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.
NHS North West London Wants £827 Million for Building Work
On 15 December 2016 Ealing Clinical Commissioning Group (ECCG) approved a ‘business case’ for future NHS building work in ‘outer’ North West London for £513 million. The business case only entered the public domain on 6 December 2016. Its appearance has been awaited for three years.
In order to make cuts in annual healthcare spending of £1.4 billion in NW London beginning in 2020, for ‘outer’ NW London building works the NHS wants £377 million of public money invested. By 2026 it wants an additional £136 million. (For ‘inner’ NW London a further £314 million will, apparently, be requested some time in the future).
These figures are extracted from a 257 page NHS document called ‘Strategic NHS NW London Outline Case Part 1’. This relates purely to the £513 million building works planned in ‘outer’ NW London. Surprisingly the document is also associated with the failed 2012 NHS NW London ‘Shaping a Healthier Future’ (SaHF) project. SaHF was announced in 2012 as ‘at least’ a three year project but has now ballooned into a ten year one.
Healthwatch Ealing and Ealing Save Our NHS raised many concerns at this ECCG meeting – none of which were sensibly or adequately addressed. SaHF promised to make 4% cost savings every year, close four hospital A&E units and replace Acute hospital services with ‘Out of Hospital’ community services. SaHF has failed to achieve any of these ambitions. However what it has achieved is a massive drop in hospital A&E performance across the region from September 2014 to date. It achieved this during a period when A&E demand has remained static. Clare Parker, Chief Officer NHS CWHHE CCGs, did not deny that the savings had not been achieved and also had the bare faced cheek to deny the A&E collapse.
The public money will, apparently, be spent on building community healthcare hubs (£140million), replacing the Major Hospitals at Ealing and Charing Cross with effectively ‘super hubs’ (£300million), and enhancing some GP surgeries (£69 million).
The location of these future hubs is very disturbing. Hounslow with 265,000 residents and a Major Hospital will have six hubs. Ealing with 342,000 residents and no Major Hospital will now, apparently, have just three. None of these are located in the areas of high deprivation at South Southall and Northolt. In the original SaHF proposals six hubs were proposed for Ealing. Dr Mohini Parma, GP surgery boss, NHS ECCG Chair and NW London Footprint boss, somewhat pathetically and unsuccessfully tried to suggest there were more than three hubs planned for Ealing.
Missing from this business case are analyses of existing and projected Acute admissions and A&E attendance, and capacity planning data on ambulance services and public transport. No details are provided on the investments in GP surgeries. There is also very little timescale data. There are many references in the document to the so far unapproved NW London Sustainability and Transformation Plan (STP). This is all very confusing as SaHF is a 2012 healthcare services transformation/cost cutting plan over ten years whilst the STP is a 2016 healthcare and social care transformation/cost cutting plan over five years. No compelling evidence is provided to suggest that there will be an adequate return on the public capital invested.
I find the business case to be inadequate. I find it hard to believe H.M. Treasury will release hundreds of millions of pounds to an organisation which has failed to successfully implement SaHF cuts and improvements over the last three years. NHS NW London in 2012 promised us ‘(SaHF) changes that will improve care in hospitals and the community’. The two million residents have been very badly let down by these failed promises.
Broadmead GP Surgery Survives to Fight Another Day
Broadmead Surgery in Northolt was under threat of closure until incumbent GP Dr James Swain, his staff, his patients, the Patients’ Participation Group, local NHS staff, Steve Pound MP and Healthwatch Ealing mounted a campaign.
The initial NHS proposal was for ‘list dispersal’ (i.e. GP surgery closure). However at a meeting of the NHS Local Joint Primary Care Co-Commissioning Committee on 15 December 2016 this proposal was dropped and a new proposal for ‘re-procurement’ was agreed. What this means is that Dr Swain can compete in an open tender with others for a new five year APMS GP contract. It is hard to envisage that anyone else could successfully compete against the incumbent for this contract given Dr Swain’s surgery growth record, range of services and massive popularity with his patients.
