ACOs, ACSs, ACPs – Start/Stop – It’s all a Shambles
House of Commons STP/ACO Inquiry, House of Commons ACO meeting, two ACO Judicial Reviews, 149 MPs sign up to ACO Early Day Motion, nine Shadow ACSs and goodness knows how many Shadow ACPs ‘paused’- hard to imagine a worse healthcare/social care futures’ shambles.
Hammersmith & Fulham has its own challenges with its GP Federation and five NHS Trusts talking big about a healthcare/social care contract of up to £300 million per year for a population of maybe 212,000. Press publicity reports an ‘alliance agreement’ being signed in April 2018, but the absence of public endorsements by the Local Authority (the social care people) speaks volumes.
Professor Allyson Pollock gave some 85 NHS activist leaders from all over England much food for thought in Laura Pidcock MP’s brilliant ACO meeting in Parliament on 22 January 2018. One of her stunning revelations was about the dichotomy of healthcare and social care patient groups. Sure enough I then did my home-based research on Ealing. 426,000 healthcare patients on 76 GP surgery lists (Ealing CCG 2016) and a 358,445 (social care) population in Ealing (GLA 2017).
Add to this the out of area registration scheme that allows any healthcare patient to register with any GP surgery in any part of the country – assuming the receiving GP surgery will accept them. Then add to this the online Babylon ‘GP Choice’ scheme, which is out of area registration on steroids! Apparently 12,000 patients in less than three months have – via Smartphone app video consultations – left their ‘geographic’ GP surgery and joined Dr Jefferies & Partner’s GP surgery in Fulham, West London. Allegedly this surgery ‘cherry picks’ its new patients – so no-one is accepted with complex mental health problems, frailty, dementia, pregnancy or drug addiction.
So…..integrate that Mr Hunt!
Last week also revealed progress by the #JR4NHS Judicial Review team in winning an important concession from NHS England (NHSE). There will now be a 12 week national, public consultation on ACOs. No ACO contract will be signed until that consultation has taken place. The judge has promised a full hearing ‘as soon as possible after 14 March 2018’. However Secretary of State Hunt still plans to push through new regulations to legitimise ACOs but apparently not now during the next four weeks. Government and NHSE claim that £90,000 has alreadyben incurred in legal costs, which #JR4NHS could have to pay. Advisors to #JR4NHS warn that the £180,000 raised so far needs to grow to £350,000 to £400,000 to cover possible costs. To donate go to:
NHSE has stated that the public consultation will ‘provide further clarity about ACOs’ role and purpose’. I don’t know about ‘further’ but ‘some’ might be good. No doubt the whole thing will be a stitch up just like the 2012 NHS North West London (NWL) ‘Shaping a Healthier Future’ consultation. We won’t be given an opportunity to say if we like or want ACOs. Another bizarre aspect is that NHSE says that an ACO is not a new type of legal entity and that it will not affect the commissioning structure of the NHS. (It doesn’t say whether it will affect the social care commissioning structure of Local Authorities). If all this were ‘true’ why are new regulations being drafted to ‘legitimise’ ACOs?
On 29 January 2016 NHE announced that the ‘second wave’ of ACSs would be delayed and re-named. The phrase ‘integrated care’ gets a mention. So…new dates and new names – but the same old concerns about disintegrated care and degraded health and social care services.
Desperate Attempts at Trying to Justify Closing Down Ealing District General Hospital (DGH) and its A&E Unit
After failing to get £513 million for building work in NHS North West London (NWL) in November 2017, NHS regional bosses appear to have been trying to find some ‘new’ numbers which they might utilise to have another go at getting the cash. These bosses, especially those still wedded to the incomplete and failing 2012 NHS NWL ‘Shaping a Healthier Future’ (SaHF) project, still maintain they need this cash in order to downgrade Ealing DGH and shut down its A&E unit.
The sticking point for these bosses and their army of management consultants is trying to convince the regulator (NHS Improvement – NHSI) that by treating patients at home and at GP surgeries/day care ‘hubs’, 99,000 emergency admissions across NWL can be eliminated annually by 2025/26. This ‘replacement’ approach is so called Out Of Hospital (OOH) services. NHSI wants NHS NWL to supply evidence to support its case.
Let’s examine NHS data to try and discover whether this evidence exists.
