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.
RIP: Children’s Services at Ealing Hospital
In just a few weeks time acute care for very sick Ealing children will no longer be available at Ealing Hospital. This will be the end of A&E services for children at the hospital after 36 years. As of 1 July 2016 there will be no specialist A&E Paediatric consultants and no beds for children. The Charlie Chaplin Ward for children will be closed.
93% of all sick children who arrive at Ealing Hospital do so in the arms of a parent and not by ambulance. 24,000 children self-presented at the hospital in 2014/15 and of these 4,500 needed A&E treatment. If you have a seriously physically or mentally ill child on 1 July 2016 or after do not take him or her to Ealing Hospital. Figure out which of the following hospital A&E units you can get to most quickly and take the child there:
West Middlesex, Hillingdon, Northwick Park, Chelsea and Westminster or St Mary’s.
Taking your very sick child to Ealing Hospital will delay the onset of treatment as there will be no Paediatric consultants there to diagnose and treat the child. The Urgent Care Centre (UCC) at Ealing Hospital will request transportation to one of the above remote hospital A&Es and you will have to wait for NHS Patient Transport Service (PTS) to take your child for treatment. Contractually, apparently, PTS will collect your sick child within one hour of being telephoned by the UCC. Apparently also your child will not be accompanied on the trip by a medically qualified paramedic/nurse/doctor.
The NHS North West London Collaboration of Clinical Commissioning Groups is producing a booklet called ‘Changes to Children’s Services at Ealing Hospital’. Draft version 20 of this booklet shamefully tells parents and carers to continue to take sick Ealing children to Ealing Hospital after 1 July 2016. This cannot be in the best interests of the child. There’s no reference to PTS in the leaflet which will lead parents and carers to presume that NHS ambulances will transfer their child to a remote hospital A&E. I’m certain that this will prove an erroneous presumption. The booklet doesn’t even define the NHS upper age of a ‘child’. 16, 17, 18 years old maybe? Surely the adresses and postal codes of the remote hospital A&Es should be included in this booklet.
You might have thought that A&E waiting times will clearly increase significantly because of the waiting time for the PTS service and the travel time to the remote hospital A&E. But, oh no……NHS bosses say that the ‘clock’ will stop when the UCC calls the PTS. The clock will only re-start when the sick child arrives at the remote hospital A&E. This amounts to despicable manipulation of a performance metric. It is unethical and completely against the spirit of the 4 hour wait as a measurement of treatment performance. Why won’t the SaHF gurus have the guts to be honest about the fact that the closure of children’s A&E at Ealing Hospital will result in degraded treatment performance?
Finally as you can read in the next newsletter item, two of the remote hospital A&Es – Hilllingdon and Northwick Park – are performing dreadfully in treating very sick patients (so called Type 1 A&E patients) in a timely manner. Imagine how much worse the performance figures at these two A&Es will be when significant numbers of very sick Ealing Type 1 A&E children start arriving in July 2016.
Northwick Park Hospital’s A&E Service for the Seriously Ill Still Performing Poorly: Even Though A&E Attendance Levels for the Seriously Ill are Unchanged for Three Years
Only 66.90% of Type 1 A&E patients (those most ill) were seen in four hours at Northwick Park Hospital at the end of January 2016. This is a disastrous performance as the target is 95%. The Type 1 A&E collapse is also evident at Hillingdon Hospital (61.3%) and at Charing Cross Hospital (69.1%) At Ealing Hospital the figure was substantially better at 87.49%. Type 1 A&E attendance figures for all north west London hospitals have remained the same since April 2013. The Northwick Park Hospital’s poor performance is in spite of a new A&E unit being installed there and repeated reports of ambulances being diverted away from the hospital.
NHS bosses refuse to acknowledge the Type1 A&E crisis in north west London.
However in the topsy-turvy world in which we live, it’s Ealing Hospital’s A&E that will close. And this closure begins in just a few weeks time when Ealing’s children will be deprived of A&E services at Ealing Hospital. Let’s hope none of them die because of this.
