Why Do I Care?

Staying alive and maintaining our health are major priorities for all of us. I guess being safe, having a roof over our heads and food in our bellies must also rank highly. If for no other reason than the survival of the human race, good education for all our children is clearly essential.

A growing body of opinion demands that these needs are met, as a priority, from the public purse. More money needs to go into the public purse from the very rich. Vanity projects like HS2 need to be dumped. We have to find a better way of measuring human happiness than calculating Gross Domestic Product (GDP).

Eric Leach

Mental Health in Ealing

The budget for mental health is the biggest item in the NHS budget, consuming more than cancer or cardiac services.

There were periods in September 2013 when there were ‘no inpatient beds in the public or private sector available in the whole of England.’ So said Professor Dinesh Bhugra Co-Chair of the Mental Health Foundation.

Severe mental illness levels – the incidence of psychosis – are above the national average in Ealing. Spending in Ealing on severe mental health is higher in Ealing than in most NW London boroughs.

However mental health spending across NW London last year was cut by £20 million (6%). The overall three year cuts (2012 to 2015) will be between £43 million and £54 million.

The severely mentally ill in Ealing who are ‘Sectioned’ under the Mental Health Act are often accommodated outside Ealing as there are too few places available in Ealing.

Hounslow Police tell us that the Lakeside Mental Health Unit at West Middlesex Hospital – just one of the venues for Ealing Sectioned patients – is an ‘Open’ facility and most of the facility is not secure. Patients abscond on a regular basis. I currently visit the assessment section of the facility  on a frequent basis and it is bleak and unwelcoming. This cannot be a pleasant place to work, and caring for people who might self harm or harm others would not be most people’s choice of profession, vocation or job. The communication skills of many of the staff are poor.

The NHS plan for Ealing is to demolish existing ‘first point of contact’ mental health services and for GP surgeries to provide these services. However, if GP surgeries don’t want to do this, the NHS can’t make them as the GPs are private contractors and not NHS employees. To be quite specific about this, top West London Mental Health NHS Trust (WLMHT) psychiatrist Dr Christopher Bench told a public meeting on 24 July 2013:

‘…the care of people with common mental illness or stable severe and enduring mental illness will be transferred from mental health services into Primary Care’.

The sub text of all this is of course saving money by reducing hospital admissions, reducing the time sufferers occupy hospital beds and moving ‘Settings of Care’ out of Ealing Hospital into your GP surgery or even into your own bedroom.

Will it work? Has your GP surgery decided to opt in or opt out of this arrangement for treating the mentally ill? How many of the 79 Ealing GP surgeries have opted out? Dr Serena Foo, Mental Health Lead, Ealing Clinical Commissioning Group (ECCG) told the public meeting in July that co-operating Ealing GPs are being trained in providing mental health services ‘this summer’. GPs, apparently, will begin offering these services in ‘autumn 2013’ in one NHS leaflet and ‘this summer’ in another NHS leaflet.

The Ealing mental health assessment service, based at Cherington House in Hanwell, now no longer operates a ‘walk-in’ service. Sufferers in Ealing are now offered just a 24 hour helpline on 03300 1234 244. Or they could ask their GP – if in fact their GP is signed up to the new mental health Primary Care arrangement. Or, of course, go to Ealing Hospital A&E – for as long as that still exists.

Two amazing figures that emerged at the July public meeting were  ‘700’ and ‘10’. According to ECCG and the West London Mental Health T rust (WLMHT) 700 is the number of mental health patients in Ealing who will be affected by these changes. Out of an Ealing population of 338,000?  That 700 figure takes some believing. The 10 figure is the average ‘less than’ number of mental health patients transferring from Secondary Care (i.e. hospital care) to a GP. And if your GP is opting out of these new arrangements……

If you have concerns about these new arrangements for yourself or your loved ones, ECCG, WLMHT and Ealing Council urge you to contact Sarah McInnes on 020 3313  9257 or at sarah.mcinnes@nhs.net. And good luck in getting a response from Sarah. I telephoned her on 5, 6, 11 and 17 September. There was no human response but I was asked to leave a message. I did this and asked Sarah to call me back. It’s now 29 September and she still hasn’t called me back.

WLMHT seems to want to turn itself into a Foundation Trust. Cynics will argue that WLMHT wants this status so it can earn revenue from offering mental health services to non-NHS patients i.e. to private patients. Cynics might also argue that WLMHT does not have adequate human and facility resources to provide a resilient service to NHS patients, never mind adding non-NHS patients to the workload. I have met some very talented, caring and hard working WLMHT staff. My suspicion and concern is that there are just not enough of them to deal with  today’s workload. – never mind tomorrow’s.

Is Jeremy Hunt Attempting to Micromanage the NHS?

Jeremy thinks that GPs should proactively monitor and manage the care of the frail and elderly when they are in hospital, at home and in care homes. This surely is cloud cuckoo land. He also thinks that all A&E staff should have to have flu jabs. More flexible work hours for carers is another of his big ideas. Not enough on site consultants in A&E departments overnight is another one of his top gripes.

And he also wants to breed NHS super managers by spending £10 million on sending them to Harvard Business School. Clearly world ranked London Business School is just not up to it as far as Hunt is concerned. He’ll also top up these selected managers’ two month jollies in Massachusetts with a stint at the convicted criminal monopoly maintainer Microsoft. Oh dear…

However, if you thought Government ministers were appointed to propose policy, think again with Mr Hunt. With regard to NHS nurses covering their faces (with burkas, for example) he is ducking the issue and passing the buck onto the GMC. Just 17 hospitals in England have banned front line staff wearing the veil. Balancing the issues of effective service delivery, hygiene and religious beliefs and practices can’t be easy – but that’s why Hunt gets paid the big bucks to fashion policy, not to do a Pontius Pilate on it.

Pocket Money for Ealing Hospital Won’t Shore Up A&E this Winter

And he’s dipping into the NHS petty cash to the tune of £55 million to attempt to stave off winter time A&E collapses in Ealing and West Middlesex Hospitals and in eight other London hospitals. So, yet again the Government/NHS takes money away from funding local healthcare services and with the other hand gives some of it back. And just how can that money-at-short-notice be spent? Probably on hiring private sector nurses, doctors, consultants and healthcare service suppliers on very expensive short term contracts.

But we won’t get much extra help at Ealing Hospital according to the Ealing Gazette. The extra cash for Ealing is only £3 million – much less than the NHS paid McKinsey & Company management consultants to come up with the ‘Shaping A Healthier Future’ plan which will destroy Ealing Hospital. The Gazette also quoted an August 2013 report sizing Ealing Hospital’s A&E staff count at 76 – way below its full complement of 106 staff. According to a BBC5 FOI request A&E understaffing is on average 10% – so Ealing Hospital A&E staffing is worse than most.

However at the Ealing Hospital Trust Board Meeting on 26 September the HR Director assured Ealing Trades Council Save Our NHS Campaign observers that there were no problems in recruiting staff to Ealing Hospital. Campaigners also raised issues of patient safety, merger, service and equipment removal and lack of community engagement. Active Chief Executive David McVittie  agreed to meet the campaigners at a separate meeting to answer all of our questions.

Ealing Council Reject or Ignore Any Assistance Offered by Local Activist Groups and Expert Clinicians in Fight to Save Ealing Hospital

Just what is it about Ealing Council that seemingly makes it unable to work in collaboration with local activists, NHS experts and concerned and knowledgeable clinicians?

I have read over 10 excellent Independent Review Panel submissions written by activists, NHS experts and clinicians. On 31 August 2013 Ealing TUC Save Our Hospitals group sent many of these IRP submissions to the Ealing Council Cabinet Healthcare portfolio holder, Councillor Patricia Walker. Not so much as an acknowledgement has yet been forthcoming.

A local clinician has compiled some very compelling treatment inequality data – for which he is an acknowledged practising expert.  However hard he tries, Ealing Council’s in-house and external experts do not even want to discuss this ‘new’ avenue of approach to save Ealing Hospital.

ECCG’s Dr Parmar is Again a No Show as 100+ Turn Up to Hear and Question Her at Ealing Town Hall

Seniors Action Group Ealing organised an event on 11 September 2013 to discuss changes in our health services. 100+ turned up to quiz Ealing Clinical Commissioning Group (ECCG) Chair Dr Mohini Parmar but she failed to show up – much like she failed to turn up at organised public events in 2012 on 26 September and on 11 October.

Ursula Gallagher, Borough Director NHS, Ealing filled in. She boldly announced that she did not know much about the current healthcare situation in Ealing as she had been away from Ealing for a year. We also had a weak presentation about the toothless Healthwatch Ealing body.

Dr Kaur, Interim Director Public Health, Ealing spoke about stroke and heart attack care service improvements brought about by centralisation of care. Impressive – but these attacks are only 3% of the A&E inflow. So it’s somewhat irrelevant to the audience’s main issue which was Ealing Hospital decimation of A&E, Maternity and Paediatrics.

The quality of the event came from the angry patients and carers in the audience. Questions there were many, but factual answers there were few. The NHS representative was clearly not aware of NHS’s Dr Mark Spencer’s public statements of demolition and home building plans on the Ealing Hospital site.

There was real emotion and anger from the floor concerning the proposed closure of the successful and well liked Clayponds Hospital.

I asked for details on how many of the 79 Ealing GP surgeries had signed up to provide mental health primary care services. I asked how many of the 207 GPs in Ealing had received mental health primary care training this summer as promised to us in July. The ever smiling Ms Gallagher supplied no answers.

