Tuesday, 22 December 2015

A&E whitewash: After chaos caused by casualty closures, NHS boss orders 'review' by the same people who had proposed shutting units.

Review found long A&E waits were 'unrelated' to the closures of two units.

Consultancy firm paid by the NHS had been paid millions for closure plan.
Authors' identity divulged only through Freedom of Information request.
Health service managers signed off a payment of £150,000 for the view.

NHS bosses have been accused of ‘marking their own homework’ over a review that claimed the closure of two A&E departments had little impact on other hospitals.
NHS bosses have been accused of ‘marking their own homework’ over a review that claimed the closure of two A&E departments had little impact on other hospitals. Above, Dr Mark Spencer, medical director for NHS NW London
NHS bosses have been accused of ‘marking their own homework’ over a review that claimed the closure of two A&E departments had little impact on other hospitals.

The ‘independent’ review, commissioned by NHS England, found that soaring waits for A&E treatment in North-West London were ‘unrelated to the closures’ of two casualty units in the area in September 2014.
Now it has emerged that the consultancy firm paid by the NHS to write the study was the same one already paid millions for coming up with the closure plan in the first place.
The NHS repeatedly refused to tell campaigners who had written it – only divulging the authors’ identity when forced to do so under the Freedom of Information Act.

Health service managers signed off a payment of £150,000 plus VAT for US firm McKinsey & Co to write the review. It was last night branded a ‘whitewash’ by campaigner Colin Standfield, who has led calls to save health services in the capital, and submitted the FoI request.
He said: ‘McKinsey have trousered at least £33 million out of the NHS in North-West London and were the main drivers of the Shaping A Healthier Future A&E closure programme.
‘Now they pick up another £150,000 for this tin of whitewash, as an extension to their existing contract.
‘That’s madness, scandalous. McKinsey are so much part of the process that it amounts to NHS bosses effectively marking their own homework.’
Dr Mark Spencer, medical director of Shaping A Healthier Future, ordered the review a year ago after The Mail on Sunday – as part of a long-running campaign to stop casualty units being axed – highlighted how the closure of those at Hammersmith and Central Middlesex hospitals was immediately followed by rocketing waiting times at Northwick Park hospital in Harrow.

That autumn, the proportion of patients having to wait four hours or more in Northwick Park’s A&E averaged 25 per cent – double the 11 per cent figure of autumn 2013.

At the time Dr Spencer said he did not think the closures were having a ‘major impact’ on other hospitals. But he promised: ‘We’ve asked for an external review… to see if there’s anything we need to learn to get it right. If we are wrong, we will find out how we got it wrong and not do it again.’

In July, NHS England published a ‘Review of the Implementation of North-West London A&E Changes’. It quoted from what was described as ‘the independent review of A&E performance’ – but the full McKinsey document itself was not published, and neither was the author named.
The ‘independent’ review, commissioned by NHS England, found that soaring waits for A&E treatment in North-West London were ‘unrelated to the closures’ of two casualty units in the area in September 2014

The ‘independent’ review, commissioned by NHS England, found that soaring waits for A&E treatment in North-West London were ‘unrelated to the closures’ of two casualty units in the area in September 2014 (stock image)
Cherry-picking its evidence, NHS England said the independent review found ‘local performance issues’ had been caused by ‘significant variances in demand’ for A&E services, but these problems were ‘unrelated to the closures’.

NHS England also concluded that ‘deterioration in A&E performance’ in October 2014 was ‘not related to the A&E changes’ but ‘in line with deterioration across London and England’.
This interpretation was based on looking at four-hour wait figures at ‘all type’ A&Es, which includes urgent care centres and minor injury units.
Analysing ‘Type 1’ units alone – meaning proper A&Es only – shows Northwick Park’s A&E has struggled ever since the double closure.
In some weeks more than 30 per cent of patients waited more than four hours – many times the Government’s five per cent limit. The hospital trust that runs it still has among the longest A&E waiting times in England.

In its response to Mr Standfield’s FoI request, NHS England claimed that McKinsey’s review was independent because they were ‘external consultants, therefore independent of the NHS’.
An NHS England spokesman said: ‘This specific analysis was undertaken by an external agency as part of an extension to an existing contract procured competitively. The work was commissioned by NHS England (London), Monitor and the Trust Development Authority.’
A McKinsey spokesman said: ‘We never comment on our client work.’