Emergency admissions in NWL (virtually all of which are so called Non Elective Admissions – NELs) are higher now than in 2013. To put the annual NELs reduction aspiration in perspective, here are the NELs totals over recent years –
October to September:
+ 2013/14 – 195,000
+ 2014/15 – 190,000
+ 2015/16 – 200,200
+ 2016/17 – 216,000
There has been no successful reduction in bed numbers since 2011 (when we started collecting the data). In fact in March 2011 there were 3,150 General and Acute beds in use in NHS NWL. In September 2017 that number stood at 3,400. Hospital bed occupancy rates are higher now than they were in 2013.
Hospital bed blocking (so called Delayed Transfer of Care – DTOC) is endemic. In Ealing DTOCs are higher now than they were in 2013. In terms of social care DTOCs in Ealing, they have risen steadily since April 2014 (100 days delay/month) and in July 2017 reached over 900 days delay/month. ‘Get West London’ research reveals that the 75+ population in Ealing has grown by 2,200 since 2012. During that time 50 care home beds and 41 nursing home beds have been lost. Ealing Council’s social care budget has been reduced annually in recent years. In 2013/14 it was £127 million. In the current year it’s £94 million.
Let’s now look at ambulance redirections in NWL – so called Intelligent Conveyance. During the period April 2016 to September 2017, no ambulances were redirected to Northwick Park Hospital. The same was almost true of Hillingdon Hospital except for 30 times in January 2017 and a handful of times in June 2017. However redirections of ambulances to Ealing Hospital happened every month with 70 in November 2016 and 90 in April 2017. Just where would the sense be to shut down Ealing Hospital A&E?
As for meeting the Type 1 (T-1) 4 hour performance target, no NHS NWL hospital has ever got near to consistently meeting or exceeding the 95% target since Central Middlesex and Hammersmith Hospitals’ A&Es were shut down in September 2014. In January 2017 NHS Northwick Park and Hillingdon’s A&E 4 hour performance slumped to around 50%. By December 2017 neither hospital reached 60%.
Out Of Hospital (OOH) services have been the SaHF ‘replacement’ strategy for removing 40% of patients from hospital Acute beds, for well over four years. SaHF has consistently said that there would be no changes to hospital services until OOH services were in place. OOH services were not in place when the two hospital A&Es were closed in September 2014 – with disastrous, on-going results. And OOH services are scarcely apparent even now. The best NHS NWL bosses can seemingly come up on OOH services amounts to 2,700 hospital admissions prevented in Brent in 2017, and 1,400 hospital ‘admission avoidances’ in Ealing in 2017. Given that NHS NWL SaHF has been trying to develop OOH services and reduce hospital admissions since 2012 it is hardly a recommendation that over five year’s work has resulted in an annual reduction of just 4,100 emergency admissions/NELs.
Apparently NHS Ealing CCG has thrown in the towel in trying to ‘commission’ NHS service suppliers to develop, run and manage OOH services in Ealing. Later this month a business case will probably emerge in an attempt to justify outsourcing Ealing OOH services to a single supplier for 10 years. Apparently this contract value could reach £1 billion. All our attempts to find out the OOH services specification have been frustrated. Apparently Virgin Care is one of the interested parties. No doubt this is all part of the Accountable Care/integrated care bandwagon.
However other rumours swirl around whether ‘austerity’, land values and land sales might be the keys to what happens next. The £513 million request is enshrined in a NHS NWL business case labeled the ImBC SOC1. This bid largely relates to so called outer NWL. There is another NHS NWL business case backed bid, still not submitted, for inner NHS NWL London labeled ImBC SOC2 for £377 million. There are allegations that NWL will only be granted SOC1 or SOC2. In terms of land sell offs clearly inner NWL land will generate far more cash than outer NWL land sales. After all London Mayor Khan’s so called London Care Devolution seems to be mostly about ‘estates’. There clearly is some sensitivity about land values/sales value as Freedom of Information attempts to access this data (so called Naylor 2) are clearly being obstructed.
Nursing Recruitment in NHS North West London is at Crisis Point
NHS Digital’s quarterly recruitment update for North West London (NWL) must ring alarm bells everywhere. In April, May and June 2017, 2,545 nurses and midwives vacancies were advertised. However only 42 new recruits were taken on – that’s just 1.65% of those they were seeking.
Nationally the statistics also make for very depressing reading. One in 10 of all nurses quit each year. The overall number of vacancies for all types of healthcare staff, which hospitals across England advertised to fill in July to September 2017, hit 87,964.