ECCG Refuses to Answer Questions

On 12 August 2013 I sent the letter detailed below to the Chair of ECCG. Over six weeks later and no answer has been forthcoming:

“Dear Dr Parmar,

Belated thanks for your letter to me dated 11 March 2013. I have enclosed a copy of your letter.

1. In 2.in your reply the fact that ECCG/NHS England allows Governing Body members to have shares in Harmoni/Care UK and in other private healthcare suppliers is deplorable. Still with 70 MPs and 120 Peers in the House of Lords having direct or indirect financial interests in the private healthcare industry I suppose you are in good (bad) company.

2. In 3. in your letter you say that ‘the majority of Ealing GPs supported clinical change’. Where is the evidence for this? How many of the 208 Ealing GPs voted for the SAHF proposals?

3. In 4. you talk about ‘an Out of Hospital Strategy’ that we have shared with you’. I am really not aware that you have shared that with me. Please resend it to me.

4. I note that ECCG has now been a statutory organisation responsible for commissioning some 60% of NHS healthcare in Ealing for over three months. I have attended one ECCG Governing Body (GB) meeting and studied the documentation provided at this and other GB meetings. For the absolute lay people these documents are mostly unintelligible. This is unhelpful and does nothing to promote understanding and transparency with regards to the activities and performance of ECCG. Might I suggest that ECCG creates and maintains a glossary of the many acronyms used in the reports. Also the average person in the street cannot understand terms like ‘underspend’, ‘overspend’, ‘adverse’, ‘favourable’, up arrows, down arrows and horizontal arrows. Graphs are fine but  when it’s not obvious what downward travel or upward travel actually means then no universal ‘communication’ is taking place.

5. Can you explain what the £77,000 budget is for ‘Chair and Lay Members’. Is it fees and expenses? In which case what fees and expenses?

6. How can ‘Shaping A Healthier Future’ be ‘making progress’ when four of the hospitals being proposed for downsizing are subject to IRP examination and Ealing Council is pursuing a Judicial Review of the SAHF process and proposals.?

7. In an age of financial austerity how can the ECCG possibly justify an annual spend of £105,000 on ‘Communications and Public Relations’? To rub salt into the wound Month 3 figures show an overspend/deficit of £10,000.

8. Which clinical contracts were transferred to ECCG under Section 300-302 of the Health & Social Care Act 2012?

9. Which services are coming to an end over the next six months? What process does ECCG intend to follow to re-commission these service?

10. Is ECCG considering alternatives to competition, including:

+  a ‘single tender action’ on the basis that there is only one provider ‘capable’ of delivering the service

+ adjusting an existing contract with a provider

Yours sincerely,

Eric Leach”

Dr Spencer, Now a NHS England Big Wig, Attacks Resident ‘Inaccuracies’ on Ealing Gazette’s Letter Page

Here’s my reply:

Dear Sir/Madam,

“Dr Spencer was the medical architect of the ‘Shaping A Healthier Future’ (SAHF) plan. He no longer works locally as he recently became Associate Medical Director for Service Design and Quality, NHS England. The SAHF plan, which cost £7 million, will eliminate A&E, Maternity and Paediatrics at Ealing Hospital. His 13 September 2013 letter published by you attacks my 6 September published letter on the basis of ‘inaccuracies’. Oh dear….

Why is it that Dr Spencer appears to be the lone voice praising SAHF on these pages? No local residents, consultants, nurses, GPs or surgeons seem moved to write in support of SAHF. Five Ealing residents have recently graced these pages with SAHF criticisms.

Dr Spencer has himself said at public meetings that there will be closure and demolition on the Ealing Hospital site.

Engagement by local stakeholders during the formative stage of plan making is what was and is needed. This did not happen with SAHF. I have interviewed attendees at two if the early NHS NW London SAHF gatherings at Lords and at Wembley. Ealing residents at these meetings offered to work with the SAHF zealots to produce a plan. One of them suggested that scientific rigour required running a small pilot. He even offered to give up huge amounts of time to help SAHF. All his and every other Ealing residents’ views and suggestions at these meetings were completely ignored. This is not community engagement. It’s not even public consultation. It’s sales and marketing!

Dr Spencer writes he is proposing to ‘move Ealing Hospital A&E’ not to destroy it. Trying to fit Ealing Hospital into Hounslow (West Middlesex Hospital) or into Harrow (Northwick Park Hospital) or into Hillingdon Hospital does indeed destroy local A&E services in Ealing. One wonders whether Dr Spencer passed his Geography O Level or indeed whether he possesses and can interpret a map of West London.

Yours, in sickness and in health,

Eric Leach”

Nurse/Patient Ratios At Dangerous Levels

3,000 nurses surveyed by King’s College London revealed that in 43% of hospital wards nurses had more than eight patients to care for. A series of studies have shown that in wards with this nurse/patient ratio there was an increased risk of patients dying in hospital.

NHS Trusts are desperately trying to recruit more nurses especially abroad as there are no spare indigenous nurses. Nurses from Spain, Portugal and Ireland are being wooed abroad to try and get them to come here and fill up some of the hole left by 5,000 nurses who have lost their jobs since 2010.

The Chartered Institute of Personnel Development recently noted, however, that recruiting more nurses won’t be sufficient if poor management leads to high levels of stress, absence and staff turnover. A lack of investment in training and development is needed along with better use of qualitative anecdotal data from staff.

NHS Salary Differentials Dominated by 13% Rise in Senior Managers’ Pay Since 2009

 The Health and Social Care Information Centre (HSCIC) has announced that the average full time NHS worker was paid on average £29,543 this year. Senior NHS managers were paid on average £75,759 this year. Other average salaries were nurses £30,619, doctors £58,813 and hospital consultants £87,584.

The Guardian has also revealed that a total of 291 NHS staff employed by NHS England earn over £100,000 per year. 62% of these very highly paid individuals are managers. NHS England employs a staggering 6,115 staff to run the NHS. NHS England, an unelected body, has replaced a Government Secretary of State as the body responsible for the day-to-day running of hospital trusts and clinical commissioning groups. It has an annual budget of £96 billion.

The Guardian yet again quotes HSCIC telling us that  in 2012 700 GPs earned more than £200,00/year, with 160 earning over £250,000/year. These figures include income from the NHS and from private practice. Interestingly enough the number of high earning GPs has gone down somewhat compared to 2011. The BMA is saying that falling pay, increased bureaucracy and growing workloads are all contributing to GP shortages. The average salary in the UK in 2012 was £26,500 (ONS).

706 GP Surgeries in England ‘Need to Make Major Improvements’

So says Professor Steve Field the NHS’s first Chief Inspector of Primary Care. He says that too many of the 7,607 GP surgeries in England are not responsive enough to patients’ needs. He’s going to push for seven days a week GP services. Clare Gerada of the Royal College of General Practitioners  was quick to respond to Field’s plans. She branded them as ‘unrealistic’. GPs get just 10% of the total NHS budget and an additional 10,000 more GPs are needed now to cope with current workloads. She wants NHS bosses to employ more carrot and less stick when dealing with GPs

Independent Review Panel (IRP) A&E Closure at Ealing Hospital is Delayed ‘,..until further work has been completed…’

On 30 October 2013 the IRP report on changes to NHS Services in North West London delayed the destruction of Ealing Hospital A&E using these weasel words:

‘The A&E departments at Ealing and Charing Cross hospitals must be sustained until further work to inform a final decision on the future of these two local hospitals has been completed and the alternative services that will provide a safe, high quality urgent emergency care system for local residents are in place’.

So it’s not ‘if’, but ‘when’.

Jeremy Hunt MP, Secretary of State for Health, did not have the bottle to spell this out in Parliament as Ealing MPs Bray, Sharma and Pound successively battered him and demanded clarity.

Appeal Court Overrules the Department of Heath – Lewisham Hospital Wins Yet Again

On 29 October 2013, an Appeal Court Judge rejected the DoH’s appeal against a Judicial Review decision that halted the downgrade of Lewisham Hospital. This was a slap in the face for Health Secretary Jeremy Hunt MP and an expensive waste of tax payers’ money.

Ealing Council Loses Ealing Hospital Judicial Review in the High Court

On 9 October 2013 Mr Justice Mitting in the High Court would not give his permission for Ealing Council to pursue a Judicial Review  against Ealing Hospital downsizing (part of NHS Shaping A Healthier Future – SAHF).

Ealing Council admits that the judge pointed out that alternative proposals to SAHF had been invited, but none had been given by Ealing Council. The judge cited the approval of SAHF by Ealing clinicians, and that the public consultation was not flawed. These two latter statements are just plain wrong and this leads us to believe that this legal judgement was politically driven.

Maybe this outcome was inevitable or maybe Ealing Council argued the wrong case. We will probably never know, as Ealing Council has consistently refrained from open, collaborative working with activist groups or Ealing Hospital staff to fight the destruction of our local hospital.

The decision seems to be one of approving the SAHF process, rather than approving the NHS NW London closures’ decision. This should worry us all very much as many activists have over and over again highlighted multiple flaws in the public consultation process, not to mention the complete absence of any community engagement during the formative phase of plan making.

We now have the ‘verdict’ of the Independent Reconfiguration Panel (IRP). The IRP Chair, Lord Ribeiro, has never voted against his Tory Party’s wishes. When I was giving evidence to the IRP, the questions from and discussions with panel members almost resembled community engagement. How ironic to have community engagement after the SAHF process has finished, rather than before the plan was formulated! I’m reminded of the Queen’s comment during the trial in ‘Alice’s Adventures in Wonderland’ – ‘sentence first – verdict afterwards’.

