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.
The Secret Planning of Healthcare and Social Care Services:
The Sustainability and Transformation Plan (STP):
At the 6 July 2016 Ealing Clinical Commissioning Group (ECCG) public meeting hard copies of nine NW London STP slides were handed out. In December 2015 NHS England announced that England would be divided up into 44 ‘Footprints’. Each Footprint (let’s call them regions) would create a five year plan (an STP) for delivering cost cutting in the provision of healthcare services and social care services. Each region would pull together a supergroup of all its Local Authorities, NHS CCGs and NHS Trusts to work together collectively to create the plan. These supergroups meet in secret and have no Parliamentary mandate.
As well as massive cost cutting, each of the 44 STPs must deliver healthcare services seven days a week. The number of Acute hospital beds must be reduced and more Acute care delivered in the home and in the community. All historic healthcare debts must be eliminated and healthcare services and social care services must be integrated. A fundamental flaw in trying to integrate healthcare and social care in England is that the former is free at the point of use and the latter is means tested.
The deadline for submitting the first draft of the 44 STPs was 30 June 2016. However in typical NHS style this deadline was slipped in early June to October /November 2016.
Our region is North West London. Our STP supergroup numbers over 30 public bodies. On 5 April 2016 a summary version of our STP was created. An early draft dribbled out into the public domain in June. In April the debt target was £1.1 billion. Now the debt to be cleared appears to be £1.3 billion. On a pro rata basis this would mean an annual reduction in healthcare and social care spend in Ealing of £160 million. In order to comprehend the difficulty of meeting this cost cutting target, let’s look not for the first time at the 2012 NHS NW London ‘Shaping a Healthier Future’ plan (SaHF). SaHF’s cost saving target was 4% per year. So by now SaHF should have a saved over £400 million on the NHS NW London costs. Not once over the last three years has the SaHF brotherhood announced any savings achieved whatsoever.
I can find no reference in any of the April or July NW London STP drafts about the projected population increase and how this has been factored into the plan. ONS/GLA figures calculate a current population of 2,093,972. By 2022 they predict it will have risen to 2,206,451 – a rise of 112, 479 people. This equates to adding the population of a city the size of Carlisle or Worcester to our regional population. The population increase for Ealing alone is just under 20,000.
Bed Losses: Changing Numbers
Bed losses are on the agenda. In a 15 April 2016 STP document it states the target bed loss is 500 Acute beds. In a 27 May 2016 STP document it states a bed loss of 592. However on 1 June 2016 Carolyn Downs boss of Brent Council and one of the NW London STP hotshots said that the closure of 500 beds target had been dropped.
Carolyn Downs is the Local Authority (LA) STP lead for all the eight LAs in NW London. She also said that the three guiding principles of the NW London STP were 1) prevention 2) integration of health and social care and 3) innovation via technology. She voiced LA concerns about closure of Acute beds when alternative community provision was not in place. Also LAs are worried about funding the social care aspects of the STP mandated requirements.
Net savings apparently total £328 million This presumably must be annual savings for year one. Apparently £208.9 million will be saved by ‘improving consistency in patient outcomes and experiences regardless of the day of the week that services are accessed’. This clearly is where seven day working is implemented. But seven day working means employing more staff at the weekend and overnight or reducing service levels Monday through Friday. How over £200 million can be saved in this scenario – without massive service deterioration – is beyond my comprehension.
Outsourcing Mental Health?
Are the STPs being set up to fail so that the private health companies (‘the cavalry’) can then charge in and rescue our healthcare and social care services? Well, perhaps not. The small print shows us that the cavalry are actually being planned into the STP. Nestling inside ‘Delivery Area 4: Improving outcomes for children and adults with mental health needs’ (net savings of £11.8 million) is ‘implement accountable care partnerships’(ACPs). The ACP idea has been around for a while in the NHS. It is England’s version of the American Accountable Care Organisation which first emerged 10 years ago. (ACO) ACPs are a vehicle for introducing private care companies into the delivery of public care services. A contract is drawn up with often private care providers, Primary, Acute and social care providers to provide all care for a given population for a defined (long!) period of time. Very often there are tight performance parameters and financial incentives in place when targets are met. The jury is still out in America as to whether ACOs are effective or even cost-effective. Critics of the ACO/ACP approach see them as a means of destroying single payer national care systems. .
