Goodbye Mr Easton and Dame Jacqueline and Hello Sir Amyas Morse

A new year, a new Prime Minister and lots of promises about extra money for the NHS. However, extricating the NHS from its many crises will take more than money. It will take time, good management, realistic planning, expanded educational resources, effective staff recruitment and retention and sustained prudent decision making.

Goodbye Mr Easton and Dame Jacqueline and Hello Sir Amyas Morse 

In NHS North West London (NWL) two of the ‘big beasts’ are about to depart the stage. Mark Easton, NHS NWL supremo for 18 months and Dame Jacqueline Docherty – Northwick Park/Ealing Hospital/Central Middlesex/St Mark’s Hospitals’ boss for 4 years – will both be gone by 31 March 2020.  Neither of them have covered themselves with glory. Mr Easton was a cheer leader for the obviously failing ‘Shaping A Healthier Future’ (SaHF) project and famously asked NHS England for £260 million for building work and was granted just £10 million. He’s had 9 different NHS roles in just 13 years. It will be fascinating to see what heady heights he’ll be promoted to now. Dame Jacqueline originally trained as a nurse and has filled NHS executive positions for 23 years. She inherited a disastrous 2014 merger of Ealing Hospital and Northwick Park Hospital creating NWLUHT and oversaw the almost malevolent downgrading of Ealing Hospital, stripping it of its on-site management, Maternity, Paediatrics and Urology services. Both individuals depart organisations mired in debt – NHS NWL’s ‘underlying deficit’ was £324 million and NWLUHT’s ‘operating deficit’ was £37 million in 2018/19.

As of 1 January 2020 another big beast entered the fray. Peter Worthington is gone and replaced as NWLUHT Chair by Sir Amyas Morse. He’s 70 and is the ex-boss of PwC and the National Audit Office. A Scottish auditor who has a high national profile, he is continuing as Chair of The Hillingdon Hospitals Foundation Trust (HHFT). No doubt, with debt reduction still in the air, another merger (NWLUHT + HHFT) seems to be on the cards. Bizarre as it seems the head-hunters started looking to probably pay a fortune for a new Chief Operating Officer (COO) for NWLUHT on 23 December 2019. Sounds suspiciously like going through the motions to advertise over Christmas – no doubt NWLUHT had already found the COO it wants. 

None of this probably bodes well for Ealing Hospital. With no on-site management and no development plan, the prospect of it becoming an even smaller pawn in a bigger Trust looms large.

 

Sir Simon Stevens and Sir Iain Duncan Smith – Oh No!

Simon Stevens is the NHSE/I boss who allowed the NHS NWL ‘SaHF’ farce to decimate Ealing Hospital and to waste £100s millions – during his tenure from April 2014 to March 2019.

Iain Duncan Smith is the genius who introduced Universal Credit and the Bedroom Tax in 2013 which have brought pain, poverty, eviction and death to far too many people.

 

Circle Health Acquires BMI Healthcare

A £1 billion private hospital business has been created. Circle Health was formed in 2004 by ex-Goldman Sachs banker Ali Parsa. It’s had a chequered history. It famously abandoned the high profile 2010 Hinchinbroke Hospital, Cambridgeshire 10 year management contract in 2015. It cited that the contract was ‘no longer financially viable’. The local NHS Trust ended the year with a £14 million deficit. BMI Healthcare has 54 hospitals and healthcare facilities in the UK. It was formed in 1970 as AM group and became BMI in 1993. Mergers, sell-offs and changes in ownership happened over many years until a South African company Netcare took over control in 2006. Circle Health is significantly smaller than BMI Healthcare. This consolidation in the private hospital market is either a sign of market maturity or of a market in significant difficulty.

 

Secret Meeting To Discuss Selling Our Patient Data

‘The Times’ of 31 December 2019 reveals details (first exposed by technology news site ‘The Register’) of NHS bosses’ recent meeting with Microsoft, Amazon and Astra Zeneca to discuss selling off patient data. The meeting was held in October 2019 and attending were Chair and Chief Executive of NHS England Lord Prior of Brampton and Sir Simon Stevens.

