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.
‘Shaping a Healthier Future’ Strategy in Tatters as ‘Care Closer to Home’ Fails to Materialise
Colin Standfield of Save Our Hospitals (saveourhospitals.blospot.co.uk) continues to forensically analyse NHS NW London’s performance in implementing its 2012 ‘Shaping a Healthier Future’ strategy.
The central plank of this 2012 – 2015 strategy is ‘shifting more investment into Primary Care and other local healthcare, providing more proactive services in the community closer to patients’ homes’. However no evidence has ever been presented that ‘care closer to home’ results in better care outcomes. There is also no evidence that there actually are any improvements in Primary Care and community care. There is no NHS data available to measure this.
As Colin points out, the budget for ‘care closer to home’ is various pitched at £120 million, £138 million and £190 million. It’s impossible to figure out how much of this money has actually been spent by CCGs on ‘care closer to home’ and there’s certainly no evidence of any cost/benefit analysis of any such expenditure.
If in fact there is no local improvement, then the consequences for residents in north west London will be quite devastating. Closing A&E units and reducing the number of intensive care beds and consultants in hospitals, whilst apparently providing no replacement capabilities in local communities, must result in more pain, anxiety and death.
NHS Suggests More ‘Less Well’ Patients in North West London are the Cause of A&E Meltdown
NHS NW London bosses are suggesting that an independent review has found ‘no direct link’ between closures of A&E units and poor A&E performance in north west London. They are suggesting that an increase in acuity (with people less well leading to increased length of stay and bed occupancy) is the main contributory factor. The publication of this report was due in January 2015 but as of 27 February 2015 it has not appeared.
The performance of A&E units across London generally is above the national trend. It’s only in north west London (where two A&E units were closed in September 2014) that A&Es are performing so badly. It seems incredible that so many of these ‘less well’ patients only live in north west London and not in other parts of London. In fact if this demographic feature is real and sustained, then this is surely a reason for expanding hospital A&Es not contracting them.
23% More NHS Operations Cancelled in October, November and December 2014 in England
At 19,473 cancelled operations this was the worst figure recorded since 2001-02. These last minute cancellations were for non-clinical reasons. Most Trusts were forced to call off planned procedures at short notice because they ran out of beds. Shortage of beds is thought to be caused by the surge in demand for care and the demands of A&E admissions.
However here in north west London the 2012 NHS plan was for the total number of beds to be reduced from 3,268 to 2,470 by 2015. No doubt this plan is being implemented and no doubt it is having a major impact on the number of cancelled operations.
Retiring Ealing Hospital Chief Executive David McVitie made two interesting statements in public in February. He stated that Ealing Hospital Maternity Unit would close in July 2015. (However Ealing CCG is now saying that it might make a decision on the closure date at a meeting on 18 March 2015). Mr McVitie stated that Type-1 (the most ill) A&E patients would still be being admitted to the hospital for the next five years time.
CQC Criticises Hillingdon Hospital
The Care Quality Commission (CQC) states that improvements are needed in maternity. A&E, critical care, family planning and children’s care. It noted an incidence when one nurse was caring for 20 patients. CQC also criticised the state of the hospital buildings.
The problems in maternity are particularly worrying for would-be mothers in Ealing. Hillingdon Hospital Maternity Unit is one of the designated units for pregnant Ealing women when Ealing Hospital Maternity Unit is closed down.
The hospital is to receive £12.3 million Department of Health funding to build a new Urgent Care Centre and improve facilities for A&E, emergency paediatrics, acute medical admissions and endoscopy.
Chelsea & Westminster and West Middlesex Hospitals to Merge
It’s not exactly clear how this merger will improve patient care. It’s also not clear how this merger will improve the finances of these two financially troubled hospitals. It’s also only four months ago that CQC stated that Chelsea & Westminster Hospital needed to improve in A&E, medical care, surgery, children’s services, end of life care and outpatients.
90 Ealing Hospital Midwives Warn that Pregnant Women in Ealing are At Risk
In a long letter to Ealing CCG and to the ‘Shaping a Healthier Future’ (SaHF) team Ealing Hospital midwives describe how their top performing Maternity Unit is ‘rotting away in front of our eyes’. They compare the likely dangerous consequences of closing their unit with the A&E carnage being caused by the closure of Central Middlesex and Hammersmith Hospital A&Es.
Ealing CCG has been telling Ealing GPs not to refer pregnant women to Ealing Hospital. Consequently birthing admissions are down. This action by Ealing CCG is completely contrary to what was agreed in order to keep Ealing open and a safe ‘going concern’ until the point of planned and carefully considered closure.