PUBLISHED: 01:51, 20 December 2015 | UPDATED: 12:53, 20 December 2015

Only God and the bed manager

The consultant was clear – you need to be on an IV drip getting antibiotics in your local A and E within the hour because of complications with chemotherapy treatment.

The patient, my partner, was already very ill, had developed a high fever, and was forbidden to drive because of radiotherapy treatment for five brain tumours.

The nearest A&E had once been local but had been shut down. So our new nearest A&E was now around 30 minutes’ drive away from our house.

I was worried as I was over an hour’s drive away from home. The extra distance to the hospital and the Christmas traffic combined would eat into the ‘one hour to get treatment’ ordered by the consultant cancer specialist during a phone call.

So the next phone call was 999 to the regional ambulance service. No help in this emergency.

All that was on offer was a phone call within the hour from a doctor who would carry out triage – to assess the urgency of the request. The ambulance service was told that a consultant had instructed A&E attendance and treatment within the hour, half of which would be travelling time.

Still no go from the ambulance service. Only a phone call in the next hour from their doctor who would assess the urgency on behalf of the ambulance service.

In the event there was no phone call from the doctor. But an ambulance did arrive an hour and a half after the initial call for assistance, by which time my partner was being taken by a neighbour to A&E.

Eye opener
Not a great start, but then as a family we had little experience of using A&E. It was an eye opener for me when I arrived at the hospital.

It was an ordinary, mild December day. No ice causing slips, trips and falls. No cold snap creating problems for an ageing population, no flu warnings.

I checked and there were no major accidents on any of the major road routes nearby. Nothing out of the ordinary at all.

At the A&E there was the roofer who had fallen off a ladder. A young lad who had tweaked his ankle playing football the day before and had woken up unable to walk.

There were broken bones, kids with high temperatures and really awful coughs. And a few elderly patients with a range of ailments.

So why did the A&E build up during the eight hours I was there to being standing room only in the waiting room? By the time I left there was a row of patients on trolleys, every seat in the waiting room was taken and people in pain were on the floor because there was nowhere to sit.

On our arrival we waited around two hours to get into a cubicle to be seen by a nurse. And that was only because the need for treatment within an hour and the risk of picking up further infections and viruses had put us on the fast track.

The cubicles were being bogged down by patients waiting for acute beds. And there were far too few cubicles to start with.

This A&E now serves a much bigger catchment area than it did five years before. It was one of only three to survive in the area, the other two were closed.

So emergency cases which had gone to three A&Es were now being crammed into one.

According to the health service staff I spoke to, the other two hospitals had also lost acute beds, putting even more pressure on this hospital.

And the area has a seen a big increase in population – it’s a major London commuter area which has seen a huge amount of house building. But neither this A&E, nor the hospitals nearby, have seen an increase in capacity to cope with a rising population.

This A&E did not have the physical space to handle the number of patients arriving. When you did see a medic it was highly professional and the care wonderful.

But this was a medical staff battling against the odds. Doctors were going in and out of cubicles looking for the only portable electro-cardiogram (ECG).

Another was searching around looking for ‘the’ lamp to help with an examination. None of them had a flat surface to place their notes down to update them.

The nurses were run off their feet. The work was a slog. They barely had time to draw breath.

And all the time they could see the A&E waiting room filling up, getting more and more full. This is clearly not an NHS that is coping – and you could see the stress and pressure on the staff.

It took us eight hours to get out of A&E, the last four hours simply waiting for a vacant bed in the acute unit to which my partner could be discharged. When we asked when we would go we always got the same reply – ‘that’s up to God…and the bed manager.’

At eight o’clock that night we made it to an acute bed. But I walked back through an A&E filled to capacity. I was truly shocked by what I saw.

Older people waiting on trolleys in the corridors. Every seat filled. Standing room only.

People in pain on the floor, one woman curled up holding her stomach. It was all reminiscent of the health service in the 1980s , in the bad old days of Thatcher.

This should not be happening in the UK in 2015.

Put all the figures and statistics and funding claims aside. What I saw was a health service which has not kept pace with a growing and changing population, and which clearly cannot cope.

An ambulance service which can only offer an emergency patient assessment on the phone within the hour is not acceptable. And what sort of response time is an hour and a half?

