Friday, 31 October 2014
Thursday, 30 October 2014
In response to the report, Ealing Council will write to the Health Secretary Jeremy Hunt MP to raise concerns over the conclusions made by the chief inspector of hospitals.
Councillor Hitesh Tailor with Ealing Council Leader Julian Bell at a Save our Hospitals demonstration
A report released today (October 28) has shown that services at a west London hospital are ‘dangerously’ overstretched.
In response to the report Ealing Council will write to the Health Secretary Jeremy Hunt MP to raise concerns over the conclusions made by the chief inspector of hospitals.
The inspection carried out by the Care Quality Commission (CQC) of services at Chelsea and Westminster Hospital NHS Foundation Trust found an increased demand for services at the trust, including in its accident and emergency (A&E) service.
It also found that the A&E did not have the recommended levels of medical staff working there and that this service was ‘experiencing difficulties’ in meeting the extra demand.
Hospital staff told inspectors they believed the reconfiguration of services across London had contributed to the increase in demand.
The inspectors said they had no evidence to support this view.
Councillor Julian Bell, leader of the council said: “This is the second report in as many months where the chief inspector of hospitals has highlighted concerns about the remaining A&E services in our area. Since the plans to shut A&Es were announced, I have expressed concerns about the ability of the remaining A&E services to cope with extra demand in patient numbers and this second report confirms my fears.
“I will now be writing to the secretary of state for health to reiterate the very real concerns that this council has about the NHS’s plans for accident and emergency services in this area and ask that he assures us that patient safety is not put in jeopardy by further reconfiguration. The way things stand at the moment our feelings are that the services are dangerously overstretched.”
On September 10, two A&E services in the region, at Central Middlesex and Hammersmith hospitals, were closed as part of the NHS’s plans to rationalise services across north-west London. This meant that people who previously used A&E services at these hospitals now have to use services at the remaining hospitals in the region, including Chelsea and Westminster Hospital NHS Foundation Trust.
Inspectors rated accident and emergency, medical care, surgery, children’s care, end-of-life care and outpatient services at the Chelsea and Westminster as ‘requires improvement’. Critical care and maternity and family planning were rated as ‘good’. CQC rated the hospital as ‘requires improvement’ overall.
In August, the CQC released a report about services provided by North West London Hospitals NHS Trust. It identified a number of areas where Northwick Park Hospital needed to improve including ensuring there were enough staff to deal with A&E patients.
It also wanted the trust to put in place better systems to assess and monitor the quality of A&E services to make sure they were safe and could be benchmarked against national standards.
In addition to the closure of A&E services at Central Middlesex and Hammersmith Hospitals the NHS intends to downgrade A&E services at Ealing Hospital and Charing Cross Hospital – leaving the area with five major hospitals with fully-functioning A&Es.
Councillor Hitesh Tailor, cabinet member for adults, health and wellbeing, said: “This report tells us that people who need to be seen quickly are waiting longer to be assessed and treated and that there aren’t enough medical staff working in A&E.
“This is unacceptable and raises serious concerns about the NHS’s plan to reduce services further. On reading this latest report, I am deeply concerned about the ability of A&E services to cope as we enter the winter period, when demand normally increases.”
A spokeswoman from Chelsea and Westminster Hospital Foundation Trust said: "Increased attendances is something being seen at many A&E departments. We have a strong historic A&E performance having been the best performing trust two years in a row. Our A&E performance against the four hour target in October is the best in North West London and so far this year is 96.6%, compared to the national target of 95%.
"We are investing £10m to refurbish and extend our Emergency Department. This will mean more space, more staff and state of the art equipment to treat patients in an emergency. Work on the new unit is underway and is due to open summer 2016."
A damning report on the quality of healthcare at Chelsea and Westminster Hospital has raised major concerns about whether its A&E could cope if emergency facilities at Charing Cross close.
An inspection report by the Care Quality Commission (CQC) rated Chelsea and Westminster's A&E as 'requiring improvement' while also concluding that some of the medical staffing levels 'did not meet national recommended standards' at the Fulham Road hospital.
The inspectors noted concerns from staff that the A&E unit was struggling to cope because of the closure of Hammersmith Hospital and Central Middlesex A&E in September.
