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.
What is Going to Happen to Ealing Hospital?
In 2012 NHS NW London’s ‘Shaping a Healthier Future’ proposed to downgrade Ealing Hospital from a ‘Major’ to a ‘Local’ Hospital. What has happened so far is the removal of Maternity birthing services in 2015 and the threat to discontinue any services for children in June 2016.
According to rumours picked up by Andy Slaughter Hammersmith & Fulham MP more departments will close at Ealing Hospital but the building of a new Local Hospital on the site will not happen. The closed departments will just be mothballed. Of course most hospital Trusts are in debt and the NHS bosses say that those hospital Trusts that don’t balance their books by the end on March 2016 will get no extra cash in 2016/2017. Ealing Hospital’s Trust is hopelessly in debt. In fact John Lister’s research in early February 2016 reveals the debt for London North West Healthcare Trust to be the second largest in England at £76.3 million. As such no ‘new’ money’ will be forthcoming for demolition and new build on the Ealing site – or for anywhere else in Ealing.
It is clear that daily heroics are taking place at Ealing Hospital A&E. Few medics want to take on a permanent position at the hospital because of the three years of continuous uncertainty about its survival. NHS bosses have capped Agency temporary staff use. What immediately follows from this Catch22 scenario are staff shortages, tired staff and higher risk of staff errors. Staff will become increasingly susceptible to stress, domestic disruption and physical and mental illnesses.
Care UK, who were shown to be incompetent at Ealing Hospital’s Urgent Care Centre (UCC) in an ITV documentary in July 2015, take their leave of the hospital sometime before the end of April 2016. Replacing them to run the UCC is the Greenbrook Healthcare Consortium. Greenbrook Healthcare looks quite experienced on paper. They have managed aggregated GP practices since 2007 and UCCs since 2012. Greenbrook manages UCCs in Hounslow, Harrow, Bromley & Beckenham, Kensington & Chelsea, Hillingdon, Woolwich, Orpington and Surrey.
If A&E does close down completely at Ealing Hospital, the impact on Ealing residents and A&E performance in north west London will be devastating. Quite simply more people will suffer pain and die unnecessarily.
Musings on Ealing Clinical Commissioning Group (ECCG)
ECCG will soon be five years old. Many of us have been consistently critical of it. We believe the ECCG costs £10 million a year. I recently spent some time reviewing the ECCG web site. Below are some of my reflections on the web site’s content.
There are still only six GPs on the 20 person ECCG Governing Body. So much for it being a GP-led body. It is quite extraordinary that only 10 of the 20 Governing Body members have their pictures displayed on the site. For seven of the body there are no biographical or qualification details. Is the turnover of the staff on the Governing Body really so rapid that the web site content maintainers can’t keep up?
On the ‘Shaping a Healthier Future’ web page this sentence appears:
‘The Department of Health is expecting to review these (SaHF business) cases during the second half of 2014’.
The sentence suggests that it was written before July 2014. Did this review ever take place? No clues are given as to when the final business cases for the 2012 conceived SaHF will be published.
There are also many references to ‘Better Care, Close to Home: our three year strategy for co-ordinated, high quality care out of hospital’. However the Strategy details ‘initiatives’ which were to be completed by March 2015, with cumulative savings of £27 million. There is no mention of completing these initiatives and achieving these savings in the ECCG 2014/2015 Accounts. Goodness knows whether these initiatives were completed or are still to be completed. As for the savings…. if they had been achieved ECCG would have trumpeted this from on high.
On the ‘News’ web page what’s not there sticks out like a sore thumb. For example:
+ No reference to ECCG’s response to the damning ITV documentary on Ealing Hospital Urgent care Centre (UCC) in July 2015
+ No reference to Greenbrook Healthcare Consortium taking over the running of Ealing Hospital UCC by April 2016
+ No reference to the fact that children’s services (including A&E) at Ealing Hospital will close in June 2016.
Hammersmith & Fulham Council Leads The Way in Pursuing the Mansfield Independent Healthcare Commission Recommendations
In 2012 NHS NW London announced its ‘Shaping a Healthier Future’ (SaHF) programme. SaHF proposed changes that would ‘improve care both in hospitals and in the community’. Put crudely the strategy revolved around demolishing some hospitals, reducing the number of hospital A&E units and hospital beds, and replacing acute hospital care with ‘Out of Hospital’ care. Opposition by local citizens to the proposed changes was immediate and has been extensive and continuous. In fact this monthly newsletter came into being in May 2013 to document SaHF’s ‘progress’ along with the impact of a constant stream of unhelpful NHS, Department of Health and Government healthcare initiatives.
In 2014 Hammersmith & Fulham Council (H&FC), supported by Brent, Ealing and Hounslow Councils, set up the Independent Healthcare Commission (IHC) chaired by Michael Mansfield QC. Its brief was to examine whether or not SaHF was, is, or could be, fit for purpose. The commission’s final report was published in December 2015. The report documented evidence of SaHF failing to meet its healthcare, operational and financial goals.