It is not that paramedics are unwilling. Not at all. It is an ambulance service running on empty and a wing and a prayer. That’s just not good enough for a 999 service.

Re-organisation – and when is the NHS not being re-organised? – has not helped. From what I have seen A&E re-organisation has been about cuts and leaving us with less capacity than before.

A highly trained team of medical specialists is not good enough if the team is not big enough. And if it is big enough, it needs the physical space, beds and back up to handle the numbers of patients it is now dealing with.

More worrying is that we are not yet into the worst of the winter. What I witnessed was an NHS unable to cope even on an ordinary day.

I can only hope God – and the bed manager – helps us when the frost comes.

A&E in crisis: a UNITElive reader's personal account
UNITElive reader, Monday, December 21st, 2015 

Saturday, 19 December 2015

London NHS devolution - "It's obvious to all but gullible, power-grabbing councillors - this is about dumping blame for closures"

Osborne's plans for London "devolution" look likely to lead to more hospital closures - and even less say for local people. 

On Tuesday, George Osborne made the surprise announcement that health across London would be ‘devolved’. The deal will be piloted in Hackney, Barnet, Camden, Islington, Haringey, Enfield, Lewisham, Barking & Dagenham, Havering and Redbridge, but it is envisaged that the “devolution agreement” will then extend to cover the 33 London Boroughs and 32 Clinical Commissioning Groups covering the capital’s 8.6 million residents.
Observers of the previous biggest scheme – in Manchester – will recognise much of what’s on offer:
A new deal announced and clearly led by Chancellor George Osborne, with local government and health leaders playing a subordinate role.
Devolution – previously seen as a positive aspiration for local campaigners – had turned into something very different, imposed from the top downwards.
No prior public consultation - proposals rubber-stamped by Clinical Commissioning Group chairs and council leaders without reference to their boards or elected councillors, let alone any wider discussion.
No parliamentary debate. Tory legislation to extend devolution across England did not initially make any reference to the NHS. Section 18, which was added as an amendment, requires prior consultation: that clearly is being ignored in both big ‘devolutions’ so far.
Indeed the London announcement seems to have taken even NHS England boss Simon Stevens by surprise.
On Monday he told the Health Service Journal that he did not expect any rapid spread of devolution plans beyond the Manchester experiment. But then on Tuesday he was wheeled out in George Osborne’s press release to show his support for London’s even bigger plans.
As in Manchester, deals which start out as furtive, bureaucratic lash-ups are likely to remain so – with no democratic accountability, transparency or genuine devolution of power to local people.
In London we are offered only some sketchy detail of the initial pilot schemes.
But worryingly, the “devolution agreement” is conspicuously silent on controversial plans in North West London to close Ealing & Charing Cross Hospitals, with the devastating loss of over 600 beds, demolish most of the land and sell it off for flats.
Will that plan now be pushed through under the new powers? The closure of two smaller A&Es (Hammersmith and Central Middlesex) has already reduced local emergency services for the most serious cases at Northwick Park Hospital to some of the worst in the country.
As in Manchester, there’s no new money on the table to develop new services.
In fact London is supposed to find a further £4 billion of ‘efficiency savings’ by 2020, though almost all of its hospitals are already deep in the red.
It’s supposed to ‘free up’ cash by finding yet more ‘surplus’ hospitals and GP surgeries and arranging their ‘disposal’ for housing developments. One of the pilot London projects is to focus on just this, in the five boroughs of “North Central London”.
It’s obvious to anyone but a gullible or power-grabbing councillor, mayor or CCG chair that the government plan is to “devolve” responsibility and dump blame for massive debts and unpopular cuts and closures, onto those same dim-witted  or ill-informed councillors.
Particular blame in each city must land on the Labour council leaders, who in each case are a clear majority of those declaring support (Labour leads 20 of London’s 33 boroughs, with the Tories currently leading only 9 in the run up to London elections in May 2016).
Tory Mayor Boris Johnson now has a key role in deciding on health services in London. Who thought that was a good idea?
One of a handful of specific plans is the setting up of an Accountable Care Organisation ‘integrating’ health and social care in Barking & Dagenham, Havering & Redbridge.
But the local NHS side is in no position to play its full role: the local Barking Havering & Redbridge hospitals trust is mired in massive debt as a result of a hugely expensive Private Finance Initiative contract for the £240m Queens Hospital in Romford, and seeking to make savings by closing the busy A&E at King George Hospital in Ilford.
Barking & Dagenham and Havering councils are also in a poor position to offer support – they are amongst the third of UK authorities who have joined the list of shame of those who have totally scrapped all “meals on wheels” services for elderly and vulnerable people.
Social care is on skid row. Care homes are nearly bankrupt. There are severe shortages of GPs, community and district nurses. Debt-ridden NHS trusts simply have no spare beds.
In this situation, 80% of areas expect to fail to deliver their targets for reducing emergency hospital admissions as part of the “Better Care Fund”. The cosy term “integration” ceases to have any useful significance - what’s the point of lashing together two broken and cash-starved organisations?  
Add to this a blatantly undemocratic “devolution” plan, signed off by council leaders with a grim record of failing to stand up in defence of local services, there are real fears the “integration” of health and social care will mean the plundering of already inadequate NHS budgets to prop up local government services. Yesterday the Chair of the Local Government Association, Lord Porter, told BBC’s The Daily Politics that “we have to get our hands on the NHS funding”.
Social care has been plagued for decades by cuts, outsourcing and piecemeal privatisation of services, leaving many staff on zero hours contracts and service users with bewildering 15 minute sessions of ‘care’.
Now there is the danger that in some localities services could be “integrated” under local authority rules which levy means-tested charges for services, rather than the NHS principle of services funded from general taxation.
Simon Stevens stressed the need for “integration” in his Five Year Forward View but was at pains to give the impression that the NHS would remain in charge of its budgets. The new devo plans make clear that is not the case.
Campaigners see the risks now in plain sight – of more hospital sell-offs, and more services being privatised, withdrawn altogether, or charged for under the header of ‘integration’ - as Osborne pointedly fails not to adjust funding to meet the growing population and rising demand. This is not devolution, but dumping blame.
JOHN LISTER 18 December 2015 https://www.opendemocracy.net/ournhs/john-lister/london-devolution-its-obvious-to-all-but-gullible-power-grabbing-councillors-this