Ealing Hospital Bosses Try to Schedule the Hospital’s Future in the Context of Healthcare and Social Care Integration
The LNWH NHS Trust, which runs Ealing and Northwick Park Hospitals, has published details of the Sustainability and Transformation Plan (STP) for the North West London ‘footprint’. STP is the latest of a number of State initiatives to cuts care costs whilst miraculously and simultaneously integrating healthcare and social care. The Trust is one of 11 Trusts, eight Local Authorities and eight CCGs who have been thrown together in this footprint to save money. A new body has been formed to run this footprint – the NWL Strategic Planning Group (SPG).
The SPG must produce an STP which must specify how:
+ existing local NHS debts are eliminated
+ 7-day NHS working is implemented
+ hospital beds will be replaced by care at home
+ A&E units will be replaced by Urgent Care Centres
+ healthcare and social care provision will be integrated.
The first worrying thing about the LNWH Trust document is that the phrase ‘social care’ does not appear anywhere. What this suggests to me is that the senior NHS folks see STP as being exclusively about healthcare.
By April 2017, the Trust expects the ‘Shaping a Healthier Future’ project (SaHF) Ealing Hospital Implementation Business Case to actually exist. SaHF is a 2012 NHS healthcare cost cutting initiative which, amongst other things, aspires to demolish Ealing Hospital. By April 2018 the Trust expects the existence of an ‘Ealing Hospital A&E/UCC model’. This little gem is all about post demolition creation of a First Aid post on the site staffed by GPs and nurses.
‘It is anticipated that much of this work will be overseen by (Local Authority) Health and Wellbeing Boards’. How this marking of its own homework will be accomplished is unclear – given that the eight Local Authorities will be jointly authoring and jointly implementing the STP in the SPG.
A new bureaucratic layer will be added in 2018/19. This will be the Accountable Care Partnership (ACP). The ACP is apparently all about mental health as its constituents will be Local Authorities, mental health service providers and the voluntary sector.
Finally it’s stated that ‘…the aim is for the eight CCGs in North West London to work within a single financial control total with the NHS service providers’. Surely what this means is that there will exist, in effect, a regional health authority. It also means that GP led control of local NHS spending will disappear completely – given that it ever existed since CCGs were forced upon us in 2012.
Ealing One of Just Eight Local Authorities in England Not to Raise Council Tax to Help Pay for Social Care
Chancellor George Osborne announced a precept in November 2015 which would allow Local Authorities to raise Council Taxes by 2% without facing any punishment or the need for a local referendum. 144 Local Authorities in England took advantage of this. Ealing Council was not one of them. Had Ealing followed the vast majority of other authorities it would have raised at least an extra £2 million for social care.
I for one would have supported this Council Tax rise, and I suspect so would many other local tax payers. Ealing Council’s reasons for not raising Council Tax seem to be purely political. I know of one single unemployed mother with a four year old child who upon being evicted in April 2016 could not be re-housed in Ealing. The best Ealing Council could do was put her and her daughter in a B&B room with a single bed and a fridge outside the borough of Ealing.
To compound Ealing Council’s hubris, they decided that even the registered disabled would pay something towards their Council Tax this year. In previous years the disabled were exempt from paying Council Tax. Who would have thought a Labour administration would favour taxing the poor instead of taxing the rich?
Healthcare and Social Care Integration: A Muddle of Mutually Exclusive Initiatives?
First we had the NHS Better Care Fund. Then we had NHS Vanguard projects. We also now have devolved integrated healthcare and social care eg Manchester. And recently we have had the NHS Sustainability and Transformation Plan.
All these four initiatives variously throw Local Authorities, NHS CCGs and NHS Trusts together and effectively say to them ‘sort this integration stuff out between you and at the same time make major cost savings’.
