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Issue: 41 <\/b><\/p>\n
October 2016<\/b><\/p>\n
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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>\n The Ealing STP Now Appears, But It\u2019s Called \u2018Ealing local plans\u2019<\/b><\/p>\n On 29 September 2016 I first got to see the Ealing Sustainability and Transformation Plan (STP). I and many others have been searching for it for many weeks. The purpose of the plan is presumably to describe how, when and where future less costly healthcare and social care services will be delivered in Ealing – 2016 to 2021. This plan was submitted to NHS England (NHSE) on or before 30 June 2016. The somewhat oddly titled document displays two logos on its front cover. Neither of these logos belong to the NW London Footprint (our regional STP body) or the London Borough of Ealing (LBE) (our local commissioner of social care services). Clearly LBE has no \u2018ownership\u2019 of this document or its contents. The Ealing Clinical Commissioning Group (ECCG) logo appears along with a new one on me, \u2018Living Well in Ealing\u2019. Google cannot locate the existence or mission of this enterprise. \u00a0<\/span><\/p>\n <\/p>\n I defy anyone to find the Ealing STP on the ECCG web site.<\/span><\/p>\n <\/p>\n However the convoluted URL below will link you to its secret location:<\/span><\/p>\n www.ealingccg.nhs.uk\/media\/33990\/ealing_ccg_local_plan_working_document_2016_.pdf<\/span><\/p>\n <\/p>\n Here follow my initial comments and observations on this ten page, but 5,500 word, document:<\/span><\/p>\n <\/p>\n Readability<\/b><\/p>\n The document is very difficult to read<\/span>. <\/b>Most of the text is rendered in a tiny type size. Some of the text is presented vertically, not horizontally. The text appears against a coloured background. Why could it not have been rendered in a \u2018normal\u2019 12\/14 point type size, all of it horizontal, all black text against a white background over 30 pages?<\/span><\/p>\n <\/p>\n Understandability<\/b><\/p>\n I counted 20 unexplained acronyms, with no supporting glossary. <\/span><\/p>\n <\/p>\n Viability<\/b><\/p>\n Presumably this document purports to be a freestanding proposal outlining five years of care service changes for over 300,000 people across 21 square miles. If this is the case then where are the pointers towards any evidence to justify and support these changes?<\/span><\/p>\n <\/p>\n According to the STP there\u2019s clearly an enormous amount of work scheduled to be completed by 31 March 2017. In the coming six months are there really the resources and cash available to successfully complete this work? Also there\u2019s no hope of any successful outcomes unless those paying for the changes and new services (National Insurance payers) are fully involved in planning and implementation. With just three weeks to go before the final draft is submitted to NHSE, this involvement, if it even happens, will be too little, too late.<\/span><\/p>\n <\/p>\n Is It Appropriate?<\/b><\/p>\n This plan is not written for patients or users of social services in Ealing. It is not written from a service user\u2019s perspective. If it were it would explain in jargon-free or in a jargon-explaining fashion something along the lines of the following:<\/span><\/p>\n What is going to change and why and when with regard to my GP, our local hospital, ambulance services, my local pharmacist, and physical and mental healthcare and social care for mothers, children, adults and the elderly.<\/span><\/i><\/p>\n <\/p>\n Cost Cutting?<\/b><\/p>\n STP is about significant cutting costs over the next five years. If \u00a31.3 billion has to be saved across the eight \u00a0NW London boroughs by 2021 then pro rata in Ealing the cost savings must be \u00a3162.5 million. However there are no financial details whatsoever in this document. I find this unfathomable. Why not tell the truth about why all these changes are about to be made?<\/span><\/p>\n <\/p>\n Ealing Hospital<\/b><\/p>\n There is no information on the facilities to be provided at the hospital over the next five years. The 2012 \u2018Shaping a Healthier Future\u2019 (SaHF) plans were to demolish the Major Hospital and replace it with a new Local Hospital on the site. Is this no longer the plan \u2013 or is there another secret plan?<\/span><\/p>\n <\/p>\n Hospital Beds<\/b><\/p>\n There is no information on reduction of hospital\/acute beds. Earlier NW London STP plans and rumours quoted bed reductions of variously 500 and 592. Will there be no reduction in local Hospital\/Acute beds? Or is there another secret plan?<\/span><\/p>\n Mental Health<\/b><\/p>\n There\u2019s no mention of the emerging \u2018Ealing Mental Health Strategy\u2019. There\u2019s also clearly, currently a mental health epidemic among girls and young women. Two recent authoritative national surveys lead us to believe that 4,800 14 year old girls and 5,000 16 to 24 year old young women in Ealing have significant mental health problems. There is no reference to resources and new processes to help these women or in fact to any contingency planning for epidemics in Ealing.<\/span><\/p>\n <\/p>\n On page 7 this statement appears:<\/span><\/p>\n \u2018Development of local mental health tariffs\u2019<\/span><\/p>\n Tariff means paying a tax. Who pays? Is it the service user?<\/span><\/p>\n <\/p>\n Southall and Areas of High Deprivation<\/b><\/p>\n The most deprived areas in Ealing are in Southall. Southall is mentioned once in the document. There do not appear to be any special provisions, local facilities or service developments in\/for areas of high deprivation.<\/span><\/p>\n <\/p>\n Social Care<\/b><\/p>\n There is not much in the document explicitly about social care. It\u2019s by no means clear how healthcare, free at the point of use, and means tested social care will be integrated throughout Ealing.