Apparently what is planned is the creation of a data repository, which could be available within two years, containing patient data from GPs, NHS Trusts and directly from medical devices. Lots of alarm bells ring about this. There was the Tony Blair inspired NHS National Programme for IT, first conceived in 2002, which featured an electronic care record for everyone. It was abandoned in 2011, with little of value created or retained, at a final cost of £12.4 billion. Even more recently we had the care.data fiasco, announced in 2013 and scrapped in 2016. The plan was to extract patient data from GP surgeries and put it in a central database. The project failed because patients did not trust it and GPs wouldn’t support it. The money wasted was £7.7 million. 

 

Just 15 More Months for Ealing CCG

Our local Clinical Commissioning Group (Ealing CCG) has just 15 more months of life. It too wallows  in significant debt (losing £5.2 million in 2018/19) and one does wonder how long its boss Dr Mohini Parmar will remain in post. She was, truth be told, one of the signatories of the 2012 £250+ million flop known as the NHS NWL ‘Shaping a Healthier Future’ project. Dr Parmar was also one of the cheer leaders of the now replaced 2016 NHS NWL ‘Sustainability & Transformation Plan’. She is, however, contracted to work with ECCG until 14 July 2021. As well as her it will be interesting to see where the 9 ECCG middle/senior managers (earning over £50,000/year) find themselves new speaking parts in the emerging NHS NWL Integrated Care System (ICS). It will be especially interesting to see where ECCG MD Ms Tessa Sandall – currently earning £100,000+/year – finds herself a new role.

 

NHS NWL Long Term Plan and Integrated Care System

Ealing Save Our NHS provided copious feedback on the draft NWL LTP on 13 October 2019. However, there’s still no sign of an approved version of the plan. Where is it? It looks like the NHS England Integrated Care System (ICS) web page has not been updated since June 2019. The much vaunted trailblazing Dudley ICP is not even listed. The delegated Greater Manchester ICS is suspiciously silent also. No doubt some NHS footprints/regions will be operating with a single CCG in just 3 months’ time – but where is the news/detail about this? NHS South East London is one of these regions but there’s scant information about collapsing six CCGs into one there.

As Mr Johnson talked incessantly about the NHS during his election campaign it will be interesting to watch what, if anything, he does about it. When he was Mayor of London he had to have his own ‘new’ London Plan. Maybe he’ll want his own ‘new’ NHS Plan.

I have been of the opinion for years now that throwing healthcare and social care together (so called integration) is not a solution to any known care service problem. The ICSs which are being created are accountants attempts to reduce operating costs. As far as I can deduce the ICSs offer no real prospect of improved care services from either a quantitative or qualitative aspect.

Maybe in future years we’ll see more ’mergers’. By 2030 we might have a single ICS (or some fancy new name) for London and possibly just four NHS Trusts in London, and maybe just 10 Major Hospitals.  Just think how NHS accountants would love that – with lots of directors, managers, administrators, human resourcers, IT, public relations and others made redundant. Not to mention acres and acres of urban land to sell off to property developers.

 

NHS NWL’s 4,000-strong EPIC ‘Citizen’s Panel’ Will Not Replace Engagement and Public Consultation with 2.3 million Residents

NHS North West London’s PR supremo Rory Hegarty is currently assembling a ‘super group’ of 4,000 residents who will act as care policy /process reviewers. Quite pointedly very healthcare-savvy residents in activist groups like Ealing Save Our NHS (ESON), Hammersmith & Fulham’s Save Our NHS (SCXH&H) and Brent Patient Voice (BPV) were not on Rory’s invitation list. The panel cheerleaders/bosses held their first workshop on 17 December 2019.