Now we know that the IRP and Hunt now back the SAHF, we can look forward to the complete demolition of Ealing Hospital. Somewhere amongst the blocks of private flats some kind of new medical facility will be assembled occupying just 4% of the site that for 34 years housed Ealing Hospital.

Ealing Hospital

Four Ealing residents and patients attended the Ealing Hospital Trust (EHT) Board Meeting on 26 September 2013 as observers. There is no permanent Ealing Hospital boss. However the Acting Chief Executive Officer, David McVittie, attempted to answer some of our questions in public and then offered us a separate meeting with him. Unfortunately, because of his holiday arrangements, this meeting will not take place until 7 November 2013.

The questions and issues we will be quizzing him on include those concerning privatisation, staffing, the attempted merger of the Ealing Hospital NHS Trust with the North West London Hospitals Trust (which includes Northwick Park Hospital), out of hospital services, risk analysis, Foundation Trust aspirations and finance. Mr McVittie is apparently in a difficult conflict of interest position with regard to the merger machinations, as he is the CEO of Northwick Park Hospital, as well as the Acting CEO of Ealing Hospital.

Ealing Hospital NHS Trust is forecasting a £8.9 million deficit for this financial year. Monitor, the NHS regulator, will only grant Foundation Trust status to those Trusts which the Care Quality Commission say are providing good quality care. Foundation Trust status allows NHS staff and facilities to be used by private patients to generate income for the Trust.

All these confusing references to ‘Trust’ are ironic as it’s trust in the future of the NHS which millions of us in England no longer have.

I, like thousands of other Ealing residents and patients, want the retention of District Hospital status for our local hospital – Ealing Hospital.

Dr Mark Spencer Promises What He Can’t Deliver, Reshapes Local NHS Healthcare On the Fly and Voices Unsupported Opinions  

On 24 September 2012 Dr Spencer, at a public meeting in West Ealing chaired by Eric Leach, promised to identify two West Ealing GPs who supported the SAHF proposals. Some eight months later after lots of chasing no such individuals have been named.

Dr Spencer emailed Colin Standfield on 25 October 2013 in connection to loss of Obstetric services at Ealing Hospital ‘…Chelsea and Westminster (Hospital) are online to open their expanded maternity services in December.’ This will be of little comfort to pregnant women in Southall when Obstetrics at Ealing Hospital is destroyed. Colin also points out that the CQC rates Chelsea and Westminster Hospital as overall a riskier hospital to attend than Ealing Hospital.

On BBC London News on 30 October 2013, Spencer said ‘there will be smaller A&Es at Ealing and Charing Cross, (but) they’re unlikely to take blue flashing lights’. A ‘smaller A&E has no defined existence anywhere in the NHS. Did Spencer just make this up on the spur of the moment?

Spencer also comes up with opinions unsupported by any evidence. He states   ‘We know that maternal deaths are most common in the early hours and at weekends.’ Standfield is Chair of Ealing SOS campaign and an established and respected medical research analyst. He spent five days searching for data to back up Spencer’s claims. He looked at data collected in the UK, Guyana, India, Canada, New Zealand as well as in worldwide UN studies. He found no supportive data. The key research report/body in the UK CEMACH/CMACE also failed to support the Spencer assertion.

Dr Spencer MBBS, FRCGP, DRCOG, is the Medical Director, Quality and Service Design, NHS England (London). Worrying isn’t it?

Hospitals and Clinical Units with Insufficient Staff Should be Closed Down Says Robert Francis QC

Robert Francis, the author of the hugely damning NHS Mid Staffordshire Hospital scandal report, believes there is an intimate link between staff numbers and care standards. So much so that units with too few nurses and doctors should be closed down. On that basis Ealing Hosptial A&E in August 2013 with only 76 out of 106 staff should almost certainly have been closed down.

Further, Mr Francis believes that the arguments for legally mandated ‘safe staffing’ ratios, supported by Labour and the Royal College of Nursing – but rejected by Jeremy Hunt MP – are persuasive.

He has also re-iterated his concern that Mr Hunt seems unwilling to introduce some of Francis’ far reaching proposal, such as introducing a duty of candour on individual NHS staff.

After looking at the NHS for three and a half years he has found that  willing staff often lack the support to do their job and feel under valued in what they can do. (‘The Guardian’ 9 October 2013). The Department of Health’s final response to the Francis Report is due later this month.

Jeremy Hunt Wants GPs To Break The Law and Work More Than 48 Hours per Week

The working convention in England for many decades has been to work five days a week and not to work at weekends. The current European Working Time Directive (EWTD) allows GPs to work over nine hours per day Monday to Friday. Those really are quite long days and where some GPs are seeing 60 patients per day even most fit GPs will be tired come Saturday each week. One of the legal solutions to these long hours is the hiring of more GPs. Mr Hunt’s solution is apparently looking at ways the EWTD can be circumvented or in fact changed.

NHS Regulator Mouths Off About The Wonders of Cheap Mexican and Indian Healthcare Services Such As Cataract Surgery and Orthopaedic Services

‘The Guardian’ of 10 October 2013 quotes David Bennett, Monitor’s Chief Executive, as saying that NHS services could be provided at much lower cost by the NHS employing Mexican and Indian private healthcare companies.

These comments seem inappropriate from the person running a body which is the health services ‘referee’ existing to make sure all participants play by the rules and act fairly.

Most of his other comments were about costs and not about how enforcing the ‘rules’ would bring about better clinical outcomes for more and more people. Reducing the number of hospital beds, closing hospitals, introducing private healthcare companies, shifting patients into their community (and into their bedrooms) seem to be Monitor’s raison d’etre.

Is Serco Fit For Purpose? Are Some NHS Contracts Fit for Purpose?

Why, oh why, should Serco be allowed to subcontract an NHS  service contract to another organisation? Serco won a contract in Devon to provide out-of-hours GP services, but now (for whatever reason) it wants to subcontract this service to another organisation. For starters, private contractors should not be allowed to subcontract at all. Accountability goes out of the window and service fragmentation is almost inevitable.

And why Serco anyway? Serco was found by ‘The Guardian’ to have falsified its GP out-of-hours performance data when reporting to an NHS Trust in Cornwall. Serco won this contract on cost. However it was caught out as unsafe and, on one occasion, had only one GP on duty over night to cover the whole of Cornwall.

GP Surgeries ‘Open All Hours’ is Pie In The Sky

One does wonder sometimes whether David Cameron was actually listening in his basic arithmetic classes at Eton College. The Royal College of GPs (RCGP) tells us we need 10,000 more GPs to cope with rising demands. RCGP also informs us that GPs as well as working in their surgeries are also looking after patients in Urgent Care Centres and walk-in clinics and through 111, NHS Direct and out-of-hours providers. So how exactly can any surgery provide an 8am to 8pm service seven days a week as Cameron trumpeted at the Tory Party Conference in Manchester? An even more extraordinary trick would be for the 18 one person GP Surgeries in Ealing to provide this 12 hour every day Primary Care service!

Of the 9,305 GP Surgeries in England only 100 are open on Saturdays and Sundays. 1,439 are open on Saturdays.

The £50 million Cameron pledged to pay for nine 12 hour/7 days a week GP Surgery pilots has been stolen from another part of the healthcare budget and is not ‘new’ money.

We rate very poorly worldwide on our patient-doctor ratio in England. It’s 440:1, and that places us 37th in the world. In Cuba it’s 170:1, in the US it’s 390:1 and in Ireland it’s 360:1. Our medical schools are full to bursting with 10 students applying for every place.

The Government/NHS seems to revel in beating up GPs. How this helps to persuade medical students to go into general practice in England, rather than into hospitals here and abroad, is hard to fathom.

What Do We Want from Our NHS?

When we feel unwell we need rapid access to free expert triage, advice, diagnosis, prognosis, treatment and after-care. Face to face is better than telephone, email, texting or Internet. Using legacy NHS structures this means access to a GP close by and access to a local District General Hospital. It also means access to responsive telephone, email and texting services staffed by clinicians.

It’s not rocket science is it?

NHS England London Region Plans for £4 Billion Additional Cuts

This new regional body, which has replaced NHS London, is already talking about present NHS services in London being ‘unsustainable’. It is proposing future additional cuts of £4 Billion throughout London by 2020. More on this at www.peoplesinquiry.org

The Two Faces of Hunt

‘Stop rejecting complaints by patients…’ says Hunt:

+ Over 60,000 patients complain in writing about plans to close Ealing Hospital A&E, Maternity and Paediatric units. So what does TwoFace do? He’s closing down these hospital units

+ Over 20,000 complain in the streets of Lewisham about plans to close Lewisham Hospital’s A&E, Intensive Care and Maternity units. What does TwoFace do? He’s changing the law so he can close down these units at Lewisham Hospital.

+ ‘Ealing Hospital A&E will not close’ says TwoFace in the House of Commons on 30 October 2013. IRP report of 30 October 2013 accepted by Hunt states, in effect, that after ‘further work’ including setting up ‘alternative services’ – A&E will close.

£22.7 Billion Set Aside by NHS to Cover Medical Negligence Lawsuits

The NHS 2013/14 budget provision for medical negligence is a staggering 22% of the whole NHS budget for England. With this money over one million nurses could be hired. Some individual payouts are over £1 million.

Competition Champion To Take Over NHS England

Simon Stevens, currently President of the largest US healthcare company UnitedHealth in Minneapolis, will replace David Nicholson as NHS England supremo in April 2014. He’s 47 years old, born in Birmingham and a former Labour Councillor

Stevens, a former advisor to Tony Blair from 1997 to 2001, is a fan of Free School zealot Michael Gove MP. Ominously he drove the introduction of independent private sector healthcare suppliers into the NHS under New Labour.