And if Charing Cross Hospital was to close, experts predict 40 extra cases a day would also have to shift to the already overwhelmed Chelsea and Westminster Hospital.
H&F Council leader Cllr Stephen Cowan said that the report raised yet more doubt about the wisdom of closing A&E at Charing Cross.
He said: "Chelsea and Westminster is clearly struggling to cope with its current case load, so how on earth will it cope with an extra 40 cases per day if Charing Cross A&E closes? This shows how ill-thought out the current proposals are.
"Across London and across the country we are seeing A&Es struggling to cope with existing demand. It is total madness to think about further closures."
The CQC said that the Chelsea and Westminster Hospital NHS Foundation Trust requires improvement in four out of five areas.
It said that, while the overall standard of patient care at A&E was 'good', the service was under increasing pressure because of rising attendances which was causing delays in assessment and treatment. It noted that waiting time at A&E exceeded the four-hour national standard.
Staff told inspectors that morale at A&E was 'low' with insufficient levels of engagement with management.
Overall the CQC rated the Trust as requiring improvement when it comes to the safety, effectiveness, responsiveness and management of services.
Cllr Cowan said that he will be immediately writing to the Secretary of State with his concerns and added: "We should be focused on improving A&E services, not taking them away.
"We will continue to do everything in our power to block the removal of emergency services at Charing Cross."
Just this evening we heard about a child sent home from an urgent care centre in the borough who then required a 999 ambulance and hospitalisation. Someone else emailed after an A&E attendance at St Mary's afternoon saying it "felt like a third world hospital.....waiting for over four hours to be seen and for most of that time there weren't even enough chairs to sit down." Meanwhile we hear that the community trust is planning to cut by almost half the number of senior clinicians responsible for organising continuing highly complex care for people at home or in nursing homes across 4 boroughs including H&F. These are just a sample of the countless reports of local cuts making a mockery of the idea that community services are able to compensate for cuts and closures in acute hospitals.
It's important the general public hear about stories like this and what can be done to defend our localNHS. That's why we're having a Halloween stall outside Charing Cross Hospital between 1 and 3pm on Friday 31st. We'll have treats, tricks and leaflets - join us if you can. If not there's always the Saturday stall at King street Sat 1st Nov 2 - 4pm- all welcome to help spread the word.
The new NHS plans published yesterday ask for £8bn - more than any of the big three parties are offering - and offer £22bn of savings. But we've heard such promises before - where will they come from?
Will new NHS plans get us out of the woods? Image: Nicholas Tonelli / Flickr. Some rights reserved
Simon Stevens’ Five Year Forward View document is being reported in much of the press as a call for an £8 billion increase in NHS funding by 2020, to facilitate a raft of other policies aimed at reducing demand on hospitals and improving efficiency.
Even those suspicious of Stevens’ history in the US private medical corporation UnitedHealth, and as a Blair aide in opening the NHS up to the private sector, should be pleased to see him raise the need for more funding – asking for considerably more than any of the main parties have yet proposed.
But his cagey interview on BBC Radio’s Today programme yesterday, in which he dodged questions on the role of the private sector and PFI, didn't help allay suspicions of some of his proposals. While his plans to reorganise local services are a long way short of a full-blown blueprint for privatisation, it certainly offers the potential for private corporations seeking to leach profits from the NHS budget.
The report itself is evasively worded. It appears to focus mainly on NHS provision.
It defends - if a little tentatively - core NHS principles, saying “nothing in the analysis above suggests continuing with a comprehensive tax-funded NHS is intrinsically undoable”.
The briefings around Stevens’ proposals are significantly different from the Report itself. The £8 billion figure does not appear in the 39-page document, and nor does the accompanying figure of £22bn further “efficiency savings” (or demand reduction) that the Report says will be needed to bridge a £30 billion projected financial gap in NHS funding.
£30 billion is the widely agreed ‘gap’ between resources and demands for the NHS over the five years from 2015, if coalition spending plans to freeze funding in real terms prevail. The three main parties are living in denial.
Stevens’ report correctly points out that ‘flat funding’ along these lines ignores population growth, and could result in a reduction in real funding per head.
