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)

Issue: 17

September 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.

‘Nearly 100 GP Surgeries in London Face Closure’

So says the Royal College of General Practitioners (RCGP). RCGP blames this on the Government’s changing the funding formula and taking money away from deprived areas such as East London. This funding change is the removal of the Minimum Income Practice Guarantee (MIPG). The MIPG was introduced in 2004 to support practices moving to a new GP contract. It’s a top up payment given to some GP surgeries. The Government began stopping these payments in a phased programme over seven years which began in April 2014. The Government argues that MIPG funding is not weighted to reflect the demographics of a practice population.

The Jubilee Street GP surgery in Bow, London faces losses of over £900,000 if these funding cuts go through says Practice Manager, Virginia Patania. She expects her practice to close in November unless the NHS provides them with another funding support solution.

Replacement GP Surgeries May Be Run By Private Providers

On 18 August 2014 ‘Pulse’ magazine revealed that all new GP contracts are to be thrown open to private providers. Allegedly Competition Law now demands that GMS or PMS contracts are no longer appropriate and time-limited APMS contracts will be used instead. General Medical Services (GMS) contracts and Personal Medical Services (PMS) contracts both exclusively contract GPs with the NHS. Alternative Provider Medical Services (APMS) contracts were introduced in 2004 to support the Labour Government’s ill-fated polyclinics initiative.

APMS facilitates a whole host of types of organisations to provide primary healthcare. These include commercial providers, voluntary sector providers, mutual sector providers, social enterprises and public sector bodies. APMS allows one private provider to transfer the GP surgery contract to another private provider. There have been some APMS contract failures including Camden Road Surgery in London. UnitedHealth ran this surgery for three years under an APMS contract. It then sold it to another private firm – The Practice – who closed it down in April 2012, leaving 4,500 people without a doctor.

Ealing GPs Publicly Silent on the Challenges Facing Them

Given the obvious pressures on GP surgeries it seems quite odd that apparently none of the 200+ GPs practising in Ealing and none of the 79 GP surgeries have apparently spoken publicly about the pressures they face.

These challenges and pressures include:

+ Heavy case loads – each GP seeing 30 to 40 patients every day

+ Being encouraged to extend surgery hours

+ Threats by CQC to place under-performing GP surgeries in ‘Special Measures’

+ 90% of GPs feel pressure from patients to hand out antibiotics (research by Nesta)

+ Offering (or not offering) mental health primary care

+ The impending closure of Central Middlesex Hospital A&E (10 September 2014)

+ The impending closure of Ealing Hospital A&E (When?)

+ Ealing GPs to work in six ‘Health Networks’

+ Patient consultation by telephone – just how effective and efficient is this?

+ An additional 10,000 GPs needed nationally for a sustainable service (RCGP)

+ 56.6% of GP surgeries have been unable to recruit doctors (RCGP)

+ Shortage of District Nurses and Community Matrons

+ Implementing the Better Care Fund (BCF), which aims to integrate healthcare with social care

A&Es at Central Middlesex and Hammersmith Hospitals To Close on 10 September 2014: NHS Public Leaflets  Inform, Mislead and Infuriate

It’s very worrying to be just days away from one of the early phases of the unique social experiment that is ‘Shaping a Healthier Future’- i.e. the closure of NHS A&E units in Park Royal and in East Acton.

NHS leaflets publicising the closures were delivered to homes in Hanwell, Ealing in August. The leaflets are strangely incompetent as regards the mentally ill. 1 in 5 adults and 1 in 10 children are mentally ill. There is guidance in the leaflet as to which physical medical conditions are suitable for treatment at big GP surgeries called Urgent Care Centres (UCCs) and which are suitable for treatment at NHS hospital A&Es. However no guidance at all is provided for those who are mentally ill. This omission makes an absolute nonsense of the 2013 guidance from NHS National Medical Director Sir Bruce Keogh for parity of care and esteem for both physically and mentally ill patients. Whoever approved this leaflet text ought to be fired.

The leaflet also strangely lists ‘the nearest A&E departments’ as those at Northwick Park Hospital, St Mary’s Hospital and Charing Cross Hospital. This statement is quite clearly a lie. Ealing Hospital A&E and West Middlesex A&E are the two closest A&Es for those living in Hanwell, Ealing. Also the new A&E unit at Northwick Park will not be complete till October 2014.Were the wrong leaflets delivered to homes in Hanwell?

The latest CQC report on Northwick Park Hospital A&E describes significant staff shortages and states that the service requires improvement. Services which CQC say need improvement also include surgery, critical care, maternity and family planning, services for children and old people and outpatients. So the suffering citizens of Hanwell are to be directed (by ambulance) to Northwick Park Hospital A&E as from 11 September 2014. How this will play out in a short staffed/improvement needed A&E department some five miles away though congested traffic is all too clear. Long waits for an ambulance, long waits inside an ambulance, long waits in A&E reception, more pain and possibly more deaths.

Self-Harming and Overcrowding on the Increase in England’s NHS Mental Health Trusts

The Labour Party, using Freedom of Information requests, has discovered a 56% increase in self-harming over four years in NHS mental health trusts. Also instead of trusts operating up to a maximum of 85% capacity, some of the trusts are operating at up to 135%.

More ‘Physician Associates’ is Jeremy Hunt’s Solution to Shortages of Doctors and Nurses

To cope with the shortage of doctors and nurses in NHS GP surgeries and NHS hospitals the Government is advocating training and using more science graduates with just two years medical training. ‘Real’ doctors receive seven years medical training.

Apparently these associates are allowed to carry out triage, diagnoses, admission and discharge of patients. However they are not allowed to sign off prescriptions and will not be registered with the General Medical Council. Annual salaries of £30,000 to £40,000 per year make these associates a much cheaper option than fully qualified doctors.

Fans of these associates cite the fact that there are 80,000 of them (presumably operating successfully) in the US healthcare service. There is also a move in England to re-name these associates as ‘assistants’ on the basis that this would clarify their role.

The role of a Physician Associate in the NHS sounds somewhat similar to Police Community Support Officer (PCSO) in the Metropolitan Police. PCSOs look like ‘real’ Police persons, but are no such thing and have only limited powers. PCSOs get paid less than real police.

Incompetent triage and diagnosis could lead to more pain, longer lasting medical conditions and possibly unnecessary deaths.

50 Carers for the Disabled in Doncaster On Strike: Care UK Cuts Wages of 237 Former NHS Staff by 25%

‘The Observer’ has reported on a long running strike by former NHS staff in Doncaster. Care UK won a contract in November 2013 to run community care services for the NHS, involving 140 people with learning disabilities located in about 40 properties in Doncaster.  237 NHS staff transferred to work for Care UK.

When Care UK reduced wages by 25% some staff left in disgust. 50 of them went on strike. When they worked for the NHS, the carers’ basic hourly rate was £8.91. Care UK cut this to £7/hour. 100 new staff are being recruited at £7/hour. On 11 August 2014 the 50 strikers voted to extend the strike – taking their action with no pay to nearly 70 days.

Care UK says that workers’ demands are unrealistic in the light of reduced funding available for the NHS. However the company would have been only too aware of the funding realities when they signed the contract ten months ago.

There is no legal requirement for support workers to have qualifications before they deliver care. Less than half the British care workforce have completed a basic NVQ Level 2 qualification.

Care UK was acquired by private equity firm Bridgepoint Capital in 2010. Bridgepoint owns a range of businesses which include the Pret à Manger café chain and clothing retailer Fat Face.

Surely NHS Hospitals Should be Cost Centres Not Revenue Earning Organisations?

One of the most ludicrous aspects of the Health & Social Care Act 2012 is that it allows NHS hospitals to ‘earn’ up to 49% of total revenue from treating private patients. As more resources are used on treating private patients, then clearly fewer resources are devoted to ‘public’ patients who have already paid for their treatment via National Insurance payments.

London NHS hospitals which are devoting reduced resources to treating public patients include:

Name                    Increase in private patient revenue  

2010/11 to 2013/14                             

University College                  39.63% to £10.3 million

Royal Brompton                      37.7% to £33.6 million

Moorfields Eye                        31.84% to £21.3 million

Chelsea & Westminster           20.99% to £13 million

Failed ‘NHS National Programme for IT’ (NPfIT) Project Just Cost Us All Another £481 Million

In 2002 Microsoft founder Bill Gates persuaded our then Prime Minister, Tony Blair, to set up an online system so that NHS patient records could be accessed instantly anywhere. This promised to be the biggest civil IT project in history. The cost of the project was estimated at £11.4 billion. The project was spectacularly mismanaged and was terminated with nothing or little to show in 2011.

Fujitsu, just one of the IT suppliers involved, had its £896 million contract terminated in 2008 and it threatened to sue the Government.  On 1 August 2014 it was leaked that the Government would pay Fujitsu £400 million in compensation and £50 million to cover Fujitsu’s legal costs. The Government’s legal costs are £31.5 million. Estimates of the total losses on the whole NPfIT project range from £10.5 billion to £13.2 billion.

Issue: 16

August 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.

Will the NHS be a General Election Issue in May 2015?

With a General Election just 10 months away, the Tories will have to make lots of right noises here in Ealing about the NHS for Angie Bray (MP Ealing Central & Acton) to keep her seat. Nationally the Labour Party could actually get elected if they back a 100% reversal of four years of changes to the NHS. Labour must commit to injecting more money into the service and bring us more in line with state healthcare spend per head in France, Germany, the Netherlands and Belgium. Labour must promise to dismember the 2010 Health and Social Care Act.

Many think the LibDems will be wiped out in the May elections. Nick Clegg MP’s failure to hold the Coalition Government to account over ‘…no top down re-organisation of the NHS’ will be part of this. Shirley William’s surprisingly inept support in the Lords of Section 75 of the 2010 Act – which paved the way for wholesale privatisation of NHS service provision – will also be part of this.

3,950 NHS Staff Made Redundant in 2010 to 2013; Paid Off; and then Rehired

How it can be ethical, legal or sensible to do this is almost beyond belief.

£1.55 Billion Paid Out in NHS Staff Redundancy Payments Since 2011

40 of the redundancy payments to NHS staff in 2013 each exceeded £200,000. This really does seem obscene when compared with nurses being denied even a very modest pay rise.

Audit Commission Raises Concerns About Value For Money at Ealing, Northwick Park and Central  Middlesex Hospitals

The Audit Commission’s ‘Auditing the Accounts 2013/14’ report criticises Ealing Hospital NHS Trust and North West London Hospitals NHS Trust (Northwick Park and Central Middlesex Hospitals) for ‘non-standard conclusion of Value For Money arrangements’. The annual accounts for NW London Hospitals NHS Trust are also subject to ‘Referral to the Secretary of State for Health’.

Ealing Clinical Commissioning Group is also criticised in the report because of ‘difficulties making pension-related disclosures in the remuneration report’.

Private Healthcare Companies Invited in Staffordshire to Bid for £1.22 Billion NHS Cancer Care Contracts

Likely bidders for these 10 year contracts include Virgin Care, Care UK and Ramsay Health. Macmillan Cancer Support is advising the four ‘federated’ CGCs who will commission these for-profit companies should one or more of them be selected. NHS England is heavily involved in this initiative.

The Royal College of Radiologists (RCR) writing in ‘The Guardian’ on 5 July 2014 voiced its ‘..fear that there might be unintended consequences’. RCR described this move to privatisation as ‘..a gamble’.

It’s important to note that the four CCGs allied to NHS England do not equate to ‘local GP driven services’ as CCG and NHS colour brochures have been telling us for years now. This is top down privatisation of the NHS – ‘red in tooth and claw’.

The revered publication ‘The Lancet’ takes a dim view of privatisation. Of the Staffordshire tender it says ‘…to try to excise an entire clinical pathway that has several links to other parts of the NHS is an ill-considered fix to a complex issue, and will ultimately not serve those for whom the NHS was first created’. Unison called this procurement process ‘a dangerous experiment’ and Labour’s Andy Burnham MP said that the public had not given the government permission to ‘put the NHS up for sale’.

The Department of Health (DoH) – clearly confused – bleated that NHS competition rules have not changed under this Government. If the DoH can’t see that competition rules changed dramatically with the 2010 Health and Social Care Act and with Section 75, they really do need to go to SpecSavers.

Insane Scheme by NHS Boss to Give Cash Directly to the Mentally Ill

NHS boss Simon Stevens wants vulnerable ‘people with severe and enduring mental health problems’ to be given cash to spend as they see fit on health and social care services. As a registered mental health carer I find this alarming. From my direct experience and drawing on the experiences of other mental health carers, the mentally ill often manage their finances badly, can be manipulated by others into buying alcohol and recreational drugs, give money to strangers and lie about how they have spent cash.

The initiative begins in April 2015 and is called the Integrated Personal Commissioning (IPC) programme. Stevens says that ‘voluntary/Third Sector organisations will be commissioned locally to support personal care planning, advocacy and service ‘brokerage’ for these individuals enrolled in the IPC programme’. I have no idea what this actually means.

He also says that this initiative ‘builds upon, but is in addition to ….the ground breaking Better Care Fund (BCF)’. BCF itself is a worry as it attempts to knit together the NHS, Department of Health and hundreds of Local Authorities in melding together healthcare and social care. The £3.8 billion BCF cash will be spent in order to make savings. A leaked Cabinet report earlier this year reveals concerns about how these savings will actually be achieved.

Improving Access to Psychological Therapies (IAPT) Shines a Ray of Hope on the Mentally Ill

I, along with over 100 others, attended a public interview by BBC’s Andrew Marr of Professors Layard and Clark at LSE on 10 July 2014.

