Saturday, 28 March 2015

Health Commission holds ‘successful’ session in Ealing

Published 25 March 2015
A full day of evidence was presented to the Independent Health Commission, set up to investigate the impact of past and proposed changes to healthcare in west London, on Saturday, 21 March.
Save our Hospitals march
 Ealing’s contributors included a hospital consultant, local doctors, a midwife from Ealing Hospital, residents and representatives from Ealing Healthwatch and Ealing Save Our NHS Action Group.
Local politicians also gave evidence including: Stephen Pound MP; Dr Onkar Sahota, GLA Assembly Member, Councillor Julian Bell, leader of the council; and Councillor Hitesh Tailor, cabinet member for adults, health and well-being. 
The commission, which is led by Barrister Michael Mansfield QC, was set up by Brent, Ealing, Hammersmith & Fulham and Hounslow councils, which have raised serious concerns about the scale, speed and safety of the changes and the ability of the remaining services to cope with the extra demand. It is the largest reorganisation ever undertaken in NHS history. 
The changes reviewed included the closures of A&Es at Hammersmith and Central Middlesex hospitals last September, as well as plans to demolish Ealing and Charing Cross hospitals, replacing them with much smaller hospitals. Other aspects considered were the changes to maternity services in Ealing, which will mean that women will no longer be able to give birth in Ealing Hospital.

The Independent Health Commission is creating a detailed picture by taking a wide range of evidence into account, including examining the facts and figures, as well as personal accounts from patients and healthcare professionals.  The session held in Ealing was the second out of four public evidence-gathering sessions being held between March – May.  
Councillor Bell said: “We all know how important our local health services are and so it was really important to bring such a diverse group of experts together and watch them provide their evidence to the commission. 
“It was good to see our residents supporting this by listening to the information presented to the commission.   I would encourage anyone with an interest in finding out more to go along to either the Hounslow or Brent sessions.” 
The commission also examines the impact of the NHS’s decision to change hospital services in the area, including A&E and maternity.

Cameron's biggest broken promise on the NHS

Virgin Care has won a £280m contract to run NHS healthcare for frail and chronically ill people in the Midlands, it was revealed today.

Image: Protect our NHS and People's NHS supporters protesting against Virgin last weekend
Virgin Care have won a £280 million contract to run NHS healthcare in East Staffordshire, it was revealed today. Virgin will now provide (or sub-contract to other providers of its choice) healthcare services for 6,000 frail elderly people and around 38,000 people with long term conditions such as diabetes or heart disease.
The decision - along with other big pre-election privatisations - appears to contract David Cameron's pledge in November 2014, when he told the BBC "It's our National Health Service. It's in the public sector, it will stay in the public sector. That's not going to change."
In fact there is evidence that despite government denials, the pace of NHS privatisation is accelerating. Commenting on the latest Virgin takeover, Clive Peedell, leader of the National Health Action Party, told OurNHS:
"This is yet more evidence of the increasing privatisation of the NHS which adds weight to the findings of a recent BMJ editorial, which quoted research from Oxford Economics showing that in the first 3 years of the coalition, the value of outsourcing had increased from £6.9bn in 2010 to £12.2bn, equivalent to 10% of the NHS budget."
Local health commissioners, East Staffordshire CCG, explained the decision, telling the Health Services Journal that without the contract it would be unsustainable by 2018 and overspend its allocation from NHS England by £10m. The decision follows a KPMG report highlighting the ‘distressed local health economy’. 
Quite how Virgin will deliver the service cheaper than the NHS is unclear.
Although separate from the £1.2 billion contracts to deliver cancer and end of life care across the rest of Staffordshire, details of which were leaked to openDemocracy last week (the larger part of which, Virgin is also bidding for), the contract is another of the new ‘prime provider’ contracts. As we exposed last week, the ‘prime provider’ model typically allows the winning company a remarkable amount of leeway to choose what services will be continue to be provided to patients, to what standards (using a vague ‘outcome-based’ model), and whether it provides these services directly or sub-contracts them to other organisations of its choice.
Of today’s deal, leading trade publication Health Services Journal reported “The group said Virgin Care will coordinate services across providers to deliver agreed outcomes, although it has not published what these outcomes are.”
Virgin already operates 30 primary care services across England (often hidden under the NHS logo) including GP practices, GP out of hours services, walk-in centres, urgent care centres (UCCs) and minor injury units (MIUs). Their ‘Urgent Care Clinic’ in Croydon was last year criticised by official inspectors for putting patients at risk by using receptionists with minimal medical training to assess how unwell arrivals were.
Campaigners have already voiced concerns about what the privatisation announced today will mean for frail elderly patients in East Staffordshire .
Richard Murphy, who has just released a report with Unite the Union on the tax avoidance activities of companies like Virgin and other private firms bidding for NHS work, told OurNHS today:
“There can only be one reason for doing this, which is that it is believed that despite the fact that Virgin will want a reward for its work they can deliver the service cheaper than the NHS can. That is only possible if services, wages or quality are cut. There is no other option…the NHS is as efficient as any large, complex organisation dealing with polysymptomatic health problems can be. It is only by pretending that the complexity will disappear that Virgin can claim otherwise.
"That's a fraud on the people of East Staffs just as much as the use of tax haven based structures is a fraud on all the rest of us.”
The issue of tax avoidance by private firms taking over parts of the NHS is also becoming increasingly sensitive as the scale of the NHS financial crisis mounts.
Unite’s research reveals how Virgin uses 13 intermediate holding companies to distance the firm’s healthcare division from its parent company, based in the tax haven of the British Virgin Islands.
Len McCluskey, General Secretary of Unite, commented: 
“Despite the NHS being under huge financial strain the Coalition government is behaving like an accomplice to private companies with tax avoidance structures in place.” 
Today the Kings Fund released a report showing how waiting times are at their highest for years and criticising all parties for not showing how they would plug the £2bn NHS funding deficit the Kings Fund has identified.

