Over 36,000 Hospital Beds in England Closed Since 2000 : All kinds of Flu Kick In and the NHS is in Meltdown
A&E waiting times have shot up. Patients on trolleys in hospital corridors has become common place. Elective surgery throughout England has been cancelled nationally for a month. Anecdotally I heard that the A&E unit at Ealing Hospital has been under unprecedented pressure. One report also stated that for a recent 21 consecutive day period there were no available beds at Hillingdon Hospital.
Experts are now saying that ‘Australian Flu’ is not the main culprit, but it’s just one of a number of flu types affecting many of us. Shortage of A&E units, doctors, nurses and beds are the main causes of mayhem in NHS hospitals.
The latest NHS Unify 2 data makes for chilling reading. It shows that the number of A&E attendances year on year has remained remarkably stable. For Type 1 A&E attendances at Ealing Hospital and Northwick Park Hospital in November 2017, the number of patients was just 2.81% more than in November 2016.
In NHS North West London the plan for the next three years includes over 25,000 NHS staff being terminated. 600 hospital beds to be closed. By 2025/26 Non-Elective (i.e. emergency) hospital admissions (so called NELS) will, apparently, be reduced annually by 99,000. Ealing District General Hospital (DGH) along with its A&E will closed by 2021. Instead of being treated in residential Acute hospitals the idea is that these seriously ill people will be treated in some expanded GP surgeries, new ‘Hub’ day care centres and/or in their own homes.
However, the plans are in disarray. NHS NWL asked NHS bosses for £513 million for building work and on 7 November 2017 the NHS Regulator – NHS Improvement (NHSI) – said no. NHSI said no compelling evidence had been presented to justify NHS NWL cutting NELS annually by 99,000 beginning in 2025/26.
NWL stated last month that without this cash Ealing Hospital DGH and its A&E would, in effect, continue to exist. The creation of day care ‘Hubs’ and the expansion of some GP surgeries would be abandoned – without this cash. So far we know of no formal attempt by NHS NWL to create a new business case to support another bid for the £513 million. Since 2009 NHS NWL has spent over £89 million on management consultants. No doubt more cash is being thrown again right now at management consultants in order for them to unearth (probably non-existent) ‘evidence’ in an attempt to justify massive cuts in emergency hospital admissions.
Why is NHS Ealing Clinical Commissioning Group (ECCG) Trying to Outsource Out Of Hospital (OOH) Services for 10 years?
Why does ECCG want to outsource OOH services at all? Is it because ECCG, along with the other seven CCGs in NHS North West London, has failed to implement the OOH strategy outlined in the 2012 NHS North West London (NWL) ‘Shaping a Healthier Future’ (SaHF) programme? On page 39 of SaHF (‘11. Proposals for delivering care outside hospital’) a reduction of 110,000 hospital stays annually is promised along with 48,000 avoided hospital emergency admissions annually. On page 11 SaHF states ‘…it will take at least three years to put…in place’. Now, over five years later, there is still no significant annual reduction in emergency admissions. According to the 2012 SaHF proposal, £120 million was to be invested across NW London to enable this OOH transformation. On 8 September 2017 the ECCG Chair confirmed that OOH NHS NWL spend for 2017/18 is £729,283,000 with OOH NHS Ealing costs at £121,794,000.
The 10 year contract length is interesting. CCGs have three year contracts. Healthwatches normally have three year contracts. NHSE has a five year ‘Five Year Forward View’. So why 10 years? The crunch date is of course 2021 when annual healthcare ‘losses’/’debts’ costs have to be paid off. So no doubt this fixed price ECCG OOH contract will be signed at, let’s say, 20% of current costs i.e. all things being equal at around £100 million per year. Although initial ECCG statements posited a 1April 2018 start date this seems now unlikely to be met.
The estimate in my 15 November 2017 newsletter of the potential size of the ECCG OOH 10 year contract was £1billion. However until (and if) we see the details of the Invitation To Tender it will be difficult to firm up this figure.
On 19 September 2017 and 4 October 2017 ECCG invited interested parties to come to talk to it about an OOH OH contract. A recent Freedom of Information request response has revealed who attended. 25 different organisations attended – 12 of them attended both events! There were nine NHS Trusts and nine private healthcare service suppliers who attended. The private companies were Allied Healthcare, CHS Healthcare, Connect Health, Homelink Healthcare, NRS Healthcare, Philips, Shaw Healthcare, Specsavers and…..
Virgin Care Services
Jeremy Hunt MP Has His Cabinet Role Increased to Include Social Care
If this was a plot development in a ‘Carry On Caring’ comedy film I might find it far fetched. Presumably no-one else wanted to take the healthcare (or the social care) job on. My take on Mr Hunt is that he is an attention seeker. He’s always smiling when the cameras are on him. In 2017 he sold his Hotcourses business and pocketed £15 million – so he doesn’t really need the work. He’s had a chequered past. An Admiral’s son, he once worked as an English teacher in Japan and allegedly failed in a venture selling marmalade to the Japanese. He has variously been accused of cheating on his Parliamentary expenses and his tax bill, upsetting Junior Doctors which led to strike action, and constantly misleading the public about healthcare reforms.