Sixty years ago William Beveridge wrote a report to the British Parliament which provided a summary of principles necessary to banish poverty and ‘want’ from Britain. He described five giants on the road to reconstruction – want, disease, ignorance, squalor and idleness. According to Professor Lord Layard of LSE a missing giant in that list was mental illness. Because this giant was not identified, the mentally ill suffered decades of inadequate or non-existent treatment. Layard estimates there are six million mentally ill people in this country.

The major reasons for decades of inadequate treatment can be grouped into three categories. Firstly the words that have historically been used have not been helpful. ‘Talking Therapies’ have been construed by many as just the simple act of talking to the mentally ill, whereas in reality it comprises specialist interventions by trained therapists. Secondly there has been no definition and monitoring of outputs. Thirdly investment in recruitment and training of therapists has been woefully inadequate until recent years.

Lord Layard has worked with Chartered Clinical Psychologist, Professor David Clark of Oxford University since 2006 to establish evidence-based psychological therapies. They have worked successfully with the previous Labour Government and the Coalition Government in establishing the funding for the training of 6,000 psychological therapists. Those 6,000 therapists have treated 250,000 patients so far, half of whom have ‘recovered’ and for many of the others their lives have improved. The NHS treatment programme is called Improved Access to Psychological Therapies (IAPT).They now want the next elected Government to fund the training of an additional 6,000 therapists. An early supporter of IAPT Alan Johnson MP and the Coalition Government’s current IAPT standard bearer Norman Lamb MP were both in the audience.

Layard is an economist and he emphasise that the implementation of these treatment programmes saves, and will continue to save, money. Most mental illness occurs during people’s working lives (whereas physical illness is most prevalent during retirement). If the mentally ill can be helped so that they can carry out paid employment this will save on benefits payments. A course of IAPT costs £650, but a monthly benefits payment is £615. The mentally ill also often have associated physical illnesses. On average these cost the NHS £2,000 per head per year. Successfully treat a mentally ill patient and the cost of his/her physical health treatment is reduced or eliminated. Dealing with alcohol and drug abuse (often associated with mental illness) costs the country £1 billion annually. The cost of a complete psychological therapy programme would be £0.5 billion and there would be significantly reduced costs for handling substance abuse.

Treatment for mentally ill children has been even more scandalous in England. The earlier an individual is diagnosed and successfully treated the greater the chance of that individual enjoying a ‘happy’ adult life.

When I first heard about Lord Layard’s proposals in 2012 the target number of newly trained therapists was 10,000 and the proposals also included the establishment of 250 new mental health centres throughout England. There was no mention of these centres at the event.

Layard and Clark have just written a book which supports IAPT. It’s called ‘Thrive’ and is published by Allen Lane. ISBN: 9781846146053.

To put all this in a local context, the Ealing Clinical Commissioning Group (ECCG) mental health spend on IAPT with the West London Mental Health Trust in 2013/14 was £2.085 million. The IAPT budget for 2014/15 is £2.110 – a negligible increase. The 2014/5  ECCG budget for learning difficulties is £4.250 million. Public Health England states that there are 36,436 people in the whole of London known to have learning difficulties. HealthWatch Ealing states that there were 34,415 adults who had a common mental health disorder in Ealing in 2012.

However mental health spending as a percentage of total health care spending is the highest in the country in NHS West London at 18.02%. This compares with the lowest in NHS Surrey Heath of 6.55%. It’s hard to believe that the need for mental health care in Ealing is almost three times greater than in Camberley.

Jeremy Hunt Now Threatens Care Homes and GPs with ‘Special Measures’

Mr Hunt is apparently setting up an inspection system for England’s 25,000 care homes. 700 people are to be recruited and those homes ‘failing’ could be placed in Special Measures by Spring 2015.

Hunt is also threatening GPs with Special Measures if they are judged to be failing patients. No doubt inspectors will have to be recruited to inspect the 8,000 GP surgeries in England. The doctors’ union – the British Medical Association – thinks a witch hunt amongst GP surgeries may not be helpful. Some GP surgeries are suffering because of lack of GP or nursing resources and /or ironically struggling because the NHS itself is denying GPs adequate funding and resourcing.

These ‘special’ moves are thought to be inspired by his placing 11 hospitals in Special Measures last year. Three of the 11 have now been taken out of Special Measures – presumably because they are now judged to be performing satisfactorily.

No doubt all of this additional inspecting will be carried out by the Care Quality Commission (CQC). The CQC – infamously accused of cover ups and a bullying culture in 2013 – will soon have much more on its plate. Let’s hope it’s special enough to make a positive contribution to improving primary care and social care in England.

We Must All Fight to Kill Off TTIP

Transatlantic Trade and Investment Partnership (TTIP) is not a negotiation between two competing trading partners, but an assault on European and US societies by transnational corporations seeking to remove regulatory barriers to their activities and to massively undermine democracy.

For many years big business on both sides of the Atlantic has long dreamt of creating a transatlantic free trade zone in which large corporates can make even more money in deregulated markets. Private meetings on the subject are known to have begun in 1995. In 2011 the European Commission and US officials announced the formation of a working group on the topic. Over 100 closed door meetings have taken place since then. Barack Obana is keen to rush TTIP through and no doubt David Cameron and Nick Clegg are too.

TTIP seeks to create new markets by opening up public services and government procurement contracts to competition from transatlantic corporations. This threatens to introduce a further wave of privatisations in key sectors such as health and education. TTIP poses demonstrable and measurable threats to food safety, environmental regulations and jobs.

A key component of TTIP is the Investor-State Dispute Settlement (ISDS) mechanism. ISDS effectively elevates transnational capital to a status equivalent to the nation state itself, and threatens to undermine the basis principles of democracy in the EU and USA alike. ISDS exists in a number of existing international bilateral treaties. These ‘Kangaroo’ secret ISDS tribunals involve a small clique of lawyer arbitrators. The largest ISDS award yet made involved Ecuador paying Occidental Petroleum $1.77 billion for terminating the oil giant’s contract when Occidental broke Ecuadorian law.  

Here in Britain TTIP/ISDS, if introduced, threatens to grant US and EU corporations the power to challenge democratic decisions made by the British Government and to claim compensation where those decisions have an adverse impact on their profits. British MEPs and MPs are being denied the chance of knowing what the USA is demanding and no documents relating to the negotiation or development of TTIP/ISDS will be placed into the public domain.

50% of NHS Maternity Units Closed for Periods Because of Lack of Staff or Lack of Beds in 2013

Most closures were for only a few hours, but some lasted over 48 hours. Nottingham University Hospitals NHS Trust’s Maternity Unit closed 97 times! The Royal College of Midwives claims England needs an additional 4,500 midwives.

NHS Ealing Hospital however was fully staffed in 2013 and over 2,900 babies were born there. The unit is modern and includes a new £300,000 birthing centre. However under the NHS NW London Shaping a Healthier Future ‘fatwa’ Ealing Hospital Maternity Unit will be closed down.

Now the Government Wants to ‘Mutualise’ the NHS

Francis Maude MP, the Cabinet Office Minister, is peddling mutualisation as a future ownership/management model for delivering NHS services as well as other public services. He says he wants NHS hospitals to be owned by the people who run them. Mutualisation is a big step down from 100% public ownership. The classic mutual organisation has the majority of its shares owned by customers, staff and suppliers. In real mutuals and co-operatives customers, staff and suppliers are all peers and work together collaboratively and democratically.

However the Coalition Government’s new mutuals will never have more than 25% of shares owned by staff. 25% of any corporate ownership grants virtually zero power to those shareholders. So Francis Maude is being somewhat economical with the truth here. The successful NHS example quoted by right wingers is Hinchingbrooke Hospital in Cambridge. However, although there is significant employee ownership it’s still less than 50%. One suspects that the money men who own 50%+ of the shares hold the whip hand.

The unions’ view is that mutualisation is just privatisation by another name.

Issue: 15

July 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 is the Cheapest Healthcare System in the World – Offering the Best Health Outcomes

The New York-based Commonwealth Fund ranks Britain top of 11 advanced countries’ healthcare systems for cost and health outcomes. Britain spends $3,404 per head compared with $8,508 in the US with the other nine countries in between. On ‘effectiveness, safety, patient-centredness, co-ordination, quality and access’ Britain’s NHS  rates number one.

Who Cares for the Carers?

In 1983 Crossroads was founded in Brent. It’s a charity which provides respite breaks and information for unpaid carers of adults and children which grew to provide these services throughout Brent, Hounslow and Ealing. Well it did until 11 June 2014 when it closed down. Around 300 family carers who support disabled, elderly and vulnerable people in Hounslow, Brent and Ealing will lose the help of 60 support workers.

Block grants from Local Authorities have over time been replaced by competitive bidding processes, which led to financial uncertainty and now to closure. The closure of Crossroads is cruelly ironic given the increasing size of the aging local population and the financial cuts in welfare payments, in the NHS and social care budgets throughout Local Government.

Accident and Emergency in Crisis – Yet Again

The week ending 15 June 2014 saw 297,527 attendances at major A&Es in England. This is the highest weekly figure ever recorded, and this is the summer not the winter. 97% of patients were seen in less than four hours.

As ever the Government after taking money out of A&E services is now throwing ‘crisis’ money back into it. No doubt ad hoc emergency beds are sourced from somewhere. Expensive Agency staff are hired in haste. And no doubt tired and harassed staff are coerced into working too many extended shifts.

What a way to run a national health service….

West London Mental Health Trust (WLMHT) Boss Opens Up to Ealing Carers

On 10 June 2014 Steve Shrubb, Chief Executive of WLMHT spent 75 minutes talking with 50 volunteer Ealing mental health carers at NHS Avenue House in Acton. WLMHT is the major supplier of NHS mental health services to the 780,000+ people who live in Ealing, Hounslow and Hammersmith & Fulham. It also manages the Broadmoor high security psychiatric hospital in Berkshire.

Steve joined the NHS as a ‘domestic’ in 1976, trained and practised as a Cognitive Therapist   and rose to a number of mental health Chief Executive positions. He took charge of WLMHT two years ago and is likely to do another three years and then retire. His appreciation of the carer role has been sharpened recently with the onset of dementia in one of his parents.

He says that WLMHT could not function without the contribution of volunteer carers.

Although he has 3,500 staff he admits it’s not enough. In 2012 he had 4,000 staff and in 2013 3,750. In 2012 the Trust’s annual budget was £250 million – this year it’s £230 million. He thinks the Trust is ‘holding its own’ in helping those with anxiety and depression, but he feels the Trust is failing the seriously mentally ill – especially those with Schizophrenia. He then said that if he’d been talking to cancer carers and told them the NHS was providing an inadequate service they would have torn him apart limb by limb. This is because awareness and visibility of cancer suffering is much, much greater than with mental illness. We must all work much harder to raise awareness and visibility of mental illness.

That all being said, one carer whose son is a serious long term Schizophrenia sufferer said she is devastated by her poor son getting only 15 minutes face to face with a specialist and it was such a short time as to be completely useless. I piped up to point out that my troubled mentally ill son has had five different diagnoses over the last 20 years and, even if his treatment had been first class, it really counted for little if it was treating the ‘wrong’ illness.

With inadequate resources, Steve has to be quite creative in making sure the budget is used cost effectively. Hence WLMHT ‘partners’/employs/outsources with charities, volunteer groups and private suppliers. In effect in Ealing, the Trust is outsourcing mental health Primary Care (via the Ealing Clinical Commissioning Group) to 39 of the 79 Ealing GP surgeries. Of course some of the troubles and risks associated with outsourcing include:

– losing control. Atos’ broken promises, delays and huge backlogs in assessing claimants eligibility for Personal  Independence Payments (PIPs) is a recent dramatic example of this.

– the risk of losing the ‘spirit’ or even the content  of the original intent of the task, especially in, a ‘daisy chain’ of outsourcing deals.

– those providing the service are not accountable to the commissioning stakeholders (e.g. citizens if it’s the NHS) but are accountable to some other group who could be commercial shareholders

– if outsourced to a commercial for-profit company that company will structure its business and its resourcing so that its priority is to make a profit for its shareholders as opposed to providing a superior product or service. The Department of Education recently ‘pulled back’ from privatising child protection services after considerable negative feedback on profit taking degrading the private service supplier offering.

Steve is a big believer in the positive impact of good physical health for mental health patients. He’s also a big fan of Lord Layard’s proposals to train 10,000 mental health therapists and set up 250 mental health centres in England. In fact in a previous role he was a lobbyist for this cause.

He wants us all to get involved with ‘Time to Change’ – the organisation dedicated to challenging mental health stigma and discrimination. I have, and you can too at www.time-to-change.org.uk

The initiative to convert the NHS Lammas Centre in Mattock Lane, W5 into a 12 bedded residential mental health Recovery House is his. When he arrived at WLMHT he was surprised to find no residential Recovery Houses – half way houses between long term admission wards and going back home. Two more are planned in Hounslow and Hammersmith & Fulham. The mental health charity Rethink will run the Lammas Recovery House. WLHMT prides itself on rarely having to send service users outside Ealing, Hounslow and Hammersmith & Fulham for treatment.

Steve seems to be re-thinking the Trust’s approach to volunteer carers’ groups and has commissioned an internal report on a way forward. Spending so much quality listening time with the Carers Support Group – probably the largest and best run volunteer mental health carers group in Ealing – is a very good start to his own personal research on support for carers.

Jean-Claude Juncker will Scupper TTIP/ISDS – Which Would Be Good News for Our NHS

Without going into mind bending details, the proposed Transatlantic Trade and Investment Partnership along with its Investor-State Dispute Settlement adjunct (TTIP/ISDS) aims to give greater powers to big international businesses and undermine democracy. Under ISDS large global corporates will challenge national regulations and go straight to Industrial Tribunals (ITs). Theses tribunals will consist of just three arbitrators – one chosen by the company, one by the State and a third agreed by both. These tribunals are not answerable to any British or European courts.