The 'ninja' NHS privatisers you've never heard of...

Meet the shadowy team at the heart of many of the most controversial NHS privatisations to date, including the Staffordshire deal leaked last week to openDemocracy. 
”Despite our warnings about the risks... no one has been held accountable for the consequences.” That was the fierce criticism last week from watchdog Margaret Hodge MP and her Public Accounts Committee of the failed flagship privatisation of Hinchingbrooke hospital. No-one can hold Circle Holdings accountable. On the day inspectors gave the hospital they were running, the worst rating for ‘caring’ of any hospital in the country, the firm announced they were giving up and walking away, three years into the ten year contract.
The Committee concluded that the deal was an expensive experiment that left taxpayers to pick up the bill.
But who cooked this deal up in the first place? And have they learnt their lesson?
Step forward, the Strategic Projects Team (SPT), a shadowy organisation initially set up within the NHS to design the Hinchingbrooke deal.
And no, they don’t seem to be in apologetic mood.
”Change is a combat sport.”
So said Strategic Project Team co-founder, Stephen Dunn, at this week’s SPT anniversary celebration. For six years, these ‘change-makers’ have been, in their words, ”supporting the brave” and ”encouraging the timid” to reform health services and hand them over to the private sector.
That’s to say, roaming around England’s health service looking for things to privatise.
‘Change from within’ is SPT’s tag line.
Today, though, SPT is having trouble defending its record, which may explain why they are in fighting mode.
The list of failed projects is growing. On the back of Hinchingbrooke, SPT started open competitions to ‘franchise out’ the running of both George Elliot Hospital in Nuneaton, and the Weston in Weston-super-Mare, with companies like Care UK and Circle throwing their hats into the ring. Both projects resulted in expensive U-turns with the planned sell-offs being abandoned - but only after a million pounds had been spent on administering the process, in George Eliot’s case. The SPT was also behind the beleaguered privatisation of pathology services around the country; and the friends and family test, designed by MacPherson and Dunn, rolled out across the NHS at huge cost, and slammed as ‘inappropriate’, ‘unreliable’ and highly questionable as a measure of patient experience.
When not trying to flog hospitals off - of which more later - SPT has also been ‘intervening’ in hospitals, as in Bedford, which has recently lost services to both Circle and US health giant, UnitedHealth.
SPT appear not to have spent any time reflecting on the aborted privatisations of Hinchingbrooke and elsewhere, their costs, or consequences. As a speaker from SPT’s law firm and last night’s hosts, Wragge & Co, said: ‘Business doesn’t research things to death’. If it doesn’t work, bin it, move on.
SPT is a big fan of the world of business. It talks of creating a ‘customer-centric’ (not ‘patient-centric’) NHS. They call healthcare a ‘distressed purchase’.
But who are SPT, and who are they answerable to? The Team was originally set up by senior NHS officials in the East of England, a pioneer region when it comes to private sector involvement in the NHS (and coincidentally home to Andrew Lansley’s Cambridge constituency). They provided the “air cover” forSPT’s controversial operation.
SPT’s other co-founders are Sir Neil McKay, now with healthcare industry consultants, GE Healthcare Finnamore, although at the same time still advising a ‘local NHS body in the Midlands’; and Andrew MacPherson, current SPT managing director. MacPherson’s background is in customer services in the transport business. His experience of the NHS prior to running SPT was as a non-exec director of his local hospital.
Dunn has since moved on to the Trust Development Authority, where he helped decide the fate of many other small hospitals like Hinchingbrooke. More recently, he was given his own one to run, his local hospital in West Suffolk, where he says he is ‘very keen to see if we can create a Kaiser Permanente-type organisation’, referring to the US health insurer’s model.