Stevens points to the astonishing success of the NHS in largely maintaining services despite the spending freeze since 2010, and acknowledges the sheer effort and dedication of staff that has made this possible.
But he glosses over the fact that a third of the apparent “savings” since 2010 have been at the expense of massive reduction in real terms salaries of the million NHS staff whose pay has been frozen since 2009.
It’s clear to all but Jeremy Hunt that another five years of the same cannot be delivered.
Stevens gives a brief nod to pay, suggesting “as the economy returns to growth, NHS pay will need to stay broadly in line with private sector wages in order to recruit and retain frontline staff”.
If this means more pay, it will require considerable new investment.
As will promises to:
· Radically upgrade prevention and public health
· Give “new support” to 1.4 million full time unpaid carers whose efforts keep the NHS afloat.
· Give “resources and support” to the introduction of “radical new care delivery options” throughout England – among them new “multispecialty community providers” bringing together GPs, nurses, community health services and mental health, employ hospital consultants, run community hospitals and have admitting rights to hospital beds.
· Give more NHS support for frail older people living in nursing homes.
· “Invest in new options for our workforce, and raise our game on health technology”.
But where will the money come from? Many of these are good ideas, but the price tag is never discussed.
Stevens claims that some of the investment will eventually deliver record levels of efficiency savings. But he doesn’t explain how.
Take the plan for “multispecialty community providers”. This is an even more ambitious revival of Lord Darzi’s controversial plans for “polyclinics” that were resoundingly rejected by most GPs and by local communities seven years ago. Despite government pressure only a few, expensive and unsuccessful, Darzi clinics were built – and most of them have since closed.
Now, as then, Stevens offers no serious discussion of the costs of the new modern buildings, equipment and professional staff that would be required to deliver this.
The plan potentially hugely fragments services currently provided in hospitals, with GPs employing hospital consultants in much smaller localised units serving very much smaller populations. This might sound good - but Stevens doesn’t it explain how it will do anything to reduce costs.
He does at one point suggest a “pump-priming” by “unlock[ing] assets held by NHS Property Services, surplus NHS property…”
Stevens also offers us a diametrically opposed alternative to GPs employing hospital doctors - that in some areas, Foundation Trusts in some areas could begin to run primary care, becoming “primary and acute systems”.
Stevens worryingly compares these with “Accountable Care Organisations” now developing in the US and “other countries”, often under private ownership.
He also offers “Clinical Commissioning Groups” the option of “more control over the wider NHS budget, enabling a shift in investment from acute to primary and community services.” Stevens ignores the reality that far from being “led by GPs” as he suggests, most CCGs are largely run by managers or by Commissioning Support Units and management consultants.
And he sets out hopes that prevention and health promotion changing people’s behaviour and lifestyle to reduce the demand for hospital care.
We’ve heard most of this before.
A shift from hospitals to ‘the community’, ‘alternative settings’ or ‘closer to home’ has been set out in every plan for hospital ‘rationalisation’ in the last 20 years or more - underpinned by the assumption that more localised services would somehow be cheaper. But there’s no evidence they are. As a result, even as local acute hospitals are undermined in the teeth of local opposition, community health services remain desperately under-resourced and further fragmented by repeated outsourcing and contracting.
And few GPs - except the most entrepreneurial - want to deal with the administration required to deliver such models.
More health promotion and prevention of ill-health is obviously a good thing. But it’s hard to change ingrained behaviour. Many of the health promotion targets have been wildly unrealistic, and the resources allocated to them completely inadequate. Time and again the burden of ill health among older adults that has already resulted from previous decades of less than healthy diet and behaviour has been underestimated.
There is no quick fix. Hospital attendances and admissions have risen throughout this same period - compounded by the massive cutbacks in social care, which are set to continue under Osborne’s public spending plans.
The result: intensifying pressure on the remaining hospital services - now taking the form of huge, under-funded demand on A&E, lengthening waiting times, and more delays in discharging patients from hospital for lack of suitable support in the community. A recent report in the Times shows the decline since 2010:
· The number of people waiting for operations has gone up by one million to 3.3million people.
· People are now waiting on average 10% longer for treatment.
· The numbers waiting over 18 weeks and over 26 weeks for outpatient appointments and treatment have gone up by 25%.