UnitedHealth must be heart broken to lose him. Maybe he will find some way to connect with his former senior executive chums in his new role…..

CQC Rates NHS Northwick Park, Central Middlesex  and West Middlesex Hospitals as At Risk of Poor Quality Care

The Care Quality Commission (CQC) exists ‘..to make sure hospitals, care homes, dental and GP services and all other care services in England provide effective, compassionate and high quality care’.

CQC in October 2013 rated NHS Trusts from 1 to 6. 1 = high risk of poor quality care and 6 = very low risk of poor quality care. Northwick Park, Central Middlesex and West Middlesex Hospitals are rated at 2 i.e  at risk of poor quality care. Hillingdon Hospital is rated at 6 i.e with a very low risk of poor quality care. Ealing Hospital is rated as neither high nor low risk at 3.

BMI Hospitals Is Over £2.2 Billion In Debt and Unhappy with  Competition Commission’s Assertions of Exercising Market Power and Making Excess Profits at Patients’ Expense

‘The Times’ of 19 August 2013 reported on the financial and regulatory ‘health’ of BMI Hospitals, which owns and manages 69 private British hospitals. BMI’s property company has debts of over £2.1 billion on properties which have dropped in value to £1.45 billion from £1.8 billion. BMI’s operating company has debts of £145 million.

BMI was also investigated by the Competition Commission for allegedly carving up the country into local monopolies. The other companies also investigated were Spire, Ramsey, HCA and Nuffield. The investigation was sparked off, in part, by new private healthcare ‘player’ Circle Healthcare in effect complaining that established private healthcare ‘players’ were making it difficult for Circle to join the game.

The Commission published its report on 28 August 2013 and found that most patients in UK private hospitals are paying more than they should for treatment because of a lack of local competition. BMI, Spire and HCA have been ‘earning substantially and persistently in excess of the cost of capital’. 20 hospitals in 11 locations owned by these three private hospital groups will have to be sold by them. The Commission estimates patients were  being overcharged by these three companies by up to £193 each year between 2009 and 2011.

BMI Hospitals is the trading name of General Healthcare Group, itself owned by Netcare and private equity group Apax Partners. Netcare is an investment holding company which manages the largest private health hospital network in South Africa.

Government Takes £20 Billion Out of NHS – and Puts Back £0.5 Billion

Ostensibly to help A&Es which might still exist in the winters of 2013/4 and 2014/5, the Coalition Government – ever aware of the upcoming 2015 General Election – is boasting of giving £0.5 billion to the NHS. As the Coalition Government/NHS is in the process of taking £20 billion out of the NHS this PR farce is pure electioneering.

NHS has Spent £1.4 Billion on Redundancies Since 2010

‘The Daily Mail’ of 28 August 2013 revealed this staggering figure. Other jaw dropping figures are 2,299 staff have been handed six figure ‘golden goodbyes’ with some of them receiving more than £600,000. 20% percent of those made redundant walked straight back into the NHS to take up new positions! Altogether 32,000 managers have been made redundant since 2010. This data was obtained from the Department of Health and the National Audit Office.

With around 4,500 posts in the shiny new world of brand new NHS organisations yet to be filled many, many more millions will be paid out in redundances and recruitment costs.

Jeremy Hunt MP – No Longer Responsible for Supplying a Universal Healthcare Service – Wants GPs to be Responsible for Life and Health

Quoted in ‘The Sunday Times’ of 11 August 2013, Jeremy Hunt says he wants GPs to go back to the days when they checked on vulnerable patients. He clearly means a return to home visits. He also talks about transforming out-of-hospital care. I can’t imagine many existing GPs want the former and it’s unclear certainly in Ealing how and where the latter might be implemented.

GPs are private contractors and are clearly not all ‘biddable’ by the Government/NHS. In fact that has been the case since the NHS was founded 65 years ago.

I can’t find anyone who thinks this is a viable strategy. It will hardly persuade students at medical school to choose to be a General Practitioner in England.

As for hospital services, Hunt wants Consultants to work at night and at weekends. Again this won’t be popular at medical school and as private contractors (again for 65 years) many Consultants will plump for private practice in England or elsewhere. This consequence is probably what Hunt’s ‘handlers’ want anyway.

Hunt also bangs on about sustainability. There is rich irony in this here in West London when it’s his hand which is pushing for the closure of four major hospital A&E departments. Of all these A&E closures, the one at Ealing Hospital in densely populated, expanding and highly deprived Southall is the most unsustainable.

The old chestnut of electronic patient records is on his dance card too. Bill Gates persuaded Tony Blair in 2001 to begin the world’s largest IT screw-up to have online patient records in England by 2005.  This vastly overambitious project (‘NHS Connect’), costed at £12+ billion, was littered with very poor decisions and it petered into oblivion in 2011 having squandered and still squandering around £13 billion. McKinsey, Microsoft, Accenture, BT, CSC and Fujitsu all variously made and lost money in the fiasco. No doubt Hunt wants some other global players to have another go at this search for the unattainable Holy Grail of anywhere, anytime, access to 53.5 million patient records. His deadline for reaching this nirvana is 2018.

Hunt’s comments and ideas on the NHS are about as useful and credible as alleged war criminal Tony Blair’s comments and ideas about peace in the Middle East.

Ealing Council’s Request for a Judicial Review (JR) of NHS NW London’s Proposed Downsizing of Ealing Hospital is Denied

No details are seemingly available on why the JR was refused. Of course Justice Secretary Grayling said in April 2013 that many JRs were  ‘…needlessly holding up building projects’. So maybe it’s a political decision and the Government wants to crack on and demolish Ealing Hospital and get some luxury flats built on the site.

Independent Reconfiguration Panel Evidence Gathering Ends as Developer Announces Plans To Increase Southall’s Official Population by Some 10,000 Residents.

Clearly the biggest losers in the downgrading of Ealing Hospital will be Southall residents. And in the great big wonderful joined up world we live in Berkeley Group is trumpeting building 3,750 new homes in Southall. This development alone (on the old Gas Works site) will raise the official population in Southall by some 10,000 within 15 years. The 2011 population projections estimated that Southall’s population in 2015 would be 84,000. Add maybe 5,000 illegal residents living in sheds in Southall then a population in 2015 of 89,000 emerges. If we then add the new Gas Works site residents we begin to approach 100,000.

Parts of Southall are in the top 5% deprived areas in England in terms of income deprivation, crime and access to housing and services. The incidence of Chronic Heart Disease, Diabetes and Tuberculosis in Southall is very high.

For Ealing generally the semi-destruction of Ealing Hospital is a real backward step. Birth rate in Ealing in 2012 was 81.8 births/1,000 women (15 – 44 years of age) – well above the national average of 65.4 births/1,000. In 2012 there were 28,200 under fives. The loss of well performing Maternity and Paediatric units at Ealing Hospital will seriously adversely affect expectant mothers, babies, toddlers and nursery children in our town.

On the independence front I recently discovered that Chair of the Independent Reconfiguration Panel Lord Ribeiro is an advisor on hospital reorganisation to PriceWaterhouseCoopers. You just couldn’t make this stuff up.

Patricia Hewitt Wants the NHS to Operate in India

Australian born ex-MP Patricia Hewitt is Chair of the UK India Business Council. She told ‘Health Service Journal’ in August 2013 that she wanted many UK NHS, private health companies and charities to operate in India.  

As I understand it, Indian hospitals suffer from staff shortages. So….Indian students come to the highly rated UK medical schools to get qualified. (They have a good chance to gain entry as they pay higher fees than indigenous students). Once qualified some of them return home and treat UK patients who are flown over to India for treatment. It does sound nuts doesn’t it?

Dr Kailish Chard of the BMA told the ‘Daily Mirror’ that he thought the plans were ‘..a huge scandal’. He went on to say that the plans ‘..would mean losing manpower here – which could pose a serious threat to patient safety’.

Ms Hewitt had just a two year spell as Health Secretary but gained fame by being suspended from Parliament when caught asking for £5,000/day to advance commercial clients’ interests at Westminster. Her health sector clients include BUPA, Boots and Cinven the healthcare industry buyout specialists.

Anti-Depressant Prescriptions Reach New High in England in 2012 – Over 50 Million Issued

The Health and Social Care Information Centre has reported that anti-depressant prescription issuing was up 7.5% in 2012. In some towns and cities one adult in six was prescribed anti-depressants in an average month. The North features strongly in those places where medication for depression and anxiety was highest – namely Barnsley, Redcar, Durham, Middlesbrough, Salford and Sunderland.

Dr Mark Spencer of NHS England Attempts and Fails to Rubbish Residents’ Views on Closing Ealing Hospital

Ealing Gazette 16 August printed a letter from Dr Mark Spencer who is one of the leading Ealing Hospital closure protagonists. Dr Spencer attempted to belittle local residents’ letters in the previous week’s issue. Here’s the letter I wrote in response to this:

“Dr Mark Spencer of NHS NW London ‘Shaping a Healthier Future’ (SAHF) fame is somewhat selective with his facts in his 16 August 2013 Ealing Gazette letter.

What is beyond dispute is that A&E, Maternity and Paediatrics units at Ealing Hospital will be closed as part of SAHF. 104 beds will be eliminated 2012 – 2015. The Unite Union publicised the NHS NW London Ealing Hospital tower and three level podium demolition cost of £3 million and land sale value of £9.9 million in August 2012. The major hospital that is Ealing Hospital as we have known it since 1979 will soon close and be demolished.