Exactly who the Strategic Projects Team answers to today is unclear. In one email released under Freedom of Information (FOI) law, MacPherson casually asks a colleague in NHS HQ for ‘insight as to where we might do the most good during 14/15?’, which suggests perhaps that SPT has little in the way of official remit.
SPT’s intent is clear, however, from a ‘commercial in confidence list’ of its activity. NHS bosses twice tried to block the release of this list under FOI law, but it reveals the extent to which community services around the country have had the SPT treatment: the NHS in Coventry & Warwickshire, Huddersfield, Cheshire, and Cambridge & Peterborough have all employed SPT’s services. The latter spent £220k on SPT in 2013-14 to help it open up older people’s services to the private sector, according to figures released under FOI. Companies that bid for the £800m Cambridge & Peterborough contract included: Circle, Capita, Care UK, UnitedHealth, Interserve and Virgin Care. (Virgin Care’s ‘senior relationship manager’ was at last night’s birthday bash).  
The SPT - which claims to specialise in ‘major change initiatives’ - has also been involved in Staffordshire for several years, the list reveals. Staffordshire faces cuts to hospital beds across the county and the downgrading of one of its hospitals, as recommended by KPMG in its recently leaked review of Staffordshire’s ‘distressed’ health economy.
According to its confidential activity log, SPT has made multiple interventions in the area’s hospitals, its community services - and in the redesign of Staffordshire’s cancer and end-of-life services.
And now, these are big contracts up for grabs, with SPT running the bidding process.
It was SPT who produced the ‘Memorandum of Information’ - leaked to OurNHS this month - which set out some of the details for the £687m cancer care contract. It shows that most of the elements of the contract’s design, such as standards and targets, will unusually be decided after the contract has been awarded. Also, there doesn’t appear to be any provision for a break clause for the NHS to get out of the ten-year contract if it doesn’t work out.
Perhaps the most concerning thing about the plans as drafted, though, is their lack of accountability. The Kings Fund described such plans as "a risk to take with taxpayers’ money”, which has a certain resonance in light of the Hinchingbrooke debacle.
Companies shortlisted for the huge cancer contract are UnitedHealth, Interserve and CSC Computer Sciences (which also appears to be a ‘supply chain partner’ of UnitedHealth). The same three companies have also thrown their hat into the ring for the £535m palliative care contract, along with Health Management Ltd (a subsidiary of US outsourcing firm, Maximus) and Virgin Care.
SPT’s role in pushing through such radical reforms is not only in advising its NHS colleagues. It also ‘works closely’ with the healthcare marketplace.
This week’s birthday bash, for example, was aimed at ‘senior NHS and independent sector healthcare leaders’. SPT says it has provided a ‘forum’ for private healthcare companies to influence the direction of the NHS. This includes discussions on making it easier for them to enter the NHS market.
Two groups appear to have driven SPT’s ‘commercial engagement’: a cooperation and competition panel, and a commercial advisory board. The latter is referred to as a ‘unique interface’ between NHS executives and the independent sector, and in typical MacPherson management-speak, as ‘a catalyst for shared learning in healthcare strategy’.
publication by SPT’s parent body provides more detail. The 15-20-strong commercial advisory board, it says, regularly brings together ‘existing and potential future providers’ of healthcare from all sectors (public, private and voluntary) to discuss NHS reform and ‘market issues’. Topics include the NHS’s approach to procurement, ‘lowering barriers to market entry’ and introducing more ‘innovative’ ways of commissioning care.
It is not known whether the groups are still active: opportunities for continuing the advisory board were under discussion in 2013.