· Cancer treatment targets have been missed for two successive quarters.
· For well over a year A&E departments have been failing to hit targets for treatment within 4 hours.
· Trolley waits for a bed have almost trebled in the last three years.
· Last minute cancellation of operations last year hit the highest level for nine years.
· Delayed discharge of patients fit enough to leave hospital have hit a new record level.
· 60% of patients have to wait more than 48 hours to see a GP.
Both hospitals and GPs are clearly under huge pressure. Before doing anything that could undermine them, new services have to be put in place to ensure patient care is improved. This needs money and will take time.
Some of Simon Stevens’ ideas may help - if there was money to pay for them. But - whilst the three main parties have professed their welcome for Stevens’ plan, none have pledged to increase spending by anywhere near the £8 billion above inflation he says is needed by 2020.
And it’s unclear how his plans would generate anywhere near the hugely ambitious £22 billion savings target he sets.
Given this, his plan lacks credibility.
It’s noticeable that none of Stevens’ proposals to boost efficiency takes on the costly and wasteful elephant in every CCG and Trust boardroom – the inflated transaction and overhead costs of running the NHS as a competitive market.
Instead, his plan leaves room for private sector inroads that would further destabilise struggling and indebted NHS Trusts and contribute nothing of value to patient care.
Campaigners will have to fight on for genuinely alternative plans for the NHS. We need a short term increase in funding - followed up by efficiency savings based on stripping away the wasteful bureaucracy of the market. And we need longer term plans to get the rich and big business to pay their fair share of tax towards public services we all need, but which are being starved of resources.https://www.opendemocracy.net/ournhs/john-lister/nhs-leaders-promise-another-%C2%A322bn-of-savings-but-sums-don%27t-add-up?
We reveal the dozens of maternity and A&E units which have been closed or downgraded since 2010 and the dozens more now under threat
Research by The Telegraph shows that dozens of NHS maternity and Accident & Emergency units have been closed or downgraded since the last election, with even more under threat. Here, details of the changes which have taken place, and the changes facing decisions in the coming months:
Accident & Emergency closures and downgrades since May 2010
Hammersmith, west London September 2014
Central Middlesex Hospital, north London, September 2014
Chase Farm, north London December 2013
Wycombe Hospital, Buckinghamshire downgraded from an emergency medical centre which took some ambulance cases to a minor injuries unit, October 2012
Trafford Hospital, Greater Manchester, November 2013.
Queen Elizabeth II, Welwyn Garden City, A&E services reduced to 12 hours a day in January 2012, with minor injuries service overnight. From Oct 1 2014, no A&E but 24-hour urgent care centre dealing with minor injuries and illnesses.
Queen Mary’s Sidcup, south east London, temporarily closed winter 2010, officially downgraded in October 2013
Cheltenham Hospital, Gloucestershire July 2013
St Cross Hospital, Rugby, September 2013
Stafford Hospital, closed overnight, December 2011.
Newark Hospital, Nottinghamshire, April 2011
Rochdale Infirmary, Greater Manchester, April 2011
Maidstone Hospital, Kent, September 2011
Downgrades agreed but not yet implemented
Wansbeck Hospital, Northumbria, due mid 2015
North Tyneside Hospital, North Shields, due mid 2015
King George’s Hospital, Ilford, due 2015
Dewsbury Hospital, west Yorkshire due 2017
City Hospital, Birmingham, due 2017-18
Sandwell Hospital, Birmingham, due 2017-18
University Hospital of Hartlepool August 2011, urgent care centre opened elsewhere in the town
A&E downgrades or closures now planned or under consideration
Calderdale Royal Hospital, Halifax, west Yorkshire, preferred option was to close A&E earlier this year - public consultation delayed
Bedford or Milton Keynes; decision on preferred option to scale back could come this month
North Manchester Hospital, Fairfield Hospital, and Tameside Hospitals - proposals to close emergency surgery, so A&E patients likely to require it will be diverted to more major centres
Two or three of four hospitals - Wythenshaw, Stepping Hill, Royal Bolton and Royal Albert Edward Infirmary, Wigan – are proposed to lose emergency surgery
Lincoln, Grantham and Boston hospitals, Lincolnshire; plans to reduce the number of sites with full A&E
Basingstoke Hospital, Hampshire and Royal Hampshire County Hospital, Winchester; proposals to centralise services – possibly at a new hospital – will be consulted on later this year
Royal Shrewsbury Hospital and Telford Hospital – proposals under discussion could lead to loss of full A&E from one of the hospitals
Alexandra Hospital, Redditch, proposals still to go to public consultation, but officials seeking to downgrade to an emergency centre, with major emergencies diverted to Worcestershire Royal Hospital and an emergency centre at the Alexandra Hospital.