Wednesday, 2 December 2015

West London A&E closures 'are deeply flawed'

Report calls for “immediate halt” of NHS plans which saw A&E and maternity ward closures

The Independent Healthcare Commission, which has been criticised in some quarters, says legal action should be taken if the NHS’s Shaping a Healthier Future continues

Michael Mansfield QC chaired the Independent Healthcare Commission (Pic: Matthew Lloyd/Getty Images)

A long-awaited report has damned controversial NHS plans in north west London which resulted in the closure of A&Es at Hammersmith and Central Middlesex Hospitals and thematernity unit at Ealing .
The Independent Healthcare Commission called for the “deeply flawed” NHS West London’s Shaping a Healthier Future (SaHF) plans to be “halted immediately”.
The commission also suggested legal challenges take place if the plans do not stop.
The report by the commission, chaired by Michael Mansfield QC, also calls for the decision to close the units at Central Middlesex and Ealing hospitals to be reversed and for A&E units at Charing Cross and Ealing to retain full services for the foreseeable future.
Ealing Hospital

The report was commissioned by Labour-run authorities a year ago (December 2014), drawing criticism by opponents that it is not independent and politically motivated .
Mr Mansfield is launching his report at the Royal Festival Hall on Southbank this lunchtime (December 2).
There are fears that further down-grading of Ealing Hospital will follow along with the closure and sale of some of Charing Cross .
In his report, Mr Mansfield says: “The findings of the Independent Healthcare Commission for North West London are stark - the reforms, both proposed and implemented thus far, are deeply flawed.
"There is no realistic prospect of achieving good quality accessible healthcare for all, and any further implementation is likely to exacerbate a deteriorating situation.
“Our recommendations are equally stark. It is the view of the Commission that the Shaping a Healthier Future programme should be halted immediately, and that the affected councils should consider a legal challenge if it is taken forward in the current circumstances.”
Charing Cross Hospital

The report says costs of the SaHF stands at £1 billion, and does not represent good value for money, while deprived communities feel the brunt of the changes.
It also says there were inadequate alternative provisions in place to deal with the closed NHS facilities and that an increasing population requires an increasing need for services.
Detailing the issues, it calls for a substantial investment to be made in GP and out-of-hospital services.
Mr Mansfield is critical too of the government, adding: “In so many ways, the catalogue of failings, missed opportunities and profligacy we have seen in North West London act as a microcosm of a wider malaise across the English NHS.
"As such, though this report focuses on the NHS in North West London, it should act as a warning call to the top of government.”
The report was commissioned by Hamersmith and Fulham, Ealing , Brent, Hounslow and Harrow Councils.
Get West London