There has been considerable uncertainty about the closure date for the Ealing unit. In sheer frustration some Ealing Hospital midwives have already quit their jobs. The Ealing Hospital boss is now saying that the Maternity Unit will close in July 2015. However Ealing CCG and SaHF apparently refuse to commit to a closure date, but hint that they might decide on 18 March 2015.
Ealing CCG and NHS NW London has formally responded to the Ealing Hospital midwives. It blames the uncertainty and delays on concerns about patient safety. This is all well and good until we reach the statement ‘The A&E changes have not impaired care or service provision for patients…’. Well blow me down with a feather – this statement is an outrageous distortion of the truth. NHS NW London has for many weeks been the worst performing A&E segment in the whole of London. Ealing Hospital A&E has consistently been one of the six worst performing A&Es in the whole of England. Ealing CCG deny instructing Ealing GPs not to refer mums-to-be to Ealing Hospital. Ealing Hospital midwives dispute this and given the ECCG’s economy with the truth on A&E performance I’m minded to side with the midwives.
One has to ask the question here – who is in charge of and responsible for this chaos?
West London Mental Health Trust (WLMHT) Responds To £4 Million Overspend Allegations in ‘Independent on Sunday’
On 3 February 2015, WLMHT responded to the ‘Independent on Sunday’ 25 January 2015 allegations of financial impropriety at WLMHT. The Trust emphasised that there was no financial overspend at Broadmoor Hospital or for the Trust’s financial year as a whole. It stated that the reason the Lammas Centre Recovery House project (in Mattock Lane, W5) was abandoned was one of building unsuitability and was not related to finance. The Trust did confirm that an independent investigation was underway relating to other projects mentioned in the press article.
Greater Manchester to Get Control of a £6 Billion Health and Social Care Budget in April 2016
This will be a huge reorganisation impacting over 2.6 million residents. It will involve 10 Local Authorities, 12 Clinical Commissioning Groups (CCGs), 14 NHS partners, NHS England and National Government. There will also be a newly elected Mayor for Greater Manchester in 2017 who will control this budget.
On the face of it Manchester CCGs will lose power, as Councillors will decide priorities. Monitor presumably becomes redundant. Some might see this Greater Manchester experiment as a logical development of the national Better Care Fund (BCF). BCF will attempt to integrate social care and health care via local pooled budgets spent jointly by a CCG and a Local Authority. BCF commences in April 2015. It has had a rocky gestation period with accusations of poor planning. There has been little ‘gelling’ of cost cutting aspirations of the NHS and the revenue searching zeal of Local Authorities. BCF is untested. It may fail and the Greater Manchester plan may similarly fail. However if the latter is seen to succeed we might see other cities being given similar devolved powers.
There are some worrying technology and governance issues being raised. For example there is no common identifier of a citizen shared by health and local government. Tracking patients through the care cycle will be a big challenge in successfully integrating health and social care. There will be IT problems to overcome due to the lack of interoperability between disparate health and social care IT systems. There is also a future worry that cities may devise their own, different ways of integrating health and social care. We could finish up with a ‘patchwork quilt’ of IT approaches to integrating health and social care. This will make life complicated for those patients who move from one city to another or between cities and rural areas.
Sadly there is no indication that the Manchester initiative is some kind of city ‘pilot’ scheme. And anyway if one were choosing a pilot conurbation one would not pick one so large with so many residents, Local Authorities and CCGs.
It’s important to appreciate that none of the £6 billion will be ‘new’ money. The acid test will be to try and deduce whether this regional devolution of integrated health and social care results in improved health and social outcomes. We are unlikely to see any metrics on this before 2017.
NHS England Concedes GP Advice Must be Provided by the 111 Telephone Service at Peak Times
In a policy climb down, NHS England has conceded that its 2013 111 launch policy of just using non-medically trained call handlers is inadequate – certainly during peak periods. A GP presence in call centres or a GP available to provide clinical advice must be put in place as soon as possible.
Major Study Finds the Sustainability of Clinical Involvement in Commissioning (CCGs) of Primary Care Is At Risk
The King’s Fund and the Nuffield Trust have just published a study of six Clinical Commissioning Groups (CCGs) in order to monitor the changing role of CCGs in General Practice.
The risk to clinical involvement is due to waning levels of GP leader engagement in CCGs, potential problems in the recruitment and retention of leaders, and significant pressures on GPs’ time and capacity.
The research suggests that the benefits provided by the shift towards CCGs co-commissioning Primary Care could be compromised by potential conflicts of interest, reductions in running cost budgets and strained relationships with fellow GPs and NHS England.