" 'Our' NHS?" an article on the Kensington, Chelsea and Westminster Today.co.uk website

The article "Our" NHS (October 2015) by film director and producer John Furse, a resident of Kensington and Chelsea, argues that behind the trusted logo "our" NHS is becoming "their" NHS, its services increasingly outsourced to private sector providers. And at a far greater cost to the NHS than if it remained its own provider... Is it surprising that NHS costs, as a percentage of GDP, have doubled since the first major privatisation legislation in 1990?

It includes biographies of the Chairman, Sir Richard Sykes, and directors of Imperial College Healthcare NHS Trust. Their backgrounds, with the exception of the chairman, are exclusively in the financial/ hedge fund/ large accountancy firms sector.

Sir Richard is a prominent biochemist, his CV includes chairmanships of GlaxoSmithKline and currently three biotech/health tech companies.

He’s also chair of think-tank Reform, who want total public spending cut along with taxes so that individuals can provide for their own healthcare needs and obtain high quality services more ‘efficiently’. Paying for your GP visits is one of their wheezes.


....The Imperial Trust has other non-executive private sector notables on its board – Jeremy Isaacs, founder of hedge fund JRJ, with an arm in tax haven Jersey. His CV includes spells as a Goldman Sachs director and a Lehman’s overseas CEO until 2008, Lehman’s annus implodius. He is joined by Rothschild executive vice chairman Dr Andreas Raffelm, and Sarika Patel, partner in Zeus Capital, an investment bank heavily into infrastructure and real estate, who are also Imperial Trust board members.

Patel has held ‘key roles’ at accountancy giant Grant Thornton. Such accountancy behemoths are the ‘fixers’ between corporate and investment big hitters and their targets. Imperial has a biggie in Sir Gerald Acher, a senior partner at mega auditors KPMG.


With friends like these, who needs enemies?


The directors of the Chelsea and Westminster Trust are less well-known to supporters of Charing Cross hospital, so it's worth reproducing these biographies here:

Chelsea & Westminster Hospital NHS Foundation Trust’s non-executive chair is Sir Thomas Hughes-Hallett, a former banker who promotes the line that “The NHS can’t afford to treat us all for free. It’s time we paid for our care”. Begging the obvious question that if we could bail out his lot, why not the NHS?

His vice-chair is Sir John Baker, whose CV includes leading the UK electricity privatisation programme before becoming CEO of privatised National Power plc. Chelsea & Westminster Trust non-executive director is Jeremy Jensen, director of Aaronite Partners, specialists at ‘restructuring’ distressed businesses. He’s also director of MPG Hospital Holdings who own, operate, and lease UK hospitals. Adding her mergers and acquisitions expertise is former BP exec Eliza Hermann.

He concludes:
....a publicly funded and serviced NHS is far cheaper than a privatised one. Bank bailouts and Quantitative Easing (QE) have been a revelation – governments can actually print billions without causing rampant inflation or the collapse of their currencies.

Whether through QE, taxes, and/or bonds, our government could in fact fully fund the NHS, particularly with interest rates set to remain at historic lows. It’s also an investment that produces tens of thousands of jobs, healthy workers, and consumers old and young with spending power to stimulate the economy.

But the NHS, like most of our politicians, has been infected by 30 years of a free-market ideology whose true workings have been exposed by the 2008 Banking Crash and its aftermath. The boards of our local hospitals are overseeing the turning over of NHS assets and services to the private sector are symptomatic of that infection.

"At what cost? Paying the price for the (internal) market in the English NHS" by Prof Calum Paton

This is a paper published by the Centre for Health and the Public Interest in February 2014: a seminal and excoriating indictment of the "evidence-free" policies of successive Governments in England.

Calum Paton is now Professor of Public Policy at Keele University, where he has been Professor of Health.

 

1. Extreme financial pressure upon the English NHS for the foreseeable future makes avoidance of waste imperative. The 'market' in the NHS is a major source of waste.Creating and maintaining markets has incurred huge direct costs and significant 'opportunity costs' – money which could have spent upon patient care and clinical re-design.

