NHS North West London Healthcare Services – The Future Disaster in Numbers – February 2017

 

Issue: 45

February 2017

 

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 Healthcare Services – The Future Disaster in Numbers

 

Number of Staff, January 2017:  48,258

2017/2018    18/19 19/20      20/21

Staff Reductions (cumulative)

3,658             5,222 6,592    7,753

155 NHS STAFF WILL BE FIRED, ON AVERAGE, EVERY MONTH FOR THE NEXT 50 MONTHS

 

Outpatients

    Cut by 222,370 up to 2020/2021

 

Elective Admissions

    Cut by 34,437 up to 2020/20/21

 

Non Elective Admissions

    Cut by 64,175 up to 2020/20/21

 

Figures courtesy of an FOI response received by a Brent health campaigner.

 

Most of England Has Just One Massive Healthcare Care Cost Cutting Plan – But North West London Has Two!

In the summer of 2012 NHS North West London launched its ‘Shaping a Healthier Future’ (SaHF) project. It was an ‘..over three year’ programme of cuts and restructuring  which would achieve annual savings of 4% each year. SaHF involved downgrading four Major Hospitals (one of which is Ealing Hospital), closing four of the nine hospital A&E units, cutting the number of Acute hospital beds and replacing them with ‘Out-Of-Hospital’ (OOH) arrangements. However no annual cost savings have been achieved (by now they should exceed £400 million), just two of the A&E units were been closed (in September 2014) and A&E performance has been some of the worst in England ever since. Hospital Acute beds have been cut, but replacement OOH arrangements are nowhere to be seen.

 

Over a 10 month period in 2016 the NW London Sustainability and Transformation Plan (STP) was conceived in secret by over 200 civil servants. The STP is a five year cost cutting plan for care services. Its financial goal is to reduce the annual running costs for care services throughout the region by £1.3 billion by 2021. The STP’s mission is similar to SaHF but there are significant differences. STP covers both health care and social care services and the integration of the two. As such, Local Authorities are thrown together with NHS bodies to sort this out. SaHF however is just about healthcare; STP aims to mandate recent new strictures like seven day working and parity of esteem for the physically and mentally ill – neither of which were SaHF goals – in fact mental health is hardly mentioned at all in the SaHF. The STP also mandates  the creation of brand new, long term fixed private partnerships called (generically) Acountable Care Organisations (ACOs). ACOs do not feature in SaHF at all.

 

Many of us, watching the SaHF fail in 2015/16, presumed that it would be quietly retired and be replaced by its newer big brother the STP. But…no. December 2016 saw SaHF come roaring back with a 356 page business case. We had been waiting for this business case for some three years. Sadly this was only Part 1 of the business case – asking for just £513 million for building works in ‘outer’ NW London. Part 2 – aimed at building works in ‘inner’ NW London asking for £314 million – has yet to be published. To my astonishment Part 1 tells us all that SaHF has now become a 10 year project!

 

On 25 January 2017 Ealing Council Councillors met SaHF (and STP) bosses in public  for three hours to scrutinise Part 1 of the SaHF business case. The catchy title of the business case is ‘Shaping a Healthier Future: Strategic Outline Case (SOC) Part 1’. The publishers are a non-statutory body who call themselves ‘NHS North West London Collaboration of Clinical Commissioning Groups’.

 

A common complaint by Councillors was their struggle to understand much of the jargon and financial complexities. Some said that on the doorstep their constituents knew absolutely nothing about the proposed cuts and changes to local healthcare services. Councillors variously voiced their opposition to the downgrading of Ealing Hospital. Some could simply could not understand how this downgrade would improve healthcare for Ealing residents. Others worried about what would happen if H.M.Treasury refused to hand over the cash for building work. Others felt that Ealing residents would endure pain and worse travelling to remote hospitals after Ealing Hospital ceased to be a Major Hospital.

 

Councillors also wrestled with the concept of  ‘Hubs’. Hubs seem to be collections of GP surgeries (20,000 patients/hub). It’s possible that there will also be some social services and some mental health services residing in a Hub. Apparently Ealing will have three Hubs. One will be in/at Ealing Hospital site, with a new one in the north, probably on the GSK site in Greenford and a new one in the east probably on the site of Acton Health Centre. Each of the new Hubs will cost £20 million to build. SaHFers then referred to Hubs as Health and Wellbeing Centres. Councillors went nuts. One name or the other they cried. Let’s have Health & Wellbeing Centres they demanded. It was made clear that no more GP businesses were to be created. The SaHF business case described a future facility at Ealing Hospital as a ‘Local A&E’. Councillors struggled to get their mind around the idea that any hospital’s emergency unit with no Intensive Care and no arriving blue light ambulances could ever be labeled  ‘A&E’.

 

There were a number of instances when Councillors pressed for more evidence or risk assessment data and were fobbed off with promises to carry out further research /data gathering. Some Councillors understandably were dumbfounded by this. SaHF has had over three years and spent millions of pounds with management consultants designing and implementing these SaHF changes. Even though the SaHF business case (Part 1 only) is three years late, is it still incomplete?

