Is NHS A&E Performance Data in Ealing Unfit for Purpose? – September 2015

 

Issue: 28

September 2015

 

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.

 

Is NHS A&E Performance Data in Ealing Unfit for Purpose?

The NHS is riddled with targets and performance is measured against these targets. Waiting more than four hours for treatment in an A&E unit is deemed unacceptable performance. A target of 95% of patients waiting less than four hours is a well established metric. Clearly all managers at all levels of any organisation need ready access to relevant and accurate performance data in order to manage, but evidence is increasingly coming to light which leads me to believe that much of the NHS NW London A&E performance data is becoming variously irrelevant and ‘hidden’.

 

+ Aggregating A&E and Urgent Care Centre Data

Common sense tells us that the key A&E performance data is the data relating to Type-1 patients i.e. those who are the most unwell. However the only A&E performance data quoted by NHS NW London/Shaping a Healthier Future is aggregated data of all A&E Types and Urgent Care Centre (UCC) data. This is a pretty useless metric. UCCs are not A&E units and their relevance to A&E units is tenuous. In virtually all cases UCCs act as triage units for A&E units.

 

+ Discontinuing the Publication of Weekly Performance Data

On a very hot day in July 2015 the A&E unit at Ealing Hospital was over run and performed very badly. If weekly performance data had been published this poor performance would have shown up. However monthly data would not have revealed this dip in performance.

 

+ Aggregating Ealing Hospital A&E and Northwick Park A&E Performance Data

Since the merger of the two hospitals into a single Trust, A&E performance data of both hospitals is aggregated together. There is much recent evidence which shows that Ealing Hospital A&E performance is consistently better than that of Northwick Park Hospital A&E. However merging the two units’ performance data together overstates Northwick Park’s A&E performance and downgrades Ealing Hospital’s A&E performance.

 

+ Untimely Publication of A&E Performance Data

As of 7 September 2015 NHS NW London Hospital A&E performance data for July 2015 had still not been published.

 

And for the record, across the whole of NHS NW London the 95% performance target remained unmet from September 2014 to June 2015. It reached its nadir at 82% in January 2015. For Type-1 patients in January 2015 it plummeted to 53%.

 

Reflections on Ealing Clinical Commissioning Group

One of the many strange anomalies of the current NHS organisation is that all the knowledgeable people never get round a table to discuss keeping us all healthy and alive. It’s true that some local GP doctors sit on Clinical Commissioning Group (CCG) Governing Bodies – but hospital doctors do not. CCGs are a part of a ‘confrontational’ system with NHS service purchases on one side and service suppliers (NHS Trusts, charities and private healthcare suppliers) on the other side. This artificial separation of buying and supplying is of course a device to facilitate the entry of private healthcare suppliers into the NHS.

 

I’ve attended a few Ealing Clinical Commissioning Group (ECCG) Governing Body meetings. The meetings last over four hours and there are pages and pages of material full of unexplained acronyms you need to read prior to the meetings. Often there has been very little discussion and few arguments. I’ve never witnessed a formal vote on any issue. At one of these meetings only 7 of the 27 ECCG attendees actually spoke. All this persuades me that topic discussions and decisions are made in other private meetings.

 

Ealing Council to Confront Care UK and ECCG Publicly About Ealing Hospital Urgent Care Centre Failings Revealed by ITV

The London Borough of Ealing’s Health and Adult Scrutiny Panel (H&ASP) is holding a public meeting on Wednesday 9 September 2015. At this meeting the H&ASP will hold Care UK and ECCG to account for the Ealing Hospital Urgent Care Centre failings revealed in an ITV documentary broadcast on 22 July. The meeting starts at 7:00pm and it will be held in Committee Room 3 at Ealing Town Hall.

 

Age UK Ealing Appeals Against Ealing Council’s Plan to Starve the Charity of Funding

Age UK Ealing’s day services for older people are still in danger of imminent closure. Ealing Council decided in July 2015 to no longer provide financial support for Age UK Ealing. The charity launched three appeals against this decision and on 25 August 2015 Ealing Council informed it that two of the appeals have been successful. It has to resubmit its bid by 31 August 2015 and should hear by 11 September 2015 whether Ealing Council has changed its mind.

 

Ealing GP Surgery News

+ NHS Cuckoo Lane Surgery in Hanwell is rated ‘Outstanding’ by CQC

The surgery is one of only 36 highly rated surgeries out of 1,100 inspected by the Care Quality Commission (CQC). The provision of mental health services at Cuckoo Lane has been singled out for praise. 19 patients with mental health problems, who would previously have been treated in secondary care, are being treated at the surgery instead this year. Rob White, a primary care mental health worker with the West London Mental Health Trust, holds clinics at the surgery twice a month.

 

+ NHS Somerset Medical Centre in Southall is Shut Down by CQC

CQC ordered the closure of the centre because of ‘concerns about patient safety’. The centre was given two days notice of closure. The centre’s Dr Dodhy Bashir said that the order was made concerning ‘paperwork and policies’. CQC stated that it was a temporary suspension.

 

Charing Cross Hospital

Andy Slaughter MP continues to try and discover what the future might be for this hospital. The definition of ‘local hospital A&E’- promised for a future Charing Cross Hospital – is just not available. It seems it could be till autumn 2016 before this is revealed. There is no business plan to examine for the new local hospital. Apparently this will not be finalised till at least autumn 2017. Andy Slaughter has issued Freedom of Information requests for both the details of the A&E services and the business plan.

