Ealing there will be seven local GP networks and a new overall GP federation. There will be seven day appointments, but not all 79 GP surgeries will offer this.

There are plans to develop two new ‘Health and Wellbeing Centres’ – one in LBE north and one in LBE east. Further such centres will be located on the Ealing Hospital site, Grand Union Village and Jubilee Gardens and on the Mattock Lane Healthcare Centre site.

There are commitments to improved diagnosis of depression and dementia, especially in Southall. There are also plans to boost Improved Access to Psychological Therapies (IAPT) services and IAPT recovery rates. There are a whole range of prevention, information, day care and out-of-hospital initiatives aimed at older people. Ealing AgeUK will pilot a new home visiting scheme.

The ‘Healthy at Home’ budget is over £13 million. £875,000 has been allocated for additional support for carers.

The voluntary sector has a key role to play in spending the BCF. Andy Roper of Ealing Community and Voluntary Services (ECVS) is working hard to unravel Ealing BCF complexities to help volunteer groups to bid for BCF projects. See www.ealingcvs.org.uk

Less Than 1.5% of Local Authority Public Health Budgets Spent on Mental Health Services

Local authorities collectively spent just £40 million of their Public Health budgets on mental health in 2013/14. This compares with £671 million spent on sexual health and £160 million on smoking. These figures have been researched and published by the mental health charity Mind.

Currently mental health problems account for 23% of the total disease burden in the UK.

Parity of Care for Mental Health and Physical Health Patients

Nuffield Trust research has revealed that mental health patients are waiting, on average, 48 days for treatment after referral by a GP. This compares badly with a 27 day average wait for physically ill patients. £120 million is being invested over the next five years in an attempt to achieve a parity of care across mental and physical health domains. I suspect though that considerably more money and additional high quality trained human resource will be needed to create this care parity.

Terminating Hospital PFI Contracts

Private Finance Initiatives (PFIs) are opportunities for private companies to make huge profits but incur minimal risks. Originally dreamed up by the Tories in 1992 it was New Labour in 1997 who created the current PFI contract conditions so loved by private investors.

So far 118 new NHS hospitals have been built in England using PFIs. Most are 30 year contracts. Total build costs are over £11 billion and total repayment costs are over £79 billion. Some will give returns to investors of up to 70%. Annual interest payments are high and are often major factors in tipping Trusts into so called debt.  NHS England boss Simon Steven’s finger prints are all over many of the early hospital PFIs. In 1997 he became policy advisor to Health Secretary Alan Milburn and then he was Prime Minister Blair’s health adviser 2001 to 2004.

In June 2014 the NHS hospital PFI worm finally turned and the first English hospital PFI was terminated. This termination was in Northumberland and concerned Hexham General Hospital which was opened in 2003. It cost £54 million to build. It cost Northumberland NHS Healthcare Foundation Trust £114 million to pay off the hospital ‘owners’ the Catalyst consortium. Catalyst members included Bank of Scotland and Bovis.  Savings of almost £67 million (3.5 million each year for the next 19 years) accrue from the termination. The average interest charged on PFI contracts is 8%. However borrowing though government is half that. In order to finance the deal the Trust borrowed £114 million from Northumberland County Council. In turn the Council borrowed the same amount from The Treasury. As ever with the PFI ‘witchcraft’ the Healthcare Trust refused to reveal the details of the original PFI deal.

In October 2014 ‘Private Eye’ revealed that PFI specialist Deloitte had been contacted by ten other NHS trusts about the possible termination of their PFI contracts.  

Issue: 18

October 2014

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.

Labour Party Finally Go Public on Saving the NHS and the Social Care Service

Andy Burnham, Labour’s Shadow Health Minister, delivered a good speech at Labour’s Annual Conference in Manchester on 24 September 2014. He not only talked about repealing the Health and Social Care Act 2012, but talked about creating a single national health and social care organisation. This is clearly what is needed as we now we have a universal healthcare system interfacing, often unsuccessfully, with a means-tested, public/private social care system.

Labour is also talking about recruiting 8,000 more GPs, 20,000 more nurses and 3,000 more midwives. But some GPs say it’s difficult to hire GPs and as GPs are seen to be under great pressure, one wonders just how many medical students are attracted to become GPs. Many nurses and midwives are up in arms about a pay rise and are threatening industrial action. This is unlikely to act as a magnet to attract new recruits either.

Of course there is the no small matter of money to pay for all this. Raising £2.5 billion annually through a mansion tax, increased duty on tobacco and cutting tax avoidance is a start. But it’s probably going to cost much more than this.

Appalling ECCG 2014 AGM Serves No Useful Purpose

On 17 September 2014 Ealing Clinical Commissioning Group (ECCG) held what it called its Annual General Meeting (AGM). It chose Greenford Hall at 6:00pm on a Wednesday. Currently the centre of Greenford has messy road works and with rush hour this made it very challenging for those who had to travel to the meeting.

In the financial year 2013/14 ECCG purchased £426 million of  healthcare services for the citizens of Ealing. ECCG has published online an annual review of its work. This is over 90 pages long! Even NHS England’s annual review report is only 25 pages.