This is a rare victory for common sense by NHS management.
North West London STP Set In Concrete Now from April 2017 to March 2019
According to NHS England, STP-based service contracts for North West London were signed on or before 23 December 2016 with NHS providers for the period 1 April 2017 to 31 March 2019. Apparently these contracts are based on the ‘final’ STP version as of 21 October 2016.
So….public engagement and public consultation on our local STP for years one and two is over – before it ever even began!
One does wonder exactly what is in these contracts. Are they fixed price? Are there social care delivery contracts? Are there contracts which cover integrated healthcare and social care service delivery? Two years’ NHS healthcare spending alone in NW London amounts to over £7 billion. Who exactly has ‘commissioned’ these services? It’s not the statutory CCG or Local Authority commissioning bodies. Is it in fact NHS England? Or is it the nebulous non-statutory body referred to as a ‘transformation’ group thrown together by the eight NW London CCGs. Google can’t find who serves on this group except for Dr Mohini Parmar who leads it and four named clinical directors.
You might think that a group that will purchase over £10 billion STP care services for NW London by April 2020 might have its own STP web site. On such a site one might expect to find a constitution and minutes of meetings at which discussions were held as to how much to pay to whom for what. Also one might find copious evidence to support ‘transformation’ and details of meetings discussing the content, finance and operation of the five Accountable Care Partnerships to be formed. Sadly none of this exists.
Could 2017 Be the Year When the Tidal Wave of Opposition Sweeps Away the STPs?
As we enter 2017 there is much speculation and concern as to how Brexit and a Trump US Presidency will affect our lives. What’s scary about Brexit and Trump is that there are no plans. As for the NHS and social care services, what is even more scary is that there are plans – the Sustainability and Transformation Plans (STPs). Also people voted for Trump and Brexit. But no such luck with the 44 STPs which are being foisted upon the people of England.
I first became really concerned about the NHS in 2012 and began this newsletter in May 2013. In 2012 I was pretty ignorant about the NHS structure and its jargon. I naively thought that the NHS North West London ‘Shaping a Healthier Future’ (SaHF) plans were just a local cost cutting/hospital closing initiative. However now I and thousands across England understand how the NHS now works and what the STPs cost cutting ‘common purpose’ actually is.
In late 2012 I joined an Ealing Trades Union activist group which was opposing the SaHF plans. This group – Ealing Save Our NHS (ESONHS) – is now very strong. Healthwatch Ealing – after ignoring patients’ concerns for three years – is now a potent patient voice. The Seniors Action Group Ealing (SAGE) is now re-energised in its current and future concerns for Ealing’s elderly. Many of us have joined our GP surgery Patient Participation Groups (PPGs) and will be both asking STP questions and explaining STP consequences in the local patient forums.
Throughout NW London activists groups are sharing information and supporting each others’ campaigns of protest. Links are particularly strong between groups in Hammersmith, Lewisham, Brent, Harrow and of course Ealing. There’s also a flourishing NW London activist co-ordinating body.
At a national level there are two well supported bodies – Health Campaigns Together (HCT) and Keep Our NHS Public (KONP). HCT has led the country in discovering and publishing the ‘secret’ STP proposals.
The 44 STPs, if and when approved by NHS England and the Department of Health, will need capital budgets for building work. NHS NW London wants £827 million. If this is a representative figure then nationally H. M. Treasury will be asked to stump up over £36 billion by 2020. If this cash is to be raised through PFI-type deals then this must be robustly resisted. It could saddle UK taxpayers with 30 years of debt totaling over £250 billion.
On the cost cutting front no doubt Accountable Care Organisations (ACOs) of many flavours will be created. These private consortia will work to long term, fixed price budgets in order to reduce annual healthcare costs by £22 billion by April 2020. To achieve this in 39 months will surely be impossible without massive downgrades in service levels. This brutal butchery will cause unnecessary hardship, pain and death.