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.
NW London’s Draft STP and an STP Engagement Tool Enter the Public Domain
The Sustainability and Transformation Plan (STP) is the Government’s latest initiative to reduce spending on healthcare and social care. Each of 44 regions (so called footprints) in England will have their own STP. Ours here in Ealing is the North West London STP. We also have a NW London STP Engagement Tool.
The draft NW London STP aims to cut the annual care spend by £328.3 million in year 5 of the STP (optimistically set for 2020). On 5 August 2016 the latest draft of our STP was placed into the public domain. On 16 August 2016 the NW London STP Engagement Tool was also put into play.
The 55 page draft STP and the 6 page STP tool can both be viewed at:
The tool is clearly aimed at those with little time to wade through the thousands of words and new acronyms in very small type size in the STP. The STP tool is very, very much shorter with easy to read words and almost no acronyms.
STP Engagement Tool
We are asked to submit our views on improving our health, better long term care, home care for the over 65s, improved mental health care and high quality services. However no explicit references are made to across the board cost cutting, hospital bed reductions, staff numbers and closing Ealing Hospital.
One of the STP goals is integrating healthcare services with social care services. There is no explicit reference in the tool as to how any of this might be achieved. What about Accountable Care Partnerships (ACPs) – the vehicle being trialled around England to do this job? The tool doesn’t ask our opinion about ACPs – even though some are planned in NW London. Much more on ACPs below.
The tool informs us that the STP will improve ‘housing, employment, schools and the environment that affects health’. This is twaddle. There is absolutely no way that the 31 public sector organizations thrown into a room together and told to cut care costs are going to improve housing, employment, schools and the environment. In a similar vein ‘more focus on preventing ill-health’ is all well and good, but will it achieve anything? Persuading people to adopt healthier life styles costs money and is not always successful. The marketing budgets of drug, alcohol, food and tobacco companies are huge. It took Government action to ban smoking in public places which clearly has reduced the number of people smoking and the amount many smokers smoke. It’s not clear how prevention success might be calculated or measured. So it’s clearly debatable how annual savings of £11.8 million on prevention in five years time might be computed. However the STP tells us that grants of £110 million will be received for ‘investment in prevention and social care’ over five years.
The tool page on improving mental health services opens with ‘We all have mental health’. This is a ludicrous statement. Statistically 50,000 adults in Ealing and 328,000 throughout NW London have mental ill health. ‘Improving mental health services ‘is again a laudable goal, but it’s going to take more money and more staff to achieve this. If you have already been waiting for over six months to see a psychologist only hiring more psychologists is going to improve things. More emailing, more Skyping, more telephoning and new ‘models of care’ just won’t hack it. STP grants expected over five years should total £53.7 million. The annual mental health spend in 2015/16 of £308 million will rise to £358 million in 20120/21. In year 5 annual mental health savings are quoted at £11.8 million.
Old people are asked whether they want care at home as opposed to visiting hospital or residing in a care home. The choice being offered here is an illusion. Hospital care is free, but social care at home is not, it is expensive and is, in effect, unregulated.
I view the NW London STP Engagement Tool as a deflection or displacement exercise. NHS NW London has for four years been cutting hospital beds, cutting staff and closing local services. Its excuse for this was that these cuts and closures would provide us all with better healthcare services. The jury is still out on that one. The STP carries on this cuts-mean-better-services charade. The decisions on more home care, more technology, fewer beds, fewer staff and Ealing Hospital closure have already been made. How cruel is it to ask citizens for their opinions after the service re-designs have been completed? This is disrespectful and insulting to people like me whose taxes pay the wages of these after-the-event engagers.
Will Accountable Care Partnerships (ACPs) Finally Destroy the NHS?
The national media, thanks to prodding by 38 Degrees, has finally caught up with STPs. But it hasn’t, as yet, cottoned on to Accountable Care Partnerships (ACPs) as the engine of STP change and the harbinger of doom for the NHS. In the NW London STP ACPs are mentioned for delivering ‘end of life’ care for elderly people.
ACPs are/will be networks of organisations which will assume clinical and financial responsibility for providing care for a defined service user audience for a fixed price for at least 10 years. The potential area of operations for ACPs is wide, including community care, out of hospital care, core primary care, social care, Acute/hospital care and mental health care. The patient populations will be aggregations of GP surgery patient lists. Partners’ organisational boundaries will be removed and no doubt the partner brands will by subsumed by the ACP brand.
The key puzzles ACPs will be asked to solve will surely be cost cutting, integrating healthcare services with social care services and shifting much of Acute hospital care into GP surgeries, the ‘community’ and into people’s homes. There is no doubt that achieving these goals will not be easy. However removing clinical and financial responsibility for these tasks from public NHS and Local Authority bodies and handing it to untested, private partnerships seems foolhardy at best.