2. Not only has evidence to justify 'market reforms' to the English NHS from 1990 to the present-day been absent, but the recent Health and Social Care Act of 2012 actually ignores, or even inverts, evidence which suggests that 'commissioning' by GPs in local markets characterised by separate 'purchasers' and 'providers' is costly and of dubious effectiveness. The only reasonable conclusion is that that market policy is based upon ideological dogma, pressure from commercial interests or both.

3. It has been argued that the only way in which hospitals and other service providers can be reimbursed in a timely manner for their workload, and given the incentive to increase workload and productivity, is through the operation of market forces. This is simply untrue and based on a re-writing of history.

4. The recurrent, annual costs of the market can be estimated (conservatively) at £4.5 billion.

5. The one-off, start-up costs of the various phases of the market (1991-97; 2001-2007; 2010 to date) have run into billions of pounds, with (again, conservative) estimates of the most recent market initiatives under New Labour and then the Coalition government comprising £3 billion each.

6. This paper sets out how the wider costs of the market have included both opportunities foregone and likely harm to the system.

7. Possible benefits from the market are hotly contested in the research community and – even if one grants the benefits claimed by supporters of the market – very small when set against the costs.

8. It would take ideological chutzpah of the most irresponsible sort to suggest that the answer to the failure of the market so far is 'more market'. The paper suggests why.

9. It is possible to have patient choice and high-quality health-care without the market. The paper suggests how.

Submission to the People's Inquiry into London's NHS - commission chaired by Michael Mansfield QC

 

SAVE OUR HOSPITALS: HAMMERSMITH & CHARING CROSS

 

Submission to The People’s Enquiry into London’s NHS

December 2014

 

 

Save Our Hospitals (SOH) has been campaigning, together with other groups in NW London, against the proposals in Shaping a Healthier Future for over 2 years. As well as campaigning, every week, in the London Borough of Hammersmith and Fulham, we have attended CCG meetings, Imperial Board meetings, Healthwatch and have had two formal meetings of our officers with the CEO of Imperial, Dr Tracey Batten, and several of her senior officers. (We have attached our reports on these meetings to this submission as Appendix A and Appendix B). Week by week we are told of how concerned people are at the proposals and how angry they feel that their needs are not being taken into account.

 

1. Shaping a Healthier Future (SaHF)

 

Shaping a Healthier Future is the most extensive proposed reorganisation that the NHS has experienced and it is feared that it is being seen as a prototype for further massive reorganisations elsewhere in England. Within this quadrant of London it is proposed that 4 A&E departments of 9 will be closed and that many hospitals will lose services with some hospitals being downgraded. The plans for NW London should therefore be of key concern to The People’s Enquiry.

 

2. A&E Closures

 

On September 10th 2014 two A&Es in NW London, at Central Middlesex and Hammersmith Hospitals were prematurely closed – with the claim that each was ‘unsafe’. Ironically, in the CQC inspection of NW London Hospitals Trust, it was Central Middlesex which obtained a ‘good’ rating while Northwick Park was found wanting! Since then there have been major consequences in the NW London area for A&E services with major failures at Northwick Park AND within Imperial College Healthcare Trust in meeting the 95% target for seeing patients in A&E. We assume that you have seen the figures for this, but it is worth noting that not only are there major failures in meeting the target but that both Trusts have fallen significantly in the league tables of hospitals meeting the target. (Even prior to the 2 closures, St Mary’s was reported as being already in ‘winter mode’ in July 2014.) Any claims that there is a London- or country-wide increase in demand simply cannot explain the landing at the bottom of the league tables. Further, there seems little concern at the knock-on effects on ambulance services when ambulances are left queuing outside hospitals.

 

3. CQC Inspection of Imperial Health Trust

 

The just-published CQC report on Imperial Health Trust gives no cause for the complacency that Imperial management and the CCGs seem to be showing. Following from the point above for A&E closures, we have a further irony in that Charing Cross A&E was rated ‘good’ while the A&E at St Mary’s was rated ‘inadequate’ – yet it is Charing Cross that is marked for closure under SaHF. While Imperial have said that action has been taken over St Mary’s A&E in terms of the hygiene issues, other issues were identified for the St Mary’s A&E site, not least the inadequacies of the unloading bay and the access. Yet Charing Cross has excellent facilities.

