But First The Care Bill – Clause 118 now 119! – March 2014



Issue: 11

March 2014


This occasional newsletter is researched, written and edited by a group of concerned residents in Ealing, West London who want to preserve our NHS. We view the wholesale engagement of private, for-profit healthcare service suppliers as unnecessary, profligate and dangerous. Process improvement is what is needed in our NHS – not revolution.

In this issue:

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


But First  The Care Bill – Clause 118 now 119!

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


The Better Care Fund (BCF)

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


LBE Vision for Ealing

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


Let’s hope these bold aspirations can be met.


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

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


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


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


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


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

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


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


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


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


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


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

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


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


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


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


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


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


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

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


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

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


Competition Thoughts of CQC Chairman David Prior

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


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


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


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

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


And More and More on ‘care.data’

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


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


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


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


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


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


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


Redundancies and Rehiring Chaos at NHS

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

+ Up to 10,000 NHS clinicians and nurses gone

+ 40,000 NHS managers gone

+ One in five NHS staff made redundant have been rehired

+ Redundancy bill of about £450 million


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

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


NHS Mental Health in Numbers

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

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

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

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

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

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

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

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

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


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

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


310,000 Increase in Patients Waiting for NHS Hospital Treatment

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


Jeremy Hunt Hires Retail Expert to Train NHS Hospital Bosses

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


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

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