 

SaHF stated that in 2025/26 there would be 22,000 fewer hospital admissions. Presumably this is an annual figure. No clues were provided as to how this figure for nine years hence had been calculated.

 

Healthwatch Ealing (HE) presented an update on its response to the business case. Chair James Guest reprised his oft stated reservations about the exclusive adoption of a ‘top down’ design approach. What was needed was a ‘bottom up’ approach to validate the ‘top down’ high level assumptions. This would begin with a detailed description and analysis of the current services and patient volumes at Ealing Hospital and grow into where these services and patient activities will be relocated. Other concerns highlighted included lack of evidence re ‘efficiency’ and Acute beds’ reduction proposals, patient access and transport issues, lack of overarching accountability, too few Hubs and Hubs in the wrong place, and lack of clarity and detail about the new provision of Frail Elderly Beds on the reconfigured Ealing Hospital site. The Councillors welcomed the HE report and SaHF agreed to respond in writing to it.

 

The most surreal part of the meeting was when the SaHF PR person did a sales pitch on ‘engagement’. The person also handed out copies of a questionnaire. SaHF wants to know how Ealing residents would like the £513 million to be spent. This is so insulting to Ealing residents. SaHF has published a 356 page business case to support the spending of this money on building works. It’s already decided how this money is to be spent.

 

NHS North West London Hospital A&E Performance Continues to be the Worst in England

Latest available A&E performance figures (November 2016) for the sickest patients (Type 1) reveal that four of the NHS NW London Hospital Trusts were amongst the ten worst performing in England. On one dreadful day (29 November 2016) Hillingdon Hospital managed to treat just 41% of Type-1 patients within four hours.

 

However NHS NW London top management continues to be in denial about this dreadful performance. On 11 January 2016 Dr Mark Spencer, Medical Director, on being confronted with these horrific performance figures said:

 

‘As ever, the NHS’s priority in NW London , as elsewhere, is on treating the sickest A&E patients first, whilst endeavouring to reach the 95% standard for all patients  whenever possible, even in winter’.

 

But…There Could be Much Worse to Come

The current A&E chaos still awaits the completion of the 2012 cost-cutting NHS NW London ‘Shaping a Healthier Future’ (SaHF) programme. SaHF promised us the closure of four hospital A&Es – but so far has closed just two, and both of those were in September 2014.

 

The NHS mantra underpinning SaHF is that 30% of those people occupying hospital beds should not be there. This percentage was first spouted by the NHS’s favourite management consultants McKinsey & Co in 2009. The way the logic goes is that if you have fewer people filling beds in hospital you can get rid of lots of those expensive hospital beds. Nationally 13,822 NHS hospital beds have been eliminated since 2010.  Our cost-cutting Sustainability and Transformation Plan (STP) wants to close another 500 Acute beds by April 2020.

 

Lies, Damned Lies and NHS Hospital A&E Attendance Data

Lying by politicians has reached unprecedented levels with regard to attendance levels  at NHS hospital A&E units. Secretary of State Jeremy Hunt MP told Parliament in December 2016 that A&E attendance levels were up 30%. Sarah Wollaston MP, Chair of the Health Committee, also said in December 2016 that there were ‘unprecedented levels of demand’ at NHS hospital A&E units.

 

But, these statements are completely untrue.

 

Colin Standfield has been collecting, collating and analysing NHS hospital A&E attendance figures for 3.5 years. For all attendances in London the uplift April 2013 to November 2016 is 6.15%, but the population rose by 3.69%. Throughout England for all attendances the uplift is 6.5%, but the population over the three years rose by 2.37%.

 

The actual increase across England in real terms is 4.13%.

 

As for NHS NW London generally and Northwick Park and Ealing Hospitals specifically, A&E attendance levels have reduced slightly over the three year period.

 

Are these politicians consciously lying? Maybe they are just spouting whatever NHS England and the Department of Health are telling them. So…is it NHSE and the DoH who are consciously lying?

 

Ealing Clinical Commissioning Board (ECCG) Governors’ Meeting 18 January 2017

I sat through almost three hours of this meeting. The meeting content variously astonished, depressed and surprised me. The NHS ECCG currently decides how our money is spent by the NHS to provide for secondary/hospital care for Ealing residents. However of the 20 Governors the three dominant members are part of the five person team which decides on how money is spent on secondary/hospital care for much of North West London. The fivesome run the consortium of five of the eight NHS NW London CCGs. They also run the NHS NW London 2012-2022 cost cutting project ‘Shaping a Healthier Future’ (SaHF) and the 2016-2021 NW London cost cutting project the Sustainability and Transition Plan (STP). SaHF and the STP are often presented as being the same but of course they aren’t. When any one of the three big bosses speak they may be speaking as ECCG, the NW London CCG consortium, SaHF or STP – or in fact as all four.

 

Engagement with the public is very poor at ECCG meetings. No hard copy of the documents to be reviewed/approved is provided. We were not even given an agenda. The ECCG had no interest in discovering who we were. No names or email addresses were collected, so even if answers were forthcoming at the meeting or afterwards there was no way the answers could be sent to any of us. Quite pathetic.