 

SOH is additionally concerned at the failures by Imperial in providing timely and adequate outpatient services and in the very long waiting times etc for elective surgery. Since it has been impossible to find out from Imperial just what services are to be closed/relocated etc in implementing SaHF, we are left with major questions about just what health services will be available locally to Hammersmith and Fulham residents, where they may need to travel to for which services etc. Indeed, since we are unable to get answers to these questions and now have a CQC report raising serious concerns about these areas, we are left wondering whether the management of Imperial is more concerned with seeking foundation trust status, ‘keeping in’ with NHS England and with local CCGs, and becoming a ‘world class’ research centre than with ensuring that it provides top-class health services to local people.

 

4. HASU

 

It is worth noting here that both Imperial and SaHF claim that the HASU at Charing Cross needs to be co-located with the major trauma centre at St Mary’s. SOH has no difficulty in accepting the importance of centralising particular services. That is, we accept that there is a need for HASUs and for major trauma centres. But no clinical evidence has been provided at any stage to support the contention that the HASU and trauma centre need to be co-located; nor have we heard of moves to co-locate these services elsewhere. There is a HASU at UCLH – it has no major trauma centre. Why this inconsistency? Further, why move Charing Cross’s HASU – according to the CQC report, the 3rd best in the country – to St Mary’s when there is one no more than 2 miles further down the road at UCLH? This is not just centralisation of specialist services – it is centralisation of key services for NW London into central London itself. We have asked for the data that shows that, as a result, no patient in NW London will be more than 30 minutes from a HASU. Imperial has not been able to provide us, as yet, with this evidence and the evidence they say is there is from some 5-6 years ago!

 

5. Transport

 

A key issue identified by SOH is that of transport. Again in our meetings with Imperial we have consistently raised concerns about transport. Much of the response has been about needing to improve inter-hospital transport i.e. the transport service that they provide. Despite repeated questioning – and to the CCG – there seems to be little recognition that SaHF will have a major travel impact on patients, carers and families living in Hammersmith and Fulham. Indeed, the chair of the local CCG, laughingly said, in one CCG meeting, that it takes several years to get a change in bus routes! Public transport is key, even more so in the north of the borough than the south because there is significant poverty in the north and therefore more dependence on public transport.

 

Charing Cross Hospital is superbly located for public transport services for those within and outside the Borough. There are Underground services calling at Hammersmith (4 lines) and at Baron’s Court (2 lines); the bus station services is a major bus transport hub in west London and from there, numerous buses run a short 2 stops directly to the hospital, while these routes also provide access for those coming from further south. In contrast, St Mary’s is difficult for local people or those living further south or west to access, with multiple public transport changes. For self-referral to A&E, this will be a major problem with the potential for a greater demand for ambulance services or for people not to access A&E services when they need to.

 

The CQC report on Imperial makes the point that there are too many late night patient discharges. This possibly relates to Out of Hospital care (see below), but is also a major concern in relation to travel. Unless hospital transport is provided – an unlikely outcome! – patients are therefore having to organise their own transport at late hours and at their own expense. This can only be exacerbated if we have further reduced A&E services. Key people who feel they have the need to use A&Es are the homeless, who have little resource to fund travel, low income groups for whom taxi fares would be prohibitive, those with mental health issues, for the elderly, for the disabled and mothers with young children for whom late night public transport travel is less than ideal.

 

6. Finance

 

The reorganisation will cost an enormous amount of money – yet another irony at a time when the NHS is under severe financial pressure because of government policies. Imperial’s clinical strategy, involving sale of Western Eye Hospital, demolition of Charing Cross with sale of 55% of land and a rebuild of a mini-hospital, the demolition of parts of St Mary’s with sale of 45% of that land and a major rebuild. In all, according to their own clinical strategy paper, they will need to borrow in excess of £400m. While it is a relief to know that they do not plan a PFI arrangement, it remains unclear just how they will finance this and how, with such significant borrowing, they will be able to afford the interest payments (at current interest rates something like £16m p.a.) let alone pay off the capital. What sort of ‘efficiency savings’ might be necessary for this! And what will be the knock effects on patient care? They admit that they hope to increase revenue by extending the number of private beds. But this also raises a further question about what proportion of the rebuilt hospitals will be for public rather than private provision.