NHS reforms by Tories have been deeply flawed says top lawyer Michael Mansfield

"The catalogue of failings we have seen in North West London acts as a microcosm of a wider malaise across the English NHS"

Michael Mansfield QC
The Tory NHS shake-up has been labelled “deeply flawed” by one of Britain’s leading lawyers.
Michael Mansfield QC led a probe into the impact of the changes in North West London where two A&E units and a maternity unit have been axed.
He insisted the cuts are having a devastating impact on the poor not only in London but across England.
Mr Mansfield said: “It is crystal clear that the impact of fragmentation through privatisation is slowly eroding what was a National Health Service.
“The catalogue of failings we have seen in North West London acts as a microcosm of a wider malaise across the English NHS.”
He demanded the “deeply flawed” reforms end. There could be a legal challenge if the Government ploughs on.
Accident and Emergency department

Mr Mansfield chairs the Independent Healthcare Commission set up by four councils in the capital.
He said: “Though this report focuses on the NHS in North West London, it should be a warning call.”
A&Es at Hammersmith and Central Middlesex hospitals and Ealing maternity unit have shut. Further downgrading at Ealing is planned plus the sale of most of the Charing Cross hospital site.
Mr Mansfield added: “The Shaping a Healthier Future programme should be halted immediately.”
Brent, Ealing, Hammersmith & Fulham and Hounslow councils say the poorest are being targeted.
Cllr Stephen Cowan, leader of Hammersmith & Fulham, said: “People have been horrified to see their treasured NHS deteriorating so quickly and unnecessarily.
“They’ve begged local health chiefs to stop this madness and have been ignored.”

Halt A&E closures in North West London, says commission

Ealing Hospital's maternity unit and A&E services must stay, says the report

The "deeply flawed" decision to downgrade several North West London hospitals must be halted, according to a report by Michael Mansfield QC.
It warns the closures threaten "the fundamental principles of a universal NHS".
Waiting times at local A&E departments increased sharply after those at Hammersmith and Central Middlesex Hospitals were closed.
The report says the reorganisation had no "up-to-date business plan".
Consultation was inadequate and departments had been shut without providing adequate alternative healthcare, it added.
It said: "Overwhelmed and inconsistent" GP services are "clearly failing to meet demand across the region".

'Costs spiralling'

But a spokeswoman for NHS London said patients now had better access to GPs and that more A&E consultants and nurses had been recruited.
The Independent Healthcare Commission for North West London, led by Michael Mansfield QC, found the 'Shaping a Healthier Future' (SaHF) plan would cost at least £1bn, with "spiralling management and consultancy costs".
Cutbacks had been aimed at the most deprived communities, and many vulnerable patients were now forced to travel to hospitals with poor public transport links.
The commission was particularly concerned about plans to close the "exemplary" maternity unit at Ealing Hospital.
The SaHF programme had failed to consider the fast-growing population of North West London and the rise in the number of over-60s.
It had sought to save money in anticipation of NHS cuts that had not transpired.

The report's recommendations

•The decision to close Ealing maternity unit should be reversed immediately
•Reopen the A&E department at Central Middlesex Hospital
•The National Audit Office should undertake a review of the programme's value for money
•A new public consultation is needed as the proposals have changed significantly
•Substantial investment should be made in GP and out-of-hospital services
.•Ealing and Charing Cross hospitals must retain full 'blue light' A&E services for the foreseeable future

The plan aimed to redirect patients to Urgent Care Centres, but the commission said there was "widespread confusion" among GPs, consultants and patients about what the centres could do and who should go there.
It said they should be co-located with A&E departments wherever possible to avoid "fatal consequences".
Surgeons perform an operation at Charing Cross Hospital. The report says it must maintain its A&E services
NHS London defended the plan, saying patients were already benefitting from it.
"We now have eleven community hubs open across North West London, which provide a range of health and social care services in one place, closer to people's homes.
"Part of the improvement plan includes additional investment to modernise and increase capacity in our hospitals and community sites."

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