In theory a single Government department responsible for cradle to grave care is certainly not a bad idea. However new Primary Government legislation and a massive national relocation of resources will be needed to turn the idea into reality. Social care staff in the 326 Council Authorities will now somehow all ultimately report to Jeremy. Exactly how will that work? Of course by 2025/6 all care might well be delivered by Accountable Care Organisations (ACOs) which will, of course, render NHS organisations and Local Authority social care operations powerless. No doubt Mr Hunt will still be with us then with a new job title of ‘Secretary of State for Accountable Care’.
Accountable Care Is In For a Rocky Ride in 2018
Accountable Care Organisations (ACOs) will at some point in the future, to put it simply, replace NHS organisations and Council Authorities in determining care budgets and managing care service delivery. ACOs will, according to NHSE’s 2014 Five Year Forward View be the STP delivery vehicles to deliver improved care services. ACOs will appear in lots of flavours including ACS, ACP, MCP, PACS and PCH. A single provider (e.g. Virgin Care) might run an ACO, but so could a cabal/consortium of NHS, public, private companies and charities. This could all kick off with some ‘Shadow’ ACOs in April 2018. However the Full Monty 10/15 year £multi-billion ACO contracts will not happen till at least 2019.
ACOs will be ‘command and control’,cost-cutting vehicles which deliver care at a fixed price over 10 to 15 years.
Fear kicks in when Jeremy Hunt MP tells us all that ACOs are ‘simply about improving the quality of care the NHS offers’. With a First Class Oxford University degree Mr Hunt is clearly not unintelligent. As a founder of a PR agency, he clearly knows how to mislead by not telling anything like the complete truth. (Believe me I’m an expert on this subject having run my own PR agency for 21 years).
ACO Judicial Reviews (JRs)
There are two of these on the go:
+ The JR4NHS ACO JR, filed on 11 December 2017, has attracted £144,000 donated by over 5,000 people. The grounds of the JR are that ACOs have not been subject to any public consultation, and lack Parliamentary scrutiny and legislation. High profile supporters include Public Health Professor Allyson Pollock and Professor Stephen Hawking. More at:
+ The ‘999 Call for the NHS’ ACO JR questions the legitimacy of replacing payment by results with a Whole Population Budget. (The latter is better known in the founding home of ACOs – USA – as a Capitated Budget). The JR is led by a West Yorkshire health activist Jenny Shepherd, supported by lawyers Leigh Day, and it was filed in November 2017. The first legal hurdle has been cleared as a judge has granted permission for the JR to proceed. The case will be heard in Leeds High Court on 24 April 2018. £12,000 more is needed to fund this JR. Donations can be made at:
Labour’s Early Day Motion (EDM) on ACOs
Tory plans, apparently, are well advanced to submit new draft legislation soon to legitimise ACOs in February 2018. In response to this, the Labour Party initiated on 6 December 2017 an Early Day Motion (EDM) 660 on these proposed changes – so that the House of Commons can discuss them. The primary sponsor of the EDM is Jeremy Corbyn MP.161 MPs have signed so far. My MP Virendra Sharma has signed, as have Andy Slaughter MP (Hammersmith), Ruth Cadbury MP (Brentford and Isleworth) and Gareth Thomas MP (Harrow West). Why is it taking so long for all the other North West London Labour MPs to sign?
Dudley ACO Delayed
Hardly a storming start for the flagship pioneer Dudley ACO. Its start date has been put back 12 months! Dudley CCG, in the West Midlands, is attempting a Multi-Speciality Community Provider (MCP) ACO. The contract value is £5 billion. In August 2017, Dudley CCG announced that a hotchpotch consortium of local GPs and four local NHS bodies was the preferred bidder.
Greater Manchester ACOs are Also Delayed
Another of the top ACO pioneers, Greater Manchester – with its delegated care budget – is also failing to meet its ACO plan dates. VAT complications are being touted as the reason the £6 billion MCP contract has not been awarded to the preferred consortium of existing care providers. ACO number two in Stockport aims to ‘create a new care trust capable of holding an MCP contract’. It has been ‘paused’.
And After ACOs……?
One can’t help but speculate what might come next after ACOs. After all recent NHS history is littered with organisations here today and gone tomorrow. Regional Health Boards and PCTs are long gone. If ACOs ever get off the ground and take over nationally then that’s the end of CCGs and possibly the NHS itself. If ACOs never take off or fly and burn – what will come next?
The BMJ Exposes £5+ Million ‘Sponsorships’ of CCGs – Most of It Undeclared Publicly
The British Medical Journal (BMJ) has announced findings, obtained through Freedom of Information (FOI) requests, that NHS Clinical Commissioning Groups (CCGs) have overtly and covertly received gifts and payments from a range of commercial organisations. Of the total of £5,027, 818 payments uncovered, only £1,283,767 was declared in public registers. Bath University and Lund University in Sweden carried out this research.
Amongst the undeclared payments was a £24,000 NHS Southwark CCG project funded by drug companies Bayer, Boeringer Ingelheim and Pfizer. Amongst declared payments was a £75 England cricket match ticket given to NHS Medway CCG by AMP Infrastructure, a property investment company.