But SPT has a new set of associations these days. Since early 2013, when the NHS organisation that established SPT was dissolved, SPT has been ‘hosted’ by another NHS organisation -the equally ‘commercially-minded’ Greater East Midlands commissioning support unit (GEM) (though SPT maintains its offices in Cambridge and inside NHS England’s London HQ).
The East Midland organisation certainly talks SPT’s language. According to GEM’s chief executive, John Parkes, organisations like his can ‘provide access to... a £70bn market’. They ‘know local decision makers’ and can ‘create opportunities’, he says (writing in a publication for outsourcing giant Sodexo, which now runs many English pathology services).
But who are GEM? They are one of a number of organisations, both private and public, which provide services to the GP groups that hold most of the NHS budget. From HR, PR and IT support, to analysing population data, negotiating contracts and redesigning services, in many places these ‘commissioning support providers’ appear to be essentially taking over the process of planning health services in the NHS, and so determining how and where the NHS budget goes.
The government’s recent NHS reforms created a market in these ‘commissioning support’ services. Organisations like GEM compete with commercial operators such as Capita, and a consortium led by UnitedHealth (that includes KPMG, CSC Computer Sciences, BT and others).
But the relationships are entangled. UnitedHealth, KPMG, Capita, and GE Healthcare Finnamore (where SPT founder Neil McKay now works) are also ‘strategic partners’ of GEM, providing a range of commissioning services to GEM’s GP clients. KPMG, for example, was being paid over a quarter of a million pounds a month through GEM for services, including the development of a ‘commercial strategy’, and the provision of an interim chief operating officer, according to figures the NHS recently reluctantly released.Payments by GEM were also indirectly made to UnitedHealth, via a company sub-contracted by KPMG, although it’s not known what for.  
SPT CEO, MacPherson sees GEM as providing a ‘fertile environment’ for his team to build new partnerships.
It perhaps wants to keep its distance from some of GEM’s other partners, though. With UnitedHealth bidding to run Staffordshire’s cancer and end-of-life services, and SPT running the bidding process (not to mention KPMG helping to reconfigure Staffordshire’s health services), the situation looks pretty cosy.
The Strategic Project Team insists that it is ”committed to the ethos and values of the NHS”. Its work, though, betrays a prejudice towards market solutions and the private sector.
It prides itself on ”breaking new ground”, on ”meeting difficult challenges head on” and on delivering a series of ‘firsts’ in the NHS. Yet, little of what it does appears driven by evidence of what works.
One innovative way of commissioning care currently being championed by SPT is the ‘integration’ of services. In very simple terms, ‘integration’ is sold as a way of improving standards and reducing costs by changing the way healthcare is planned and purchased (or commissioned), so that services are more joined up. (Which sounds like common sense, but treat with caution: The National Audit Office described plans to save money through better integration as being based more on ‘optimism rather than evidence).
Both the Cambridge & Peterborough, and Staffordshire contracts are so-called ‘integration’ projects.
In 2014 SPT’s commercial director, Martin Peat, outlined what SPT saw as the main drivers of this innovative approach to commissioning. ‘Improved services for patients’ comes in at number two on his list. Reduced costs is fifth. Number 1 on his list of what’s fueling integration, though, is: ‘The market’.
Which begs the question: is SPT’s focus on the ‘integration’ experiment, the result of discussions with private sector companies that stand to benefit?
The truth is SPT is itself a failed experiment.
Yet if this week’s event is anything to go by, the team fully intends to continue to push its ‘change strategies’ in the NHS and provide the private sector with bigger entry points, all seemingly without any oversight.
MacPherson’s aim, he told a ‘Nudge’ conference in 2013, is to ‘revolutionise aggressively the world’s fifth largest employer.’
Unfortunately, at the moment nothing except perhaps confusion is standing in their way.