Apparently 3,700 citizens have already signed up to be EPIC members. It’s important to realise that EPIC has no statutory legitimacy whatsoever. Robin Sharp of BPV has described the contents of the  17 December 2019 EPIC Workshop slides as representing a parallel universe. In some ways this is almost a kind comment.

Two of the workshop speakers are of interest. One was Christine Vigars of Central London Healthwatch. She consistently attempts to hold NHS institutions to account in meetings held in public. The other was Carmel Cahill who now has a new role as Chair of North West London Integrated Lay Partners Group. She was one of the founding members of the ill-fated 2013 Ealing Healthwatch which was eventually terminated in 2016 by Ealing Council. She was also a very vocal supporter of the disastrous 2012 NHS NWL ‘Shaping a Healthier Future’ (SaHF) project. She’s also on the Governing Body of the technically bankrupt Ealing CCG which will be wound up by March 2021.

Economy With The Truth

Some of the workshop slides contain some breath-taking content;

+ ‘Historically, our patch has a reputation for engaging well’.

I’ve been researching NHS NWL’s performance since 2012 and in terms of engagement and public consultation NHS NWL has not ‘engaged’ well with its customers – in fact in the classical engagement terms of ‘…during the formative stage of plan making ‘ – not at all.

+ ‘NHS staff, community activists and service users are in regular dialogue’

Not with ESON/SCXH&H/BPV. Dialogue is a two way process. NHS NWL writes/says something. Activists respond. NHS NWL does not respond. Activists write/say something to NHS NWL. NHS NWL does not respond.

There’s a fascinating ‘Diffusion of Innovation’ bell curve diagram, the like of which I saw many times during my IT career in the 1990s. The headline of this slide is a mind boggling ‘Creating a Coalition of the Willing’. It reveals that NHS NWL sees itself as a leading edge innovator. Change in itself is not a benefit. Beneficial change is, of course, to be welcomed. Local activists have for some 7 years consistently asked for evidence to justify changes like SaHF, Sustainability & Transformation Plan (STP) and now ICS. Having received no evidence to support the now abandoned SaHF/STP why would we support the unevidenced ICS? The patronising placard holding cartoon figure supporting the Flat Earth is not in fact ESON/SCXH&H/BPV but NHS NWL!!

Is EPIC Just Expensive Time Wasting for 4,000 Residents?

Another seven slides have the Delphic title of ‘Would the content transend role’. None of this content is remotely understandable. The slides then do indeed go into outer space in academic discussions about three types of organisation structures – hierarchical, hybrid and network.

New jargon emerges – the most prominent for me being QSIR. Quality, Service Improvement and Redesign is an NHS initiative dating back to 2016. Apparently there is a ‘QSIR College’ at which service improvement skills are taught. Seemingly QSIR is ‘a catalyst for place and value-based integration’. If I knew what that meant I might be able to confidently disagree with this.

In the slides mentioning Primary Care Networks there are some outrageously aspirational mentions of ’housing’, ‘QPR’ (!), and ‘retired teachers’. However for sheer brilliance in confusion is the complicated ‘Community Resilience’ graphic. None of my dictionaries can define ‘Transactional Resources’.

And after all care policy does not emanate in NHS NWL but no doubt far away in Dominic Cummins’ brain, via Mr Johnson, his Cabinet, the Department of Health & Social Care, NHS England and NHS London. Do we think if the gang of 4,000 say no to closing Charing Cross Hospital it will influence the decision being reversed?

NHS NWL has come up with the acronym EPIC after describing its citizens’ panel as Engage, Participate, Involve, Collaborate. Somehow I think Expensive, Irrelevant, Patronising and Contrived is more appropriate.

However, judge for yourselves at:

www.healthiernorthwestlondon.nhs.uk/sites/nhsnwlondon/files/documents/epic-involvement_workshop_17_december.pdf

One does wonder what Mark Easton’s replacement will make of this leading edge, innovatory groupthink initiative.

Happy New Year!

Eric Leach