16 April 2018
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.
NHS North West London (NWL) Hire Management Consultants For £95,400 to Yet Again Re-write Business Case for the Stalled 2012 ‘Shaping a Healthier Future’ (SaHF)Project
The NHS NWL Clinical Commissioning Group cabal has revealed that in November 2017 it hired management consultants GE Healthcare Finnamore. The consultant’s task was/is to work on ‘Urgent & Emergency Care Strategy (Strategic Outline Case)’. The cost for completing the task was/is £95,400.
The work described here relates to the December 2016 NHS NWL SaHF ImBC SOC1 business case which was rejected by NHS England (London) and NHS Improvement England (London) on 28 September 2017. A major component of this business case was/is a request for £513 million for building work. NHSE/NHSI could find no evidence in the business case to support the assertion that 99,000 Non-Elective admissions could be eliminated annually at NWL Acute hospitals by 2025/26. A further claim was that implementing SaHF SOC1 would save 334 lives each year!
The SaHF, published in 2012, promised to ‘..improve care both in hospitals and the community and save many lives each year’. It also promised 4% cost savings every year. In September 2014 SaHF downgraded Central Middlesex and Hammersmith District General Hospitals with the consequent loss of two hospital A&E units. A&E performance in NWL immediately plummeted and has never recovered. No SaHF figures on lives saved or cost savings have ever been announced.
Apparently on 9 February 2018, NHS NWL bosses were going to have another go at persuading NHSE/NHSI on the merits of its revamped ImBC SOC1 business case. However this meeting was cancelled. Seemingly another such meeting was likely in March 2018, but if it happened and NHS NWL had succeeded, no doubt we would have heard about it by now.
NHS NWL has acknowledged in public numerous times that if ImBC SOC1 continues to be rejected and consequently the request for £513 million is refused, then the plan to close Ealing District General Hospital will be abandoned.
Sean Boyle and Roger Steer Deliver Another Compelling Critique of NHS North West London’s Plans and Performance in ‘Current Issues in the Delivery of Health Care in NW London’
Published on 19 March 2018, this 20 page report provides clear evidence that the 2012 NHS NWL’s ‘Shaping a Healthier Future’ (SaHF) plan was ill-conceived and its goals are not being met. The authors are both very experienced and this is the third report they have authored on this topic. They wrote up the findings of the ‘Independent Healthcare Commission for North West London’ in 2015 and along with John Lister authored the ‘Health and Social Care in North West London: a Review of SaHF and the NWL STP’ in 2016. This latest report was commissioned by the London Borough of Hammersmith & Fulham (LBH&F) who have been consistently the leading West London Local Authority in researching and reporting on care planning and implementation realities in recent years.
Highlights of the report include:
+ Population Growth
SaHF underestimated this. The 2016 population was larger than SaHF estimated it would be for 2022 by some 800,000. ONS data quoted shows a 10.5% projected growth of population in NWL from 2016 to 2026.
+ Attendances at Acute A&E Units
This has fallen in NWL by 16.5% since 2011/12
+Attendances at non-Acute ‘minor A&Es’
This has risen drastically (at Urgent Care Centres and walk-in centres) since 2011/12. This pattern of attendance is very different in NWL compared with the rest of London and the rest of England. In 2011/12 in England, 65% of A&E activity was Acute, whereas in NWL it was 49%. By Q3 2017/18, A&E activity attendance at Acute units remained at 65% but in NWL it had fallen to 37%.
+ Admissions into Acute Hospitals
Risen by 8% in NWL since 2011/12. This figure includes a dramatic rise in the number of emergency admissions not via A&E. Direct admissions by GPs rose from 12,000 in 2011/12 to 29,000 in 2016/17.
+ Waiting Times at Acute A&E Units
Since September 2014, the proportion of people not treated within four hours has been consistently poorer in NWL than elsewhere in London and in England
+ Waiting Times to be Admitted to a Bed in Acute Hospitals
In Q3 2017, 5.3% waited for up to 12 hours for admission to NWL hospitals. For the rest of London it was 2.75% and the average for England was 4.1%.
+ Acute Bed Capacity
Between 2009/10 and 2017/18 this fell 270 beds in NWL.
+ Report Recommendation to LBH&F
Worth repeating in full:
‘The Council should continue to monitor NHS plans, and to insist that these are subject to the full scrutiny of the Council. Future demand projections and evidence for the success of out-of-hospital services and new models of care continue to be updated and although there is evidence that acute A&E attendances may have fallen across NW London, this has not resulted from SaHF plans presented now. In our view the introduction of minor A&E units has had the biggest influence. Moreover the level of emergency admissions has risen since 2012, not decreased as SaHF would have projected’.
The report makes for refreshing reading as it’s written largely in everyday language with a minimum of jargon. One does wonder just how many more times these experienced, expert healthcare researchers, observers and communicators have to document the continuing failure of the 2012 SaHF initiative. Surely it would be a mercy killing to stop attempting to resuscitate SaHF?
Read the report at:
+ 999callforNHS – Accountable Care Organisations, Whole Population Budgets: Judicial Review
In Court on 24 April 2018 in Leeds
+ JR4NHS – Accountable Care Organisations, lack of public consultation and lack of Parliamentary scrutiny and legislation: Judicial Review
In Court on 23 and 24 May 2018
+ Barnsley and Rotherham
Both Barnsley Save Our NHS and Rotherham Save Our NHS are seeking to raise funds to support a legal challenge to fight the planned closure of the emergency stroke services at both local hospitals in South Yorkshire.