So if UnitedHealth of Minneapolis was not invited to bid to run NHS Ealing Hospital under an open tender, it could immediately go to an IT with no doubt its own world expert barrister as one of the three decision makers.

If TTIP/ISDS gets sadopted it will make the privatisation of our public services permanent.

No wonder Prime Minister Cameron is so agitated. Mr Juncker is courting European Greens and socialists who want to kick out TTIP/ISDS. With Juncker now elected lets hope TTIP/ISDS does not get signed!!!!

Future NHS Cash ‘Crisis’

The Conservative, Labour and LibDem political parties have all recently tried to ‘out doom’ each other by variously saying ‘no more cash for the NHS’ and ‘£30 billion 2020 deficit in the NHS budget’. But Labour is also talking about ‘re-setting the NHS’ by, in effect, suggesting it will roll back much of what is contained in the Health and Social Care Act 2012.

Labour’s pronouncements come out of the mouth of Andy Burnham MP, but not from Labour Top Trumps Ed Milliband MP or Ed Balls MP. Also some of Burnham’s statements are not really credible. He said on 5 June 2014 that patients can expect a single point of contact to co-ordinate their NHS care. So every one of 250,000 adults in Ealing would have a single point of contact? So one person would deal with my arthrytis, blepharitis, psoriasis, back problems and no doubt possible future dementia – never mind a one in five chance of mental health problems. This is just not credible for the 47 million adults in England.

NHS Hammersmith Hospital A&E and NHS Central Middlesex Hospital A&E (Harlesden) to Close on 10 September 2014

NHS St Mary’s Hospital in Paddington will in just few weeks time become very crowded in its A&E department as many people in pain in Hammersmith, Harlesden and Acton will have to travel there.  Charing Cross A&E in Hammersmith will also get very busy, but it may well also close this year with a formal announcement scheduled for July/August 2014. We know the future of NHS Charing Cross A&E. It will close, even though Prime Minister David Cameron shamefully lied about this in Hammersmith on 15 May 2014.

The future of Ealing Hospital’s A&E in Southall is well known. It will also close. What we don’t know is when. Dr Mohini Parmar Chair of NHS Ealing CCG and David McVittie, NHS  Ealing Hospital Chief Executive, both tell us that its closure will only take place when adequate replacement, accessible A&E facilities are available. Trouble is ….we just don’t believe them.

After 10 September 2014 a large GP surgery staffed only by GPs and nurses will provide a 24 hour service on the site of  Hammersmith Hosppital. In NHS jargon it’s called an Urgent Care Centre (UCC). Flashing blue light ambulances do not travel to UCCs. UCCs have no Intensive Care beds, consultants or equipment. You will not find an Intensive Care Unit in a UCC and there are 44 defined medical conditions not treated in a UCC.

NHS Ealing Hospital and NHS Northwick Park Hospital are Clearly ‘In Love’ and are Desperate to Get ‘Hitched’

In the middle of all the carnage wreaked by the ground breaking (could be career breaking) ‘Shaping a Healthier Future’ blitzkrieg, Ealing and Northwick Park Hospitals are desperately trying to ‘live together’ in order to save money. ‘Two can live as cheaply as one’ is the guiding maxim no doubt. £Millions have been spent on this shot gun wedding with full colour brochures being distributed like confetti.  

The ‘marriage’ target date keeps changing and now it’s October 2014. We even know who the designated non-executive directors are (four months before the nuptials). It’s interesting that NHS bosses have plumped for folks with experience in Southern Cross Healthcare, Barclays Bank, the Probation service, the Magistrate service, the Employment Tribunals service and Housing Associations. To be fair there is some medical experience in there too.

Will Charities and Volunteers Have to ‘Rescue’ Huge Swathes of NHS Services?

‘The Guardian’ of 6 June 2014 featured the impressive set of services provided by the 30 staff at the charity Integrated Neurological Services (INS) of Twickenham, West London. INS is funded by the NHS and by the Big Lottery and provides creative and wide ranging support for sufferers with MS, Parkinson’s, strokes and many other neurological complaints.

With local staff cuts and budget cuts will local volunteer groups and charities have to fill in gaps with carer services, carer recruitment and carer training?

NHS Midwives Could Go On Strike

The Royal College of Midwives (RCM) is recommending industrial action if the 1% pay rise for NHS staff is killed off. On 9 June 2014 RCM began consulting its 30,000 midwives and maternity support staff about industrial action. The Royal College of Nursing (RCN) and Unite have variously described the 1% pay rise climb down by the Government as ‘shameful’ and ‘insulting’.

Ealing Hospital midwives have been, in effect, been given their marching orders but they don’t know where they are marching to or when.

‘care.dot’ Makes a Re-appearance

‘care.data’ is the name of the Atos software driven personal medical records /Atos managed personal medical records data extraction and data sharing service. ‘care.data’ was revealed to the public in January 2014. It caused a furore. Citizens had to write to their GPs to stop their data being used. And then it was revealed that our personal health medical records had already been sold to pharma companies, insurance companies and goodness knows who else. On 19 February 2014 NHS England retreated from instantly implementing care.data and announced a six month delay in implementation.

Well, barely four months on, NHS top brass is banging the jungle drums about care.data. Tim Kelsey, NHS England National Director for Patients and Information said at a conference on 6 June 2014 ‘…the true scandal in our health service is ignorance’. He went on to say that plans for a giant GP database (i.e. care.data) were ‘the biggest data revolution any public service had embarked upon’.

Oh dear….

Firstly citizens no longer trust the Government /NHS bosses with our personal data. Don’t trust it to collect it accurately, anonymise it consistently and effectively and don’t trust that it will not give it /sell it to Tom, Dick or Harry.

Secondly, citizens (and IT folks specifically) have zero confidence in the Government/NHS successfully designing, building, implementing, managing and maintaining such a giant database. Aren’t  we all still paying for the abortive fiasco hatched by Bill Gates and Tony Blair in 2002 to computerise all English medical records and make them accessible 24/7 anywhere in the world? The initial budget for the project named NPfIT was £11.4 billion. The project was abandoned in 2011 with no usable value created. We are all still paying for it and the current losses are £10 billion and rising.

BMA Accuses Government of ‘Economic Illiteracy’, Being ‘Bonkers’ About Seven-Day Working and Driving GP Surgeries Out of Business

The British Medical Association (BMA) – the doctors’ trade union and professional body – is demanding a £2 billion cash injection into the NHS in order to head off a crisis in patient care. The BMA is also saying that seven-day working can’t be done without the investment of more state money. It says seven-day working is unfeasible without cuts during the week or hospital closures.

The BMA claims that there has been a reduction of £450 million in funding GP practices in real terms allied to a 40 million increase in annual demands for appointments. These changes are driving GP surgeries out of business. An ominous forecast by the BMA is that a 6% reduction in GPs seeing patients will double the number of patients at hospital A&E units. Apparently the Department of Health (DoH) is in complete denial about the BMA’s accusations and predictions. The DoH describes it all as ‘scaremongering’. Yet again….oh dear….

CORRECTION

In June’s issue we publicised England’s first mental health eclinic. Sadly we were given the wrong URL for this useful resource. www.ealingeclinic.com is a useful online facility for service users and for carers.

Issue: 14

June 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.

The Vulnerable

The true test of any healthcare/social care system is how successful it is in treating and caring for the vulnerable. The vulnerable in our society include the mentally and physically ill and disabled, the frail and elderly, the poor, the uneducated, the homeless, the friendless, those living alone and the very young. This is a growing group as, for example, people are living longer and more people are presenting with mental health problems.

So what recent Government initiatives punish the vulnerable? Well…here’s a few:

+ Reducing the annual spend per head on our State healthcare will put us below 10th in the world (where we stand now)

+ Reducing the number of hospital beds has now placed us below France, Germany and even Eastern European countries in hospital beds /1,000 people

+ Reducing the budgets for the care of the mentally ill

+ 5,000,000 children could be living in poverty in the UK by 2020 (Save The Children)

+ The ‘bedroom tax’

+ Closure of A&E units

+ Closure of Maternity and Paediatric units

+ Demolishing major hospitals and using them the sites for new homes, none of which are Social Homes for Rent

+ Destroying the clinically based NHS Direct telephone advice service and substituting a non-clinically based call centre service

+ Privatising the provision of State healthcare services resulting in NHS services being provided by companies and staff mandated to make a profit for shareholders rather to make patients better.

EALING HOSPITAL FUTURES

Now is a good time to review the unique, revolutionary changes mandated in the NHS North West London ‘Shaping a Healthier Future’ (SaHF). The 2012 proposals were effectively fully given the green light when the London Borough of Ealing’s Judicial  Review of Ealing Hospital closures failed in November 2013. According to the 2012 proposals, SaHF implementation will take ‘at least three years’. That takes us to December 2016. However SaHF fans were no doubt convinced they would win against any legal challenge and will have been working on all the changes since February 2013 – so closure of all four A&Es at Central Middlesex, Ealing, Hammersmith and Charing Cross Hospitals could be much sooner than 2016. However Jeremy Hunt MP said in October 2013 said that Central Middlesex and Hammersmith Hospitals’ A&Es should close ‘as soon as possible’.

What is clearly the future for the Ealing Hospital site is what is happening this year on the adjacent St Bernard’s Hospital land – demolition and new build. The new three ward medical building to be built on the Ealing Hospital site sounds like a Cottage Hospital. It will be rather like a private hospital or even a hotel in some ways as each bed will be in its own room. There will be 82 beds – none of them acute – and the patients will be pre- or post-op patients who will be operated on or have been operated on elsewhere. The medical staff will be GPs and nurses. Diagnostic services will also be provided, no doubt by a private supplier like InHealth. As private healthcare company Circle currently runs the Urgent Care Centre on the site they must be favourite to run the new Cottage Hospital.

Ealing Hospital’s Maternity will be the first service to be destroyed. Sometime during the next nine months no more babies will be born at Ealing Hospital. A lot is being expected of Queen Charlotte’s Hospital Maternity Unit in Hammersmith and Northwick Park Hospital Maternity Unit in Harrow to handle the Ealing workload, which in 2013/14 numbered 2,915 births. A lot is being asked of vulnerable, poor Ealing mothers getting easy access to continuity of care in Hammersmith or Harrow before, during and after their child’s birth.

The General Election on 7 May 2015 could play a crucial part in what happens next. Many Labour Party fans want Labour to campaign on stopping this revolution in the NHS and getting funding levels and funding increases back to pre-Coalition Government levels. This would of course mean cutting budget proposals elsewhere and upsetting those Labour MPs who have financial interests in private healthcare companies. The re-election of the three Ealing MPs (should they all stand for re-election) may to some extent depend on the NHS question.

Ealing Clinical Commissioning Group (ECCG) in Public Open Warfare with Ealing Hospital NHS Trust (EHT)

When I ran my own business I was never at war with my major suppliers. ECCG is seemingly at war with EHT, its historic major service supplier. ECCG claims EHT offers a poor and expensive cardiology service for example. But EHT says after a recent unplanned Care Quality Commission (CQC) visit to EHT all its services got favourable reports. (In fact CQC’s main criticism of EHT was similar to its criticism of ECCG i.e. one of inadequate complaint reporting). ECCG is also claiming failures by EHT uncovered by CQC in ‘patient pathways’. This public bickering between our local service purchaser and our major local service supplier is unseemly and a gross waste of time and money.

NHS NW London Spent Over £10 Million on Management Consultants in 2013/14 and £3.3 Million of it with McKinsey & Company on ‘Whole Systems Integrated Care’

Why oh why is so much public money being lavished on management consultants by our regional NHS organisation? The eight CCGs in NHS NW London employ some 600 staff. Its Commissioning Support Unit (CSU) employs 432 staff. NHS England employs 6,100 staff. There must be a veritable army of accountants employed in these three organisations. Aren’t any of these folks capable of, for example, implementing SaHF or creating business cases or articulating ‘Primary Care Investment Principles’?

But the biggest regional NHS financial car crash concerns ‘integrated care’. NHS NW London spent £3,355,621 with McKinsey & Company on this topic in 2013/14 and the Government (see below) has just delayed (pulled the plug on?) spending the £3.8 billion on the Better Care Fund to implement this ‘integrated care’. What a shambles.

‘Whole Systems Integrated Care’ Approach In Tatters as Government Delays Launching its £3.8 Billion Better Care Fund (BCF)

With just 12 months to go before its introduction, the Government’s grandiose dream of saving money, reducing pressures on hospitals and helping to keep us all healthier in our own homes by integrating health care with social care is turning into a nightmare. The Government’s £3.8 billon Better Care Fund – the vehicle for this ‘integrated care’ – was due to be formally launched on 30 April 2014. The launch never happened and on 7 May 2014 press reports revealed the reason for this. A Government Cabinet Office report now exists which allegedly says the plans lack financial credibility and there is no detail at all as to how savings would be delivered. I’m sure many of us who questioned this very same lack of detail in SaHF will be variously vindicated and furious about this ‘Emperor’s New Clothes’ charade.

One of the cornerstones of BCF was to be the successful interworking between the NHS, Department of Health (DoH) and the hundreds of Local Authorities in England. It is of course the latter who deliver local social care services and the former two who variously deliver local health care services. All three institutions are going through endless organisational changes and financial gyrations. Local Authorities have recently suffered significant budget cuts with the worst of these due in 2015/16. The DoH was slimmed down in 2013. Our own local NHS Ealing CCG has, in its short life, got married to three other CCGs in Spring 2013 and then divorced them and got into bed with three others in December 2013! Our local hospital (EHT) is clearly going to be demolished as is our local mental health hospital (St Bernard’s). Also involved in the mix is the Local Government Association. A meeting of all these parties took place on 19 May 2014.  HSJ magazine remarked that the DoH was planning tougher tests for the BCF. A 15% reduction in emergency activity is apparently expected by NHS England on implementation of the BCF.

