{"id":1358,"date":"2015-05-14T10:20:00","date_gmt":"2015-05-14T09:20:00","guid":{"rendered":"https:\/\/ealingsaveournhs.org.uk\/?p=1358"},"modified":"2018-04-14T10:21:41","modified_gmt":"2018-04-14T09:21:41","slug":"will-nhs-still-be-centre-stage-after-the-general-election-may-2015","status":"publish","type":"post","link":"https:\/\/ealingsaveournhs.org.uk\/?p=1358","title":{"rendered":"Will NHS Still Be Centre Stage After the General Election? &#8211; May 2015"},"content":{"rendered":"<p><b>Issue: 25 <\/b><\/p>\n<p><b>May 2015<\/b><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">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 \u2013 not revolution.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>Ealing Save Our NHS (ESON)<\/b><\/p>\n<p><span style=\"font-weight: 400;\">For over three years this campaigning group has fought to save Ealing\u2019s hospitals and our NHS from cuts, closures and privatisations. On 30 April 2015 ESON together with Hammersmith\u2019s Save Our Hospitals campaigning group presented a 15,000 signature petition to Health Minister Jeremy Hunt at the Department of Health in Westminster. The signatories want the new Government to suspend plans to close Ealing Hospital Maternity unit, cut 600 beds from Ealing and Charing Cross Hospitals and take away their A&amp;E units.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">See <\/span><a href=\"https:\/\/www.facebook.com\/ealingsaveournhs\"><span style=\"font-weight: 400;\">https:\/\/www.facebook.com\/ealingsaveournhs<\/span><\/a><\/p>\n<p>&nbsp;<\/p>\n<p><b>Will NHS Still Be Centre Stage After the General Election?<\/b><\/p>\n<p><span style=\"font-weight: 400;\">Somehow I doubt it \u2013 whatever the result.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">However, locally politically sensitive healthcare documents and decisions \u2013 no doubt many of them already written and made \u2013 may well enter the public domain after the election. They include:<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ \u00a0The new \u2018Shaping a Healthier Future\u2019 Business Case<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ \u00a0The date of the closure of Ealing Hospital\u2019s Maternity Unit<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ \u00a0The demolition and new build plans for the Ealing Hospital site<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ \u00a0Sir Bruce Keogh\u2019s new definition of a \u2018Modern A&amp;E Unit\u2019 which no doubt will be the blue print of the yet to-be-built new not-really-an-A&amp;E-unit \u2013as-we-know-it on the Ealing Hospital site<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ The McKinsey report on the reasons for the A&amp;E Type-1 chaos in NHS North West London post the September 2014 A&amp;E closures <\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ The final report of the North West London Commission on Health<\/span><\/p>\n<p><span style=\"font-weight: 400;\">+ The fate of Solace, the Bowman\u2019s Close, West Ealing walk-in mental health centre.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>Pressure on A&amp;E Has Not Increased and Is Not Increasing<\/b><\/p>\n<p><span style=\"font-weight: 400;\">Colin Standfield of Save Our Hospitals continues quoting NHS statistics which refute the Coalition Government\u2019s lie that there is increasing pressure on NHS hospital A&amp;E units.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">From November 2010 to March 2015 Type-1 A&amp;E (the most seriously ill) attendances have remained steady \u2013 averaging at 273,388 per week. In fact recently they have dropped below this figure.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">So the recent A&amp;E chaos is not to do with what patients are doing to A&amp;E, it is a result of hospital closures (5 in London alone, 2 of those here in NW London), bed cuts and savage culling of social care, meaning that people cannot be discharged from hospital.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>North West London Commission on Health: Initial Report<\/b><\/p>\n<p><span style=\"font-weight: 400;\">This excellent report, published on 26 March 2015, contains the initial findings of the independent commission chaired by Michael Mansfield QC. The report was written by independent consultants Sean Boyle and Roger Steer. For those of you who may not have the time to read the 119 page report, I have tried below to summarise and highlight the findings which constitute a review of \u2018Shaping a Healthier Future\u2019 (SaHF).<\/span><\/p>\n<p>&nbsp;<\/p>\n<ol>\n<li><span style=\"font-weight: 400;\"> SaHF HISTORY<\/span><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">A McKinsey and Company report to Government in 2009 put forward the view that the NHS spends too much money on acute care and that \u00a3billions could be saved by shifting care from acute hospital settings. NHS boss Nicholson demanded \u00a320 billion savings on NHS costs across England during the period 2009 to 2015.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Out of this came the approach in NHS North West London to save one \u00a3billion by 2015 by downgrading four of the nine major hospitals, moving expensive acute hospital care into cheaper Out of Hospital (OOH) services and primary care, and centralising services at five major hospitals.