 

Independent Healthcare Commission

This body, set up by Brent, Ealing, Hammersmith & Fulham and Hounslow Councils, spent months collecting evidence on the implementation and performance of NHS NW London’s ‘Shaping a Healthier Future’ (SaHF) strategy. The body’s final report will be launched at a press conference in late October 2015.

 

The initial report was published on 26 March 2015. It found serious failings in SaHF implementation in the areas of access to care, quality of care, the business case and flawed business processes.

 

One hopes that the Local Authorities will make constructive use of this report and use it to hold the NHS and the Government to account. Independent Healthcare Commission witness statements and hearings’ transcripts can be viewed at www.bpv.org.uk

 

Care UK Cries ‘Foul’ When It Loses Out to an NHS Trust

Barking, Havering and Redbridge Hospitals NHS Trust has won an £multi-million contract to provide a range of elective NHS services. The commissioned services include general surgery, orthopaedics and ophthalmology for 965,000 people. Four Clinical Commissioning Groups awarded the contract. Care UK, the incumbent service supplier, has lodged a complaint with NHS Monitor. Care UK says that the CCGs’ refusal to renew its contract and switch to the Trust was discriminatory. Keep Our NHS Public has accused Care UK of being a bad loser.

 

Massive Nurse Shortage in London Causing Stress, Bed Closures and Huge Agency and Overtime Costs

Hospital wards and operating theatres in London are being closed because of a shortage of nurses – reported the ‘London Evening Standard’ on 30 July 2015. At the country’s largest NHS Trust – Barts Health – there were 1,173 nurse vacancies in June 2015. The Trust runs five east London hospitals. The situation has deteriorated since March 2015 when there were 562 nurse vacancies.

 

‘Health Service Journal’ reports nationally that more than two-thirds of hospitals failed to have sufficient numbers of nurses working at any one time. Also 83% of acute trusts have failed to meet their own safe staffing targets.

 

Monitor Tells NHS Trusts to ‘Ensure Vacancies Are Filled Only When Essential’

This is all about heading off a predicted £2 billion deficit for 2015/16. Monitor has also told Trusts to ensure that safe staffing guidance has been adopted in a ‘proportionate and appropriate way’. ‘Health Service Journal’ (HSJ) readers’ comments are that Trusts will just ignore this ‘advice’. As for safe staffing guidance surely it is followed or not followed. If not followed then no doubt patients and staff are put at risk.

 

Safe staffing guidelines for A&E were expected to be published on 30 July 2015. On 29 July 2015 HSJ was told that NICE would not, after all, publish these guidelines. NICE went on to say that an ‘NHS Improvement’ release would publish the A&E staffing guidelines later this year.

 

Treasury To Cut Annual Public Health Grant to Local Authorities by £200 Million: Impact Could Cost £1 Billion

August 2015 was the month for public consultation on the proposed 6.2% cuts announced in June 2015. This consultation is unlikely to stop the cuts. Expert commentators estimate that these cuts could generate costs exceeding £1 billion – due to cuts in many local services and rapid increases in preventable diseases. Services affected are likely to include child health, mental health, drug and alcohol, sexual health and health improvement.

 

All this seems completely at odds with the heart of the NHS Five Year Forward View, which emphasise the importance of prevention and public health. (Story source – the Kings Fund).

 

Thousands of Blood Donors Turned Away by NHS – And 40% Slump in Volunteer Donors

Between June 2013 and June 2104, 6,798 people who wanted to give blood complained to the NHS that they did not have their blood taken. Apparently shortage of staff – lack of appointments and cancelled appointments – was the NHS excuse. There have been plenty of warnings about a potential shortage of blood stocks. (Story source – Keep Our NHS Public).

 

Corbyn on the NHS

All polls are predicting that in September 2015 Jeremy Corbyn MP will become the Leader of the Labour Party. As such, his views on the NHS are very important to those of us who want to save our NHS.

 

Jeremy’s wants for the NHS include:

 

+ protecting the principle of universal healthcare which is free at the point of use

+ removing any element of privatisation in the NHS

+ increased support for mental health

+ more money for hospitals, doctors and nurses

+ removing the PFI burden from the NHS

+ improving public health

+ the service not to be diminished to a service of last resort for the poorest people

+ supporting the NHS Reinstatement Bill – a Bill which he co-sponsored.

 

I sat in Ealing Town Hall on 17th August 2015 along with 400 others and heard Jeremy’s loud, impassioned plea for the NHS ‘….away with the market opportunity!’

 

Cost of Use of Private Ambulances by NHS Ambulance Trusts soars to Over £40 Million in 2014/15

In 2010/11 the figure was around £16 million. These figures do not include the £16.5 million spent on volunteer ambulance services including St John’s and the Red Cross. The College of Paramedics said that the pressure of increased demand, staff leaving and lack of training places has forced Trusts to rely on private services and overseas recruitment.

 

CQC Keeps Closing Care Homes and Shipping Out Fragile Elderly People in the Dark

Roy Lilley (nhsManagers.net) tells the horrendous story of CQC doing this TWICE!

Just before Christmas 2014 CQC closed Merok Park Care Home in Surrey. They shipped out the patients in the evening, in the dark. It was freezing and 48 hours later an 85 year old patient died.

 

At 6:30pm on Friday 7 August 2015, CQC closed the Old Village School Care Home in Bedfordshire. Transfers were carried out over the following 6 hours. Complications developed for some patients and they finished up in A&E in Bedford Hospital.

 

Why couldn’t these closures and transfers be started in the morning, in the day light? Why couldn’t interim management be put into these places – local social services, the NHS or nominees – to run the failing home so that adequate time, care and planning could be given to make effective, safe and risk free transfers to other care homes?