Health care is under-funded, undergoing massive service delivery changes and staff are under enormous pressure. Social care is also under funded, much of it in crisis and staff are also under-trained, under-paid and under enormous pressure. Attempting to integrate two dysfunctional services in the hope that some kind of merger and changes to ‘settings of care’ would or will produce a single, efficient integrated care system is fanciful at best and idiotic at worst. Next year Clinical Commissioning Groups throughout England will have to hand over £2 billion to BCF. This money will be used for ‘joint commissioning of out-of-hospital and social care’ (whatever that actually means). The best estimate of when the latest ‘plan of plans’ will be approved is September 2014.

The NHS Trust Development Authority (TDA) – a provider of leadership and support for NHS hospitals – has ‘major concerns’ about BCF because hospitals have not been properly consulted about it. The King’s Fund – a charity formed in 1897 working to improve health and healthcare in England – thinks the financial case for BCF is ‘hopeless’. MHP Health has also done research that suggests that money that might be given to Local Authorities might well not be spent on BCF purposes like finding better ways to join up NHS healthcare with Local Authority social care – but will be spent on propping up existing services.

This major set back is a real embarrassment for two Secretaries of State who publicly backed this initiative – Jeremy Hunt MP and Eric Pickles MP.

NHS Choose and Book  Appointments System to be Scrapped

IT failures are legion in the NHS. Choose and Book, which has cost £356 million since 2004, is being quietly ditched by the NHS. It appears that not enough GPs use it to justify its survival. The DoH and NHS England are expansively talking about introducing a new ‘e-refferal’ system available on ‘mobile apps’ sometime in 2016.  Its development cost is unknown, but is likely not to be cheap.

The NHS Mental Health Service is Failing Children – and it is Getting Worse

NHS England recently revealed that only a quarter of children with mental health conditions are receiving the treatment that they need. It also admitted that there is just one mental health specialist per 30,000 young people under 20 in England. This compares badly with other countries. It’s one per 5,300 in Switzerland, one per 6,000 in Finland and one per 7,500 in France. The mental health charity YoungMinds (www.youngminds.org.uk) recently published a report in which it found that two-thirds of Local Authorities had cut their budgets for young people’s mental health. YoungMinds says that 850,000 children and young people in the UK have been diagnosed with mental health problems. But is this just the tip of the iceberg?

The Association of Educational Psychologists (AEP) says that one child in ten has a mental health problem. With over 11 million under 16 years olds in England that means over one million children in England have a mental health problem. According to AEP three quarters of these young sufferers never receive any treatment or support. The Children’s and Adolescent Mental Health Service (CAMHS) claims that the reduction in prevention and early intervention budgets is denying young people early help. Children are having to travel hundreds of miles for treatment and are regularly and inappropriately being admitted to adult psychiatric wards.

Norman Lamb, the Minister for Care and Support, claims that investing £54 million in children and young people’s mental health will improve matters. Even if the money were spent wisely it’s just a drop in the ocean of funding that is actually needed.

Paediatric Services and Infant Mortality

Mortality and morbidity of children in England and Wales are significantly higher than in Scandinavian countries. Part of the problem is lack of  GP training. To rectify this, a training programme was put forward, but rejected as too expensive. With the reorganisation of the NHS, the Royal College of Paediatrics & Child Health has proposed that there should be fewer in-patient sites, but the number of Consultants should be increased by 66% as well as an increase in advanced children’s nurse practitioners and GPs trained in Paediatrics. So far NHS  North West London CCGs have acknowledged this deficit but have yet to train or employ staff.

A recent confidential enquiry by the Royal College of Physicians reported in the British Medical Journal (10 May 2014) found that two thirds of asthma deaths could have been prevented, with primary care failing in the routine care of  70% of the deaths studied. 28 of the 195 deaths were of individuals under 20 years of age. This investigation underlines the urgent need to improve training of practitioners and also recruitment and training of advanced children’s nurse practitioners. With devolvement of more care to GPs, all General Practices should include at least one member who has been trained in the care of children and employ an advanced children’s practitioner. There should be a network where GPs and advanced children’s practitioners have a working relationship and continuing training with a group of Consultant Paediatricians. If this is no put in place, our child mortality is likely to rise rather than fall.

Clara Lowy

NHS NW London CCGs Have Apparently Given their Commissioning Support Unit (CSU) Marching Orders

But marching into the arms of themselves! In the Merry Go Round that is the NHS some of the 432 folks now working for the NHS NW London CSU (who offer outsourced support to the NHS NW London CCGs) will now transfer to the NHS NW London CCGs to work in-house. The decision was apparently made in early May because it would save the CCGs £5 million by 2015/16. NW London CSU now intends to merge with South London and Kent and Medway CSUs. And according to healthcare consultant Roy Lilley,  CSUs are trying to consolidate their place in the market might offer their services to schools, police and prisons. Sounds a bit desperate to me……

Issue: 13

May 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.

Roche Adopts Ransom Aproach – Wanting £180,000 for Each Breast Cancer Patient Having a Few More Months To Live

The new ‘wonder’ breast cancer drug Kadcycla is still in use in the NHS, even though the National Institute for Health and Care Excellence (NICE) says it’s too expensive. Roche, the drug’s developer, seemingly wants to be paid £180,000 per patient treatment (assuming there is no ‘mark up’ by the NHS). Roche pleads that the cost of research, testing, trials, regulation (and no doubt litigation) is so cripplingly high that they have to charge this much. Poor old Roche only made profits of £7.7 billion last year.

The cash behind the drug’s continued use in England is provided by the NHS England’s Cancer Drugs Fund. So the NHS says yes to funding the use of  Kadcycla in NHS hospitals in England and NICE (accountable to the Department of Health) says no. Joined up thinking, eh?

UK Now Has the ‘Least Hospital Beds in Europe’

Shocking figures have emerged from a recent Organisation for Economic Co-operation and Development (OECD) survey of 23 European countries. The UK has fewer than three hospital beds per 1,000 people, compared with over six in France and over eight in Germany. Eastern European countries now have more hospital beds than the UK.

Ealing Hospital currently offers 358 beds. In 2012 it had 327 beds. When Ealing Hospital is closed and demolished a new Urgent Care Centre ‘Plus’ will be built on the site offering just 30 beds, plus some beds moved from Clayponds Hospital in South Ealing (after it is closed and demolished).

GP Surgeries Opening at Weekends? With No More GPs and Nurses Available Surely This Will Just Degrade the Weekday Service?

There’s no sign that many more doctors and nurses are being trained or are signing up to work in GP surgeries. So the 1,147 GP surgeries that take the pieces of silver from the Government and open at weekends will have to work more days a week than they are doing now. Logically, that will degrade the weekday service, as they will almost certainly have a finite staff resource of trained GPs, nurses and administrative staff. If they attempt to operate for 6/7 days and in the evening, the existing staff will become tired, less effective and their error rate will no doubt increase.

There’s also lots of grandiose talk about communicating with patients on email and over Skype. This approach will not appeal to many of the 700,000 or so over 65 year old patients at the 7 day week GP surgeries. Skyping and emailing will of course reduce the quality face to face time GPs and Nurses actually spend with their patients.

Royal College of Physicians’ President Warns Care of Patients is Under Threat

Sir Richard Thompson presides over a well established and respected organisation which represents most of the UK’s 30,000 doctors (except in Scotland). He told ‘The Guardian’ last month that care of patients was under threat because of absolutely destructive case loads. During their shifts acute medicine doctors are regularly facing case loads of more than the recommended maximum of 20. Some, frighteningly, have case loads of up to 70 patients in a single shift. He claimed that ‘the NHS is under-doctored, under-nursed, under-bedded and under-funded’. Dr Mark Porter, the leader of the British Medical Association, immediately endorsed Richard Thompson’s claims.

Surely this is a train crash just waiting to happen.

As We All Suspected – NHS Patient Records Have Been Released to Astra Zeneca, Baxter, Bayer, Bupa, Roche, BMI, McKinsey & Co, PwC, Care UK, Ernst & Young and others

On 3 April 2014 in response to concerns about transparency, the Health and Social Care Centre (HSCIC), a Department of Health body, published data which showed that medical record information had been released on more than 450 occasions to recipients including 56 private sector organisations. Identifiable data has been released on 75 occasions. Critics have pointed out that HSCIC is deliberately concealing releases of data that might cause itself, Ministers or other officials embarrassment or political damage. No details at all have been released concerning Police access to personal medical records.

HSCIS has existed in one form or another since 2005. It stores, analyses (and releases) data on hospital activity in the NHS in England. It also supplies NHS IT systems for health and social care.

www.ealingclinic.com – England’s First Mental Health eClinic

Ealing Council, the ECCG and The TASHA Foundation trumpeted the launch of this ground-breaking  digital ‘walk-in’ mental health clinic in ‘Ealing Gazette’ on 4 April 2014. Sadly on 7, 8, 13,19, 21, 26 and 28 April 2014 the web site was ‘Server not found’.

Not an auspicious start for what might become a useful online help facility.   

Capita Failing to Clear Medical Assessment Backlogs for PIPs for Terminally Ill, Sick and Disabled

The Personal Independence Payment (PIP) was introduced in April 2013 to replace Disability Living Allowance (DLA). PIP is already in a mess. According to the Department of Work and Pensions (DWP) fewer than one in six who have applied for PIP have had their claims decided. Two out of three people who apply for PIP are receiving nothing at all. In February 2014 DWP revealed that 220,300 people had made claims for PIP in the nine months since its inception. Of these only 12,654 have been awarded the benefit.

Capita, ‘a UK leader in business process management and outsourcing solutions’, was awarded the contract to assess PIP claimants in 2013. By February 2014 the National Audit Office had sized the Capita assessment backlog at 92,000 claimants. If Capita is the UK leader in outsourcing one dreads to think what the laggard outsourcers are like……

DWP civil servants have had to abandon their jobs and step in in an attempt to help Capita in its struggle to clear the backlog.

PIP is worth between £21 and £134 per week. Assessment for PIP is made using a points based system. Points are awarded on ‘descriptors’ on a range of activities related to someone’s daily living needs and mobility. Like the other key disability benefits, Employment Support Allowance (ESA) and the controversial Work Capability Assessment (WCA), PIP’s point-based assessments result in poor decision making and widespread appeals. Even the Government’s own figures predict the 600,000 people with disabilities will lose their entitlement to support under the new criteria.

And at www.spartacusnetwork.org.uk ‘Beyond Repair’ research on ESA was published last month. Successful appeals against assessments are at an all time high of 43%. Just 5% of those referred to the Jobcentre Plus Work Programme have found sustained work.

Surely another inevitable disaster is in prospect here.  

Understaffed, Overworked and Underfunded NHS Hospitals Urged to sell Skills Abroad

To add insult to injury English NHS hospitals – many stretched to breaking point with rising demand and depleted budgets – are being officially urged to sell their skills abroad. This brainwave comes from Healthcare UK. Healthcare UK supports the sale of UK public and private healthcare services abroad and the import of any healthcare services. It is a joint initiative of the Department of Health, UK Trade and Investment and NHS England.

Instead of NHS funds being raised by conventional taxation, attempts are being made to persuade NHS hospitals to take on commercial contracts abroad, mainly to provide staff training in places such as China, India and Russia. And foreign nationals in the UK are also fair game for paid treatment by English NHS hospitals according to Healthcare UK.  

EALING CLINICAL COMMISSIONING GROUP (ECCG)

A group of us spent an hour on 2 April 2014 with Dr Mohini Parmar and Kathryn  Magson – Chair and MD respectively of the ECCG. After maybe a year in their Greenford offices ECCG will soon move to occupy a floor in the London Borough of Ealing (LBE) office block Perceval House just next to Ealing Town Hall. The ECCG employs over 80 people and it is supported by the NHS NW London Commissioning Support Group (CSU) with 432 staff. The CSU supports eight CCGs in total.

I pursued my research in trying to understand just how Ealing GPs will deliver mental health primary care. Of course one of the challenges for CCGs is that they have no statutory control over GPs. ECCG has so far managed to persuade (by offering them money) fewer than half of the 79 Ealing GP practices to provide mental health primary care. The mantra seems to be that these 35 practices will only care for the small number of patients in their catchment area with long term but stable conditions. I asked about ECCG commissioning mental health carer support and was directed to the £24 million Better Care Fund (BCF) and asked to contact Andy Roper of the Ealing Community Network. After studying BCF documents I am still no wiser.

The Better Care Fund (BCF) is apparently a £3.8 billion ‘single pooled budget’ to be spent to ensure a transformation in integrated health and social care. Announced in June  2013 its aim is for health and social care services to work more closely together. Organisationally, fiscally and from an accountability perspective this will all be very tricky. CCGs commission hospital/secondary care services. NHS England commissions GPs. Local authorities commission local social care, and health and wellbeing services. CCGs and GPs now appear to be delivering mental health services. In Ealing the BCF is a partnership between ECCG, LBE and the Ealing Health and Wellbeing Board.

We tried to get a handle on what healthcare services the new expanded Urgent Care Centre to be built on the site of the demolished Ealing Hospital will offer. A long discussion ensued about hospital beds. 102 hospital beds will exist and these include those at Meadow House hospice which is thankfully not being demolished. In 2012 Ealing Hospital operated 327 hospital beds.

ECCG did not deny that the birth unit at Ealing Hospital will close by February 2015. Two years ago a brand new birth unit was opened at Ealing Hospital. 2,915 babies were born in Ealing Hospital’s Maternity Department last year. ECCG pooh-poohed home births as just 0.2 % of all births. They seemed very relaxed about Ealing ladies in labour travelling to Harrow, Hillingdon, Hounslow and Hammersmith.

We asked ECCG to explain ‘Co-commissioning’. They were somewhat unsure themselves but they felt it was all about economies of scale, and like minded professionals getting together to bid for service delivery contracts.

