Why Do I Care? – October 2013

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 [email protected]. 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.


  1. 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?


  1. 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.


  1. 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.


  1. 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?


  1. 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.?


  1. 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.


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


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


  1. 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