 

Ealing GPs apparently will soon be asked if they want to be controlled by NHS England or the ECCG. If they choose ECCG we will have the bizarre situation where the GP led ECCG will determine the finances and potentially the professional lives and deaths of 200+ GPs at 80 GP surgeries. This really cannot be right. It’s like giving your young children the right to determine how much pocket money they receive!

 

Apparently only 11% of those needing physiotherapy were receiving it within four weeks.

 

Local activists at the end of the meeting raised issues about the A&E crisis in Ealing and throughout NW London. The complacency which radiated from the ECCG Governors was appalling. ECGG would not accept that there was a local A&E crisis. ECCG said that each hospital collected A&E performance date in its own particular way. This made meaningful data aggregation across hospitals and across the country an impossibility. So according to the ECCG/CCG consortium/SaHF/STP measuring and comparing A&E performance data is a futile exercise. Unbelievable.

 

When questioned about bed blocking Clare Parker, one of the NHS bosses, said there were plenty of beds in North West London – 2.2 million in fact. I found this quite offensive. Some of these home beds would obviously be unsuitable from a clinical/medical perspective. For example the elderly, the mentally ill and substance abusers often live chaotic lives in unhygienic situations. Thousands of poor people are living in bed and breakfast accommodation throughout NW London. Also, more than 8,000 people slept rough in London during 2015/16. Ms Parker also blurted out that there were 4,000 acute beds in NW London. I found this surprising as the health emergency researcher John Lister counted just 3, 449 beds way back in 2012. However at 4,000 beds we have just over 2 beds per 1,000 (GP registered) population. The World Health Organisation recommends a minimum of 5 beds per 1,000. France has 6.4 beds and Germany 8.2 beds.

 

The issue of offering patients at Charing Cross Hospital the opportunity to have their operations at remote private hospitals was raised. One of the big issues was that these private clinics had no intensive care services on site and if an emergency arose delays in getting to an NHS acute hospital could prove fatal. . Incredibly what emerged was an amazing queue of 400 Charing Cross patients awaiting operations for over 52 weeks.

 

I tried in vain to ask my question, but was never invited to speak. The question I would have asked was one identified by eagle eyed Brent Patient Voice’s Robin Sharp:

 

‘Appearing for the first time in the 22 October 2016 version of the STP was £108 million savings from Local Authority Social Services. Can you please explain how these savings will be achieved?’

 

If I had asked the question I suspect the chances of my receiving a content bearing response would have been zero

 

Healthwatch Hounslow Annual General Meeting.

On 24 January 2017 I attended the Healthwatch Hounslow (HH) Annual General Meeting (AGM). We were told about many meaningful research activities. We also heard about extensive patient engagement. Staff and volunteers were thanked over and over again for their efforts. However, quite bizarrely, there was no written AGM report, no written financial report or any financial details, and no election of officers.

 

Hounslow CCG did a presentation on the NHS NW London Sustainability and Transformation Plan (STP). Two things not mentioned were the 900 hospital beds to be lost and annual savings of £1.3 billion to be achieved by April 2020 i.e. in just 38 month’s time.

 

Hounslow and Richmond Community Healthcare NHS Trust (HRCH) made a presentation. This was largely about how closely HH and HRCH worked together. Seemed a bit odd when the Healthwatch mission is to hold commissioners and suppliers to account.

 

Another presenter was a private company – LHM. LHM runs patience experience projects for HH – at what cost was never revealed. Maybe this is a good use of public money or maybe it isn’t.

 

None of the presentations mentioned the massive local A&E performance and bed blocking crisis. No mention was made of the ailing 2012 NHS NW London ‘Shaping a Healthier Future’ (SaHF) project. It is SaHF which has brought about the A&E crisis and has failed to make the promised aggregated annual savings of over £400 million.

 

Healthwatch Ealing asked from the floor what the impact on Hounslow residents might be when the implementation of the STP closes Ealing Hospital A&E. How would the STP deal with the inevitable increase in demand at West Middlesex Hospital? Sue Jeffers Managing Director of Hounslow CCG talked about various refurbishment and small expansions at West Middlesex Hospital. HCCG also referred to the future STP development of the six community healthcare hubs in Hounslow. As ever in such discussions NHS management failed miserably to explain how glorified GP surgeries (hubs) could in any way replace 24/7 hospital Acute care with co-located Intensive Care consultants. She didn’t even try the other approach which is to suggest that such care could be replaced by care at home. Her final throw away line was about the December 2016 NHS NW London SaHF business case (part one only) which stated that ‘outer’ NW London SaHF building work would need some £0.5 billion in capital from the Government. I am not alone in doubting that H.M. Treasury will agree to handing over this cash to the failed NHS NW London SaHF project.

 

In seven weeks time the same company which runs Healthwatch Hounslow will take over running Healthwatch Ealing for the next three years. Only time will tell whether they do a good job or not. There are many Healthwatch Ealing members who are very unhappy with how the STP will damage healthcare and social care services in Ealing. Let’s hope under the new administration these members remain active and help shape the local Healthwatch Ealing agenda for years to come.