ECCG along with the other seven NHS NW London CCGs are attempting to work as one by pooling some of their money over five years. This is currently illegal. However the ever optimistic Daniel Elkeles (Chief Officer of the five CCG ‘federation’ CWHHE) thinks new legislation will arrive in October 2014 to allow this. If this goes ahead £57 million will be available over the next 12 months across 2 million patients to implement the great English NHS healthcare experiment that is ‘Shaping a Healthier Future’ across north west London. £35 million will be available for the eight ‘super-federated’ NHS NW London CCGs to (incredibly) ‘ensure a more level playing field between CCGs’. £47 million will ostensibly be available to ‘improve’ (create?) Out of Hospital services ‘such as seven day opening and community services’. So much for a locally GP driven Clinical Commissioning Group in Ealing deciding and directing how 60% of our National Insurance payments are spent here.

And yet again Greenford GP Dr Parmar was a ‘no show’ at another public event. On 8 April 2014 the Seniors Action Group Ealing (SAGE) gathered some 60 elderly people in Ealing Town Hall to hear Dr Parmar speak about the proposed changes to health services in Ealing. She failed to appear, but said she had arranged for ECCG Vice Chair Dr Raj Chandok to speak in her place. When SAGE contacted him he said that he’d forgotten about the meeting. A sense of déjà vu here as Dr Parmar failed to show up at the equivalent SAGE  meeting on 11 September 2013 and at public events in 2012 on 26 September and 11 October. Maybe SAGE should send her a bill for ‘non-attendance’.

WEST LONDON MENTAL HEALTH TRUST (WLMHT)

Every now and then I come across a real hero manager in the NHS. On 8 April 2014 I (along with 20 other mental health volunteer carers) spent 2.5 hours with Jeremy Mulcaire, Sector Manager, WLMHT. He runs Avenue House in Acton, which houses Recovery East Team. There are two Recovery teams to cater for the whole of Ealing – Recovery Team East and Recovery Team West (based at The Limes, Southall), plus a single Assessment Team (at Cherrington House in Hanwell) and a single Cognitive Impairment and Dementia Team

The headlines of his job are too few staff trying to help too many patients (‘service users’). There are 2,000 registered service users. To service them he has 8 Social Workers (case loads of 25 – 35 patients!), 6 Psychiatrists, 2 Occupational Therapists, 4 Psychologists and 13 Community Psychiatric Nurses (CPNs) – full and part-time. A recent (and useful) innovation is that the Community Forensic Service has installed one of its CPNs at Acton Police Station – now the solitary Police Station across Ealing’s 21 square miles which is open all hours. The incidence of mental health problems is rising. WLMHT budgets are falling. The number of staff on the WLMHT payroll has dropped by 500 over the last two years. WLMHT disputes this arithmetic and says ‘(we) have achieved reductions in posts by not filling vacant job roles and where people have left the trust or retired we have evaluated posts and reduced numbers where possible….’. WLHMT is also claiming that it is now ‘treating more patients in the community, with more mental health primary care workers who work alongside GP’s…’. Next month I’ll try to find out just how many of these workers are in place in Ealing and just how effective this ‘changing settings of care’ approach is.

Avenue House serves a population of 170,000 residents, of whom 125,000 are adults. MIND and others assess that 9% of the population in England suffer from the most common mental illness – anxiety and depression – to meet the criteria for diagnosis. So for Avenue East just for this one mental health condition and just dealing with adults  there are 11,250 people in need. If one then adds up the % of the population with Phobias, Schizophrenia, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Eating Disorders, Bipolar Disorder, and Personality Disorders we get to 17.7%.To be fair some patients present with or are diagnosed as having multiple disorders. So if we cut this to 5%, that’s another 6,250 adults in need. In total 17,500 sufferers in need.

Clearly not all those in need are seriously ill, self harming or a danger to other people. But with ever diminishing financial and professional resources within the WLMHT service, Jeremy and his peers have to be very hard working and creative with resource utilisation. He makes use of trainee Social Workers and medical students. The fact that Jeremy spent one of his week day evenings talking to carers shows he appreciates how with more information and training carers can make a huge difference to their loved ones’ quality of life and to the overall mental health community care service in Ealing.

The evening’s presentation was organised by the excellent Carers Support Group, which meets every second Tuesday in the month at Avenue House, Acton. The volunteer Carer Supporter who runs this is Paulette Ranaraja, Sadly the group’s grant funding from the London Borough of Ealing ran out on 31 March 2014. Lobbying WLMHT and the ECCG for some financial support has yet to bear fruit. More on this hopefully next month.

And more news on the demise of mental health care facilities at St Bernard’s Hospital in Southall. 270 new mixed tenure homes are to be built on 5.6 acres of the St Bernard’s site. Catalyst Housing, part of the G15 Group, beat private house builder Bellway to the deal. Catalyst paid £24 million for the land and plans to spend £65 million developing the site beginning in Autumn 2014. WLMHT is of course going to build a new medium secure mental health unit on the St Bernard’s site.

85% of Older People With Depression Get No Help from NHS

Last month the Royal College of Psychiatrists (RCP) estimated that two thirds of elderly people with a mental health problem have a condition other than Dementia. Bereavement, loneliness and loss of physical independence can all trigger depression says the RCP – but depression is a treatable condition. The RCP points out that as well as a general lack of awareness of the size of the depression problem amongst the elderly, there is a severe lack of treatment resource throughout the NHS.

The NHS Confederation reports that NHS investment in mental health services dropped in real terms by 1% and 3.1% for older people in 2011/2012 (the most recent figures available).

Teachers Report Rise in Mental Health Fears

A recent poll of members of the Association of Teachers and Lecturers (ATL) reveals that 38% of school and college staff have seen a rise in mental health issues amongst colleagues in the past two years. 80% admitted they were stressed. 70% said they were left feeling exhausted by their work. Worryingly, 68% of those dealing with a mental health problem had decided to keep it secret from bosses, compared with 38% who kept a physical health issue to themselves.

The Department of Education’s (DoEs) response to the ATL findings was that statistics show  that teaching had never been more ‘attractive, more popular or more rewarding’ – so no mental health issues over at the DoE then…….

NHS Bosses ‘Gifted’ Huge Pay Rises and Immoral Redundancy Payments

Just by staying alive, NHS Directors John Holden, Richard Murray, Ben Dyson and Miles Ayling had their salaries raised by at least £30,000/year to at least £115,000/year. 3,950 NHS managers have received redundancy payments only to return to other NHS positions. 330 of them were each given over £200,000. Surely someone should go to gaol for this robbery.

Lord Norman Warner Wants Us All to Pay £120 Each Year So that We Can Continue to Enjoy Our Free Universal Healthcare System

Norman Warner, a former Labour Government Health Minister, may have dozed off when his school History teacher waxed lyrical about Pitt the Younger introducing Income Tax in 1798 and about the National Insurance Act of 1911. He wants to introduce a new form of taxation paid to Local Authorities in order to increase NHS funding.  Given we have a well established taxation system either increase people’s contribution to fund the NHS or stop funding other initiatives and use the saved money on the NHS.

NHS Employs 826 Public Relations Staff at a Cost of £34 million Each Year

The Tax Payers Alliance has revealed scandalous PR staff numbers at the NHS. I have to say that given there are 826 PR folks at the NHS and given its reputation is at an all time low, there’s not much value for money in the £34 million per year  being spent. That of course is assuming that all these PR people are being paid to try and generate good news and not bad news…..

Guys and St Thomas’ NHS Foundation Trust employs an incredible 22 PR staff at an annual cost of £1.1 million. West and South Yorkshire and Bassetlaw Commissioning Support Unit employs an eye watering 36 PR people at an annual cost of over £1.4 million.

Maidstone and Tunbridge Wells NHS Trust: Famous For All the Wrong Reasons

2013

February: Novovirus closed hospital wards

February: Trust Faced £3.5 million C.difficile fine

August: Agency nurse paid £1,500 for 11 hour shift – a UK record

October: £400,000 damages over ectopic pregnancy death

November: Director of Finance resigns

2014

March: Deaths of five cancer patients halts surgery

March: Fined £1.5 million again for failing to control the incidence of C. difficile

Issue: 12

April 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.

Demand Drives Investment in State Transport – But Not Investment in State Healthcare

Adding runways at Heathrow, building a new airport on ‘Boris Island’ in the Thames Estuary and creating HS2 – are all examples of UK plc driving investment to meet current and projected travel demands. However when it comes to healthcare the Government is clearly devoted to the notion that in the face of rising current demand and rising projected demand cutting £20 billion off NHS costs is the way to go.  

In January 2014 we had the highest ever recorded waiting-for- NHS-treatment figures. 2.9 million patients.

We make it quicker, easier and better for people travelling but you might not be alive to avail yourself of this – or you might have to travel in considerable pain.

Welcome to the sixth richest country in the world.

The People’s Inquiry into London’s NHS – A Unique Evidence Base Underpins 18 Recommendations

A group of experienced and well informed healthcare experts recently ran The People’s Inquiry in to London’s NHS. It involved hearing contributions from 95 people at seven public meetings throughout London , 30 hours of oral transcripts, 50 written submissions and evidence taken from the public, NHS staff, professional bodies, medics, clinicians and the great and good (and possibly the bad). Started in autumn 2013 the independent six-person panel was chaired by former NHS trust chair Roy Lilley. The Trade Union Unite funded the inquiry. The Executive Summary and much of the evidence can be viewed at www.peoplesinquiry.org.

The recommendations are indeed wide ranging but include the future of PFI, public engagement and funding, transparency, integration and right up-to-date the impact of Section 119 of the Care Bill (soon to be enacted). At the very least I urge you to view the 10 page Executive Summary.

Scrap Equal Rights When Assessing New Drugs Says NICE Boss

Sir Andrew Dillon, Chief Executive of the National Institute for Health and Care Excellence (NICE) stated last month that saving the lives of the elderly is less valuable to society than saving younger people. Critics have argued that this is blatant age discrimination. Extra weighting by NICE when assessing new drugs for end-of-life-treatment is being abolished. So much for my paying National Insurance then for 43 years.

Nicholson Out.. and Stevens In

This month sees Simon Stevens finally and formally take over running the NHS from disgraced David Nicholson. Nicholson’s exit has been ‘graced’ by his plea for more cash for the NHS. This might have been be construed as a glorious farewell gesture were it not for the fact it was he who told us all in May 2009 that the NHS must cut costs by £20 billion by 2015.

Leaving private healthcare giant UnitedHealth (where he was ‘Global Health President’) to run our free universal healthcare service Mr Stevens will clearly have profit and loss on his mind. He has graciously agreed to be paid only £189,000 in his first year – just £46,500 more than our Prime Minister.

Nicholson’s tenure at the helm of the NHS became unsustainable when the Stafford Hospital scandal revealed that at its worst he was then running the local health authority.

MENTAL HEALTH

Bosses of many UK mental health charities wrote to ‘The Guardian’ last month warning of the dangers of cutting funding for mental health services by 20%. The proposal has been made by NHS England and Monitor. The mental health charity bosses further point out that 28% of the NHS’s disease burden is mental health but mental health attracts just 13% of the budget. This makes a complete farce of the Government’s promise of ‘parity of care’ and ‘parity of esteem’ between physical illness and mental illness. As for aspirations for 24/7 operations in mental health services this surely is a cruel joke.

Roy Lilley of nhsManagers.net has recently pointed up the fact that the Bedroom Tax is shifting families out of their homes to areas where housing is cheaper. Children have to change schools, parents might lose employment (if they have any), friendship circles are lost and families broken up. Cuts in Social Services mean there are no job clubs, support services…. ‘This puts pressure on the NHS, not least Mental Health Services’.  

The Elderly

There are 10 million people in the UK over 65 years of age. According to the Royal College of Psychiatrists (RCP) 10% of them have mental health problems. That’s two million people. In Ealing there are 34,000 over 65 year olds so 3,400 with mental health problems. In my Electoral Ward there are 1,419 people over 65 years old so 141 of them have mental health problems. One wonders just how many of my troubled neighbours have been diagnosed and/or are being treated? Just how many of them have close family carers?

And the Young

The Princes Trust tells us that 750,000 young British people feel that owing to unemployment they cannot cope with day-to-day life. 25% of young people who are long term unemployed have been prescribed antidepressants and 32% have felt suicidal.

Private Mental Health Care Provider Sees ‘Significant Growth Opportunities in the Mental Health Market’

Cambian, the UK’s biggest private mental health services supplier, is planning to raise £20 million via a flotation on the London Stock Exchange. The flotation is likely to value the company at around £500 million on 2013 earnings of £41.1 million. The company is, owned by private equity investors GI Partners, and provides services to more than 1,100 mental health patients in over 60 facilities across the UK. As well as providing mental health services the company also offers educational facilities to children with autism, learning disabilities and challenging behaviour. The 10 year old company employs 6,000 people across 23 schools, 35 hospitals, 188 specialist homes and three fostering offices.,

MENTAL HEALTH IN EALING

Most of the mental health services in Ealing are provided by the West London Mental Health Trust (WLMHT). WLMHT employs 3,500 staff and attempts to meet many of the mental health cares needs of the 770,000 people who live in Ealing, Hounslow and Hammersmith & Fulham. In 2012 WLHT employed 4,000 staff. Dr John Lister of London Health Emergency estimated in 2012 that between £43 and 54 million would be cut from the WLHMT budget between 2012 and 2015.

However the draft Ealing Clinical Commissioning Group (ECCG) mental health budget for 2014/15 (beginning today) is £46.019 million. In 2013/14 it was £45.003 million. Of this year’s budget WLMHT is allocated £31.871 million (in 2013/14 it was £33.005 million). This year there is also £2.110 million for Improving Access to Psychological Therapies (IAPT) and £2.573 million for High Cost Area Supplement (HCAS) both relating to WLMHT services. Neither of these amounts are much changed from 2013/14.