There are yet again scant details on social care savings or initiatives. Nothing on social workers, personal care, protection or social support services to children and adults with needs arising from illness, old age or poverty. There are clearly planned changes on how the total spend cake will be sliced in 2020/21 compared with 2015/16. However even if, for example the slice for ‘Community’ rises from 9% to 13% there may well be less cash This is because the total cake is just over £4 billion now but will be less than £3 billion in 2020/21. Astonishingly there is no slice of the total spend cake labeled ‘Social Care’ or even ‘Social Care and Healthcare Integration’.
On the mental health front the slice of the cake will stay at the current 8% of total spend in 2020/21. This will represent a serious annual drop in real cash terms of some £80 million. On a pro rata basis that would cut the annual mental health spend in Ealing by £10 million. There is a quite incredible projection about how there will be a 1% fall in serious and long term mental health needs over the next five years. I can find no clinical or research data to back up this claim.
The plan for addressing social isolation is amazingly ‘Address Social Isolation’. This really is pathetic. In ‘Socially Excluded Groups’ the only data – and partial data at that -concerns rough sleepers. If the STP creators think rough sleepers are the only socially excluded people they are the wrong folks to be creating my STP.
In the plan delivery section it states ‘…delivery to ensure it (the STP) sustains investment on the things that keep people healthy and out of hospital’. Well blow me down with a feather …isn’t that what the NHS was created for in 1948? Also in this section we find that at least 178 NHS and Local Authority staff in north west London are working on our STP. However the number could be over 200. Nationally there might well be over 8,000 paid public servants working on the 44 STPs as well as many £millions being spent on management consultants.
There’s reference to ‘joint governance’ and ‘joint accountability’. This is so much nonsense. I keep meeting STP /SaHF staff who tell me that they are being paid and employed by both the Local Authority and the NHS. This sends me berserk. You can only have one boss. You can only be accountable to one bunch of shareholders and one organisation.
Multi-Speciality Community Provider: The Outsourcing Vehicle
On 22 July another public NW London STP event took place. Labelled as a workshop so many residents asked questions that the workshop format was abandoned. Allegedly a NW London STP public event will take place in Ealing Town Hall in September or October 2016. There are no explicit plans to involve the local Healthwatch organisations in any NW London STP plan making or public engagement. More emerged on ACPs (see above) and on them being ‘delivered through Multi-Speciality Community Providers (MCPs). I first referred to these MCPs in May 2016 when discussing Devo-Manc Health (in Manchester). The scary idea emerging from the jargon littered verbiage is that traditional GP surgeries might well be closed down. They would be replaced by MCPs /’superhubs’/’networks with shared infrastructure’ which will – using the GP surgery patient lists – ‘provide…the full breadth of services ….including primary medicine and community services’. How this will threaten or destroy the traditional GP surgery is unclear. However in Brent, all the GPs have joined a newly created limited company. It’s no surprise that the directors of that company are GPs who serve on the Brent CCG Governing Body.
NW London STP, following the lead of the monster STPs in Manchester and Liverpool, wants a devolved budget. A recent Localis survey says 78% of NHS and Local Authority bosses want this. New London Mayor Sadiq Khan says he wants it for a London STP. However devolving health and social care could create a patchwork quilt of differing approaches and arrangements. It could wreck the NHS as a consistent, universal healthcare service. To give, as some have suggested, tax raising powers to the 44 unelected STP cabals – even with the blessing of Parliament – would destroy this country as a representative democracy.
Believe me STP will end in tears – in fact it’s starting in tears. Rumours abound that in my region two of the Local Authorities (LAs) have refused to ‘sign off’ on the latest draft STP. They were recently given a two page STP summary to sign their names to. The two LA bosses refused, saying no-one had showed them the latest full draft. They were then shown the 51 pages of draft version 39 and given just three hours to peruse and sign. Again they refused. NW London STP bosses then told the two LAs that they would ‘take money away from community health services for local people’. The two LAs are the London Borough of Hammersmith & Fulham and the London Borough of Ealing – the areas still most threatened by Major Hospital closures under the 2012 SaHF declaration.
The Judicial Review Option
Thanks to research by Peter Latham of Brent Patient Voice it’s clear that Ealing CCG has a statutory duty under S.14Z2 of the National Health Act 2006 (as amended by Section 26 of the Health and Social Care Act 2012) to involve and consult its publics as to proposals for healthcare commissioning and changes to healthcare commissioning that affects patients. This is clearly not happening with NW London’s STP. ECCG is at risk of the procurement of or changes to commissioned healthcare affecting patients without full statutory patient/public involvement and consultation of being challenged by Judicial Review proceedings in the High Court This will, of course, apply to all 211 CCGs in England.