Tuesday, 24 March 2015

NW London Hospitals Health Commission - Hammersmith & Ealing hearings

Take a case of a rapidly expanding population and the rapid shrinking of essential services...

Saturday 21st March marked the half way point of the Michael Mansfield Health Commission investigation into the so-called ‘Shaping a Healthier Future’ giant reconfiguration of the West and North West London hospitals infrastructure, which includes the seismic closure of 4 out of 9 A&Es – two of which have already bitten the dust before any other plans have been put in place, or indeed before the elusive business plan has been published.

This is all being done in contravention of the original NHS concept of universal healthcare in line with the needs of population.’ (Cllr Steve Cowan – Leader of Hammersmith & Fulham Council).

Just a few days earlier over 600 people had packed Hammersmith Town Hall to listen to a range of speakers share their passion for the need to Defend London's NHS

Witnesses to the People's Commission so far have included the leaders of both Councils and their cabinet members with responsibility for health; MPs Andy Slaughter and Stephen Pound (others were invited but declined ); campaigners from Save our Hospitals and Save our NHS; Tories with differing views from Hammersmith & Fulham and Kensington & Chelsea; hospital consultants; RCN & RCM spokespersons; patients and patient representatives – also local Healthwatch representatives.

The majority of witnesses at both sessions so far have offered a clear line of similar arguments and evidence – which is in part unsurprising, given that as the QC said on day one in Hammersmith Town Hall Council Chamber – ‘we have asked the local NHS to participate or at least respond on several occasions – but so far we have not had a proper reply’. This is a very different situation from the last inquiry, where the Lewisham People’s Commission, which included Baroness Mary Warnock and Blake Morrison along with Mansfield in the chair, heard evidence from Lewisham Hospital CEO, as well as from numerous consultants and nursing staff, also the CCG Chair.

Dr Mark Spencer’s name was repeated often – but in the context of ‘conflict not congruence’ ( Cllr Vivienne Lukey) - ‘Not one single Shaping a Healthier Future person could come out with access figures - evidently just plucking approximations out of the air and hoping for the best’

A series of chaotic approach descriptors emerged in both of the Hammersmith & Ealing Council Chambers......
There are too many known unknowns - but what is known is that other hospitals are operating to capacity’ said Hammersmith & Fulham Council Leader Steve Cowan

There appears to be an ‘awful lot of vested interest in not stirring up the public’– as evidenced by the poor advertising of ‘changes’ rather than closure ( which we have previously documented on here) as well as a consultation which witness after witness cited as being inadequate, ..........................

Andy Slaughter, MP for Hammersmith, said the whole plan was based upon flawed assumptions about population growth, The plans will result in the removal of 93% of inpatient beds in the borough and all consultant emergency medicine, including the hyper-acute stroke unit, intensive treatment, and type 1 accident and emergency.

Given that targets are regularly missed by wide margins and the pressure on staff and patients is intolerable - there is already insufficient capacity in the system..... It appears therefore that the sole benefits of SaHF are cost savings, or generating capital receipts by land disposal. ‘

Of course this will then result in a further population expansion ‘ we cannot believe they are about to close and downgrade when the population is growing so fast!’ said one witness. In particular, developments in Old Oak Common & Earls Court constitute the largest property expansions in Europe – and there are many are other new builds in the area, which could potentially see these shrinking services completely swamped.

A key question which also remains unanswered : Who will fund out of hospital care?

Consultation :
With the odd Tory exception, the overarching consensus was that the extremely costly McKinsey consultation was to say the least faulty and inadequate.
Access and information ‘might have been done better – there was an insufficient information stream.’ is one of the more polite descriptors. Merrill Hammer, Chair of Save our Hospitals and her husband Jim, reported their own experience of the consultation.

'There was no space for proper public debate. A large number of the population thought that the outcome had been ‘pretty much pre-decided. Options were closed. Minority ethnic groups under-represented – partly because it was very badly advertised. Staff on the door had no idea re nature of a key meeting. The CQC meeting was much better run.’

Jim reported ‘The planned reduction to 24 beds has been accompanied by no answers to any questions. No one responds! It is impossible to work out who is in charge...!!’

Whilst CCG Chair Spicer has refused over a 2 year period to provide the evidence to back up all the plans whilst also declaring ‘Shaping a Healthier Future is not about reducing hosp beds!’ - that is clearly the case and it is also very clear that the retained services will be concentrated in the richer south.
‘ it cannot be said that due process has been followed in terms of establishing a case, or in terms of consulting with the public, a point which my constituents frequently mention to me. Despite SaHF affecting two million people in west London, most feel they have no ownership of the proposals and that their views are disregarded. ‘ Andy Slaughter MP

Tory-Flagship rump-man Andrew Brown took a different view and even on occasion seemed to disagree with himself. He cited 'working relationships in difficulties' between the Council and / Trust CCG, but when challenged to be specific he said it was 'not documented'. He felt it was unfair to be critical of NHS bodies and dived off the main points to cite the Imperial College Healthcare NHS Trust role in social care and the use of Better Care Fund (the insufficient to need programme which he referred to as a 'leading area') though struggled to explain the correlation with the dangers of uncertainty over A&Es.