Budget cuts and ‘reconfigurations’ of staff are apparently ongoing at WLMHT. But capital investments are still being made. However the jury is still out on the efficacy and utility of the new £250,000 WLMHT ‘Meridian’ Electronic Patient Feedback System so revered by management.

Support for Carers

West  London Mental Health Trust (WLMHT) has allocated £150,000 to be spent by volunteers over each of the next three financial years (April to March)  to improve mental health service user and carer experiences in Ealing, Hounslow, Hammersmith & Fulham. One might naively think that that is the role of WLHMT, and the three Clinical Commissioning Groups along with the three Local Authorities.

WLMHT’s Flippa Watkeys (Local Services Recovery & Involvement Lead/Professional Lead for Occupational Therapy) and WLMHT service user Jane McGrath are running a WLMHT project (currently called ‘The Voice’) with service users and carers to try and formulate how this money might be spent. No carer is part of the team running this project. The Voice currently has no written draft Constitution

A number of meetings of The Voice have taken place in 2013 and 2014, most of them apparently dominated by service users. The latest meeting took place at St Bernard’s Hospital on 14 March 2014. It has already been decided that the Accession social enterprise will ‘host’ The Voice. Accession was set up largely by effort and finance from WLMHT and the London Borough of Ealing. The Voice describes Accession as ‘an independent social enterprise’. Accession will get £30,000/year for its efforts. This leaves £120,000 each year to help improve the lots of the service users and carers in the 770,000 tri-borough area population. Using the RCP estimates quoted above there are some 7,700 over 65 year olds with mental health problems in the WLMHT catchment area. If only 50% of them have family/loved one carers that means around 3,850 volunteer carers for over 65 year olds alone. That’s a lot of people spread out over a wide geographic area.

At the 14 March 2014 meeting a group of carers presented some views on how some of the £120,000 annual grant money should be spent to expand and improve carer support. However the tone of most of the meeting was that most (all?) of the £120,000 would be spent on service users by service users. I’m part of the Carers’ Group based at Avenue House in Acton. This group offers excellent support, information and training for carers across Ealing. LBE has discontinued its grant to the group so it’s looking like being broke as from today. I attended the WLMHT Carer’s Strategy Group Meeting on 25 March 2014 (ably Chaired by WLMHT Service Manger Kieran McCann) at which it was resolved unanimously that some of the £120,000 should be used to support existing Carers’ groups in Ealing, Hounslow and Hammersmith & Fulham. It will be interesting to see how much of these suggestions find their way into The Voice’s business plan which is due in July 2014.

On 26 March 2014 I spoke to Dr Serena Foo, GP Lead for Mental Health, about funding for mental health carers. She did seem to grasp what I was saying but whether ‘quick’ money can be found quickly to help the Avenue House based Carers’Group and other similar groups in Ealing is anybody’s guess. How frustrating it is to have to lobby both the mental health services purchaser and the mental health service supplier in order to try to get even miniscule funding.

Support for GPs

A support group of four mental health Primary Health Care workers has been established to provide mental health support to Ealing GPs. We understand that two of them are locums. Anecdotally it’s proving hard work training some of the Ealing GPs at the 30+ Ealing GP practices who have signed up to providing Primary Care mental health services. (There are 79 GP practices in Ealing). Instead of 24 hour real time psychiatric telephone support, the Ealing GPs have seemingly decided on just one hour of psychiatric consultant telephone support during the weekday daytime. How this will assist a suicidal patient who presents him or herself at even a participating Ealing GP surgery for seven of the eight hour GP weekdays is worryingly difficult to deduce.

EALING HOSPITAL

Apparently Ealing Hospital Trust (EHT) has managed to break-even in its financial year which ends today. This is in spite of  ‘Non NHS Staff Costs (Agency)’ of over 17 million which were budgeted in February 2013 at £1.73 million. Still when NHS bosses (led by McKinsey and Co) condemned Ealing Hospital to death in 2012’s ‘Shaping a Healthier Future’, why would anyone want a permanent staff post at Ealing Hospital?

At a public meeting attended by 150 people on 26 March 2014 Ealing Council Leader Julian Bell announced that Ealing Hospital’s Maternity Unit would close by February 2015. On 27 March 2014 I attempted to attend an EHT Board Meeting to confirm financial and maternity details. But closed doors kept the public out for over 40 minutes as confidential matters were discussed by a worried looking Board. I left before the public were allowed into the meeting.

Apparently the ‘must have’ merger between EHT and the North West London Hospitals NHS Trust has been delayed by three months as everyone and his brother has to sign off the finances which underpin the deal.

EHT has got a £500,000 grant to equip District Nurses and Midwives with ‘mobile working technology’. We might find that there are more ‘tablets’ than District Nurses as only five new District Nurses qualified throughout the whole of London in 2013.

NHS Rates Ealing Hospital as The Best Performing Hospital in London        

Truly astonishing performance figures have just emerged from NHS Trust Development Authority slides shown at the ‘London Trust Chairs Meeting, 16 January 2014’. Of all the  NHS Trusts reviewed in London, Ealing Hospital Trust came out overall top in the only three ‘Performance Highlights’ slides. In the ‘Referral To Treatment (RTT) Months Achievement of 90% Standard’ performance metric – which measures how quickly a hospital treats a patient – Ealing came first.  In the ‘NHS Cancer Plan 62 Day Standard’ Ealing came way out in front. In the ‘Year to date A&E Performance’ Ealing came second. Of the 42 cases of MRSA diagnosed throughout London only one case was at Ealing Hospital.

The Coalition Government and NHS bosses signposted plans in 2012 to close Ealing Hospital A&E, Maternity, Paediatrics and downgrade the service to one provided by just by GPs and nurses. Recruiting permanent staff at the hospital against a backdrop of doom and gloom about its future has been very challenging. Temporary staff costs are well over £10 million for the current financial year just ended.    

In 2006, the Healthcare Commission interviewed 75,000 patients throughout England. Out of 165 Acute and Specialist Trusts in England, Ealing Hospital was rated as providing the worst care of all of them.  

All the staff at Ealing Hospital should be congratulated on their current performance. Dr William Lynn and Mr David McVittie, who jointly run the hospital, deserve special praise.

NHS Strike on the Cards Nationally and 150 On Strike at Ealing Hospital

Health Secretary Hunt in a seeming attempt to goad 600,000 NHS staff into industrial action has frozen their pay. Unite the Union is consulting its 100,000 NHS members regarding industrial action. The Royal College of Nursing accused Mr Hunt of treating nursing staff and patients with contempt. The TUC commented that its members were being hit by an escalating cost-of-living crisis whilst 2,400 NHS bosses were earning more than the Prime Minister.

At Ealing Hospital Trust (EHT) 150 domestic, catering, porters and help desk workers are earning at an hourly rate of £6:31 some 44% below comparable London NHS workers. They receive no sick pay. These poorly paid GMB members work for EHT outsourcers Compass Medirect. They went on strike in February 2013 and again from 14 to 21 March 2014. EHT management detects no disruption in safe and effective services. Clearly EHT/NHS have no blanket commitment for their suppliers to pay the London Mayor’s  London Living Wage of £8:80/hour.

EALING CLINICAL COMMISSIONING GROUP

Our attempts to get a meeting with ECCG Chair Dr Mohini Parmar in March were unsuccessful. We had a date but then she postponed the meeting until 2 April 2014 when she’ll just have returned from her skiing holiday. In her place as Chair at the public ECCG meeting on 26 March 2014 surprisingly was appointed lay member Philip Wood. At this meeting ECCG Chief Officer Daniel Elkeles waxed lyrically about co-commissioning and the federation of the five CCGs ECCG (CWHHE) is now embedded into. NHS Co-commissioning, perhaps currently illegal until the law likely changes in October 2014, is where two or more NHS Service Commissioners align their priorities while retaining responsibility for their own resources. Critics of this practice bring up a range of related issues which include coercion, lobbying, personal influence and conflicts of interest. At least Mr Elkeles is cognisant of the latter as he himself raised it as an issue to be resolved.

Community Care – Underfunded and Possibly Unsustainable

Only 8.39% of the NHS budget is spent on community care – the rest is spent on hospitals. The community care share has been falling since 2003/4. The Royal College of GPs (RCGP) warned in March 2014 that GP services are ‘under severe threat of extinction’ because they cannot cope with the growing demand for care. RCGP also reported a ComRes finding that 28% of patients in England are currently unable to book an appointment within the week of their request. The RCGP says that the NHS needs another 10,000 GPs in order to provide timely access and high quality care.

6 out of 10 GPs are considering early retirement says the British Medical Association (BMA) online tracker survey. 50% of GPs also say that their workload is unmanageable and that their morale is either low or very low.

BUPA Global Profits are Up, But Says it Can’t Make Enough Profit Out of NHS Trusts  

BUPA, one of the oldest private healthcare companies in the UK, upped its global profits last year to £635 million. However, BUPA claims that it can’t make enough profit out of NHS Trusts when providing chemotherapy, intravenous feeding and rehabilitation at home for elderly and bed ridden patients. BUPA treats 28,000 NHS patients.

NHS CCGs Want To Train Us All in Planning, Designing and Commissioning Healthcare Services

Five free sessions for patients and carers in Ealing and Hounslow are being offered this training at Ealing CCG offices in Greenford April through July 2014. Email healthwatchcwl@hestia.org  for more information or to register.

Issue: 11

March 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.

In this issue:

This issue is a very long one and reflects the local and national chaos as the Government attempts to reduce NHS costs by £20 billion every year. In Ealing there have recently been a host of London Borough of Ealing (LBE) meetings allied to a veritable snow storm of written reports.

But First  The Care Bill – Clause 118 now 119!

If this clause becomes law hospitals will be shut at the whim of  Whitehall bureaucrats – without full and proper consultation and without even the  saintly, so called ‘local GP driven’ CCGs having a say. This is being rushed through Parliament. The third reading will take place in the first two weeks of March 2014. Email you MP and tell him or her to vote against Clause 118 (amended to 119).

The Better Care Fund (BCF)

LBE  Cabinet papers for its 18 February 2014 meeting set out the BCF stall. BCF is for providing ‘better integrated care and support’. Vulnerable people are a priority. It involves ‘…a significant expansion of care in community settings’.  For Ealing it looks like £18.7 million in 2014/15 and £26.9 million for 2015/16. LBE puts in £5.4 million in 2014/15 and £2.1 million in 2015/16. The rest of the money comes from the Ealing Clinical Commissioning Group (ECCG). However in the hard to interpret figures a total of £77.4 million is quoted for 2014/15 for ‘BCF 3.0  Commissioning of Community Based Support Services’. The 2014/15 spend will focus on management of the impact in the acute sector, the protection of social care, embedded care coordination, sustaining our improved performance on Delayed Transfer Of Care (DTOC), and reducing avoidable admissions, expanding 7 day working and accelerating data sharing.

LBE Vision for Ealing

‘In Ealing organisations will work seamlessly to promote and deliver healthier communities. Patients and carers will be at the heart of decisions about their well being. Health and care services will be person centred and efficient in design and will deliver positive experiences and improved health outcomes’.

Let’s hope these bold aspirations can be met.

Shaping a Healthier Future (SaHF) Enters its ‘On the Buses’ Phase in Ealing

The grandly titled ‘Ealing Council Scrutiny Review Panel 2 – Transport’ met in Ealing Town Hall on 11 February 2014. The meeting amounted, in part, to 17 people sitting round a table discussing non-existent proposals for new bus services to take Ealing A&E sufferers and their loved ones to West Middlesex and Northwick Park Hospitals prior to Ealing Hospital being demolished. Ealing Councillors and Ealing Council Transport Officers rubbed shoulders with Transport for London (TfL) and NHS representatives. NHS Ealing Clinical Commissioning Group (ECCG) sent its new boy Andrew Pike (Communications/PR) to update the panel on the SaHF Travel Advisory Group’s  (TAG’s) work plan on strengthening patient transport. No new information emerged apart from a figure of 175 additional trips/day predicted to be ‘displaced’ from Ealing to West Middlesex Hospital which was passed onto TfL’s London Buses a few days before the meeting. TfL estimates a cost of between £550,000 to £700,000 per year to extend just one bus route (E2 or E8) to West Middlesex Hospital. As TfL’s minimum threshold of 1,250 trips/day was not met it was clearly not interested in running the service unless someone else funded it.

No mention was made about ‘strengthening patient transport’ for much-sooner-to-close A&Es at Hammersmith Hospital and Central Middlesex Hospital. And where was ECCG’s Chief Officer Daniel Elkeles who recently announced in public that ‘everything was in hand with his discussions with TfL and London Ambulance’? Mr Elkeles is now Chief Officer of the new CCG federation of Ealing, Central London, West London, Hammersmith & Fulham and Hounslow CCGs. (CWHHE). CWHHE, servicing a population of over one million patients, is hardly a local GP-driven healthcare commissioning service.

Some citizens attendees in the audience are attempting to work constructively with Ealing Council, TfL and the NHS to more accurately size current and future Ealing  patients’ and loved ones’ public transport needs for accessing West Middlesex and Northwick Park Hospitals. The Department of Health’s figures for 2011 show there were 84,000 A&E attendees at Ealing Hospital of which 30,000 were seriously ill.

TfL presented some slides which strongly suggested that TfL Buses’ Network Development folks have no community engagement strategy whatsoever.