Of course the Emperor’s New Clothes factor here is that we have an ever decreasing number of hospital and care home beds. Between 2010 and 2015, 10,000 hospital beds in England were lost. For the year up to September 2015, 1,500 care home beds in England were lost. In March 2016 AgeUK estimated that three million hospital bed days were lost between June 2010 and January 2016, due to lack of social care provision.
All this is about money – of course:
+ If you are in a hospital bed the State pays for it. The average weekly cost per bed is £2,121
+ If you are in a care home bed in most cases you will pay something towards the average weekly cost of £563. Only 37% of care home beds receive Local Authority funding. 90% of all care homes in England are privately owned.
+ For social care at home you will be means tested. If you receive three hours care each day the average weekly cost is £356.58.
Looking logically at the integration of healthcare and social care we clearly need more care home beds. However the private care home sector is failing to expand care homes or build new ones. Reasons quoted include:
+ The April 2017 introduction of the National Living Wage will threaten the viability of their businesses
+ Local Authorities are receiving less money for social care from national government. In response they have reduced the rates of remuneration paid to private care homes.
It’s obvious that the only way to increase the number of social care beds is for the State to build new care homes and run them.
Devo-Manc Health Up and Running With Only £6 Billion Each Year to Improve on the Current £10 Billion Spent on Healthcare and Social Care Across Greater Manchester
I spent the first 19 years of my life living in North Manchester. I have visited friends in Manchester regularly since 1992. The healthcare/social care experiment taking place there is of more than just a passing interest for me. It’s also probably the clue to what’s going to happen in London.
I have read the 60 page December 2015 ‘Taking charge of our health and social care in Greater Manchester’ plan published jointly by the NHS and the Greater Manchester Combined Authority (GMCA).
Greater Manchester (GM) is the pioneer in England for attempting integrated healthcare and social care services on a grand scale. Here are some relevant dates and numbers on this bold (or reckless) initiative:
+ GMCA and National Government agreement signed on 3 November 2014
+ Formal start date of the project was 1 April 2016
+ 2.8 million people’s lives will be affected
+ By 2021 £2 billion saving must be achieved
+ 37 statutory bodies are attempting to work together – 10 Local Authorities, 12 NHS CCGs and 15 NHS Trusts
+ Current official figures for the current annual spend on healthcare and social care in GM is £7.7 billion. Oldham and Saddleworth (Greater Manchester) MP Debbie Abrahams calculates it to be £10 billion
+ Currently paid healthcare and social care staff in GM number 100,000
+ 563 care homes (the vast majority of all care homes) not owned by Local Authorities in GM – none of them are represented on the GM Board which decides how the annual £6 billion budget is spent.
Themes very similar to those in the ailing 2012 NHS NW London ‘Shaping a Healthier Future’ project can be found in the plan. Although the plan contains admirable aspirations and laudable goals it is also riddled with cost cutting initiatives. These include reducing the number of acute beds, fewer visits to hospitals, more out-of–hospital/community care, increased use of technology to reduce face-to-face transaction times, more home care and more self care.
A new raft of bureaucracy is planned. New ‘models’ will be created. These include:
+ LCOs (Local Care Organisations)
+ MSCPs (Multi-Speciality Community Providers)
+ PACs (Primary and Acute Care Systems)
+ ICAs (Integrated Care Organisations)
+ ACOs (Accountable Care Organisations)
+ AHMOs (Accountable Healthcare Management Organisations)
The so called Financial Plan is absurd. Instead of detailing just how the £6 billion will be spent it lists savings to be made. There’s no overview on projected income and expenditure. This leads me to believe that those leading this experiment are unsure of its costs and its income. This is very worrying.
Given £billions will be spent over the next 11 months it’s odd that there are no stated integration performance goals and consequently no details on how integration performance will be measured. So there will be no way of making quantitative or probably qualitative assessments of services’ success – or failure.
It’s also not encouraging that the boss of the project has just left a year into his job. On 31 March 2016 a new Chief Officer was appointed. He’s Jon Rouse. At least he does have relevant senior management experience in local government, healthcare and social care. However I suspect he’s never run a three ring circus before.