Crowd funding has begun at:
A patient, supported by Defend Dorset NHS and represented by Leigh Day solicitors, is seeking a Judicial Review of Dorset CCG’s plan to downgrade Poole A&E, close Poole Maternity, close Acute beds, and close Community beds in 5 of 13 Dorset locations.
A Full Hearing has been granted for 17 and 18 July 2018.
Crowd funding is underway to raise an initial £9,000 at:
The campaign to prevent the closure of Huddersfield Royal Infirmary received a boost on 15 March 2018 when Judge Mark Gosnall approved a full Judicial Review Hearing. This is expected to take place in June 2018.
+ Lancashire County Council (LCC)
A judge ruled against LCC in January 2018 that privatisation of one service threatens the whole local NHS. The judge’s written ruling in February 2018 stated that LCC paying damages to two NHS Trusts that had challenged LCC’s award of a £100 million children’s service contract to Virgin Care, would not make up for the disruption and damage to the provision of the whole range of healthcare.
The two NHS Foundation Trusts are claiming that their loss of the children’s contract would cost them £2 million and result in 160 job losses. A Final Hearing will take place in April 2018.
Smartphone GP Consultation Services – the Good, the Bad and the Ugly
There is clearly a demand for ‘instant’ free Smartphone consultations with an NHS GP. For one thing it could eliminate waiting weeks for a face-to-face consultation. It could cut out that messy business of travelling to a GP surgery and having to sit in reception and actually meet your GP in person. The service might be available 24 hours/day and it might suit your busy life to ‘see’ a doctor on your Smartphone at 4am.
A trial of such a service was agreed by NHS bosses in 2017 using a ‘GP at Hand’’ service which uses a mobile app developed by Babylon Health. The GP surgery involved is Dr Jefferies & Partners in Fulham, West London. A Smartphone consultation is on offer at two hours notice round the clock. Within a year, 26,000 patients have used the service and new patients are registering at Dr Jefferies’ for this service at the rate of 4,000 each month. As soon as you register, you are immediately eliminated from your existing GP surgery list.
In November 2017, Local Medical Committee’s (LMC’s) national body voted not to introduce mobile GP consultation services until there is clear evidence that they are beneficial to patients.
The impact of the Fulham ‘GP at Hand’ experiment is yet to be fully evaluated, but Hammersmith & Fulham Clinical Commissioning Group (HFCCG) is in a bit of a financial pickle because of it. The HFCCG financial shortfall for its GPs is apparently now £5.4 million, but if ‘GP at Hand’ sign-ups continue at the current rate the annual HFCCG GP funding deficit could reach £10.6 million.
Concerns have been expressed by GPs and by others that the ‘GP at Hand ‘ consultation service is not available for all medical conditions and perhaps not available for certain types of patients. ‘GP at Hand’ does publicise a list of medical conditions it deals with. The words ‘mental health’, ‘cancer’ and ‘dementia’ are not on the list. However on the list are ‘colds and flu’ and ‘tennis elbow’.
NHS England (NHSE) has blown hot and cold on Smartphone GP consultations. In November 2017 it launched a £45 million funding pot for a limited number of GP surgeries to implement online consultation programmes over a three year period. However in January 2018, NHSE lodged a formal objection to a significant further roll-out of Babylon Health’s ‘GP at Hand’ service.
Now, just few months later, NHSE has decided to pay someone £250,000 for an independent evaluation of ‘GP at Hand’. However this won’t deliver its findings till May 2019. It might have been prudent for NHSE to have carried out a thorough evaluation of this service before launching this trial, which is causing disruption to GP surgery patient lists and some funding carnage in HFCCG.
In January 2018, the Department of Health announced that there would be a public consultation on online GP services. It also announced that the Care Quality Commission (CQC) would be allowed to evaluate online GP services. Babylon Health said it doubted CQC’s inspecting powers were adequate with regard to digital health services.
Babylon Health is the brainchild of a Dr Ali Parsa. He has an eclectic background in civil engineering, ‘relationship services’ and investment banking. His doctorate is in the physics of fluids. In 2004 he set up Circle which became Europe’s largest clinician partnership. He left in 2012 and in 2013 he launched Babylon Health.
In the First Seven Weeks of 2018, the Death Rate in England and Wales was 12.4% Higher Than in Previous Years
The British Medical Journal (BMJ) has reported that in the first seven weeks of 2018 93,990 people died in England and Wales. The average number of deaths in the comparable period over the last five years was 83,615 deaths. This rise in deaths of 10,375 is a rise of 12.4%.
The BMJ think it unlikely that flu or an aging population can explain this large change in mortality. The BMJ suggest that it’s a clear pattern of worsening health outcomes. Keep Our NHS Public is more forthright and says that it’s obvious that the 10,000+ extra deaths are a direct result of the Government austerity cuts to public services.
‘Our NHS in Crisis’ Newsletter Archive
Now available at www.ealingsaveournhs.org.uk
This archive stretches back over 60 issues of the newsletter since May 2013. I’m working on an index of issues which will be added soon to this excellent web site. I’ve been active in Ealing Save Our NHS (ESON) for over five years and I’m currently ESON Vice Chair.