Ealing, no decision taken, timetable likely to mean changes in 2017/18, if agreed
Charing Cross no decision taken, timetable likely to mean changes in 2017/18, if agreed
Maternity closures and downgrades since May 2010
Consultant-led units closed:
King George’s Hospital, Ilford, March 2013
Chase Farm, North London, November 2013
Rochdale, Greater Manchester June 2011
Salford, Greater Manchester, November 2011, replaced with midwife-led unit which may now be closed
Bury, Greater Manchester, March 2012
Queen Mary’s Sidcup, Kent, temporary closure September 2010, became permanent October 2013
QEII Hospital, Welwyn, October 2011
Consultant-led units replaced by midwife-led units:
Sandwell Hospital, Birmingham, January 2011,
Solihull Hospital, Birmingham, temporary closure in April 2010, midwife led unit set up in July 2010
Eastbourne District General Hospital, temporarily from May 2013, decision not to reopen taken in June 2014 .
Maidstone Hospital, Kent, September 2011
Friarage, Northallerton, North Yorkshire, consultant-led unit closed October 6, being replaced with midwife led unit
Midwife-led units closed:
Darley Birth Centre, Matlock, Derbyshire, July 2012
Corbar Birth Centre in Buxton, Derbyshire, July 2012
Canterbury Hospital, Kent, May 2012
Buckland Hospital, Dover, Kent May 2012
Castle Hill Hospital, Cottingham, near Hull closed temporarily in 2011, permanently, January 2012
Grantham Hospital, Lincolnshire, February 2014.
Heatherwood Hospital, Ascot, Berkshire – closed temporarily September 2011, permanently in February 2012
Maternity unit downgrades or closures now planned or under consideration
Bishop Auckland Hospital’s midwife-led unit, Country Durham, closed on safety grounds since July 2013, future uncertain
Salford Royal midwife-led unit, under review
North Tyneside midwife-led unit planned for closure
Proposals to replace consultant-led units with midwife led units:
Dewsbury and District Hospital, West Yorkshire
Alexandra Hospital, Redditch, Worcestershire
Bedford or Milton Keynes, Buckinghamshire
Pilgrim Hospital, Boston or Lincoln, Lincolnshire
University Hospital Lewisham
Royal Hampshire County, Winchester
Mayday Hospital, Croydon; Kingston, south west London; St George’s, south London; and St Helier, Sutton – proposals which could lead to fewer consultant-led units and more.The Telegraph
Letter from Colin Standfield from Ealing with detailed statistics on the A&E problems since the casualty closures
Dear Mr McVittie,
I am sure you were as disappointed (almost) as I was to see the A&E statistics from Unify2 this morning. It came as no surprise to me that the newly-merged Trust was languishing near the bottom of the England league table; but I was appalled to see that it ranked bottom of all of them for Type-1 waits over 4 hours.
Despite your assertion, and Dr Spencer's, that this is just because of 'peaks' and 'fluctuations', and nothing to do with the premature closures of 2 A&Es in the Sector ('earlier than we had originally planned' says Dr Spencer) with no alternative provision in place or with the slashing of 1,000 acute beds across NW London, it is clear that there is nowhere for Type-1 admissions to go; so they are backing up in A&E.
Day Case operations are also being cancelled at unprecedented rates, though I do not know whether they are still at the disgraceful level of 22 in one week for 'no beds' at Ealing last month. (The week, in fact, after Dr Spencer wrote me his 'no crisis' e-mail.) It may be time for another FoI request. I hear that critical beds are also in desperate shortage, with Consultants ringing from hospital to hospital to find accommodation for seriously ill patients.