 

7. Out of Hospital Services

 

SaHF is predicated on there being less need for hospital provision as out of hospital services are developed. Yet plans are going ahead without these services actually being in place, let alone there being clear evidence that they will reduce the need for hospital beds in a situation where there is local population growth and where people are living longer. It is worth noting here that Hammersmith and Fulham has a younger population, relatively, than London as a whole and than England with large numbers of working adults.

 

We have followed the reports on Out of Hospital provision, and Healthwatch has provided a number of sessions on this which we have attended. The extent of such services e.g. the virtual ward and whole systems integrated care is extremely limited. Small pilots, mainly involving the ‘frail elderly’, show promising results in terms of care for a small number of individuals. However, key question remain unanswered. For example, no prevalence data has been provided so that it is impossible to have any idea as to whether these out of hospital services will actually reduce the numbers of patients needing hospital care in a situation where there is population growth. Beyond the number game, nothing has been said about who will pay for these services. Will the cost go from the NHS to local borough provision which is NOT free at the point of delivery for all patients but is meanstested. Further, local government finances have already been severely cut and are expected to be even more severely cut in the future. People need to know that their health needs will be provided for, as they have been, from NHS services.

 

That SaHF and local Health Trusts are willing to push ahead with reorganisation plans while they can provide no evidence for adequate and appropriate out of hospital services is truly shocking.

 

 

 

8. CCG

 

In NW London, the CCGs have created an ‘informal’ consortium to cover some areas, particularly SaHF. For campaigners this creates yet another barrier to having our voice heard as there is no single body to whom we can make representations.

 

The H&F CCG has proved unwilling to listen to and answer the issues raised by SOH and others with concerns at the SaHF proposals. Indeed, the local Healthwatch has become so concerned at the failures to provide evidence that the ‘reconfiguration’ will work that it has recently produced a position statement which ‘recommends strongly that no further progress on either project (i.e. SaHF and the Imperial Clinical Strategy) until responses have been provided to the questions and concerns raised in our report’ – concerns that reflect our own viz, patient and public engagement, out of hospital strategy, urgent care centre, paediatric services, impact of A&E closures on other services, the future of the A&E at Charing Cross, HASU, elective surgery and travel.

 

Two further points, unanswered by the CCG, need to be raised. The first is about the initial consultation and the ongoing statements about what will be at Charing Cross after reconfiguration. It is to be a ‘local hospital’. BUT, even now, no one can tell us what a local hospital is! That is, we were consulted on something which SaHF did not understand and which is still entirely undefined! For Charing Cross the public has been told that there will be some sort of A&E in place yet they are still unable to tell the public what that service will be – and this is more than 2 years after SaHF. If they can’t do so, how can the public trust them or believe that any proposals they make are honest? Is this about health care or money?

 

Finally, the CCG spent the funds it was awarded – Pioneer Funding – for developing out of hospital and integrated care services on a junket to the United States. An award of £110,000 seems to have been entirely spent on this trip looking at private provision and facilitated by a corporation, McKinsey, dedicated to selling public health services to the private sector. I include a copy or email correspondence on this issues (see Appendix C.)

 

In summary, we hope we have provided the People’s Inquiry with evidence to support our opposition to the so-called reconfiguration currently being implemented in NW London. The implications for London more widely are as deeply concerning. Please contact us if you require more information.

 

Merril Hammer

Chair, Save Our Hospitals: Hammersmith and Charing Cross

(email: This email address is being protected from spambots. You need JavaScript enabled to view it. or phone 020 7736 4115)

SOH, 7 Kimbell Gardens, London SW6 6QG

 

 

Appendix A. Report of meeting of SOH Officers with Imperial CEO and officers on Wed. 17th Sept 2014

 

Chair: Merril Hammer (Chair, SOH)

 

Other SOH members: Jim Grealy, Una Hodgkins, Anabela Hardwick, Mark Honigsbaum (Note: the latter 2 were brought in when other officers were unable to attend)

 

Imperial: Tracey Batten (CEO), Prof. Chris Harrison (Medical Director), Steve McManus (Chief Operating Officer and Dep. Chief Executive), Michelle Dixon (Director of Communication), Mick Fisher (Head of Public Affairs)

 

  1. Merril introduced the session, pointing out the strong local opposition to the reorganisations, the poor initial consultation on the reconfiguration of hospital services; and the unexpected extent of the effects of the recently published Clinical Strategy. She noted that the very body that drew up Shaping a Healthier Future, NW London NHS, no longer exists and that the public had been left with a fragmented set of NHS bodies to try to communicate their concerns to.