Whilst saying he felt 'more could have been done' concerning the closure of Hammersmith A&E, Cllr Brown confessed that there was 'no way of knowing for certain' as to whether whatever eventually replaces Charing Cross A&E will be consult led or GP led - he also remarkably responded ' yes - in an ideal world' to Mansfield’s questioning about as to whether it was ‘remotely sensible’ to implement closures prior to there being anything in their place. Essentially his argument followed the line of a preference for there to be nothing, rather than provision which he maintained had been clinically unsafe!

(Fast-forward to Ealing a week later and we heard that the ‘unsafe’ mantra was possibly written on the back of an envelope in an unseemly bid to justify the closures after Cameron & Hunt began to voice concerns ....)

Cllr Brown also had ‘no idea’ about the huge losses in training and maintained that the Treasury would be organising the financing for the new builds, whilst showing great reluctance to discuss the unknown area of the large funding gap which has hitherto been predicated on a large scale asset strip of the Charing Cross site.

A revealing few minutes opening the lid on the mindset of the previous administration who had been responsible for the ideological drive-through of the chaos.

Interestingly, Cllr Robert Freeman of the Royal Borough of Kensington & Chelsea Conservative Group had a somewhat different take on matters from his Tory counterpart....
‘It was difficult - there was a certain expectation that the proposals would be okayed. My main concerns are how St Mary’s and Chelsea and Westminster will cope and also where the funding will come from to create the essential changes needed to cope with the additional burdens. There is great uncertainty that Imperial are not covering plans - they are not a strong trust financially and have pulled back from FT status’

Said Cllr Freeman - ‘we have to keep services open while works are done’

Cllr Rory Vaughan (LBHF Health Scrutiny Chair ) asked - ‘How is fragmentation going to work and how long will it take to re-educate the public?’

This is not simply a case of early teething troubles plus winter demand – the sharp downturn in performance at Northwick Park has remained, even since the much vaunted opening of a brand new A&E which seemingly has no more capacity than the old one.

Dr Spencer had famously said at an angry public meeting last year that anyone who was making their way to an A&E on the bus should instead stop off at a pharmacist, however in the real world, transport issues were a major concerns for almost all local witnesses.

Efficient transport routes and LAS priorities
So what preparations have been done with respect to the need for patients to undertake far more complex transport routes? Mobility challenges across both boroughs. Northwick Park is notoriously difficult to reach and there are accessibility difficulties to the St Mary’s site.
- The Transport Advisory Group has had little or no information.
- ‘Traffic has got worse, much worse – this holds up blue lighters.’
- For those who have no access to cars – many in the Acton area - there are problems with affording cab fares and complex bus routes.
- One Ealing witness reported that TfL had been approached to co-operate with travel adaptations, but nothing seems to have been forthcoming. ( see Storify)
- One patient gave first hand evidence of Patient Transport shortcomings -
3 patients plus various walking aids crushed into a minicab. On one occasion the patient reported he has passed out in the cab. Since privatisation they are often picked up late - once even arriving after the clinic had closed.

How are local GP services coping?
Not one health professional in a meeting could say how many could be treated in the community – it is clear that NHSEngland have no plans with regard to GP services’ Cllr Vivienne Lukey

There is a much vaunted view by those who promote closures that geographical proximity is not nearly as important as quality of care they allege can be found in super-hospitals. However whilst this is undoubtedly true of some conditions, such as stroke and trauma – several witnesses gave clear evidence that this is not true for over 80% of cases.
- Questions why the highly regarded hyper-acute stroke unit at Charing Cross needs to be re-located when others are not co-located...
- Following the publication of the ‘alarm bells’ CQC report there is ‘concern with more pressure we need more, not less, capacity’
- Worry about the local authorities’ capacity to provide the necessary home care due to severe budget cuts which have been landed on Labour – led local authorities, in contravention off equalities principles and guidelines.
- ‘Acute mental health problems won’t just go away. More patients are being treated in acute settings and waiting times are appalling.’

‘We cannot have a plan without the facts and I don’t think we have them yet’

Healthwatch Chairs came to give evidence and sadly the Ealing operation offered many a cause for concern. A board member related that he had not seen a particular document which he felt he should have had sight of. Both he and the chair then stated that the changes would impact on ‘just a small number of Ealing residents’, spectacularly failing to have kept up with the correct statistical analysis. Pregnancy not being an illness was also a rationale for reducing provision.