ACPs are likely to destroy traditional GP practices as federations of GP surgeries are subsumed into ACPs and asked to do more to provide replacement secondary care services for hospitals downsized or eliminated.
There are 50 fledgling ACP pilots in operation throughout England. The smallest will serve 97,000 people and the largest some 6 million. None of these ACPs are NHS bodies. Constituent ACP organizations include Local Authorities (LAs), private healthcare and social care providers, NHS Trusts, GP federations, Clinical Commissioning Groups (CCGs), Healthwatches, charities and voluntary groups.
ACPs drive a coach and horses through the Health & Social Care Act 2012 as the strict division between commissioners e.g. CCGs and LAs and service suppliers e,g, NHS Trusts and private care suppliers is completely trashed. Still, this is no more respectful to the Act than the 44 footprints which corral a similar cast of commissioners and service suppliers together to create the STPs.
The track record in England of ‘real’ ACPs is very limited and not good. There has been only one which became fully operational in 2015. Sadly it lasted just nine months. The Cambridge and Peterborough ACP was a five year, £725 million car crash which failed ostensibly ‘for financial reasons’. There is no convincing evidence around the world (USA and New Zealand ACPs are often quoted) that ACPs actually save any money.
Does Brent’s ‘Referral Optimisation Service’ Spell the End of GPs Clinical Independence?
Brent Patient Voice (BPV) has raised concerns that Brent GP referrals are about to be intercepted and reviewed by a private healthcare provider. Brent CCG (BCCG) has hired Bexley Health Ltd for £1million to second guess GPs. The Brent Optimisation Referral Service (BROS) will never have met the patient and will not have access to the patient’s full medical history.
BPV were about to meet BCCG to discuss BROS on 16 August 2016. However BCCG pulled out of the meeting. BPV wrote to BCCG about its concerns. No content bearing reply has been received by BPV. BROS goes live on 1 September 2016.
BPV further notes the workings of a pilot optimisation service for urology in Devon. 30% of all GP urology referrals to hospital consultants were refused. GPs have had to carry out further investigations themselves, such as ultrasound scans – for which they are not re-imbursed by the NHS. More on this at: www.bpv.org.uk
A surprising postscript to this story is my discovery of the Ealing Referral Facilitation (ERF) service which is surely ‘optimisation’ by another name. ERF has been in operation for at least three years and is run by a group of local GPs. ERF works with your GP ‘to ensure that the service you are referred to best meets your clinical need’. In December 2012 Ealing CCG confirmed that the ERF would be ‘challenging referrals ‘in 2013/14. Ealing CCG Governors Dr Mohammad Alzarrad and Dr Vijah Tailor are two of these ERF ‘optimising’ GPs. The ERF is commissioned by Ealing CCG. But surely healthcare commissioners can’t also be healthcare service suppliers?
One in Three 14/15 Year Old Girls are Suffering From Mental Illness
A ten year Department of Education (DoE) study of 30,000 school pupils has revealed very worrying mental ill health profiles for teenage girls. 37% of girls had three symptoms or more of psychological distress. In teenage boys the mental ill health profile only affected 15%.
Interestingly enough, alcohol consumption, drug taking, truancy and pregnancy rates have all gone down for teenagers in recent years. However, a variety of reasons have been suggested for this virtual mental ill health epidemic amongst teenage girls. ‘Pushy’ higher social status parents have been suggested as a factor as have social media pressures. Former mental health tsar Natasha Devon thinks, however, that social media is just a reflection of what is going on. She blames community breakdown and Michael Gove’s school reforms in reducing school time for sport, music, arts and dance.
The Government has committed £1.4 billion of new money for increased mental health services for children. Let’s hope some of these additional mental health services help the 4,800 or so teenage girls in Ealing suffering (according to the DoE research) from psychological distress.
Judicial Review to Challenge Hunt’s Power to Impose Contract on Junior Doctors: 19 and 20 September 2016
Justice for Health, a social justice movement founded by five Junior Doctors, has secured a Judicial Review (JD) on Hunt’s contract imposition. It’s scheduled for the High Court on 19 and 20 September 2016.
A full, expedited JD was granted in the High Court on 21 July 2016. Hunt’s blustering approach of asking for high ‘Security of Costs’ (what the doctors would pay if the JD failed) was knocked back by the judge. Justice for Health raised the reduced amount of £130,000 in just four days.
The five founding doctors have a combined 37 years’ experience as NHS doctors. Four of them are Registrars. Their excellent web site is clear and concise and puts many commercial sites to shame. More at www.justiceforhealth.co.uk