Appalling Admission of Failure by NHS North West London (NWL) as Final Anticipated Deficit Figure for 2019/20 is £112 Million

Appalling Admission of Failure by NHS North West London (NWL) as Final Anticipated Deficit Figure for 2019/20 is £112 Million

‘Unscheduled Care’ is the reason given by NHS NWL bosses for an anticipated annual deficit at the end of this financial year of £112 million. Unscheduled care equates to poor planning. A deficit equates to underfunding.

The blood on the carpet here must be attributed to the disastrous £1.3 billion ‘Shaping a Healthier Future’ (SaHF) plan. SaHF, launched in 2012 and ignominiously abandoned in March 2019, tragically closed two hospital A&Es in September 2014. This has caused rises in unscheduled care at the remaining seven Major Hospital A&Es ever since. For over six years Ealing and Charing Cross Hospitals were threatened with downgrading (loss of A&Es). NHS NWL closed down Maternity and then Paediatrics at Ealing Hospital. At Ealing and Charing Cross Hospitals – loudly earmarked for possible complete closure as ‘Major Hospitals’- hiring new permanent staff has been difficult and expensive. So temporary, Agency, ‘Bank’ and locum staff costs have been enormous.

Patients at all seven Major Hospitals will no doubt now suffer from service cutbacks, closures, more pain and possible death in order to reduce this deficit. It’s hard to forget that expert analysis of SaHF pegged the cost of the failed initiative at £235.55 million by 31 March 2018. Separate research has revealed that management consultants’ fees incurred by NHS NWL on service transformation 2009/10 to 2018/19 now total over £76 million. The ‘Sunday Times’ on 10 February 2019 revealed that the maintenance backlog at just four of the nine NHS NWL Major Hospitals stood at £729 million.

When will anyone in authority take responsibility for this NHS NWL financial, management, planning, commissioning and service delivery debacle and do the honourable thing by resigning?

 

NHS NWL Hopes That Reducing the Number of Referrals to Hospital Consultants Will Cut Costs by £60 Million

NHS North West London (NWL) has decreed that GPs will have to restrict the number of patient referrals to hospital/Secondary Care consultants they initiate. This is to cut costs. NHS NWL’s cost cutting record is not good. The NHS NWL 2012 ‘Shaping a Healthier Future’ (SaHF) programme planned to achieve cuts of £4 million every year. No achieved SaHF cuts were ever announced during the programme’s 2012-2019 existence.

Presumably with fewer referrals to consultants, fewer consultants will be needed so salary costs will be saved. ‘Alternative ways’ must be sought by GPs whose opinion is that a patient needs hospital treatment. What alternatives might these be? 

Maybe contacting the hospital consultant in a private capacity and paying for the consultation and the treatment? The patient having to put up with the pain by constant use of painkillers perhaps? Or if it’s someone with mental health problems, suggesting to the patient that they get a book from the library (or search the online world) and attempt to consult those resources for clues on how one might ’get better’.

The London North West University Healthcare NHS Trust LNWH) has been singled out by NHS NWL for cuts to its Acute costs, improvements in patient flow and reductions in Delayed Transfers of Care. For its two Hospital A&E units at Ealing and Northwick Park the 95% four hour waiting time target was breached to a level of just under 85% in December 2018. By March 2109 it had only improved to just over 88%. In a surprise revelation in September 2019 Dame Jacqueline Docherty, Chief Executive of LNWH, is seemingly stepping down from her role on 31 March 2020. A seven month notice period seems very protracted. In 2018/19 she earned £230,000.

Ealing’s Referral Facilitation Service Bites the Dust

Ealing GPs are soon to now ‘audit’ their own consultant referrals. Ealing CCG has decided to discontinue its Referral Facilitation Service (RFS) in November 2019. RFS is provide by US healthcare giant UnitedHealth at no small cost. The service was clearly aimed at reducing referrals by refusing some of them. The service has cost over £2 million over three years. Apparently very few referrals were refused and the service was correctly deemed to be a complete waste of money.

NHS NWL makes it clear that the hospitals which face the biggest financial challenges are those in the London North West University Healthcare NHS Trust. These, of course, are the Major Hospitals at Northwick Park, Ealing and Central Middlesex.