  2. Why Charing Cross? Merril asked a detailed question as to why Charing Cross, rather than any other hospital, was chosen for closure when Charing Cross is the only one of the Imperial hospitals to have estate entirely post-1964 and only 4% of the estate as ‘non functionally suitable space’ for health purposes etc. Imperial’s response was that everything was based on SaHF which had always wanted 3 hospitals for Imperial, a major acute, a specialist and a local hospital and that St Mary’s was always intended as the major acute hospital. Location and costings were raised and questions asked about how the (limited) options presented to the public for consultation were reached. Imperial responded that it was the NW London NHS then the local CCGs which had made the decision which was then endorsed by Imperial. Imperial did say, however, that they would look at the evidence used at the time and give us a more complete answer in writing.

  3. Urgent Care Centres and A&Es. Una led on this item asking what the difference between and A&E and an UCC would be. She noted it was not clear what would be treated at a UCC beyond very minor injuries, what diagnostic facilities would be available, what specialists would be available to those presenting at a UCC. She presented a long list of conditions which A&Es currently dealt with but which could not be treated at a UCC. Imperial stated that there would be specially trained GPs on site 24/7 who might be Imperial staff but, if not, would be bank or agency staff who have worked for Imperial before and who will have had appropriate training. When asked about whether concentrating all A&E services in one place would improve treatment for a wide range of emergency conditions (such as appendicitis), Imperial basically ignored the question and answered by referring to concentrating cancer services in one place. When it was pointed out that most cancer cases are not admitted as A&E patients, there was still no answer as to how effectiveness might be improved by concentrating these services at one place.

  4. Specific Health Issues, including Mental Health. Anabela raised questions about the moving of the HASU (hyper acute stroke unit) to St Mary’s. It was explained that it had always been intended to move the HASU to St Mary’s which is the major trauma centre for much of London. (It was noted that UCLH does not, in fact, have a major trauma centre.) Anabela asked about whether there were any areas of NW London which would be more than 30 minutes away from a HASU in the catchment area. Imperial stated that trials had been undertaken at the time of SaHF. They promised to investigate ambulance times etc for stroke patients to check that the 30 minute target would not be breached and to get these figures to us. Imperial stated that modelling for a major event/accident in west London, including Heathrow, had been successfully trialled. We were reassured that dialysis patients would still be treated at Charing Cross and that specialist dialysis services would continue at Hammersmith Hospital. The gender identity surgery would be transferred to Hammersmith Hospital. On mental health issues, Imperial clarified that they did not have responsibility for mental health facilities although these are currently co-located in space the West London NHS Mental Health Trust rents from Imperial. These facilities will remain at Charing Cross under current planning.

  5. Transport. Jim raised the question of planning for transport arising from the closure of A&Es at Hammersmith and Charing Cross. He asked about the difficulties faced by the frail elderly, parents with one or more children, people with disabilities and reduced mobility etc, having to use more complicated public transport routes to treatment at St Mary’s and home from treatment afterwards. What additional transport would be laid on so that such patients would not be disadvantaged? He particularly asked about additional transport for the above groups of people who will have to go to Central Middlesex hospital for elective surgery. He pointed out the poor public transport links and asked what Imperial had planned for such people. The response was that no real planning had taken place on transport issues. Jim also asked whether Imperial had considered the possibility of increased pressure on ambulance services as more people would phone 999 for help. To cover increased demand following the Hammersmith A&E closure, two additional ambulances have been stationed, one at each of Hammersmith and Charing Cross hospitals. Additional ambulance costs would be a matter for the London Ambulance Service not Imperial. Overall, there is clearly an absence of serious planning for transport issues arising from the reorganisations.