The Joint Health Overview & Scrutiny Committee (JHOSC) Makes a Very Poor Attempt to Unscramble SaHF  for 1.8+ Million Citizens in North West London

Again in Ealing Town Hall, the JHOSC met on 20 February 2014. JHOSC is made up of elected representatives from eight North West London Borough Councils who represent the interests of over 1.8 million citizens. It’s Ealing, Hounslow, Harrow, Brent, Richmond, Kensington & Chelsea, Hammersmith & Fulham and Westminster Councillors who attend. There was plenty of pre-meeting reading matter – in fact 84 pages of it. At their previous meeting on 3 December  NHS SaHF evangelists, Elkeles, Spencer and McGoldrick, led the SaHF sermon. Ealing Councillor Abdullah Gulaid attempted to gain some clarity on Mr Hunt’s fudge on future ‘A&E services’ at NHS Ealing Hospital. Spencer replied with another fudge of ‘….GP led service connected to emergency care networks’. Whether these networks were to be physical, telephonic, internet, neural, social media or telepathic was not revealed. Mr Elkeles bragged that three GP Surgeries in North West London had opened at weekends. I estimate that there are over 400 GP surgeries serving the 1.8 million people in North West London.

Of the 16 elected Councillors who attended on 20 February only one appeared to have read or be interested in either the 84 page document provided prior to the meeting or the 71 page document provided at the meeting. This was Councillor Mary Daly from Brent Council. She was the only Councillor who made strong objections to the way SaHF was being conducted and demanded real information. She complained about the unintelligible business jargon being used, as well as questioning SaHF evangelist Dr Mark Spencer about the cuts. He replied that the funding would accrue from ‘2% QIPP savings from CCGs’.  QIPP stands for Quality, Innovation, Productivity & Prevention. QIPP is the Philosopher’s Stone of medicine. It’s like the trick of turning water into wine. It’s all about cutting £20 billion from the annual NHS budget whilst at the same time improving the quality of care.

It emerged that Hammersmith Hospital A&E will close around August/September 2014. Northwick Park Hospital had hired two more A &E consultants and that that the target for a full complement – being aimed at – is eleven

In the plethora of slides presented at the 20 February meeting just one was used on ‘Mental Health Transformation’ and even that was sparse, with just 34 words on the slide….oh dear… oh dear. And as for Maternity, there was just one slide which depicted Ealing Hospital with lines round the compass linking it to Northwick Park, Hammersmith, St, Mary’s, Chelsea and Westminster, West Middlesex and Hillingdon Hospitals. The title of the slide was ‘Maternity and Paediatric Zone’. The reality of this slide is the annual dispersal of 2,500 pregnant Ealing women to these six remote maternity units. If this constitutes scrutiny of the future of childbirth for Ealing mothers then we should all be very afraid.

Living in North West London we are all part of a huge, unique experiment. No such radical healthcare transformation as SaHF has ever been attempted anywhere in England. Not only that, we are now part of yet another experiment  This one is called ‘Living Longer, Living Well’ (LLLW). This is an integration initiative which will allow patients, carers and families to decide whether they want to be treated at home or ‘in their local communities’. GPs will coordinate care ‘working with others in integrated networks to support people to meet their individual goals’. Will it work? Can it ever work? Future issues of this newsletter will monitor and attempt to ‘test’ these grandiose ambitions and aspirations.

Two Page Misleading Advertisement by the NHS in ‘Ealing Gazette’

The 21 February 2014 edition of the ‘Ealing Gazette’ contains two full-page NHS colour advertisements. One of these is selling SaHF, and the other is selling the 111 telephone help line and the availability of .GP services in the evening and at the weekend. Just why our National Insurance taxes should be spent on this sales effort. is really quite beyond my comprehension. The ads contain some inaccuracies too.

+ ‘Services….are chosen by a group of local GPs known as the Clinical Commissioning Group’. This statement is what we call a lie. Of the 20 people on the Ealing CCG Governing Body  just 5 of them are Ealing GPs.

+ There as no mention of the A&E Unit closing at Ealing Hospital. One might refer to this omission as NHS bosses being economical with the truth.

+ ‘…urgent care centres (UCCs) which will  have the capacity to treat the majority of injuries which currently go to A& E’. This statement is almost maliciously confusing. Ealing Hospital UCC will have no acute beds, no Acute Care Unit, no surgeons or A&E consultants on site. No flashing blue light ambulances will deliver the dying and those in pain to Ealing Hospital. What Ealing Hospital UCC will have is GPs and nurses. Currently there are 44 accident and emergency conditions which Ealing Hospital UCC cannot and will not handle.

+ ‘….these changes ….will help save 140 lives in North West London each year’. Quite a claim with no reference to any evidence to backup this statement

+ Do try calling 111. The robot answering service does not recognise West London as a geography of choice – so for 1.8 million citizens you get shuffled into the ‘don’t know where you live’ category. When I did make contact with a  human being the line quality was so bad I had to hang up.

Failing A&E Service in North London Putting Lives At Risk

The A&E Unit at NHS Barnet Hospital turned away all sick and injured patients on 31 January and 2 February 2014. It is by no means a co-incidence that NHS Chase Farm Hospital A&E Unit some six miles away was closed by NHS diktat on 9 December 2013. Since the closure of  NHS Chase Farm Hospital A&E, NHS official figures show that ambulances have had to wait outside NHS Barnet Hospital – with patients on board – more than 30 minutes on 236 occasions. The only other ‘local’ NHS A&E Unit, also 6 miles away from NHS Chase Farm Hospital, is North Middlesex University Hospital. Here, since the closure of NHS Chase Farm Hospital A&E, ambulances have had to queue outside for more than 30 minutes on a staggering 941 separate occasions.

Department of Health (DoH) Wants the NHS to Prioritise Treatments for Patients Who Contribute to the Economy

The DoH has instructed the National Institute for Health and Care Excellence (NICE) to consider overhauling the way it assesses the cost-effectiveness of drugs to take into account the benefits that successful treatments have on society. NICE will do this as it is accountable to the DoH. One of the quoted exemplar benefits is treatments allowing people to return to work. NICE, Age UK and others have pointed out that no such return-to-work benefit could be gained by successful treatments undergone by retired people. Presumably treatments which prevented mentally patients from committing suicide would also arguably not directly bring about return-to-work benefits either. Also taking this argument close to absurdity, we could just not offer any treatments to habitual convicted criminals or to the long term unemployed.

Competition Thoughts of CQC Chairman David Prior

The Care Quality Commissions’s (CQC’s) David Prior worries in the Sunday Telegraph that if the NHS doesn’t change it might go bust – but presents little evidence to back up his views. He states that the NHS needs ‘more competition to drive up standards of care’. However he cites no academic, clinical or business research which demonstrates this. This is probably because no such evidence exists. The former Deputy Chairman and Chief Executive of the Conservative Party and former Tory MP also has a lot to say about bullying in the NHS. He may well know quite a bit about bullying as anecdotally there is plenty of bullying in his own organisation – the CQC.

No-one will argue about his aspirations for the NHS to ‘drive up standards’, protect vulnerable patients, and to see ‘an end to pointless targets’. However all this guff about hospitals going bust is all based around the pointless construct of hospitals and Trusts being profit and loss bodies, whereas in the sensible world of public services they would be cost centres. He also bangs on about the NHS failing to listen to staff who challenge poor care and champion the rights of patients. This makes me wonder how CQC treats its own staff who blow the whistle.

All in all there is something inappropriate and unsavoury about someone who is paid to enforce a set of rules arguing publicly about those very ‘rules’. Hopefully political party politics does not play a part in this outburst…….

Police to be Able to Access Our Personal Medical Records – as a Matter of Right

David Davis MP warned us all in The Guardian last month that the Police will in future be able to access our personal medical records even if we have formally opted out of allowing our data to be passed on to Government. (If you have received the NHS ‘Better information means better care’ leaflet through your door, you have just four weeks to let your GP know if you don’t want your data to be ‘shared’). Currently the Police have to track down a person’s GP and go to court for a disclosure order in order to access your personal medical records. In future they will be legally able to hack into a massive single Government repository of 55.5 million personal medical records in England. So much for the confidentiality of the doctor/patient relationship then.

And More and More on ‘care.data’

‘care.data’ is the name of the Atos software driven NHS personal medical records/Atos managed NHS personal medical records data extraction and data sharing service. Dr Clare Gerada, a respected former Chair of the Royal College of GPs, has stated that patients who refuse to share personal medical records data are selfish. She sadly seems to miss the point that many of us can no longer trust the Government or NHS bosses generally and specifically on the handling of data. Here in NHS NW London, patients were not involved in the formative stages of ‘Shaping a Healthier Future (SaHF)’ plan making. We all took part in a flawed SaHF public consultation exercise the results of which were manipulated to ‘fix’ the result to suit NHS bosses. And the ‘Daily Mail’ has published data obtained from the Office of the Information Commissioner which sizes the number of NHS medical records lost at a staggering 2,152,560! Is it any wonder we have lost trust in NHS bosses and their Government puppet masters.

Roy Lilley in nhsManagers.net explains to us all that the legislation underpinning the NHS  ‘care.data’ personal medical records sharing is Section 251 of the Health and Social Care Act. He also explains that the folks who make the decision to ‘over-ride the common law of confidentiality’ are the 17 unelected members of the NHS Data Access Advisory Group (DAAG). DAAG meets monthly and recently gave permission, for example, for Corin Ltd to purchase NHS personal medical records. Corin is global private healthcare company specialising in orthopaedics.

The ‘Daily Telegraph’ has waded into the subject quoting 40% of GPs polled by the Royal College of GPs (RCGPs) saying they intend to opt out of sharing personal medical records. Also Mencap, Action on Hearing Loss, the Royal National Institute for the Blind, the National Autistic Society and Sense have written to Minister Hunt expressing concern that little effort has been made to ensure those with sensory impairment  are aware that their data will be harvested.

And the ‘Oxford Mail’  revealed in February that a GP has vowed to take the NHS to court if he is forced to hand over personal medical records without the consent of over 4,000 patients. Dr Gordon Gancz of King Edward Street Surgery near St Bartholomew’s Hospital in the City of  London says that the NHS data collection edict ‘..removes my right to protect my patients’ confidential information’. He added that ‘someone other than your doctor will know whether you have had a mental health problem, an abortion, gone to the STI clinic or just had a cold in the last week’.

On 19 February 2014, NHS England retreated from instantly implementing care.data and announced a six month delay in implementation. It claimed (very much as Government/NHS bosses claimed in 2011 with the Health & Social Care Bill) that citizens needed more time and more  information to understand the benefits of sharing personal medical records. We should beware of this ‘pause’ and bemoan perhaps our National Insurance contributions being spent yet again on printing and delivering a further 26 million leaflets.

Even worse it was revealed on 25 February 2014 that an insurance company – Staple Inn Actuarial Society – has been able to access the NHS records of 47 million patients over 13 years!

Quite understandably criics of care.data claim that the care.data database’s real worth is as an intrusive marketing tool.

Redundancies and Rehiring Chaos at NHS

Roy Lilley’s nhs.Managers.net summarises some of the Government inspired human relations chaos at the NHS:

+ Up to 10,000 NHS clinicians and nurses gone

+ 40,000 NHS managers gone

+ One in five NHS staff made redundant have been rehired

+ Redundancy bill of about £450 million

48 Pages of Strategy from the Health and Social Care Information Centre (HSCIC)

The HSCIC seems to really fancy itself as in January 2014 it published 48 pages of ‘strategy’. Strange that it’s only a two year strategy (2013 – 2015). Government spatial strategies are for 15 years! News to me is that HSCIC will be the NHS IT systems delivery vehicle. New NHS IT systems have an awful contemporary  history with losses of well over £20 billion. Perhaps governance of NHS IT by HSCIC might improve on this. The document emphasises regaining citizens’ trust in the NHS and the NHS HSCIC earning our trust to safeguard our personal medical records. This is a big ask. Towards the end of the document HSCIC goes large on ‘supporting the wider economy’ and on HSCIC’s ‘international reputation’. HSCIC has 2,100 staff and is headquartered in Leeds. It began life in April 2005 but became a ‘non-departmental public body’ (a sort of Government quango) in April 2013. It is not exactly clear who appointed or voted for the members of the HSCIC Board, but the Board Chair is Kingsley Manning, an ex McKinsey & Company consultant. More at www.hscic.gov.uk

NHS Mental Health in Numbers

22.8% – proportion of NHS health problems in England in 2010/2011 which were mental health problems (The Royal College of Psychiatrists – RCP)

11% – proportion of NHS budget devoted to treating mental health problems in England in 2010/2011(RCP)

2% – size of NHS mental health spending cuts over the last two years (The Guardian)

16% – increase in referrals to NHS crisis and mental health teams over the last two years (The Guardian)

1,700 – number of NHS mental health beds in England closed since April 2011 (Community Care magazine/BBC)

3,800 – number of staff in the West London Mental Health Trust (WLMHT)

800,000 – number of mentally ill people in UK signed off sick (OECD)

1.2 million – number of UK people receiving state financial support because of mental illness (OECD)

£70 billion – annual loss to UK economy caused by inability to work due to mental health problems (OECD)

Are GPs Breaking the Law By Charging Care Homes for Treating The Elderly?

‘The Sunday Times’ last month quoted the British Geriatrics Society (BGS) condemning some GPs who are charging fees to care homes for treating elderly patients. ‘People who live in care homes have already paid through their National Insurance contributions for the basic care provided by a GP,’ said BGS Hon Secretary, Dr Adam Gordon. The Care Quality Commission (CQC) found that 10% of care homes paid GP surgeries for visits.

310,000 Increase in Patients Waiting for NHS Hospital Treatment

NHS data shows that 2.88 million people in England were waiting for consultant-led treatment in December 2013 – up 310,000 or 12% on May 2010. NHS England (that genius organisation employing 6,100 people) opined that citizens growing older and having more than one illness was creating more demand for NHS services. Talk about stating the bleeding obvious….The Labour Party blamed David Cameron and the Conservative Party bamboozled us all with 18 week, 26 week and 52 week waiting figures and quoting a largish number not directly pertinent to the issue  ie 475,000 more NHS operations per year.

