“SHAPING A HEALTHIER FUTURE”
It’s Time to Abandon the Failing NHS NW London SaHF Healthcare Project
In the Summer of 2012 NHS North West London published proposals which they claimed would improve healthcare services and costs. These proposals were called ‘Shaping a Healthier Future’ (SaHF). The proposals noted that changes were already underway and that it would take ‘over three years’ to complete the changes, which involved reducing the number of Major Hospitals from nine to five, closing four hospital A&E units, reducing the number of Acute hospital beds and replacing 30% of Acute hospital care with care outside hospitals.
Four and a half years later we have to ask:
+ Have the proposals been implemented?
+ Have service improvements and cost cutting aims been met?
This paper attempts to answer both questions.
SaHF Has Not Cut Costs
SaHF planned to cut costs by 4% each year. NHS North West London spent £3.4 billion in 2011/12 which means that three years of cost cutting should have reduced spending by £408 million. However there have been no SaHF announcements or press release about cost saving. No doubt if any cost savings had been achieved SaHF would have proudly announced them.
On 22 February 2017, Ms Tessa Sandall, NHS NW London CCGs’ Managing Director was asked in a public meeting what the SaHF cost savings amounted to. She replied that she did not know. When asked for a ‘rough estimate’ she declined to answer and it appears that SaHF implementation has resulted in zero cost savings.
Healthcare Services Have Not Improved During the SaHF Project
Accident & Emergency (A&E) services are key to a seriously ill patient’s survival. In the face of public opposition, the 2012 proposals specified the closure of four hospital A&E units. Only two however have been closed which were at Central Middlesex Hospital and Hammersmith Hospital. They were closed in September 2014. Despite claims in SaHF that these closures would somehow “improve” services, hospital A&E performance throughout NW London immediately plummeted and has never recovered. North West London hospital A&E units are regularly some of the worst delays for urgent cases in England with Hillingdon Hospital often featuring as having the worst performing A&E unit in the country.
“Out of Hospital” Care: When and Where?
SaHF promised seven day a week “Out of Hospital” care to replace cuts inside our hospitals, although the proposals were vague about exactly what it would consist of. Sadly, this promised care has simply not been delivered for either physical or mental health. So-called ‘Health Centres’ were supposed to be provided for ‘networked’ GP services such as therapy, rehabilitation, diagnostics or specialist imaging. But where are these ‘Health Centres’? They don’t seem to exist!
SaHF also promised improved access to GPs, but locally, regionally and nationally we are all having to wait longer to see our GPs. SaHF told us that our GP will co-ordinate care across all services and will have overall responsibility for our health and this is clearly not the case. Instead, in many parts of NW London so called ‘Referral Facilitation Services’ determine whether your GP referral for you to see a specialist/consultant/hospital department is granted or not.
Mental Health Services Have Not Improved
The largest mental health NHS Trust in North West London is the West London Mental Health Trust (WLMHT). In 2015 and 2016 the Governments Care and Quality Commission carried out full inspections of thus Trust and both inspections rated the WLMHT poorly. In fact the December 2016 inspection report rated 9 of the 11 mental health services as ‘Requiring Improvement’. With one in five adults suffering from mental health problems this casts WLMHT and SaHF in a very poor light, to say the least.
Incredibly the 2012 SaHF proposals made no explicit mention whatsoever about improving mental health services. If for no other this reason, the SaHF proposals were completely flawed from day one and should never have been begun.
The SaHF Business Case: Four Years Late – Unfinished, Unrealistic and Unprofessional
In 2012 residents searched in vain for a detailed SaHF business case. It could not be found. It was only in December 2016 that a partial, detailed SaHF business case emerged. Amazingly the SaHF ‘over three years’ project was mysteriously now a ten-year project. There has been no convincing explanation and no public consultation on that massive project extension!
Entitled ‘Strategic NHS NW London Outline Case Part 1’ the document contained a request for money for NHS building work in ‘outer’ North West London. Apparently SaHF wants H.M. Treasury to hand over £513 million for this building work. Sometime in the future an additional £377 will be requested for ‘inner’ North West London NHS (Part 2) building work. To give some impression of just how unrealistic this request for capital funding actually is one only has to study Chancellor Hammond’s Budget proposals in March 2017. For NHS building work over the next three years across the whole of England the Chancellor has allocated just £325 million.
Surely the NW London Sustainability and Transformation Plan (STP)
and the SaHF Can’t Co-exist?
In December 2015 NHS England announced a Five Year Forward View on healthcare and social services. This required all regions to produce a five-year plan to improve services and cut £22 billion off annual care costs by 2021/22. These regions were designated ‘footprints’ and there are 44 of them.
NW London’s footprint published its STP in October 2016 with an annual cost savings target of £1.4 billion in 2021/22. Integrating healthcare and social care services, improving mental health services and illness prevention are key elements of STPs. The future delivery vehicle for the cuts and the changes for care delivery improvement will be Accountable Care Organisations (ACOs). ACOs in NW London will be private consortia of Local Authorities, NHS CCGs, NHS Trusts and federations of GP surgeries. These ACOs will enter into 10 year, fixed price care delivery contracts to deliver specific services to specific populations.
The NHS SaHF project – unlike the STP – completely ignores social care, integrating healthcare and social care, mental health services and illness prevention. SaHF makes no reference to ACOs, which in future will be the sole care delivery vehicle. SaHF is run by Clinical Commissioning Groups with no formal management roles for Local Authorities, NHS Trusts and GP surgery federations. In fact SaHF follows the commissioner/supplier split laid down in the 2012 Health & Social Care Act. On the other hand, the STP requires Local Authorities, CCGs, Trusts, GP federations and other public and private bodies to all work together. These bodies will work together as peer partners in private ACO consortia and the commissioner/supplier requirements of the 2012 Health and Social Care Act will be completely ignored.
The truth is that the STPs are also a vehicle for massive cuts to both the NHS and social care. But on top of that, it is perverse, utterly confusing and unproductive for NHS NW London management to attempt to run SaHF and the STP in parallel. STP is part of a 2016 national initiative and hasn’t had a chance to succeed or fail as yet. However, the SaHF is a 2012 regional initiative which has been shown to be a failure over the last four years. It’s time to bury SaHF so that NHS staff, GPs and Local Authorities can attempt to make the STP work – a daunting enough task in itself!