  6. Out of Hospital Care. Jim also led on this item. For SaHF, out of hospital care is supposed to reduce the stress on hospital beds and on inpatient treatment. Jim asked which facilities were in place and which were planned for out of hospital treatments and care. He asked Imperial to provide details of particular sites, recruitment and training of staff, and overall oversight. It was clear that little detailed planning has been undertaken. A small number of pilots are being carried out e.g. one pilot scheme for the over-75s, OPRAC (Older Persons Rapid Assessment Centre). Out of hospital services are essentially the responsibility of the CCG and so not directly a responsibility of Imperial once services move out of the hospitals. Imperial, however, intend to bid for some of these services but CCG may pick other providers. Final accountability and issues of who pays for what are issues that will need further clarification. Tracey Batten stressed that treatment will be ‘free at the point of delivery’ but we need to clarify whether this will continue to be the case if services go out into the community given that many services provided by Social Services are means tested etc. Jim stressed that the out of hospital care was in danger of further fragmenting our health services with possible dire consequences for patients.

  7. Finance and Privatisation. At this stage, much of the discussion was curtailed as we were running out of time. Mark pointed out that Imperial already faces some considerable financial difficulties and asked why this was the case. Imperial answered that they had had heavy losses in the early months of the year but had reduced losses last month. They were paying for unsatisfactory IT systems which had reduces the revenue stream, they were paying for the late closure of winter beds, paying heavily for reliance on agency staff, and had to pay for preparation for the CQC inspection. Mark queried the publicly quoted price for real estate at Charing Cross and St Mary’s (£270m) which seems low for London real estate prices. Imperial said this was a conservative figure for their outline business plan and that they will be liaising with the Trust Development Authority. The £400m + extra needed for the rebuilding etc would have to be raised. According to Imperial this might be from a grant from the Treasury, a Treasury approved loan which might have a lower interest rate, or a loan at market rates. When asked how the debt might be serviced, we were told that Imperial would hope to do this by efficiency savings. We were unable, because of time, to pursue this point. Nor was there time to discuss privatisation.

  8. Finally, Merril outlined one outstanding issue – our growing concern about how the transition and change process will be managed by Imperial and the absence of any published contingency plans if things go wrong. There was agreement that most issues needed more in depth discussion and that more answers were needed to the questions we had raised. Tracey Batten and her officers all asked that a further meeting – or meetings – take place to address these and any other issues we might want to raise.

 

 

 

 

 

 

Appendix B. Report of meeting of SOH Officers with Imperial CEO and officers on Fri. 28 Nov, 2014

 

Merril Hammer had prepared the agenda and chaired the meeting. The meeting was a continuation of meeting held on Sept. 17th 2014 where some agenda items had not been reached. Some new items were also raised.

 

The following issues were discussed:

 

  1. Mental Health at Charing Cross.

 

Imperial pointed out they were not responsible for mental health. These services are the responsibility of Central and North West London Mental Health Trust.

 

They pointed out that 20-25% of people presenting at Charing Cross A&E have mental health issues. Some of these will be presenting with physical/medical problems. Imperial has not discussed the effects of the proposed closure of the A&E closure with the police in relation to people with mental health issues. Nor are they in ongoing talks with CNWL Mental Health Trust on the impact of A&E closure on mental health services. It was unclear whether this was because of a reluctance on the part of the mental health trust.

 

  1. Why Charing Cross?

 

At the first meeting and in subsequent correspondence, this question had not been clarified adequately for SOH. We again pointed out that Charing Cross, according to the IRP report, was 95% suitable for health purposes and 100% ‘young’ according to their criteria, unlike the other Imperial hospitals. We also pointed out that Hammersmith Hospital had been discussed, in 2011, as the major hospital for Imperial. We also pointed out that the evidence for the proposed reconfiguration of Imperial was not given in the SaHF document. We asked what was the specific evidence that led to the downgrading of Charing Cross. Imperial have said they will try to get more detailed information to us.

 

  1. HASU and other A&E Services

 

SOH queried the moving of a highly praised HASU to St Mary’s, not least because of the ‘doughnut effect’ with the centralisation of HASUs (UCLH is less than 2 miles from St Mary’s) and in inconsistency of claiming that a HASU and major trauma centre should be co-located as this does not also apply to UCLH which has a HASU but no major trauma centre.