At a public meeting in Hammersmith Town Hall on 23 February 2016 Stephen Cowan. Leader of H&FC announced to the 200 attendees how H&FC were pursuing the implementation of the main IHC recommendations:
+ He met with a Barrister QC during the week of Monday 15 February 2016 to investigate legal/ Judicial Review options with regards to halting SaHF.
+ He has written to the National Audit Office about the value for money aspects of SaHF.
+ H&FC Scrutiny is pursuing SaHF and the Hammersmith Clinical Commissioning Group with regards to access to the final business cases for SaHF.
+ H&FC has sent every GP in Hammersmith and Fulham a copy of the 87 page IHC report.
Doctor and Nurse Vacancies Still Rising: 4,669 Doctors and 18,714 Nurses
The Office for National Statistics has revealed worrying increases in permanent staff vacancies in the NHS. For the period 2013 to 2015 the increase in the vacancy rate for doctors was almost 60%. For nurses it was 50%. Research by the BBC has revealed that 69% of all Trusts are seeking staff from overseas.
160 People Attend Ealing Save Our NHS Meeting in Ealing Town Hall on 2 February 2016
Tony O’Sullivan was our first speaker. He is Co-Chair of Keep Our NHS Public and a Paediatric Consultant at Lewisham Hospital. He pointed out that the NHS NW London ‘Shaping a Healthier Future’ (SaHF) plans said very little about children. With 400,000 children up to the age of 19 in NW London – and 86,000 of them in Ealing – this was disturbing. 50% of all critically ill children arrive at hospital A&Es in a parent’s arms and Ealing Hospital needs 24×7 coverage by Paediatric Consultants. He urged local activists to find out how many children are attending Ealing Hospital now; how long now parents have to wait for ambulances to ferry their sick children to the hospital; and how the integrated networks of care for children in Ealing will be built again should all children’s services at Ealing Hospital be curtailed in June 2016. He finished by asking just how constructive was it for Health Secretary Hunt and senior NHS executives to make virtually all 1.3 million NHS staff angry.
Next up was John Lister who is Director of London Health Emergency and was one of the commissioners on the Mansfield Healthcare Commission into SaHF. He has been campaigning for healthcare in London since 1983. He ripped into the unaccountability of CCGs. He highlighted some failed NHS outsourcing deals with private healthcare suppliers. He listed the impossible recent stream of demands from government on hospitals. If they don’t balance their books they will get no extra money. Demands on Mid Staffs to save £10 million led to it cutting corners and failing. SaHF was set up to save £1.5 million over five years. It’s now come to light that SaHF is demanding 1.3 billion in capital costs. But there is no money for this. We can’t go backwards but all we can look forward to is more closures but no new build as there is no money for this. There’s no evidence that even if out of hospital services could adequately replace acute care in hospital it would save any money. And there are no detailed plans or any implementations of these out of hospital services. The local population continues to grow but if Ealing and Charing Cross Hospitals cease to be Major Hospitals we’ll lose 700 to 800 hospital beds. Urgent Care Centres cannot replace A&Es. What we want are no more A&E closures and Maternity re-opened at Ealing Hospital. Rousing applause!!!
Dr Ajaob Sandhu spoke next. She is an 80 year old GP who has practised in Southall for 49 years. She bemoaned that humanitarian grounds had been ignored in the closures and closure plans. It is shortening life expectancy. The impending closure of children’s A&E will be disastrous for children especially ‘late presenters’ who are seriously ill.
Ealing Hospital Junior Doctor Ravi Ganepola was the final speaker. He cut through much of the misinformation about the Junior Doctors’ dispute. The bosses want to make remuneration for Saturday work the same as weekday work. The 5pm to 1am shift is to be remunerated as a day shift and not a night shift. Junior Doctors are being co-erced into working longer hours and they are worried that when tired they will make mistakes. The government’s linking of higher mortality rates to weekends is based on data for Fridays, Saturdays, Sundays and Mondays. The regulatory safeguards being proposed are inadequate.
Advertising Standards Authority Rules Against Brent CCG’s Misleading Posters on ‘A&E Only for Life-Threatening Emergencies’
In October 2015 Clinical Commissioning Group (CCG) posters proclaiming ‘A&E for life–threatening emergencies only’ appeared across north west London. We pointed this out in our November 2015 newsletter and I saw such a poster on the Brentford to Southall 195 bus. We commented that this A&E statement was incorrect. If I broke my leg it would not be life threatening, but is the NHS really telling me not to go to a hospital A&E? Where should I go – perhaps to my GP or to a pharmacist?
Brent Patient Voice (BPV) asked its members what they thought of the posters. All of them who replied felt that the description of A&Es was incorrect. BPV (www.bpv.uk) tried several times to persuade Brent CCG (BCCG) to withdraw the posters but it refused. BPV wrote to the Advertising Standards Authority (ASA) to complain about the posters.
On 3 February 2016 the ASA ruled against the BCCG and told them not to use the posters in their current form. ASA further told BCCG not to make misleading and potentially harmful claims about the scope of A&E services in the future. No doubt this ruling will apply to Ealing CCG and in fact to all CCGs.
BCCG has responded by telling the local press that its ad promoted patient safety. It has shied away from saying that it accepts the ASA adjudication and it has not apologised to Brent residents. Why is BCCG so tragically dysfunctional in this way?