Dr Spencer does not refute Arthur Breens’ 6,000 job losses – he just passes it off as not part of his bit of the NHS! He also writes about ‘employing more GPs. There are no GP employees in the NHS – they are all private contractors. And the additional weight that healthcare ‘promoter’ Jeremy Hunt MP wants GPs to carry – including night time and weekend working – is unlikely to persuade medical students to plump for General Practice in England.

What NHS NW London never did was engage with the local community. Engagement involves sitting down with residents/patients at the formative stage of plan making. Tell us that money has to be saved and discuss with us ways in which sustainable services can still be provided which will inflict the least damage on the vulnerable, sick, injured and disabled.

‘Ealing GPs are developing plans….’ No they are not. It’s clear from attending Ealing Clinical Commissioning Group public meetings that very few Ealing GPs are involved in local health service policy making or planning. A ‘….£83 million new hospital at Ealing…’ . This is a new figure. The new hospital at Barts in London cost £1 billion and the rebuilt and quite small West Middlesex Hospital cost £125 million in 2002. So £83 million won’t build us very much at all in terms of a major hospital.”

.

Shortage of High Quality Doctors

NHS Consultant Surgeon J. Meirion Thomas writing in ‘The Spectator’ on 17 August 2013 pinpoints the shortage of British trained doctors as an urgent problem to be solved. Each year the General Medical Council registers some 13,000 new doctors.

Of these doctors only 6,071 will come from British medical schools in 2013/14. The other new doctors come from medical schools both inside and outside the EU. Recently many of our new doctors are arriving from Greece, Spain, Italy, Portugal and especially Eastern Europe.

The quality of British medical schools is recognised as being higher than those in many other countries. The advantages of native language skills allied to knowledge of British culture and the NHS itself really do matter. Foreign trained doctors, for example, are up to four times more likely to be suspended or struck off here rather than their UK colleagues.

Most applicants to UK medical schools are rejected despite having the required A Level grades. This is because we don’t have sufficient training places in British medical schools.

So stop spending £billions on complex IT health systems which will probably never work. Stop the planned spending of £billions on HS2 to get folks from Birmingham to London 35 minutes quicker and spend all these £billions on TRAINING MORE BRITISH DOCTORS HERE IN BRITAIN.

Some GPs Are seeing Up to 60 Patients in a Single Day

A poll of GPs carried out by the Royal College of General Practitioners (RCGP) revealed that 80% of GPs said that they had ‘insufficient resources’ to provide high quality patient care. 70% were concerned that patients could face longer waiting times. 47% admitted that they had cut back on the range of services they provide for patients.

Patients/Tax Payers Say ‘Raise Taxes to Fund NHS’

‘The Independent’ of 13 August 2013 reported that global tax and audit giant KPMG had carried out a survey of UK patients about the funding of long-term healthcare. 87% said that Government should pay for long-term healthcare. 82% said that social care should also be funded from the public purse. 54% said they were willing to pay more in tax to meet the cost of care. More than 50% said they had ‘no means of supporting’ their own long-term care.

It will be interesting to see if this issue becomes a battleground for votes in the 2015 General Election.

Facts and Statistics You Won’t Like

+ Number of Cancelled Operations

1998:  12,389

2013:  15,443

+ Number of General and Acute Hospital Beds in England

1997:  138,047

2012:  104,858

+Visits to A&E Lasting Over 4 Hours

Q2 2003:  87.3%

Q2 2011:  95.5%

+ Total Number of Visits to A&E

Q2 2003:  3.21 million

Q2 2011:  3.58 million

+ Shortage of Midwives

May 2010:   Cameron pledges to recruit 3,000 new midwives

April 2013:  Only 1,278 new midwives recruited

+ Shortage of at least 47,000 Nurses and Maybe up to 190,000 Nurses by 2016. (Government Report August 2013)

+ Shortage of 650 A&E consultants (College of Emergency Medicine)

+ Peers and MPs with Financial Interests in Private Healthcare

73 MPs and 147 Peers

(May 2013: www.socialinvestigations.blogspot.co.uk)

+ Since May 2010

4,000 fewer nurses in the NHS.

£2.6 billion taken out of adult social care spending.

£3 billion of NHS funds have been spent on ‘reconfigurations’ under the auspices of the Health & Social Care Act 2012.

500 GP practices have stopped opening in the evening and at weekends.

25% of all NHS Walk-in centres have been closed.

25% of Doctors in New Zealand were trained in the UK.

(Much of the above data has been sourced from ‘Hansard’ and ‘The Spectator’).

Lewisham Hospital Closure Quashed at High Court

On 31 July 2013 Justice Silber found that Secretary of State Jeremy Hunt M.P. had acted unlawfully when he ordered the ‘downgrading’ of  the A&E and Maternity Departments at Lewisham Hospital. The judge quoted the National Health Services Act 2006 as the legislation that made Mr Hunt’s actions illegal.  The idea of one trust bailing out another seems to have been Mr Hunt’s undoing.

BBC TV and national newspaper coverage of the story was almost non-existent.  Apparently the Zimbabwe election and a Top Shop T-shirt showing an illegal image of Rihanna was judged as more important by national news media than the lives potentially saved by keeping Lewisham Hospital’s A&E open.

Mental Health Primary Care Plans for Ealing Cause Uproar

At a poorly publicised and poorly attended West London Mental Health Trust (WLMHT) meeting in Ealing Town Hall on 23 July 2013 mental health primary care plans for Ealing were revealed.

Ealing GP practices are to be financially ‘incentivised’ to offer mental health primary care services.  If they decline this offer, mentally ill patients at those practices will be deprived of primary care services.  WLMHT says that GPs will be given training in mental health primary care ‘this summer’. WLMHT admitted that this training had not yet started.  Only passing reference was made to resourcing challenges. Estimates of cuts to the NHS NW London mental health services are £43 to £54 million by 2015.

The few mental health service users and carers who attended the meeting expressed their disapproval.  Members of the Ealing Clinical Commissioning Group (ECCG) were on hand and they attempted to placate users and carers, but to no avail.  One service user savagely bemoaned the annihilation of the John Connelly Ward secure and successful mental health services at St Bernard’s Hospital.  She clearly had little or no confidence in moving the ‘setting of care’ from a secure, dedicated mental health hospital to GPs’ surgeries and her own front room.  No engagement has been attempted with service users, and the John Connelly Ward users wanted the ward to be re-opened.

This whole farrago exposes one of the flaws in the setting up of the NHS in 1948.  GPs should have been engaged as NHS employees way back then. The spectre in Ealing of GPs  – independent traders – electing not to provide mental health primary care is outrageous and very dangerous.  However, the NHS has no statutory requirements to insist that GPs should provide these services.

What a very worrying shambles.  Why is the NHS so unwilling to engage with its local communities during the formative stages of plan making?

My own experience of GPs and mental health issues is that the majority of GPs are not interested in dealing with mental illness.

Dedicated Government Press Campaign to Destroy our Public NHS?

Never in my lifetime can I remember such a relentless ‘headline’ campaign attacking a public service as the one now taking place on the NHS.  Every day newspapers, radio and TV are dominated by lead stories which expose, embarrass, denigrate or ridicule NHS staff, organisations, performance, outcomes, deaths, care standards, statistics, etc, etc.

No doubt there are regular failures in other public services, such as law and order, public housing, child protection, health and safety, not to mention private health care.  However, those involved in other public service failures must be delighted that they are not being pursued by a dedicated press campaign to expose their failings. When are we going to be asked if we would recommend Ealing Police Station to a friend?

‘Death Rates’ Explained

To quote ‘Private Eye’:

‘The Hospital Standardised Mortality Ratio (HSMR) represents the number by which the deaths in a particular hospital exceed the number that would have occurred if the hospital had had the national death rate for each age, sex and diagnostic group etc. for which adjustments are made.’

HSMR cannot be used to determine precise numbers of deaths.  However, the HSMR can alert managers and regulators to a potential problem or problems.

Sir Bruce Keogh’s review of 14 NHS Trusts with high HSMR rates is seen by many informed observers as being of value.  For the Coalition Government to use the review as a weapon to attack the Labour Party is pathetic. Keogh’s plea for NHS inspections to be carried out by doctors somehow got lost in the political crossfire.

NHS Good News Gets Little or No Coverage and NHS Media Failures Past and Present

Maybe in some ways the crisis is in the media coverage of the NHS and the Government’s public press relations policy to rubbish the public sector NHS services at every opportunity. However:

+ ‘The Guardian’ 20 July 2013 Letters page contains glowing personal experiences at NHS treatment centres including those in Freeman Hospital Newcastle, Barts, Homerton, a Drop In Centre in Sheffield and Kings College Hospital London.

+ As I queued for my appointment this month with the so called Independent Reconfiguration Panel I spoke with a local Paediatrician who was queuing to go in before me. He said Paediatric services at Ealing Hospital had never been better than they are now and it was clear that service needs are growing. The NHS/Government plans to close Paediatrics at Ealing Hospital will have disastrous consequences he said.

+ I’m reading the fascinating but shocking book ‘NHS SOS’. In it are chronicled failure after failure by the BBC and national broadsheet newspapers. These organs failed to report the various moves in the Bill and in Parliament to privatise the NHS and remove the statutory right for the Government to provide a universal health service. These news organisations bought all the garbage about ‘GP led’ Clinical Commissioning Groups and more or less completely missed the looming prospect (now a reality) that 49% of NHS ‘work’ could be private/paid for.