Jeremy Hunt Hires Retail Expert to Train NHS Hospital Bosses

Health Secretary Jeremy Hunt MP has hired Sir Stuart Rose to advise him on building up a new generation of managers to transform so-called failing NHS hospitals. Mr Rose has a long pedigree of retail and retail management experience having worked for Burton, Argos, Booker, Arcadia and latterly Marks & Spencer. He had a roller-coaster ride at M&S which he ran from 2004 to 2011. In 2006 he was named ‘Business Leader of the Year’, but in 2008 M&S share price dropped by over 30%. I can’t help but think that this ‘off the wall’ type hiring is as bizarrely unintuitive as the Government hiring Sir Alex Ferguson to transform the management of failing prisons or asking Jamie Oliver to transform the management of failing social services. Estimated to be worth £34 million, Mr Rose will no doubt  feel comfortable working with another multi-millionaire – Mr Hunt. Mr Rose recently defended immigrants arriving in the UK, but not on the grounds of universal equality. His support for immigration into England is based upon the financial benefits it offers UK businesses.

Atos wants To Pull Out of  its £500 Million Work Capability Assessment Contract

Following swiftly on a day of protests outside Atos offices throughout England on 19 February 2014 (including a noisy demo in West Ealing), Atos is now telling the world that it’s attempting an early exit from its contract with DWP which ends in August  2015 The Government is hinting that it might be ‘pushing’ Atos out, as it is mumbling about adding other companies to carry out the controversial assessments. Atos has revealed that its staff have been assaulted 163 times each year during the 600,000 assessments it has carried out. The Labour Government originally contracted with Atos in 2008. Horror stories abound about the 10,000+ deaths recorded soon after disabled citizens were assessed fit for work. Over 40% of those who appealed against Atos assessments have won their appeals. Atos workers went on strike recently for fair pay, at a time when  the Atos Chief Executive took a 14% pay rise.

Issue: 10

February 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.

In this issue:

+ More on Clause 118 – fascist/communist approach to NHS Decision Making

+ Blue Lights Still Flashing at A&Es

+ A&E Closure Offers No Help to Dying Baby

+ We Spend Less/Head than Other Countries on Government Health Spending

+ Want to give Atos Your Identifiable Medical Health records?

+ Will Chemists  Replace or Augment GPs?

+ Mental Health Beds Nightmare

+ The People’s Inquiry for London’s NHS

+ England’s NHS in Numbers

+ No Smoking Anywhere for the Dying, those in Pain and Anxious Carers

+ Circle Private Healthcare on the Sick List

+Upcoming Events

Clause 118 Update

Clause 118 is a proposed amendment to the Health and Social Care Bill currently going through Parliament. It will effectively allow the Secretary of State for Health to close, merge or privatise any hospital willy-nilly. The sweeping new powers would mean that decisions about local hospital provision could be taken in as little as 40 days, regardless of how hospitals are performing. Absolute power will be granted to Trust Special Administrators (TSAs) to make these decisions without any requirement for community engagement or public consultation. A TSA would be brought in under the ‘Unsustainable Provider Regime’ to ride roughshod over local views and impose a reorganisation of any part of any Trusts in the vicinity of the ‘Failing Trust’.

Opponents of Clause 118 include the British Medical Association, the Royal College of Physicians, Save Lewisham Hospital, Unite, the GMB, Our NHS, Keep Our NHS Public, National Health Action Party, NHS Support Federation, GMB and Ealing TUC Save Our NHS Campaign.

A final vote in Parliament is due in February 2014.  

Accident & Emergency Departments in England in Crisis

Dr Cliff Mann, President of the College of Emergency Medicine, says that there should be 260 new A&E Registrars each year, but over the last three years only half that number have been recruited.

Many A&E doctors are working at understaffed A&E departments throughout England. Mann describes these working environments as ‘intense, unremitting and increasingly unrewarding’. Doctors regularly work extended shifts and weekend shifts.

Ideas have been mooted for visitors to England, immigrants to England and English expatriates to pay for treatment at NHS Hospital A&E departments. So, as well as NHS A&E staff overnight on Friday and Saturdays nights cleaning up vomit, breaking up fights and episodes with drunks, drug addicts and the mentally ill,  they will also have to act as surrogate immigration officials.

According to a poll conducted by ‘The Guardian’ newspaper 88% of GPs don’t believe that the 2004 GP contract changes have contributed to greater overcrowding in NHS A&E units. The changes meant that GPs no longer had to provide out-of-hours care. Jeremy Hunt has often cited the 2004 contract changes as a key contributor to current A&E overcrowding.

The Labour Party has calculated that spending on temporary locums in A&E in England is up 60% since 2009. £83 million was spent on A&E locums last year, with some temporary staff earning £1,500 per shift.

In January 2014 the NHS announced it would give more money to support A&E units. The money was originally to be spent by local NHS organisations to set up initiatives to reduce avoidable trips to A&E. According to ‘The Guardian’ very few of these schemes have been set up. Monitor, the NHS Regulator, will decide which A&Es get more cash and how much. Critics say that the current funding rules have deprived A&E units of £500 million a year.

Annual attendance at A&E units in England in 2003 was 16,516,845 and in 2013 it was 21,724, 841.

Two Year Old Boy Dies After Mother Rushes Him to Chase Farm Hospital A&E – Only To Find It Closed

A sick two year old boy – Muhammad Hashir Naveed – was rushed by his 27 year old mother Maryam to her local Chase Farm Hospital in Enfield at 3:00am on 15 January 2014. The Government closed this A&E unit on 9 December 2013 – but tragically Maryam did not know this. She frantically got a nurse on the phone and an ambulance was called. It took her son to Middlesex Hospital A&E in Edmonton some five miles away. However it was too late to save him and he died at 4:00am.

No-one knows whether the so called Urgent Care Centre (UCC) at Chase Farm Hospital could have saved Muhammad’s life. This is all a bit irrelevant though as the UCC closed for the night six hours before mother and baby arrived outside the defunct A&E building.

Are We Spending Too Little on Our NHS?

The World Health Organisation (WHO) has calculated the per capita spend (in $s) of Government spending on health. The UK rate at $2,919/head is way below the US at $4,437, The Netherlands ($3,991) and Denmark ($3,861). We also lag behind Austria, Germany, Switzerland, Canada, France and Belgium.

Do You Trust the Government Not To Sell Your Identifiable Personal Medical Records?

The Government wants us all to agree to our personal medical records being anonymised or ‘pseudonymised’ by civil servants and then sold off to anyone who wants to buy them. 26 million Government leaflets aimed at trying to persuade us all to go along with this have been printed and are now being delivered to households throughout England.

This data for sale will include personal data, including National Insurance Number, date of birth, mental health, cancer and substance abuse habit data. Prime potential data purchasers would be insurance companies, pharmaceutical giants and private healthcare suppliers.

The Government recently set up the Health and Social Care Information Centre (HSCIC) which will administer the data collection, pseudonymisation and sale of this data. Worryingly the HSCIC boasts a Public Assurance Director. Even he admits that with plenty of other data a third party could identify individual patients from the data supplied by HSCIC.

Also worryingly, the pseudonymisation software is being written by none other than Atos. The software and the service Atos will create and manage is grandly called the General Practice Extraction Service (GPES). Atos has been working on the software since early 2012. Atos is famous (or possibly infamous) as the software and service supplier for the much discredited Incapacity Benefit assessment service.

And just what is the Government’s recent track record in handling and managing people’s personal medical histories? In a word – disastrous. Prime Minister Blair’s  ‘NHS National Programme for IT’ in 2000 had as one of its objectives the creation (in just three years) of a single electronic system for storing patient records in England which ultimately would be accessible 24/7 by anyone authorised to do so. What happened? The project lurched from crisis to crisis and was effectively abandoned massively unfinished in 2011 with a loss of at least £20 billion to the taxpayer.

And Now It’s Pharmacists Who Will Be Our NHS ‘Primary’ Care Entry Point

NHS England, The Royal College of GPs and Pharmacy Voice have proposed that NHS primary care triage should be carried out at your local Chemist’s.

However, Patient Concern is not happy with the idea that Pharmacists act as almost a ‘gatekeeper’ to conventional NHS Primary and Secondary Care.

Quite frankly, if we are unwell we need someone trained in healthcare – not in medicines – to carry out first contact diagnosis, prognosis and treatment. A severe headache could be treated with pain killers off the chemist’s shelf, but it could also require brain surgery. It’s unlikely that Pharmacists would be able to offer any ‘medicine’ to treat first contact mentally ill people.

However here at Ealing Hospital the A&E and other units will be wound down over the next six years. When  seeing your GP might take days or a week; the NHS 111 telephone service response is slow or deficient; you are not Internet savvy or connected and can’t go online to NHS Choices, then many more ill people are likely turn to their local chemist to help them.  

More on Shortages of NHS Mental Health Beds

The ‘Sunday Times’ has revealed results of research by the Royal College of Psychiatrists (RCP). It was stated that there were 32,000 mental health beds in England and Wales in 2004. ‘Community Care’ magazine has also revealed that in 2011/12 that number in England had dropped to 18,924.

The RCP says that the number of acute mental health beds currently available in the NHS in England has fallen by at least 1,700 since April 2011 – a drop of 9%.

Lack of locally available beds is resulting in treatment delays, and in some cases suicide. In other emergency cases mentally ill patients have variously travelled from Croydon to Hertfordshire, Kent to Somerset and Kent to Carlisle.

The RCP’s recommended maximum occupancy rate for acute psychiatric beds is 85%. Of the 28 Mental Health Trusts who responded to the research all reported occupancy rates of over 85%.

The Care Quality Commission (CQC) has revealed that the number of people detained for mental health treatment under the Mental Health Act was 50,408 in 2012/13. This represents a 14% rise over the five previous years from – 44,093 in 2008/9. CQC also criticised the fact that more than three quarters of wards in mental health hospitals were denying basic human rights such as patients’ use of the internet, use of a mobile phone and use of a secure outdoor space where they could smoke. Mind, Rethink Mental Illness and a group of MPs have all expressed their concern over these figures, the lack of staff and the implementation of the Goverenment’s laudable aspiration to give mental health ‘parity of esteem ‘ with physical health.

And in a January 2014 announcement worthy of inclusion in ‘Alice in Wonderland’, the Government stated that mental health patients are to have the same right to choose where they are treated as those with physical health problems. Let’s hope the mentally ill who live in Croydon choose to be treated in Hertfordshire and those in Kent continue to choose Somerset and Carlisle for their treatment.

The People’s Inquiry for London’s NHS

The People’s Inquiry is a unique, independent exercise in gathering and analysing many peoples’ views on and experiences in London’s NHS. Seven hearings were held across London over October, November and December 2013. At these meetings people presented verbal and written evidence. Funded by the Unite Union the inquiry is chaired by experienced NHS analyst Roy Lilley. The six person panel is currently reviewing and discussing the submissions of almost 100 people. A detailed response with recommendations is expected in March 2014.

An overview of the structure of the final report has been released and its headlines are:

1. The financial squeeze
2. The democratic deficit
3. The Health & Social Care Act has made things worse
4. The new bodies supposed to represent local people are weak and ineffective
5. Management and staff are under pressure.

More at www.peoplesinquiry.org

England’s  NHS in Numbers

+ 4,000 emergency doctors (Keep Our NHS Public –KONP)

+ 32,000 General Practitioners (KONP)

+ 26% of NHS doctors in England are foreign nationals (Health and Social Care Information Centre – HSCIC)

+ 34% of all UK- registered doctors were trained outside the UK (HSCIC)

+ 200 countries are the birth places of staff in the NHS and community health services in England (HISCIC)

+ 135,000 NHS beds in 2013/14 (KONP)

+ 297,000 NHS beds in 1987/88 (KONP)

+ 70% of all NHS contracts for services between April and   December 2013 won by private firms (NHS Support Federation)

+ 80,000 – the number of mental health patients waiting 28 days or more for access to ‘talking therapies’ (HSCIC)

+ £105 billion – estimated cost to the economy due to mental health problems (researched by the Centre for Mental Health and quoted by Minister of State, Paul Burstow MP)

+ 211 – the number of Clinical Commissioning Groups (CCGs) in England

+ 152 – the number of Primary Care Trusts (PCTs) in England effectively replaced by CCGs in April 2013

NHS Addenbrooke’s Hospital in Cambridge is now No-Smoking Inside and Outside. Just How Helpful is this in Reducing Patient and Carer Stress Levels?

This is one of the biggest hospitals sites in the country with a large catchment area. For those seriously ill and for their stressed out carers, having a cigarette might be one of their few pleasures.

Circle’s Credibility Dented Yet Again by its Financial Difficulties and by the Competition Commission’s criticism of its Business Model

‘Private Eye’ had private healthcare services supplier Circle in its sights in January 2014. Circle made a loss of £9.7 million on 6 months sales of £44 million up to June 2013. Conventional debts of £60 million were declared to add to an estimated ‘Enron-esque’ off-balance-sheet (and off-shore) debt of £40 million.

On 27 January 2014 it was the turn of ‘The Times’ to report that the Competition Commission (CC) intended to crack down on schemes whereby doctors who refer private patients to particular hospitals are rewarded with either cash or shares. The CC cites Circle’s business model  – the would-be ‘Big Society’ solution for medicine – as a non-compliant scheme. The CC wants to ban free secretarial services, free consulting rooms for doctors and a £500 limit of ‘freebies’ doctors can receive. These preliminary sanctions will be subject to consultation.

Circle, founded by a Goldman  Sachs banker, is the only private healthcare supplier in England to be running an NHS hospital – Hinchingbrooke Hospital in Cambridgeshire. It also owns and runs its own private hospitals in Bath and Reading and runs the Urgent Care Centre at Ealing Hospital.