The Collaboration of NHS NWL CCGs, who collectively ‘boss’ the purchasing of all healthcare services for 2.2 million people in north west London were quoted in ‘The Guardian’ 9 September 2019:

The safety of our patients and the quality of our services will always come first’.

Given that the collaboration is a non-statutory purchasing body and not a clinical services delivery body, this aspiration is in many ways quite offensive. Four of the eight local CCG bosses in this collaboration signed their names to the shambolic SaHF Acute reconfiguration programme and have drawn their not ungenerous stipends for over six years. NHSE has clearly demanded that quantity of service and cost cutting are very high priorities.

It also appears that even if you are referred to one consultant, you will then be prevented contemporaneously being referred to a second consultant (of another discipline). To employ another mental health example there is plenty of data which confirms that those with mental health problems use more physical healthcare services than those without. (Colorado Access insurance system data puts the percentage at 60%). So chances are if a consultation with a psychologist and a urologist are needed, the GP must choose between say, a 20 week wait to see a urologist or a 40 week wait to see a psychologist.  More stress for the GP, the patients and his/her loved ones – whichever choice the GP makes.

 

Yet Another Attempt at Acute Reconfiguration Transformation

Language and strategy very similar to that used in the failed SaHF is employed to instruct GPs to send fewer patients into Acute care. All attempts in NHS NWL in recent years to reduce Acute admissions (so called Non-Elective Admissions – NELs) and treat more patients in GP surgeries, GP hubs and at home mostly ended in failure – failure to cut costs and sustain bed number reductions. It will be interesting to see if West London NHS Trust’s (WLNT’s) 10 year Ealing Out Of Hospital services approach (branded Ealing Community Partners – ECP) can both save on costs and suffer no reduction in service quality. However, and somewhat surprisingly, at the 11 September 2019 WLNT Board meeting, there was no sign of cost cutting – more the opposite with lots of new hires planned. Clearly there are parts of NHS NWL not required to help reduce the enormous deficit.

The latest released monthly figures for July 2019 show little improvement with aspirations of further action on managing urgent care and limiting the growth of elective and outpatient care.

 

New Regional NHS NWL Clinical Commissioning Group (CCG) Start Date Delayed till April 2021

Lots of loud voices offered the opinion that the NHS NWL rush to eliminate eight local CCGs and ‘replace’ them with one new regional CCG in April 2020 was a bad idea. Many thought the whole process had not been adequately thought through. No doubt some (all?) of the eight existing local CCG bosses were less than impressed by the prospect of losing their remuneration in six months’ time. NHS NWL has announced that the start date will now be 1 April 2021.

 

Should the BMA Boss Be Paid More than Seven Times The Salary of a First Year Junior Doctor?

Union bosses do themselves no favours when their take home pay completely dwarfs the workers they are attempting to represent. ‘The Times’ of 9 September 2019 revealed that the salary of Chaand Nagpaul, Chairman and General Secretary of the British Medical Association (BMA) is £193,000/year. A first year Junior Doctor earns £27,100/year. One wonders whether Mr Nagpaul is worth seven first year Junior Doctors?

 

GP Locums Are Now Eligible for Holiday Pay – Backdated for Six Years

GP locums, who allegedly earn on average £140,000/year, can now enjoy holiday pay back datedfor  up to six years. This is the outcome of a Court case in Gateshead. Not only could this cost an estimated £250 million a year, that figure does not include any back payments. The General Medical Council reckons there are 20,000 locum GPs in England, some of whom can command £1,000/day.

Surely this eligibility will encourage more GPs to become locums rather than become dedicated to one practice? Does this matter? Well the growth in locums will increase the running costs for Primary Care and will slowly eat away at the number of salaried and permanent partnership roles in GP practices. It will also degrade continuity of care, which is highly valued by most patients, especially elderly patients. 

 

 A&E Waiting Times Throughout England are the Worst for 10 Years

In 2008, 93% of patients were seen in NHA hospital A&E units within four hours. In 2018 it was 88%. Separate figures show that August 2019 was the busiest August month ever. 

 

The UK Spends Less on Healthcare Than USA, France, Germany, Japan and Canada

The Office of National Statistics (ONS) has published data collected for 2017 on percentage of Gross National Product (GDP) spent on healthcare. Here are the top seven:

USA            17.1

France       11.3

Germany   11,2

Japan        10.9

Canada     10.7

UK              9.6

Italy            8.8