                                    xxxxxxxxxxxxxxxxxxxxxxxxxx

I make no excuse for devoting much of this newsletter issue to the works of the excellent Keep Our NHS Public (KONP) campaign group. KONP was formed in 2005 by the NHS Consultants Association, NHS Support Federation, and Health Emergency.

Keep Our NHS Public (KONP) – www.keepournhspublic.com

I attended the KONP AGM in Central London on Saturday 13 July 2013. It was impressive in every way. 100 people attended from all over England. KONP now has 36 groups established throughout England. Its HQ has paid staff and in 2012 its operations showed a healthy surplus.

Guardian columnist and number one broadsheet newspaper NHS campaigner Polly Toynbee delivered the Keynote Speech. It was packed with useful facts and insightful views. You might hate the Labour Party for kicking off the current Coalition NHS privatisation – she boomed – but surely they could not do a worse job than the Coalition. UKIP won’t make any Parliamentary inroads in 2015 so your least worst option is to support the Labour Party! Single issue save the NHS Parliamentary candidates are unlikely to succeed she says.

Just what are the Department of Health and Jeremy Hunt actually for asked Wendy Savage. Hunt no longer has a statutory duty to provide a universal healthcare service. Is he just there to whinge about how bad the NHS is so that his private healthcare chums can come in and take it over? Polly was positively apoplectic about the failure of the BBC to accurately report what is happening to the NHS and the laziness of BBC journalists to supinely be spoon fed Government propaganda. If you don’t like BBC coverage on NHS matters phone the BBC and complain on 03700 100222.

It was clear from the meeting Q and A that more good work could be carried out by KONP in soliciting and receiving Union grant funding nationally, regionally and locally.

KONP felt it had failed somehow by not being able to kill off Section 75 of the Health and Social Care Act 2012. However successful concerted efforts by many had watered it down so that potential delays and ‘wiggle room’ have been introduced into this open sesame for private healthcare providers.

We have all failed to prevent the damaging and at times absurd introduction of European competition law into NHS processes. Possibly sensible  hospital/service mergers are now being halted/delayed while competition lawyers earn huge fees arguing the case for the glories of competition. Polly Toynbee quoted chapter and verse of the merger of Bournemouth and Poole hospitals now subject to an OFT competition review. Earnings by competition lawyers is £1.67 million so far on this case!

Many fears were expressed about the impending US/EU free trade agreement. If the Transatlantic Trade and Investment Partnership (TTIP) agreement, when signed, includes healthcare services, it will grant transnational corporations rights to access public procurement in England. KONP will lobby heavily to try and gain an exemption for the NHS in the TTIP. It will also lobby for exemption from ‘investor protection’ which allows corporations to sue governments for loss of future profits. TTIP is expected to be signed in November 2014. More information at:

www.opendemocracy.net/ournhs

However KONP did highlight some successes.

The 2013 book ‘NHS SOS’ edited by Jacky Davis and Raymond Tallis was rightly praised. I bought a copy. (ISBN: 978-1-78074-328-8. Publishers Oneworld – www.oneworld-publications.com). The book is both brilliant and disturbing.

The demo about BBC failures and inaccuracies in reporting on the destruction of our NHS outside the BBC in Portland Place caused quite a stir.

Many delegates wanted KONP to remain apolitical.

We all agreed that healthcare and social care must be integrated together.

One Manchester delegate suggested – quite correctly in my view – that KONP should reach out to synergistic campaigning groups like Shelter, Amnesty International, student unions and medical students’ networks.

The Lewisham Hospital campaign had shown us all the power of NHS Staff and residents working together. The 25,000 on the Lewisham march was awesome. However 6,000 nurses have lost their jobs in recent years and many of those remaining in the NHS are nervous or afraid of demonstrating.

Local democracy is under attack. All CCGs have just 5 elected local GPs and 25 paid officials. National democracy is under attack. CCGs report to the new NHS Commissioning Board now renamed NHS England which is directly accountable to no-one in Government.

There was universal agreement on the fact that the vast proportion of the population and huge numbers of NHS staff have little idea of what was actually happening to the NHS.

Jeremy Hunt Says NHS is Failing: If So Then He Must Take the Blame and Be Fired

Thousands have died needlessly apparently at 14 NHS hospitals in 2010 to 2012. Casualty and maternity units at the poorly performing hospitals may close.

All this data appears in a research report from NHS Medical Director Bruce Keogh and was broadcast in Parliament by Health Secretary Jeremy Hunt MP on 17 July. Clearly these NHS failings are happening on his watch and clearly he must be fired.

No doubt we are all assumed to deduce that the key to failing hospitals is to close them down, demolish them and sell the land for residential development (like Ealing Hospital). No doubt altruistic global healthcare companies will step in and offer new casualty services (such as at the BMI Clementine Churchill Private Hospital in Harrow) and new maternity services (such as at the HCA Portland Private Maternity Hospital in Great Portland Street, W1).

The ‘NHS SOS’ book tells us that 70 MPs and 142 Peers in the House of Lords ‘…have a vested interest in the promotion of private healthcare’. So the Right Wing press rubbishing the NHS may be the softening up process before we are all bludgeoned into ‘believing’ that the public sector can’t hack it and it’s time to bring in those wonderfully efficient private healthcare companies…..

Urgent Care Centres are Nothing of the Sort: 44 Medical Conditions Are Excluded

Care UK ( ‘Fulfilling Lives’ is their catchphrase ) advises us that its UCCs (like the one at Ealing Hospital) do not treat:

‘ACS/MI, acute anaphylaxis, actively suicidal/deliberate self harm (not suicidal ideation), acute confusion, alcohol or drug intoxication (likely to need obs), alleged rape (with major injury), children with complex fracture of upper or lower limb likely to require manipulation, complex fractures/pelvic fractures/hip or long bone fractures, colles fracture, collapse state, currently having seizure, CVA/TIA (separate pathway), dental injury (Northwick Park maxfax), Dvt or suspected Dvt, extensive burns, fever with oncology, hematuria post abdominal injury, inhalation of smoke or fumes, mandible dislocation, major head injury, meningitis or suspected meningitis, needle stick injury, overdose, penetrating eye injury, poisoning, pregnancy with persistent vomiting, psychosis, PV bleeding (heavy) ( pregnancy less than 20 weeks to ED and more than 20 weeks to obstetrics), pregnant with abdominal trauma, paediatric white card holders (will go directly to paediatrics), patients with GP referral letter go to speciality direct, renal colon (blood positive on urine dipstick), severe pain (requiring parental analgesia), severe breathing difficulties, shoulder dislocation, Sickle Cell crisis, significant epistaxis, significant haemoptysis/haematemisis, gunshot injury, significant stab wound, unconscious, uncontrollable haemorrhage and unresponsive floppy child’.

So – after Ealing Hospital A&E closes you’ll need to check through this list before rushing yourself or your loved ones for ‘urgent care’ to Ealing Hospital or Northwick Park Hospital or  West Middlesex Hospital or Hillingdon Hospital or where ever else.

Whittington Hospital Plans Ripped Up!

People power appears to have forced the cuts and sell off plans for Whittington Hospital in Camden to be withdrawn and the Board to apologise for coming up with cuts without a clinical plan in place. However local activists say the Board still wants to become a Foundation Trust and ‘transfer hospital services into the community’. Whittington Hospital is also the place that Ealing CCG supremo Rob Larkman disappeared from ‘overnight’ in 2011 when his NHS plans to close A&E and Maternity were rubbished – again by people power.

Camden Council Agree Public Inquiry into Harmoni

Camden Council Health Scrutiny Committee has agreed to set up an inquiry into Care UK’s Harmoni running of North Central London’s Out of Hours GP service. Keep Our NHS Public in Camden proposed the inquiry on the basis of Harmoni failing its CQC inspection and the contract being awarded on price not quality.

Privatising Our Blood

An American private equity firm – Bain Capital – has agreed to pay £200 million for 80% ownership of state-owned Plasma Resources UK, the main blood plasma supplier to the NHS. The deal was roundly condemned by cross-bench peer Lord David Owen who described the deal as ‘the worst possible outcome’. Professor Allyson Pollock, a prominent public health researcher, warned against Bain asset stripping and subjecting our blood supplies to open market economics.

Would You Recommend Your Local Hospital to a Friend?

This is the latest nonsense in ‘consumer tests’ on hospitals.  We don’t have such tests on Police Staions, state schools, Job Centres or Magistrates Courts.  Why is that? Well, it’s probably because it’s political dogma that is driving the Coalition Government to denigrate state healthcare so that it can be wheel in private providers.

Ambulance Chasers are Alive and Well

I visited West Middlesex University Hospital on 23 July 2013. Whilst waiting I glanced at an NHS leaflet on ‘Knee Injury’. Quite useful information. However filling the back page was an advertisement by a firm of solicitors – ‘Had an Injury?….let our super lawyers help you with your claim…’

Words fail me.

Tory Press Exposes NHS Scandal after Scandal – Why?

‘The Daily Mail’, ‘Daily Express’ and ‘The Telegraph’ vie with each other almost every day with horror stories about the NHS today or in the recent past. Nicholson, Stafford, A&E closures, NHS 111, Leeds heart surgery, Morecambe Bay, loss making, Bower, CQC, redacted reports, Furness, whistleblowers, cover-up, Burnham, Lansley….it just goes on and on.

Is the Tory press supporting the Coalition’s recipe for radical changes in the NHS by publicising these shambles?