Even though I and others had pre-registered to attend the meeting, there were no badges prepared or agendas or AGM papers given to us. Attendees were asked to submit questions beforehand and Ealing Save Our NHS Campaign – of which I am a member – submitted 20 questions. The meeting Chair said that sometime in the future I would receive written answers to all the questions.

Various ECCG managers spoke at the audience for 50 minutes. Oddly the ECCG Chair did not speak at the meeting and did not even attend it. The visual facilities were dreadful and most people could not read many of the slides displayed. No slide hard copies were made available. Two speakers even covered the same ground – ECCG’s top priorities.   

Our questions were very specific. They included concerns about A&E closures and capacity, Maternity accessibility and capacity, Paediatrics, GP challenges, hospital closures, actual out of hospital locations and mental health. However the ECCG speakers were all about the ‘Shaping a Healthier Future’ aspirations and vagaries,  with regular doses of ‘pathways of care’, ‘care close to home’, ‘transformation’, ‘reconfiguration’, ‘integrated care’ and ‘patient empowerment’. We’ve heard this stuff so many times now for almost two years. Now clearly the citizens want facts, answers and efficient services. We did hear about the good work that has been done on diabetes, but many of us had heard this success story before.

Although the ECCG had purchased £47 million of mental health care services, the words ‘mental health’ were mentioned by ECCG just twice and 40 minutes into the event. This is the largest individual service spend, but not even headline details were given as to how this cash was spent. There was also very little mention of the increasing demands of the growing elderly population. There was only one mention about the Better Care Fund (BCF), which is a new pooled budget – aiming to integrate health care and social care – to be spent by London Borough of Ealing (LBE) and the ECCG. It was useful to discover that the LBE/ECCG purchasing template for the next two years was to be submitted to NHS England on 19 September 2014. It was underwhelming for ECCG to not even give us the headlines of what LBE/ECCG were wishing to spend the BCF cash on. ECCG never even told the meeting they were soon to move from Greenford to Perceval House in central Ealing.

Incredibly only 15 minutes were allocated for questions and answers. Five of our questions were dealt with (quite inadequately), as well as a few more from the floor. On A&E closures and poor CQC reports about Northwick Park Hospital (NPH), ECCG management were very sanguine. That was until a member of the audience explained that only in the last few days NPH reached capacity in its cardiac unit and new patients were all diverted to Ealing Hospital. Ealing Hospital will soon be eliminated as a major hospital, and what will happen should NPH reach capacity again? Oh, just a one off, said ECCG worthies. The audience was not really convinced of this.

ECCG is accountable to NHS England. It’s also accountable to LBE’s Health and Wellbeing Board. However the latter is dominated by NHS nominees.

An organisation running an AGM normally invites its ‘members’, shareholders and/or stakeholders to an AGM. It’s normal for the financial report to be ‘approved’ by the invitees. None of this went on at this meeting. So one wonders just what was the point of inviting Ealing citizens to this meeting?  Was it a public relations exercise? If this is the case, then in my view it was an abject failure.

NHS Central Middlesex and Hammersmith Hospitals’ Accident and Emergency Units Both Close on 10 September 2014

The closure of two NHS hospital A&Es on the same day is unusual enough, but the closure of two of them just two miles apart is surely unprecedented.

Over 50 activists turned up at Central Middlesex Hospital on the morning of the closure to demonstrate their opposition. All the boss of the hospital could offer them was free tea and biscuits.

Reassurances have been given by the NHS that alternative A&E services are readily accessible and available. However one of the local speakers at the demo told us all that he was directed to take his sick child to Northwick Park Hospital A&E in Harrow. It took him an hour by car and when he arrived he was told his child would have to wait three hours for treatment. By 29 September 2014 Northwick Park Hospital bosses were admitting that the hospital needs 80 to 100 additional beds in order to provide an adequate service.

Throughout the whole of the 21 square miles of the London Borough of Ealing there is now just one A&E unit – at NHS Ealing Hospital. And even this unit will be closing before long.

All this is part of the brave new world of the NHS ‘Shaping a Healthier Future’ experiment. But what happens next if the experiment is a failure?

Crazy Accounting Predicts 50% of English NHS Hospitals Will Rack Up £1 Billion in Debt by Financial Year End

If more than half of all NHS hospitals in England are predicted to be showing big annual losses at the end of March 2015, surely there is something seriously wrong with NHS budgeting and NHS financial arrangements?

With rising demands come rising costs to meet these demands. Maybe the £3 billion being spent on re-organising the NHS will result in some efficiency and throughput improvements and maybe it won’t.

What is clearly needed is more cash to be found for NHS hospitals, so that they can continue to provide and maintain quality services that meet peoples’ needs.

Integrating Universal Healthcare With Means Tested Social Care – Is This and the Better Care Fund (BCF) Mission Impossible?

In March of this year the Department of Health admitted the NHS will collapse under pressure if something is not done to improve the way health and social care is provided.