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">The decision to downgrade four major hospitals \u2013 and close four hospital A&amp;E units &#8211; was taken before any public consultation was undertaken. The report is critical of the consultation as it simplistically asked residents which hospital they wanted downgraded.<\/span><\/p>\n<p>&nbsp;<\/p>\n<ol start=\"2\">\n<li><span style=\"font-weight: 400;\"> ACCESS TO CARE<\/span><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">SaHF offers poor access to care especially for those living in deprived areas. A formal needs assessment for the 1.9 million population is missing from SaHF. What is evident is that SaHF supplied a set of assumptions about what reductions in demand were needed for all SaHF\u2019s pre-determined capacity reductions to work. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">A&amp;E Capacity and Performance<\/span><\/p>\n<p><span style=\"font-weight: 400;\">SaHF claimed that North West London is overprovided with A&amp;E units. The commission could find no data to back up this claim. Authoritative data from multiple sources shows that reducing A&amp;Es from nine to five would create loadings on each of the surviving A&amp;Es which would be 50% more than the national average.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">In North West London over the last four years A&amp;E attendance fell by 26.2 %. Urgent Care Centre usage seems to be the explanation here. A&amp;E performance in North West London has deteriorated since the closure of the A&amp;Es at Hammersmith and Central Middlesex hospitals in September 2014. Type-1 (the most ill patients) performance is the most concerning. For some weeks performance was the worst in England. SaHF is in denial about A&amp;E closures being responsible for this disastrous performance. SaHF refused to release a report on the subject produced by McKinseys.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">OOH Care<\/span><\/p>\n<p><span style=\"font-weight: 400;\">SaHF proposed to transform OOH care &#8211; spending up to \u00a3310 million over five years. All eight Clinical Commissioning Groups (CCGs) provided detailed plans on what they would achieve by March 2015. However there is very little to show what has been actually achieved by this date.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Beds<\/span><\/p>\n<p><span style=\"font-weight: 400;\">SaHF claims there is excess capacity, but it is unclear whether the growth in population has been sufficiently factored into calculations of the number of beds required. <\/span><\/p>\n<p>&nbsp;<\/p>\n<ol start=\"3\">\n<li><span style=\"font-weight: 400;\"> QUALITY OF CARE<\/span><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">SaHF is all for specialisation and centralisation of services. It favours big hospitals. However the commission could find no recent evidence which supports the case for centralisation of acute services.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Maternity<\/span><\/p>\n<p><span style=\"font-weight: 400;\">SaHF\u2019s reason for reducing the number of maternity units is difficulty in recruiting and retaining consultants and midwives at each of the seven sites. SaHF also claims it\u2019s uneconomic to retain Ealing Hospital\u2019s maternity unit. However SaHF has not provided a detailed financial analysis to back up this claim is not available from SaHF. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Emergency Services<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Lots of published papers quoted in the report refute SaHF\u2019s claims for centralisation of services and closure of four A&amp;Es. The commission\u2019s findings are that a much stronger case should have been put forward to justify the closure of one A&amp;E unit \u2013 never mind four!<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">OOH<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The evidence on the impact of OOH services on the demand for acute services does not support the conclusion that five acute units will be able to support the needs of 1.9 million people.<\/span><\/p>\n<p>&nbsp;<\/p>\n<ol start=\"4\">\n<li><span style=\"font-weight: 400;\"> THE BUSINESS CASE<\/span><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Financial considerations are the ultimate driver for SaHF. This section of the report examines the unproven results of OOH expansion, the affordability, risks, uncertainties and deliverability of the SaHF programme. It questions whether the SaHF costs are under control, whether double \u2013counting is going on in SaHF, and whether too little is being spent on our healthcare anyway.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">SaHF cost \u00a362.9 million in 2013\/14, yet NHS NW London enjoyed a cash surplus of \u00a3100.1 million. In 2014\/15 figures are more difficult to source but an overall loss of \u00a314.9 for NHS NWL is identified. (The overall cost of SaHF (2010\/11 to 2017\/18 ) is projected to be \u00a3235.5 million of which \u00a335.43 million is for management consultancy.)