John Lister asked if Healthwatch is ‘there for patients or just a voicepiece for health bodies.’ A : ‘The latter – we are not allowed to campaign.’
Michael Mansfield QC asked : ‘ is it your responsibility to take a analytical view of these proposals for the sake of the local population?’
A : ‘I’ll have to think about that - I’m not sure’
Dr Stephen Hirst asked : ‘are you an information or an advisory body?’
A: ‘ what’s the difference?’
Oh dear.

The Twitter Storify from Ealing Save our NHS shows the full day’s session in more detail – including the jaw dropping Healthwatch interrogation.

The Impact of Closures So Far

So with such a complex reconfiguration, with information about only change rather than closure and very challenging new travel demands – the crucial question is: Where to go? What is the public understanding of urgent care centre v the A&E?
‘One of the things that has happened is confusion as to where to go. The sensible anticipation that other hospitals will be put under huge pressure has been borne out.’ reported an Ealing witness.

Waiting times have spiked and stayed that way. Trolley waits have hugely increased – including for the very elderly.

Relocating patients has also added valuable minutes to journey times - which is accompanied by additional pressures on London Ambulance Service who are also suffering a staff retention and recruitment crisis with a 20% paramedic shortfall.

Disturbingly, one Councillor reported that private interests are also impacting on access to paediatric provision.

Ealing A&E has reported much greater attendance and pressure on staff since C Mid and Hammersmith closures.
Northwick Park 4 hr waiting has famously dipped to a 51% - and has become the worst in the country. It also takes 1- 1.5 hrs to get there from parts of Ealing and H/F.

‘It has had a very detrimental effect on Ealing. There is a much reduced chance of getting speedy treatment - to me will be a nightmare if Ealing closes’ Ealing patient

The childrens’ A&E at Hamm having gone has had negative impacts which we entirely predictable

It is clear that medical staff in West London have felt pressurised - and it seems to be only the brave who speak out. One doctor who gave evidence has been sanctioned. Another gave evidence on past work rather than their current medical occupation. Only a small number of GPs have stepped forward.

A call to doctors and NHS from Michael Mansfield QC :
‘a whole sector of the database is excluding themselves from the debate through fear.
Can any of them come out of the woodwork? They can contribute anonymously if necessary.’

We heard from expert witness Colin Stansfield, detailed descriptions of misleading information which having been clarified through FOIs, then mysteriously changed again to show a trail of what can only be a case of figures massaging.

Consultant feedback :
‘Change should be according to need not theoretical. We are experiencing an Influx due to other hospitals not coping. On the matter of centralisation ‘It is much easier to manage home discharges close to community

This can be backed up by the evidence supplied by Andy Slaughter where he cited the College of Emergency Medicine recently expressing the view that most people who go to A&E need A&E care – and the difference in centralising for specialisms and the clinical dangers of centralising all of emergency services. The downside is obvious: fewer centres and further to travel and distance for sickle cell, meningitis, placenta previa etc can literally mean the difference between life and death.

He was joined in this view by the doctors who gave evidence in Ealing the following week. Key parts of the magnificent testimonies by Dr Khan and Dr Sandhu are included in the Storify link.

Anne Drinkell – retired community matron and SoH secretary highlighted a key difficulty :
‘The really big problem is that CCGs are not being able to understand the messages - there are lots of reasons why they don’t want to pay attention to information and bad news.
There is a ‘big disconnect between managers and hugely overworked clinicians’.

She also provided us with a simple but relevant measure
‘ pressure sore stats are a big indicators concerning pressures on care – we are seeing a big increase’.

Michael Mansfield summarised the feedback so far, when he said ‘the fragmentation of the NHS is the overriding concern’.

There is no Plan B – and if the worst case scenario takes place then there will be no option to alter anything back ...

Save our Hospitals sum it up :
‘Shaping a Healthier Future is a cover up for cuts. We cannot see how longer journeys and fewer services are better – and with the extra pressure on staff, this is very, very, bad news.’

In all of this, the question remains Dr Spencer, Dr Spicer and Tracey Batten.
Just where will the patients go?

The next hearing will be on Saturday 28th in Hounslow Civic Centre and the final one will be in Brent on 23rd May, the other side of the General Election 2015 rubicon....

Jos Bell March 2015

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