Well….maybe this is true but as an approach it’s wearing a bit thin as the Tory led Coalition has now  been in power for over three years. NHS institutional and staff failings are of course meat and drink for those right wingers who want to flood the NHS with private healthcare providers.

And Please – Don’t Blame the Patients!

Allegations are also being thrown around every day that patients are visiting A&E when they should be phoning NHS 111, making an appointment with their GP or treating themselves!

I am one of millions of citizens who have paid National Insurance for decades for the £110 billion annual spend on the NHS to care for me for free at the point of service delivery. If I have an in-growing toe nail/heart attack which is giving me pain and I can’t sleep I’ll do whatever I can to gain relief. I may not know about NHS 111 or find can’t get through to them. My out of hours GP may not be available – so I would get myself down to my local A&E WHILE IT STILL EXISTS!

1,500 Whistleblowers Victimised in NHS

The charity Compassion in Care (CiC) reported in June that 1,500 people had lost their jobs or were victimised by trying to expose abuse, cover-up or wrongdoing. ‘Private Eye’ quotes Eileen Chubb of CiC rating both the 1999 Public Interest Disclosure Act and the new Enterprise and Regulatory Reform Act as unfit for purpose in offering any meaningful protection for whistleblowers. See www.compassionincare.com. The campaign group Whistleblowers UK wants a US style ombudsman with specialist lawyers to help those seeking to make public interest disclosures. See www.whistleblowers.uk.com.

Bureaucratic Response to Crises – Public Consultations

If it’s broke then go into public consultations mode seems to be the current response in accident and emergency, and care quality;

+ NHS A&E public consultation till 11 August 2013 – www.england.nhs.uk

+ Care Quality Commission public consultation till 12 August 2013 – www.cqc.org.uk

Private Healthcare Companies Cutting Corners

In 2011 the Organisation for Economic Co-operation and Development (OECD) rated the NHS as one of the best healthcare systems in the world. The NHS Support Federation has been tracking NHS service deterioration in recent years (www.nhscampaign.org). It notes many instances of private healthcare suppliers cutting corners. Currently causing concern are:

+ BMI/Netcare – children’s surgery halted

+ Care UK – failure to process 6,000 x-ray records

+ Carillion – 6 patients fear sight loss

+ Harmoni (Care UK) – out-of-hours service alleged to be ‘unsafe’

+ Netcare – Celia Collet case study of poor care

+ Serco – not enough staff and ‘fiddled’ figures

+ PIP – breast implant scandal

+ Virgin – understaffing at Kings Health Centre

First NHS Performance League Table Published – Branded as ‘Virtually Useless’

On 28 June 2013 the first performance league table for NHS medics was published. 472 Vascular surgeons were the lucky NHS professionals to be the first to rated and ranked. Several surgeons were listed as having the highest crude mortality rates in the country. ‘The Guardian’ quotes that a Simon Payne, a vascular surgeon based at Portsmouth Hospitals, had a ‘death rate of  31% – 10 times the national average and 30 times higher than some of his colleagues’. This rate related to two key vascular operations. Upon contacting Portsmouth Hospitals they told the newspaper that ‘Simon Payne has not carried out that procedure since 2011 after he had a shoulder injury’!

Professor Ben Bridgewater of the Healthcare Quality Improvement Partnership (www.hqip.org.uk) branded these crude estimates as ‘virtually useless’ as they failed to take into account the number of emergency cases, the age of the patients or the complexity of each operation.

A farcical development was that the tables had to be hurriedly re-issued. The new tables lowered the crude mortality figures substantially in many cases.

I await with bated breath the time when Members of  Parliament Performance League Tables are researched and published.

Medical Insurers Alert Competition Commission of Serious Lack of Private Healthcare Competition in Central London

Articles in ‘The Independent’ and ‘The Times’in June 2013 revealed details spilling out of the Competition Commission’s investigation into private healthcare in the UK.

We hear about the unhealthy domineering position of US private health care provider HCA in London. HCA UK apparently caters for about half of all private patients in London and 72% of all critical care in Greater London. It owns the Harley Street Clinic, the Portland Hospital, the Lister Hospital and the London Bridge Hospital. HCA UK also has joint NHS ventures all providing cancer care, renting space from public hospitals for exclusive private treatment at UCH and Queens Hospital Romford. HCA UK’s profits before tax in 2006 were £30 million.  By 2012 this had increased to £61.7 million.

Complaints Against Private Healthcare Providers On The Rise

20,316 grievances against health insurance companies were filed with the FSA last year. This is an increase of 38% over the last two years. BUPA was hit hardest by this increase in complaints. Grievance issues included:

+ Unexpected bills for excess payments after routine operations

+ A limited choice of consultants

+ Poor handling of claims

Private healthcare providers have been under investigation for more than a year since the Office of Fair Trading raised concerns about:

+ Poor transparency

+ Limited competition

+ Alleged cosy deals between insurers and hospital operators

Drug Companies Face Accusations of Overcharging NHS Hundreds of Millions of Pounds

An undercover investigation by ‘The Telegraph’ has resulted in allegations that the buy-in price to the NHS of more than 20,000 drugs could have been artificially inflated, with backhanders paid to chemists who agreed to sell the drugs.

The drugs involved are so called ‘Specials’ which are prescribed when a patient has a clinical need that cannot be met by a normal licensed medicine.

The newspaper investigation was launched after being approached by a whistleblower. The companies named in the allegations include Pharmarama, Temag and Quantum Pharmaceutical.

Jeremy Hunt MP, the Health Secretary, is quoted as having ordered an investigation into the allegations which he finds ‘deeply concerning’. And so he should.

49% of GPs Say They ‘Can No Longer Guarantee Safe Care’

A profoundly worrying survey of family doctors by the Royal College of General Practitioners (RCGP) reveals that 49% of them can’t guarantee safe care and 85% think General Practice is ‘in crisis’. Some GPs are having to deal with 60 patients a day.

General Practice currently receives only 9% of NHS funding, despite family doctors carrying out 90% of all NHS contacts.

Is Atos Fit For Purpose?

‘Private Eye’ in June exposed significant failures of delivery by Atos in the way it is assessing disabled people for the new Personal Independence Payments (PIPs). A year after a £184 million contract was signed just four NHS and four physiotheraphy providers in London /SE England have been signed up to provide assessment centres. What was promised in 2012 was a network of 740 assessment centres across London/SE England operated by 22 NHS and private healthcare providers.

The disabled in London/SE England are now incurring extended journey times travelling to assessment centres for PIP – in some cases totalling 90 minutes.

NHS NW London A&E Closures and the IRP

The so-called Independent Reconfiguration Panel (IRP) has been asked by Secretary of State Jeremy Hunt MP for its opinion on the NHS decision to close 4 of the 9 A&E units in NW London. The units to close are at Ealing, Central Middlesex, Charing Cross and Hammersmith Hospitals. Ealing Council’s Health and Adult Social Services Panel unanimously voted for the referral to the Secretary of State in March 2013.

I am indebted to Colin Standfield’s excellent research on the IRP’s rubber stamping of the NHS NE London’s decision to close the A&E unit at King George Hospital, Goodmayes (Redbridge)

According to ‘Ealing Today’ the IRP review is likely to present its report in September 2013.  The IRP members involved are likely to be past, present and/or future NHS staff or consultants. Some odd kind of independence that.  

IRP’s terms of reference are unlikely to include a phrase like ‘..the wishes of the general public..’. The major ‘test’ is likely to be whether the proposed changes ‘will enable the provision of safe, sustainable and accessible services.’ IRP Chair is Lord Ribeiro who worked as an NHS consultant for 29 years. He was ennobled in 2010 and has only voted once voted against the Government.

Colin recommends that activists persuade groups who did not lobby against the changes during the flawed 2012 consultation to make representations. He also feels that we should all make as much noise as possible about the distortion of the survey results –NHS claiming 17,022 responses when the true figure was about 4,550.  You can call the IRP on 020 7389 8046 and email at info@irpanel.org.uk. There’s also more information at www.ealing.gov.uk/soh

Child Heart Surgery Reform U-Turn

Controversial plans to reform children’s heart surgery have been suspended as the decision was apparently, based on a ‘flawed analysis’. The plan was to concentrate surgery in fewer bigger centres. This involved closing units at Leeds General Infirmary, Glenfield Hospital in Leicester and the Royal Brompton in London. Surgery now continues at these seemingly doomed surgical units. This is convenient for the Leeds unit as a High Court judge recently quashed the NHS decision to stop surgery there.

Informed observers had noted that the seven chosen centres (before the u-turn) were largely located in the western half of England leaving a large swathe of the east, from Newcastle to London, without a child heart surgery centre.

Ealing Clinical Commissioning Group (ECCG) Fails to Impress

I attended the ECCG Governing Body meeting on 22 May 2013. For budget year April 2013 to March 2014, no finalised budget exists. 60% of all NHS patient expenses in Ealing will be processed through the ECCG – a spend of £481million. 27 people sat around a very big table and 20 of them did not say a word.  On performance, red flags exist for cancer screening, meeting A&E targets, mental health referrals to therapies, mixed sex wards, serious incidents at the Imperial College Healthcare Trust, teenage conception rates and child immunisation

rates.

ECCG announced in April 2013 that it would be ‘commissioning or buying health and care services our residents need including elective/planned hospital care (operations), rehabilitation care, urgent and emergency care, community health services, mental health services and learning disability services’.

