15 November 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. Increased financial funding is what is needed in our NHS – not financial cuts, closure of vital services or privatisation.
£1 Billion+ Out Of Hospital (OOH) Services Contract Up for Grabs in Ealing: Or Is It?
Private healthcare companies must be licking their lips at the prospect of winning this ten year contract from the Ealing Clinical Commissioning Group (ECCG). ECCG is looking to hire a single supplier to ‘co-ordinate and manage’ these 31 services. This appointment would be yet another attempt to deliver on the NHS North West London 2012 ‘Shaping a Healthier Future’ (‘SaHF’) project. This initially ‘over three years’ project aimed/aims to improve healthcare services, downgrade some District General Hospitals and remove some Acute services and replace them with OOH services.
Last year it cost £127 million to run OOH services in Ealing. Given the imperative of cost cutting, an annual payment of some £100 million to this ‘outsourced’ NHS or private supplier would seem likely.
However these financial figures did not feature in a recent public ‘engagement’ event run by ECCG in Ealing Town Hall on this upcoming OOH contract. On 31 October 2017 over 60 people sat through almost three hours of presentations and workshops covering such issues as principles, care delivery, Single Point of Access – SPA (telephone not face-to-face) and expectations of a single supplier. ECCG Managing Director and two ECCG Deputy Managing Directors ran the meeting.
There is currently no certainty about exactly which OOH services will be included in the contract. However in the draft list were residential rehabilitation, physiotherapy, community nursing, primary care mental health, and Dementia support. Some of these service contracts are coming to the end of their life. Over the coming months and years each of these services could be provided by different NHS or private suppliers. It’s clearly going to take some time to hire and deploy this single supplier. The earliest start date quoted was January 2019.
There were lots of interesting observations and questions raised by the audience, but few interesting responses and answers from ECCG. Lots of attendees made it very clear that they did not want a private supplier gaining the contract. Some residents expressed astonishment that in 2012, as part of NHS NW London’s ‘SaHF’ project we were promised ‘world-class healthcare outside hospital’. In 2012 we waited two days to see our GP – now we have to wait three weeks. Also SaHF promised us that networks of GPs would be our first point of access – not a telephone service! The SPA also made little sense to some as we have had an SLA for mental health for two years and a NHS 111 telephone point of access. Surely that’s three points of access. Also given that Ealing has a high proportion of non-English speakers, surely any Ealing healthcare telephone service needs multi-lingual support.
In the 2014 NHS England Five Year Forward View and in the October 2016 NHS NW London Sustainability and Transformation Plan (STP) the delivery of social care and the delivery of integrated healthcare and social care are key attributes. ECCG never mentioned social care once – never mind integrated healthcare and social care services. Also not mentioned was the fact that with less money, services would probably be rationed. In NHS speak this is usually referred to as ‘demand management’. Again this phrase and the topic were not mentioned.
NHS NW London SaHF Business Case and £513 Million for Building Work Turned Down
Just 24 hours later a bombshell exploded with ‘Health Service Journal’ (HSJ) announcing that the final NHS NW London 2012 SaHF business case, involving a request for £513 million building work funding in ‘outer’ NW London, had been turned down by NHS Improvement (NHSI) on 28 September 2017. (NHSI is the NHS’s operational and financial regulator which ‘absorbed’ the previous major regulator NHS Monitor and other minor regulators in 2016).
Surely the ECCG MD and the ECCG Deputy MDs knew about this rejection. The whole basis of ‘outer’ NHS NW London OOH ‘transformation’ – the ability of Ealing OOH services to ‘replace’ some of the Acute care beds’ to be eliminated at Ealing Hospital, the creation and re-purposing of the three Ealing NHA OOH ‘hubs’, the expansion of certain GP surgeries, the expansion of NHS NW London District General Hospitals (DGHs) to replace some of the eliminated Acute care beds at Ealing DGH – were all dependent on this business case and securing the £513 million.
Over 60 residents and NHS staff had three hours of their lives wasted on 31 October 2017 by three highly paid NHS ECCG executives. These three ladies went through the motions of a public ‘engagement’ exercise on OOH services and their outsourcing presumably already knowing that the capital funding request had been rejected over four weeks ago.
Some £70 million has been spent by SaHF with management consultants on formulating and implementing this now rejected business case over the last five years. This really is scandalous.
After press reports hitting TV and online media, NHSI came out of hiding, toned down its criticism and said that the business case trajectory was OK, but the numbers were not credible. At a public ECCG meeting on 8 November 2017 (the Primary Care Commissioning Committee) ECCG Chair Dr Parmar rather arrogantly dismissed the business case rejection by saying ‘we need to refresh the numbers’. More work and fees for McKinsey & Co, Deloitte et al are in prospect no doubt. It’s important to note that the hurdles the £513 million business plan has to clear are NHSI (second attempt), the Department of Health and H.M.Treasury.
Reports of staff leaving and staff shortages at Ealing Hospital are ongoing. Ever since the 2012 SaHF project labelled the District General Hospital ‘for downgrading’, clinical management has grappled with significant staff retention and staff recruitment challenges. Now to discover that SaHF never had a credible business case must make many experienced, overworked and dedicated Ealing Hospital staff very angry.