Put quite crudely, hospitals are expensive to run and caring for patients at home and at day care centres is much cheaper. According to Birmingham Community Healthcare NHS Trust it costs £276 a day to keep a patient in hospital. It costs £160 a day to give a patient the maximum amount of care they are allowed at home. Over a year this can mean the care in the community costs £40,000 less than care in hospital. Allegedly 30% of all hospital beds are ‘blocked’ by patients who would be much better off at home, if care could be provided there.

Here in NW London the Government/NHS is cutting costs by closing four out of eight hospital A&E departments and is reducing the number of hospital beds across the region by almost 1,000 by 2015. National Government pays for universal healthcare.

Care homes are also expensive to run. 152 Local Authorities (LAs) pay for means tested social care, which includes funding care home places for those deemed eligible. On average in England it costs £95 a day for day care with nursing. Only those with assets under £23,250 receive financial support. The cost of care is soaring. However, two million new claimants are expected by 2016. Currently 43% of all people receiving social care have to fund it entirely themselves.

Elderly people, who represent more than a third of the patients in hospital beds, are the group which has experienced the greatest reduction in support services as a result of LA budget cuts. According to AgeUK the total number of older service users supported by LAs dropped by 35% to 548,000 between 2006 and 2013.

This is where, presumably, the Government’s Better Care Fund (BCF) comes in. Announced in June 2013, BCF is aimed at funding a transformation in integrating health and social care. It goes live in April 2015. BCF is a single pooled budget to enable the NHS Clinical Commissioning Groups (CCGs) and LAs to work closely together. £1.9 billion will be taken out of local NHS hospital budgets in 2015/16 with a view to it being spent by LAs to divert people from A&Es and speed up discharge. BCF is a five year strategy.

LA Health and Wellbeing Boards in collusion with their local NHS CCGs have less than five months to submit a template setting out their two year BCF proposals to NHS England. These templates will be assessed against a range of criteria, which include delayed transfers of care, emergency admissions, effective re-ablement, admissions to residential and nursing care, and patient and service user experience.

One hopes LAs will spend this money wisely, including helping the one in three over 65s suffering from dementia. What they and their carers need are specialist day care, respite care and intensive domiciliary care, funded by social services but with psycho-geriatric support.

However there is a sting in the BCF tail for LAs. If annual unplanned admissions to hospital by LA patients are not reduced by 3.5% then the NHS BCF money will not be paid to LAs.

Better Care Fund  – The Ealing Perspective

Later this year Ealing CCG will move offices from Greenford to the London Borough of Ealing’s (LBE’s) Perceval House offices in the centre of Ealing. This will co-locate the ECCG with LBE Officers carrying out the LBE Health and Wellbeing Board’s (H&WB) wishes.

The composition of the LBE H&WB is intriguing. Out of the 15 members seven are NHS employees! Two of the others have yet to attend a meeting. There are only four elected Councillors. Even Rob Larkman – ex-advertising executive and management consultant – is on the board and he’s had no direct involvement in Ealing healthcare and social care for many moons. He’s no longer a member of the ECCG Governing Body. This board looks to be very much NHS dominated, so in what way is it a legitimate arm of Local Government?

LBE Chief Executive Martin Smith also happens to be Chair of the London Health and Care Integration Collaborative, so he will be well placed in his Perceval House office to oil the wheels of LBE/ECCG collaboration. However, in August 2014 Mr Smith publicly expressed reservations that any further changes to BCF could make it ‘untenable’. He is unconvinced that BCF is a ‘good deal’ for local government.

Achieving Parity of Esteem Between Physical and Mental Health

In September 2014 the Royal College of Psychiatrists published details of six specific areas which the Government must address in order to deliver on its commitment to parity of esteem between physical and mental health. These are:

+ tackling the bed crisis

+ introducing maximum waiting times

+ improving crisis care

+ improving liaison psychiatry services

+ introducing minimum unit pricing for alcohol

+ investing in parenting programmes.

More at www.rcpsych.ac.uk

Key EU Trade Commissioner Says Public Services (eg NHS) are Always Exempted from Free Trade Deals Like TTIP

The BBC has reported that Karel de Gucht, who leads the European TTIP negotiation team, says TTIP will not undermine our NHS. This is good to hear.

The Transatlantic Trade Investment Partnership (TTIP) aims to remove trade barriers between the USA and Europe. Critics argue that it will allow US corporates to run rampant across UK industry and make profits by stripping away regulations which protect our privacy, food safety, the environment and the economy. TTIP threatens to give US corporates powers to take action against private and public UK organisations whose actions they see as endangering their profits. With increasing privatisation on the cards within the NHS, many worry that (via TTIP) US healthcare companies will be enabled to run NHS services and it will be very difficult to get rid of them if they fail to perform.

Health and Social Care in England – By Numbers

+£26 billion – Cost of Dementia (LSE)

+ 6,500,000 – Carers (Carers UK)

+ 1,300,000 – NHS employees

+ 800,000 –    Dementia sufferers (DoH)

+ 450,000 –    People in care homes

+15,000 –       Annual number of patients who die during emergency surgery (Royal College of Surgeons)

+ 7,800 –  NHS staff earning over £100,000/year

+ 211 –     CCGs (DoH)