US/EU Trade Deal Threatens NHS

Ex-NHS doctor and crossbench peer Lord Owen and researcher Linda Kaucher have both recently warned that a US and EU trade deal could lead to unprecedented private sector competition in the NHS. The US/EU Free Trade Agreement will ‘dismantle hurdles to trade in goods, services and investment’ and ‘make regulations and standards compatible on both sides’. So any EU or US company can pitch to the NHS for doing your hip operation or removing that tumour. If foreign multi-nationals feel that they are being excluded from any invitation to tender they will have statutory rights to go to law and complain about it.

It’s no wonder, according to researcher Social Investigations, that over 60 MPs and 142 peers are connected to companies involved with national and international private healthcare companies.

Sir David Nicholson Should Keep His Mouth Shut

Disgraced ‘retiring’ NHS supremo Nicholson – the man recently implicated in the needless deaths of 1,200 patients in Staffordshire – is refusing to go quietly. He blames all the current NHS ills on politicians. He takes credit for putting doctors and nurses in charge of the new NHS. It’s a bit like putting tube drivers and tube maintenance engineers in charge of running London Underground.

More Nicholson screw-ups are coming to light. ‘The Economist’ has just reported that £74 million worth of Tamiflu – the anti-flu drug – has had to be thrown away because the NHS was unsure  whether it had been stored properly. He was also apparently behind spending £60 million in ‘bribes’ to encourage hospitals to adopt ‘hopeless’ IT systems. Mr Nicholson oversaw some £11 billion worth of failed NHS IT systems.

He has also publicly blamed the Treasury for the widespread use of gagging orders by hospitals. In the last seven years some £2 million has been secretly paid out to some 50 staff, some of whom presumably were whistle blowers.

It’s difficult to find any informed observer who believes that the approach taken in the ‘Nicholson Challenge’ (sounds like a reality show or a game show) to secure better value at lower cost is in any way viable or sustainable.  

Methinks Mr Nicholson should shut up, see out his time and then go home and spend more time with his money.

NHS Authorise Bounty Childcare Products Company Sales Staff  to Sell To New Mothers in Postnatal Hospital Wards

The National Childbirth Trust and Dr Margaret McCartney, a Glasgow GP, have both recently expressed anger that some NHS Hospitals allow Bounty sales staff access to new mothers on the ward. Bounty sales staff grill the mothers for their personal details which Bounty sells on to commercial interests. 168 NHS Trusts are being paid up to £5.50 per baby born for this access.  Bounty claims to be the UK’s leading parenting club (whatever that might mean). The company was founded in 1959 by an advertising executive. Bounty runs two web sites, neither of which states whether the company is a charity or for profit. Presumably the company exists purely in the ether as no terrestrial postal address is volunteered anywhere on its web sites.

Dr McCartney is also up in arms about the Royal College of General Practitioners (RCGP). RCGP has apparently endorsed GPs handing out a book of advertisements  called ‘Emma’s Diary’ to pregnant women. The diary contains 119 pages of advertisements and just 25 pages of editorial.

40% Fewer District Nurses Now than in 2003

A recent study by the Royal College of Nursing (RCN) points out that with so many fewer District Nurses patients are stranded in hospitals for days.  The study found a strong link between lengths of stay in hospital and quality of care closer to home. Britain lags behind France, Spain, Ireland, Italy, Norway and Sweden in long stay/community care quality.

Health Secretary Jeremy Hunt MP Attacks GPs and Says ‘It’s All Labour’s Fault’

Acting true to his public relations background Jeremy Hunt is going to extreme lengths to deflect criticism of the stalling NHS revolution away from the Tory-led Coalition Government.  As private healthcare companies sneak into the NHS under the radar, the NHS 111 telephone service failures, the over heated A&E units, the war against GPs and Labour’s changes to GP contracts in 2004 – are all anybody’s fault but the Coalition Tories.

And Now a League Table for Doctors

League tables are scheduled to be published beginning in July 2013 rating NHS doctors on how their patients fared after surgery or treatment. However not all clinicians want to play ball here and 92 surgeons have so far vetoed the publication of ‘their’ data. Jeremy Hunt is now threatening to name and shame these surgeons.

This occasional newsletter is 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 – once the envy of the world’

Launched in 1948 our National Health Service (NHS) pioneered universal healthcare free at the point of delivery and funded by a National Insurance tax. Local doctors, called General Practitioners (GPs), became part of the NHS service, but were never on the NHS payroll as employees. They have always been private contractors. Consultants too would not go on the payroll  and not only were they retained as contractors, they got to use NHS facilities and equipment for treating their private patients.

In recent years over £100 billion has been spent annually to run and maintain the NHS in England. With 250,000 staff the NHS is the second largest workforce on earth (the Chinese Army is the largest).

The changing role of hospitals

The idea of hospitals is 2,500 years old. The first recognised hospital dates back to around 400BC in Sri Lanka. The traditional hospital idea is that it is a dedicated, secure site at which a range of research, testing, treatment, trauma, surgical and caring services are provided. Primary care (i.e. usual first point of patient contact) has traditionally been provided by GPs in England who until recently were not located in hospitals. Private hospitals have traditionally not provided Accident and Emergency (A&E) services.

Now all this is changing. In Ealing Hospital we have GPs with nurses running what is in effect a large General Practice. It’s called an Urgent Care Centre. A&E is closing down at Ealing Hospital and this will also happen at Central Middlesex Hospital. But luckily, and no doubt just by chance, a private Emergency Care Centre has recently opened in nearby Harrow at BMI’s Clementine Churchill Hospital. It’s a ‘self-pay walk in service’.

Sir David Nicholson, Head of the NHS gracelessly retires – but not until March 2014

This is the man who was recently implicated in the needless deaths of up to 1,200 patients at NHS Mid Staffordshire Hospital. Many feel he should have resigned months ago. We’ll still be paying his £211,000 annual salary until March 2014. His public pension pot is rumoured to be around £2 million.

Health and social care grants

Ealing Clinical Commissioning Group (the in-effect re-branded Primary Care Trust) admitted in April 2013 that because it had not finalised its budget, it could not commit to continuing paying health and social care grants beyond September 2013. Because of this a number of local care organisations who are dependent upon these grants are having to organise redundancies.

One does wonder what exactly is going on. The ECCG folks are largely the same people who were running the PCT. The ECCG has been meeting and working on the budget for many months. Just how credible is any organisation is which has not sorted out its budget after the beginning of its financial year?

Lack of Community Engagement Leads to Fury in Hanwell, Ealing as NHS Alcoholic and Drug Addict Recovery Centre Plans are Unveiled.

Some 100 residents and Councillors attended a public meeting on 7 May 2013. Since 1 November 2012 Recovery Intervention Services Ealing (RISE) has been providing drug and alcohol abuse treatment and recovery services .RISE is a consortium led by the charity Crime Reduction Initiatives (CRI). The EACH volunteer group and the NHS North West London Mental Health Trust (CNWL) are also involved.

RISE wants a base in the west of Ealing and has set its sights on The Studios in Cambridge Road, Hanwell. A Planning Application was submitted in January 2013 but it is still ‘Pending’. The application is incompetent in that it states that ‘the property is surrounded by other commercial properties’. This is so far from the truth as to be ludicrous. New flats are immediately to the north and established houses are immediately to the east and south. Some residents were clearly furious about this attempted deception. Other angry parents and residents pointed out that many children walked past The Studios to and from multiple schools. Others were annoyed that there had been no engagement with the local community during the formative stages of planning this drug addict/alcoholic centre. Many attendees made the point that they were aware of the problem and aware of the need for a treatment centre – but not on this site.

The obvious place to locate such a service would be a local, secure hospital site which had excellent public transport facilities. Both Ealing Hospital and St Bernard’s Hospital meet those criteria. However both hospitals are about to be largely demolished and much of the site ‘repurposed’ for housing. Also if this pantomime is an example of NHS NW London’s emerging ‘Out of Hospital’ strategy we are all justified in worrying about it.

Meltdown in A&E and the 111 telephone service?

A&E closed at Newark, Notts two years ago. Since then there has been a 37% rise in death rates (according to ‘The Mail on Sunday’). The FOI-obtained figures come from three NHS Trusts and cover six hospitals.

‘The Independent’ had a leaked letter from NHS leaders at 18 West Midlands Emergency  Departments. Rising numbers of patients have created a ‘state of crisis’ in these Emergency Departments which handle 1.5 million patient attendances each year across a population of 5.36 million.

Nationally an extra million A&E patient attendances were recorded during the period January 2012 to January 2013.

The NHS Direct health advice service referred an extra 120,000 patients to A&E departments in the past year. This happened during a period when NHS Direct staffing levels dropped by 1,200 people. (Facts courtesy of ‘The Observer’). It doesn’t take a genius to appreciate the link between these two facts. Also, of the 143 Trusts that have large A&E units, only 18 have hit the target of treating 95% of patients within four hours.

Three deaths in Derbyshire and the West Midlands are being investigated in connection with the NHS 111 telephone advice service (‘The Telegraph’). The NHS 111 advice service is being progressively rolled out across the country to replace the NHS Direct advice service. Why? NHS 111 employs call handlers who are not clinicians. NHS Direct employed clinicians on the end of the phone. NHS 111 is no doubt much cheaper to run than NHS Direct.  

50% Drop in Trainee Doctors and £500,000 spent annually by each trust

At a Select Committee on Health hearing on 22 May 2013 the College of emergency Medicine reported a 50% shortfall in trainee doctors and consultants.  On average trusts spend £500,000 annually on locums.

NHS NW London A&E Closures

In March 2013 the Secretary of State agreed to refer the decision to close 4 of the 9 A&E departments in NHS NW London.  The Seccretary of State decided to seek advice from the so-called Independent Reconfiguration Panel (IRP) on this.