<\/span><\/p>\n <\/p>\n On page 7 this statement appears:<\/span><\/p>\n \u2018Joined development of social care market development\u2019.<\/span><\/p>\n I know what each of the seven words mean but put together in this way I have not the faintest idea what they mean.<\/span><\/p>\n <\/p>\n Accountable Care Partnerships (ACPs)<\/b><\/p>\n ACPs will be the care delivery vehicle for all care services in Ealing probably by 2021. There will be five ACPs in NW London, each of them a 10 year fixed price contracts. NHS bodies, Local Authorities, and possibly private care companies and care charities will join together in consortia\/networks which will bind them together legally. ACPs will provide specific care for specific populations of between 500,000 and one million people. ACPs will be the main vehicle for cost cutting. Not to spell all this out in the Ealing STP (and the NW London STP) is disgraceful.<\/span><\/p>\n <\/p>\n Ealing\u2019s STP identifies three of the five NW London ACPs \u2013 revamped Primary Care services, Long Term Conditions\u2019 management, and prevention\/self help services.<\/span><\/p>\n <\/p>\n Seven Day Working<\/b><\/p>\n No details on how this will be achieved in Ealing.<\/span><\/p>\n <\/p>\n Staff Levels Now and Over the Next Five Years<\/b><\/p>\n Virtually no details on this. No reference to whether and when the well known shortages of staff will be made up or perhaps made worse\u2026.nurses, doctors, GPs, Psychologists, District Nurses, Paediatricians, Health Visitors etc, etc. However by 31 March 2017 we will have 400 Social Workers in Ealing which I can only presume is an increase on today\u2019s number.<\/span><\/p>\n <\/p>\n \u2018<\/span>Strong Public and Partner Engagement\u2019<\/b><\/p>\n This what is stated on page 2. \u2018Engagement\u2019 is qualitative and takes place during the formative process of plan making. It\u2019s clear that over the last eight months ECCG and LBE have been engaging. However I know of no Ealing citizen who has been engaged by ECCG\/LBE in any meaningful way in the creation of the draft Ealing STP. Asking handfuls of Ealing residents about their aspirations for care service improvements \u00a0\u2013 especially after the 30 June draft had been submitted \u2013 is and was a futile, \u2018box-ticking\u2019 exercise.<\/span><\/p>\n <\/p>\n What Might Ealing STP Success or Failure Look Like?<\/b><\/p>\n If the 2012 NW London SaHF project is anything to go by the Ealing STP is unlikely to be implemented on time or in full. SaHF was a cost cutting failure and the Ealing STP may similarly fail to attain its (secret) cost cutting targets. However if its cost cutting targets were to be attained there\u2019s a real possibility that achieving this would entail staff cuts, reduced levels of service and facility closures. What this might almost certainly mean would be increased pain and hardship especially for the deprived in our town.<\/span><\/p>\n <\/p>\n Appalling STP Public Meeting in Brent on 26 September 2016<\/b><\/p>\n I attended this STP public meeting which was organised by Brent Council and Brent Clinical Commissioning Group (CCG). Two of the five North West London \u2018Footprint\u2019 bosses spoke at the meeting. They were Carolyn Downs, Chief Executive of Brent Council and Local Authority STP lead in NW London, and ex-advertising executive Rob Larkman who is Chief Officer for Brent, Harrow and Hillingdon CCGs.<\/span><\/p>\n <\/p>\n The STP aspirations were summarized as closing the \u2018gaps\u2019 in health and wellbeing, care and quality, and finance and efficiency. Ways to close these gaps will be prevention, self-help, more home care and less hospital care. Also care for those with long term conditions, and for old and mentally ill people would be improved.<\/span><\/p>\n <\/p>\n What was sadly missing in the presentations was detail on:<\/span><\/p>\n + The Brent STP<\/span><\/p>\n + How the Brent STP relates to the NW London STP<\/span><\/p>\n + Five years of cost cutting <\/span><\/p>\n + Loss of 500+ beds<\/span><\/p>\n + Changes to access to GPs<\/span><\/p>\n + How integrating healthcare and social care will be implemented<\/span><\/p>\n + Seven day working<\/span><\/p>\n + Care staffing levels <\/span><\/p>\n + Any mention of Accountable Care Partnerships (ACPs) \u2013 the future delivery vehicle for all care services and cost cutting<\/span><\/p>\n + Evidence to support the STP.<\/span><\/p>\n <\/p>\n No-one will ever argue with efforts to improve healthcare and social care. However it\u2019s quite clear that many who spoke in the audience had serious doubts as to whether the money, staff and facilities would be available to make improvements. <\/span><\/p>\n <\/p>\n Carolyn Downs seemed surprisingly ignorant about the national STP dimension. She stated that just two STPs out of 44 nationally had been published. In fact seven regional STPs have been published. It was news to me that when the initial STP submission was made by NW London each of the eight CCGs\/Local Authorities submitted their own STPs. Given that Ealing and Hammersmith & Fulham Councils failed to sign up to the NWL STP, one could only wonder at the time what these local STPs actually contained. \u00a0<\/span><\/p>\n <\/p>\n In the Q&A the issue of ACPs was raised twice. Rob Larkman gave hopeless answers to the questions. In his answers he failed to explain the nature of ACPs and refused to identify their supreme importance for care service delivery in the future.When asked about capitated budgets for ACPs he just waffled. One wonders whether he was genuinely ignorant about the ACP details or he was being deliberately economical with the truth.<\/span><\/p>\n <\/p>\n