If the NW London Sector were an 'Area Team' in its own right – which is not unreasonable as it would be 6th busiest for overall A&E attendances out of 25 [or 26] in England and 11th for Type-1 – it would be the worst Area in the country for both Type-1s and overall 4-hour waits. It is comfortably worse than the London average at 82.0% Type-1 and 91.9% overall compared with 88.4% and 95.8%. Just to remind you, LNW Healthcare NHS Trust is the major contributor to this NW London misery at 67.8% and 86.6%. London as a whole meets the 95% target but NW London fails.
In short, 2 years in to Shaping a 'Healthier' Future, NW London has become the worst area in the country for A&E services, with its reduced resources. And the overload on the remaining A&Es is having a devastating effect not only on A&E waits but also on planned surgery.
The figures are published and undeniable and I, possibly uniquely, have been following the trend for two months now. And I defy anybody to refute my analysis of the reasons behind this sorry history.
I had naively thought that Sa'H'F would contrive a managed decline into mediocrity, not this madcap rush into chaos. The medics are working extremely hard, at Northwick Park no less than anywhere else. But it is long past time for some serious revision in the shadowy empyrean represented by the upper levels of the NHS, before the deaths begin.
Figures show patients with long-term conditions occupy 77% of hospital beds
Cutting back on hospital services in England - before community services are geared up to provide care - is a "recipe for disaster", MPs say.
The Health Select Committee said the NHS faced "one of its greatest challenges" dealing with patients with long-term conditions, such as diabetes.
They account for 70% of health spending but only 30% of patients.
The NHS has tried to ensure more care is done in the community, but the MPs questioned the wisdom of this strategy.
The cross-party group said these patients would still need specialist hospital care.
The MPs acknowledged doing more in the community was perhaps desirable for the patient, but added it would not necessarily save the NHS money - as has been widely assumed.
They said it was already clear there were gaps that needed to be plugged in the community, pointing to figures that showed there was a shortfall in GPs in training.
Continue reading the main story
Dr Sarah WollastonCommittee chairUnless we get the treatment of long-term conditions right, we are going to see more and more people unable to see a doctor in their GP surgery and therefore turning up at casualty”
But they said the NHS could not simply cut back on hospital care to pay for this.
Instead, the MPs said there needed to be greater understanding of what drove patients with long-term conditions to hospital on such a scale.
Figures show these patients are responsible for two-thirds of outpatient and A&E visits and occupy 77% of beds.
The committee's report said evidence presented to them suggested that by 2016 the NHS would need to be finding an extra £4bn a year to cope with the rising burden of treating people with these incurable conditions unless a more efficient way of working were found.
Dr Sarah Wollaston, who has just replaced Stephen Dorrell as chairman of the committee, said: "Unless we get the treatment of long-term conditions right, we are going to see more and more people unable to see a doctor in their GP surgery and therefore turning up at casualty."
She added that the answer lay in making sure community services and social care were working together to keep people living independently.
The government has already set out plans to achieve this through its £3.8bn Better Care Fund, which will be launched next year to encourage collaboration between the NHS and local councils.
'Refocus the agenda'
But that involves £2bn being taken from the NHS, which hospital leaders have warned is likely to hit their services hardest.
Bridget Turner, of Diabetes UK, said the NHS had to develop a "clear plan".
She said: "The health system needs to change to put people with long-term conditions, including diabetes, at the centre of the care they receive."
But Dr Martin McShane, NHS England's director of long-term conditions, said a number of steps were already being taken to "refocus the agenda" on proactive care to keep people well and save the NHS money.
He cited the push to improve the co-ordination of care for the frailest patients, which includes a new responsibility on GPs to take charge of their care.
Dr McShane added: "We do not underestimate the scale of the task."
Rob Webster, chief executive of the NHS Confederation, which represents NHS trusts, told BBC Breakfast that the report proved the "needs of a patient in the 21st century have changed".
He said patients with long-term conditions were still being cared for with "one-off interventions" by the NHS, which he said needed to "fundamentally change the way it looks after people".
"We need to see the people with long-term conditions as part of the team with the carers, the people who work in the general practices, community service providers and to join the services up around them, and that will take some time and some effort," he said.
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