A Government Inspection Reveals Serious Failings at Northwick Park Hospital Maternity Unit: Ealing Mothers Victims of Inadequate Service
Since Ealing Hospital Maternity Birthing Unit closed down at the end of June 2015, mums to be in Ealing have had nowhere to go to in Ealing to have their babies. Some have chosen Northwick Park Hospital Maternity Unit in Harrow.
In October/November 2015 the Government’s Care Quality Commission (CQC) carried out an inspection on Northwick Park Hospital. Incredibly it took seven months before the CQC report was published at www.cqc.org.uk. The report contains much criticism generally about hospital services and specifically about the maternity services. These criticisms about maternity are summarised below:
+ Safety arrangements
+ Early Pregnancy Unit cleanliness
+ Medicines sometimes in unlocked cabinets and sometimes stored at the wrong temperature
+ Foetal Heart Rate checks
+ Low Midwife staffing levels
+ Minimum standards of consultant presence per week not met
+ Shortage of Health Visitors
+ Too many non-elective Caesareans
+ No Consent, Mental Capacity Act and Deprivation of Liberty training
+ No documented birth plans
+ Delays in Caesareans, induction of Labour and in Discharge
+ Poor maternity and gynaecology governance.
Before the closure of Ealing Hospital Maternity Unit the NHS Ealing Clinical Commissioning Group (ECCG) stated ‘….it has been able to improve maternity care for mothers across North West London’. For many new mums in both Ealing and Harrow this statement has been shown to be patently untrue.
The CQC criticised the standard of cleanliness in the whole hospital. There was savage criticism of the London North West Healthcare NHS Trust – the legal entity running Northwick Park Hospital. CQC stated that the Trust had failed to communicate its strategy and vision, it had failed to communicate with staff and it had failed to support staff and make them feel valued.
NHS North West London CCGs Spent £5.1 Million on Management Consultants in FY 2015/16
£5,188,001 was spent by the eight NHS NW London Clinical Commissioning Groups on management consultants from June 2015 to March 2016. These contracts concerned work for the 2012 ‘Shaping a Healthier Future’ (SaHF) project and the Sustainability and Transformation Plan (STP). Over £1.8 million alone was paid to McKinsey and Company.
The fact that one of the STP contracts was signed in August 2015 leads me to believe that the STP project was up and running secretly for months before it was announced to the public just before Christmas 2015.
It defies belief that the CCGs are still paying consultants to write/rewrite SaHF business cases for the SaHF which was conceived four years ago. But sure enough, six consultancies were paid over £1.8 million to work on these business cases in 2015/16. And still there are no final, published business cases. Surely the whole idea of a business case is that you get an approved business case signed off before you start a project – not four years into the project!
If you thought that NHS England had put a cap on the size of individual management consultancy contracts – think again. In December 2015, for example, Deloittes was awarded a £585,000 SaHF business case support contract.
Presumably the hundreds of staff employed by the CCGs are deemed not competent to carry out this work. But surely public money would have been better spent last year and in the last three years if the NHS had hired bright people onto its payroll to do this work? At £80,000 per year (salary plus overheads) it would have cost £3.2 million to have 10 people on board for four years to do this work. Instead the NHS NW London management consultants’ bill for 2013 to 2016 was over £38 million. Truly scandalous.
After Spending £50 Million on the care.data Patient Health Records Sharing Scheme, NHS Bosses/Government Scrap It
On 6 July 2016 – the day The Chilcot Report condemning Tony Blair’s invasion of Iraq was finally published and filled our newspaers and TV screens – the Government quietly announced that care.data was being scrapped. Launched in 2013 the care.data scheme was an attempt by the NHS to collect patient data from GPs, anonymise it and use it internally and sell it externally. care.data has consistently attracted criticism about the anonymity and security of patient data.
In February 2014, 47 million NHS patient records were sold to insurers. In February 2015, 700,000 NHS patient records were shared with insurance companies without patients being consulted.
Tim Kelsey the genius responsible for initiating and running the care.data shambles ran away from it, the NHS and the UK in September 2015 and was last heard of in Australia. However Kelsey clearly does have a sense of humour as he’s recently published a book on the role of transparency in government and business surveillance. To misquote an old adage ‘Nothing succeeds like failure’. Also in September 2015 the care.data pilot trials were halted.
Data campaigners are still concerned that the NHS and the Government will continue to sell off confidential patient data – including data from NHS patients, like me, who opted out of the care.data scheme. However the Government has now, apparently, decided that patients can no longer opt out of their medical records being loaded onto a central NHS database.
Yet more £millions wasted by NHS/Government and still more erosion of trust between citizens and the State.