<\/span><\/p>\n<p><span style=\"font-weight: 400;\">NHS NWL is apparently in overall balance so why were there two A&amp;E closures in September 2014? This was at a time when it had not been proven that SaHF plans were affordable, deliverable or financed.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">QIPP and SaHF Entanglement<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Possible double counting of cost savings revolve around the NHS Quality, Innovation, Productivity and Prevention (<\/span> <span style=\"font-weight: 400;\">QIPP) programme and SaHF. QIPP may have already succeeded in making the savings needed without recourse to SaHF closures. The Commission thinks it unlikely that QIPP or SaHF programmes will meet the 44.5% savings required by 2020. SaHF\u2019s refusal to release its latest business case makes it impossible to unravel SaHF (and QIPP) projections and savings.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Should More Be Spent on Healthcare?<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Whether you choose money, nurses, doctors or beds as your yardstick the UK has lower numbers than Germany, France and the USA. But in 2009 McKinsey told the Government that the UK had high hospital costs and utilisation costs.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Financial Benefits of SaHF<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In 2012 annual savings by implementing \u00a0SaHF of \u00a3135 million were stated. However the commission has been told that the capital costs have been significantly underestimated, as has population growth. Annual savings might be significantly lower that \u00a3135 and might render SaHF plans unaffordable. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Investment in OOH<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The creation of new and enhanced OOH services should precede any reconfiguration of acute services. There is no evidence of these new or enhanced services. There is no evidence that there are large reductions in acute capacity as a result of extensions to OOH services.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Affordability<\/span><\/p>\n<p><span style=\"font-weight: 400;\">As well as investing \u00a3250 million in OOH services, SaHF needs \u00a3750 invested in acute services. Can NHS NWL afford this? Only a review of the latest SaHF business case might provide clues to this.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Risks<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The report questions whether the SaHF is deliverable. It questions who owns the project \u2013 the NHS Commissioning Board, local CCGs or key local providers? The fact that the programme director has changed several times is not a positive sign. The report highlights many risks \u2013 service planning, safety, quality, business interruption, estates and construction, delay and adverse publicity.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">The report proposes that SaHF develop a more conservative \u2018Do Minimum\u2019 option which would be easier to finance and easier to manage.<\/span><\/p>\n<p>&nbsp;<\/p>\n<ol start=\"5\">\n<li><span style=\"font-weight: 400;\"> A FLAWED PROCESS<\/span><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Framing the Problem<\/span><\/p>\n<p><span style=\"font-weight: 400;\">SaHF came into being during a period of great turbulence in the NHS nationally, regionally and locally. The North West London Strategic Health Authority and Primary Care Trusts were being abolished. CCGs were being created and many hospitals were wrestling with trying to attain Foundation Trust status. There was therefore no stable strategic platform to plan major changes in service delivery.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">The report cites the failure of the \u2018Better Services Better Value 2011\u2019 project in South West London. With many similarities to SaHF the project was abandoned in the face of its unsustainability. The commissioners predict a similar fate for SaHF.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Diagnosing the Problem<\/span><\/p>\n<p><span style=\"font-weight: 400;\">SaHF is based on assertions. These assertions include that only five major hospitals are affordable in North West London and that the need to improve quality of primary care implies there should be a reduction in acute capacity. However the SaHF strategy should have been based on local needs\u2019 assessments, a deep analysis of the nature of the problems and detailed research on costs in the current system.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">SaHF Objectives<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Not \u00a0clearly stated or followed. Why choose A&amp;E services for reconfiguration-based quality improvement? A&amp;E represents a small percentage of healthcare spending. Quality improvements could be made which would not involve a major reconfiguration and a capital spend of \u00a31 billion. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">The Options Appraisal Process<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The commissioners believe too few options were considered by SaHF. Critically a \u2018Do Minimum\u2019 option was not considered. This breaks Treasury guidelines and its absence could lead to SaHF failing to gain Treasury approval.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Public Consultation<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The public in 2012 were not presented with an approved business case. (In fact an approved business case still does not exist). Current plans are much more expensive and the benefits much less that those initially proposed to the public in 2012.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Local Authorities Ignored<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Local authorities have been starved of information and involvement. It\u2019s clear that they have developed doubts as to whether SaHF can deliver what it has promised.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">RECOMMENDATIONS<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The commissioners want the whole SaHF programme to be halted and independent reviews to take place on the September 2014 A&amp;E closures and the planned A&amp;E closures at Charing Cross and Ealing Hospitals. They want the assertion that OOH services can effectively substitute for acute capacity and save money to be reviewed. When the new business case emerges if it is significantly different from the one presented to the public in 2012, then a new public consultation exercise must be mounted.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b>More on the Healthcare Commission<\/b><\/p>\n<p><span style=\"font-weight: 400;\">The fourth public hearing of evidence by the commission will take place at Brent Civic Centre on Saturday 9 May 2015 from 9:30am to 4:30pm. Representatives of SaHF have promised to attend and be interviewed at this event. <\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Health Commission witness statements, hearings, transcripts etc can be viewed at:<\/span><\/p>\n<p><a href=\"http:\/\/www.bpv.org.uk\/the-independent-healthcare-commission\/\"><span style=\"font-weight: 400;\">http:\/\/www.bpv.org.uk\/the-independent-healthcare-commission\/<\/span><\/a><\/p>\n<p>&nbsp;<\/p>\n<p><b>How Seamless and Effective is integrated Healthcare and Social Care in England?<\/b><\/p>\n<p><span style=\"font-weight: 400;\">Not very might well be the answer.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In 2014\/15 there was a 23% annual increase in \u2018delayed transfer of care\u2019 \u2013 306,581 incidents in 2013\/14 and 375,700 incidents in 2014\/15. These transfers are from acute to non-acute (including community and mental health) care and occur when a hospital patient is ready to be transferred but can\u2019t be for one reason or another and is still occupying a hospital bed. These figures suggest that patients\u2019 length of stay in hospitals is rising \u2013 however the most recent data on this is not yet available.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">For patients to be transferred back to their homes engagement with family and friend carers is necessary, as can be nursing and social care staff who can visit the patient at home. NHS district nurses often provide or manage the healthcare needs of those at home. However, during the period 2003 to 2013 there was a 47% reduction in qualified district nurses in England. In 2014 the Royal College of Nursing called for the number of district nurses in England to rise to 10,000 (what it was in 2009). In 2013 there were only 6,700 district nurses and more than a third of them were over 50 years old.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">As for social care provision, this is a Local Authority service. According to the Association of Adult Social Services (ADASS) Government funding for adult social services has dropped by 12% since 2010, whilst demand had risen by 14%. Age UK reported in January 2015 that the number of people receiving meals on wheels had declined by 64% between 2010\/11 and 2013\/14. During the same period those receiving home help for washing and dressing fell by a third and the number of day care places dropped by two-thirds.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Only the vulnerable poor who are assessed as having \u2018substantial\u2019 or \u2018critical\u2019 needs get free social care from Local Authorities. The rest have to pay for social care. Most Local Authorities have sold off the care homes they once owned. In fact of the 430,000 elderly and disabled people who live in care homes only 10% live in those still owned by the NHS or a Local Authority.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">It seems to me that many thousands of care co-ordinators are needed across England to knit together community healthcare and social care. Logic says that they should be employed by the state. However looking at job advertisements for care co-ordinators they have all been placed by private care companies. None of them seem to be NHS vacancies. If elderly people are blocking beds surely pro-active initiatives (research\/co-ordination) by hospital co-ordinators with close family\/friends, the Local Authority, Age UK, District Nurses and care homes might just unblock beds somewhat faster? Or maybe GP surgeries should employ care co-ordinators for their vulnerable, disabled and elderly patients. However Local Authorities, NHS hospitals and GP surgeries will all claim that they cannot afford to employ care co-ordinators.