A Second Judicial Review is Underway Challenging the Legality of ACOs
’The Independent’ of 4 November 2017 reported that three healthcare professionals and a prominent public health academic had instigated legal action against the Department of Health. The foursome are seeking a Judicial review (JR) to stop Health Secretary Jeremy Hunt MP and NHS England from creating Accountable Care Organisations (ACOs).
ACOs will hold fixed price, long term contracts to implement the 44 Sustainability & Transformation Plans (STPs) throughout England. The ACO/STP approach is the Government’s current tactic to involve private care companies, to make large cost savings and to deliver and integrate healthcare and social care services.
Professor Allyson Pollock, the high profile public health academic jointly sponsoring the JR, is quoted as saying ‘..the Government is acting beneath the statutory radar in attempting the Americanisation of our healthcare and this fundamental re-organisation by stealth’.
This JR is separate from – but running in parallel with – the ‘999 Call for the NHS’ JR which claims the August 2017 ACO contract introduced by NHS England is illegal.
Patients Going Online is No Solution to the Shortage of GPs
We have a desperate GP retention, shortage and recruitment situation in England:
+ 400 GPs are quitting the NHS every month (‘Financial Times’ 10 July 2017)
+ 12.2% of GP vacancies are unfilled (‘Pulse’ May 2017)
+ A national shortage of 3,900 GPs (‘The Sun’ 12 May 2017)
+ 40% of GPs are approaching retirement (iNews 17 February 2017)
+ ‘Almost half of the 10,000 EEA doctors in the NHS are considering leaving the UK’ (BMA March 2017)
+ It takes on average 7.4 months to recruit a GP partner (Commons Public Accounts Committee).
NHS England wants to give GPs £45 million to make them available online. Existing online ‘solutions’ being piloted include:
+ Smartphone appointments or Skype consultations
+ ‘NHS Online App’ which enables patients to ask GPs questions, receive text alerts with a link to doctors at an Urgent Care Centre for ‘red flag’ symptoms out of hours
+ ‘eConsult’ where patients answer questions about symptoms on their surgery web site, which are then reviewed by a GP within 24 hours
+ ‘GP at Hand’ service which promises 24/7 video consultations on smartphones – within two hours.
The latter ‘GP at Hand’ service, recently announced, has been condemned by the Royal College of GPS, the BMA and at the England LMC conference. An Internet enabled patient can get to ‘see’ a GP in two hours, whilst a telephone only patient has to wait, on average, 13 days to see a GP.
The problems many medical practitioners and commentators are identifying are related to the seeming priority being given to online/smartphone patients over telephone patients. The approach apparently favours 28 year olds over 82 year olds. Also, put even more practically if a GP is diagnosing/treating 20 year olds from 3am to 7am he/she will not be available to diagnose/treat 80 years olds at noon later that day.
With a declining GP workforce the online/smartphone ‘care model’ and its promotion by NHS England amounts to unacceptable inequitable access to NHS branded services.
NHS North West London Has Spent a Gigantic £88+ Million on Management Consultants since 2009/10
Health data researcher and activist Colin Standfield has recently revealed that NHS NW London has spent £88,655,158 on management consultants since 2009/10. It’s quite along list of consultants who have benefited from this NHS largesse. They are: McKinsey & Co, Deloitte, PriceWaterhouseCooper (PWC), KPMG, PA Consulting, Moorhouse, Carnhill Farrar, GE Healthcare Finnamore, 365 Response, The Anna Freud Centre, Osca Agency, Mott McDonald, Qi Consulting, M&C Saatchi, Sky High Technology, Finnamore & Oak Group, Private Public, LCA/Consolidated PR, Baker Tilley, and Consard.
McKinsey & Co are the clear winners in take home remuneration. On one topic alone – ‘Whole Systems Integrated Care’ – it earned £8,755,621 during 2013 and 2014 by creting three reports on the topic. This topic – healthcare and social care services’ integration – is the challenge which is yet unmet in NW London, London and throughout England.
The first question that must be asked is why NHS NW London could not have done this McKinsey work (and in fact all the management consultancy work) in house? After all the salary costs/budget for the eight NHS NWL Clinical Commissioning Groups is at least £40 million per year. With this money one could hire lots of clever people with healthcare and social care experience, MBAs, first class Degrees, Masters and PhDs.
The second question to ask is were these management reports shared with other Footprints? Given that all the 44 Footprints must achieve healthcare and social care services’ integration via their 2016 five year Sustainability and Transformation Plans (STPs) in the world of the sensible these NHS NWL commissioned McKinsey reports would be shared amongst the other 43 Footprints. However from my years in the world of business, sharing of management consultant reports does not happen. So, we have the distinct prospect that, as dealing with healthcare and social care services’ integration is a national problem, each of the 44 Footprints has commissioned management consultants locally to advise them. If this is the case and NHS NW London’s McKinsey bills are typical, the care integration consultancy bill for London’s five STPs could be over £40 million and nationally some £352 million.
The third question to be asked is why didn’t the Department of Health or NHS England carry out this generic transformation research or commission it and then hand it over to the 44 Footprints?