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Which brings us to the \u00a35.3 billion Better Care Fund (BCF) which went \u2018live\u2019 on 1 April 2015. BCF\u2019s original reason for existence was to transform local health and social care services by pooling resources. However it\u2019s still mired in conflict. Local government wants the funds to be used to support adult care services. The NHS wants it to be spent on healthcare. National Government wants it spent on reducing hospital admissions and making \u00a31 billion NHS savings by 31 March 2016.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">For the first time in our history there are over 10 million over 65 year olds in the UK and of these 1.4 million are over 85. The ONS predicts that these figures will rise to 15 million and 4.2 million by 2035. Improving the quantity and quality of healthcare and social care and their integration for the elderly is going to be an even bigger challenge in the future than it is now. <\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Issue: 25 May 2015 &nbsp; 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 \u2013 [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":1243,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_uag_custom_page_level_css":"","_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[],"tags":[],"class_list":["post-1358","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png","uagb_featured_image_src":{"full":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",1024,512,false],"thumbnail":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2-150x150.png",150,150,true],"medium":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2-300x150.png",300,150,true],"medium_large":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2-768x384.png",640,320,true],"large":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2-1024x512.png",640,320,true],"1536x1536":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",1024,512,false],"2048x2048":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",1024,512,false],"td_0x420":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",840,420,false],"td_80x60":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",80,40,false],"td_100x75":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",100,50,false],"td_180x135":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",180,90,false],"td_238x178":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",238,119,false],"td_265x198":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",265,133,false],"td_300x160":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",300,150,false],"td_300x194":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",300,150,false],"td_300x350":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",300,150,false],"td_341x220":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",341,171,false],"td_341x400":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",341,171,false],"td_511x400":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",511,256,false],"td_537x360":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",537,269,false],"td_640x0":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",640,320,false],"td_640x350":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",640,320,false],"td_681x0":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",681,341,false],"td_681x400":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",681,341,false],"td_741x486":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",741,371,false],"td_1021x580":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",1021,511,false],"mailpoet_newsletter_max":["https:\/\/ealingsaveournhs.org.uk\/wp-content\/uploads\/2013\/06\/Traveling-in-London-2.png",1024,512,false]},"uagb_author_info":{"display_name":"Eric Leach","author_link":"https:\/\/ealingsaveournhs.org.uk\/?author=2"},"uagb_comment_info":0,"uagb_excerpt":"Issue: 25 May 2015 &nbsp; 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 \u2013&hellip;","jetpack-related-posts":[],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=\/wp\/v2\/posts\/1358","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1358"}],"version-history":[{"count":1,"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=\/wp\/v2\/posts\/1358\/revisions"}],"predecessor-version":[{"id":1359,"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=\/wp\/v2\/posts\/1358\/revisions\/1359"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=\/wp\/v2\/media\/1243"}],"wp:attachment":[{"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1358"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1358"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ealingsaveournhs.org.uk\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1358"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}