 

We pointed out that they had not presented evidence that everybody in NW London to get to St Mary’s in 30 minutes. Imperial said there was a report from 2008/9, which we have not seen, and we pointed out that that was some years ago. There have been population and traffic changes since then.

 

Imperial were unable to provide evidence that the majority of patients using an A&E (i.e. other than stroke and trauma patients) would receive improved treatment in the new configuration. For example, we stressed that for patients with anaphylaxis and acute asthma, speed of treatment is crucial. Imperial did say that there are staffing difficulties, in particular the recruitment of middle grade consultants and junior doctors because of increasing specialisation in medical training. We pointed out that the same issues would apply to recruitment at St Mary’s.

 

In terms of what emergency services might be at Charing Cross, Dr Batten said that they were still awaiting advice from NHS England. She did say this would go out to consultation (although we remain sceptical!).

 

  1. Financial Issues

 

Imperial were unable to explain how they could service a debt of £400m with interest payments of at least £16m p.a. Efficiency savings were mentioned, but no new revenue streams were identified. They admitted this was a major concern. It was claimed that the revenue from the sale of Charing Cross land would be reinvested in the remaining Charing Cross site.

 

  1. Issues arising from Board meeting of 26 Nov.

 

Closing of beds – Dr Batten says she knows of no beds that can be closed at the moment because ‘Imperial hospitals are busy’. She said THAT BEDS WOULD NOT BE CLOSED UNTIL FACILITIES ARE AVAILABLE IN THE COMMUNITY. She agreed that she can be quoted on that. She agreed that Imperial will keep SOH informed of any changes that are happening in the hospitals that might concern the public e.g. bed losses, ward closures.

 

Dr Batten also said she’d get back to us about what was meant in board papers about identifying non-profitable services and beds that can be closed to save £0.5m.

 

She agreed when we pointed out that services in the community and social services budgets are being cut.

 

Dr Batten informed us that she would NOT be going on the CCG-funded tour of America, organised by McKinsey, and recognised that the community disapproved of this.

 

Dr Batten said that Imperial had not been negotiating with property developers, whatever Dr Spencer had been up to.

 

6. Transition and Change

 

Dr Batten acknowledged that transition and change is a complex process, even more so given the extent of the SaHF proposals. She said there was no definite 5-year deadline for completing the reorganisation programme. Imperial are very concerned at the A&E waiting time breaches and are looking at contingency plans. Much of the planning seems to depend on the Business Case, which has not yet been agreed and indeed, it is only the Outline Business Case which has been submitted.

 

She said there is and will be continual review of the process and that she and the Imperial Board would have to take responsibility for anything that went wrong.

 

 

7. Moratorium and Reconsultation

 

We clearly outlined the case for a moratorium and for reconsultation on new proposals and pointed out that the Council and Healthwatch, as well as SOH, support the need for a moratorium.

 

  • The initial consultation on SaHF was badly executed, with many not consulted or knowing about the consultation and with closed options, the rationale for which having never been fully or adequately explained

  • The proposals in Imperial’s clinical strategy, despite claims by Imperial, do not match up with what we were told following the IRP which include:

  • The continuing failure of Imperial, the CCGs or NHS England to tell people what a ‘local hospital’ actually is. That is, we were consulted on something which SaHF did not understand and which is still entirely undefined!

  • For Charing Cross the public has been told that there will be some sort of A&E in place yet you are still unable to tell the public what that service will be – and this is more than 2 years after SaHF. If you can’t do so, how can the public trust you or believe that any proposals you make are honest? Is this about health care or money?

  • The promised out of hospital services are not in place; the trials are limited and provide no evidence that they will cope with need

  • Who pays for out of hospital remains unclear? Social services budgets are being drastically cut and are means tested – hospital services are free. Are you passing costs on to patients?

  • The A&E closures have led to major local failures

  • The promised greater elective surgery and other electives at Charing Cross seem to have been reduced rather than increased since the IRP. The promise from Dr Spencer of urology services at Charing Cross doesn’t seem to be in the plans. We need to be consulted on just what will be where. We need to know if people are going to have to travel to Central Midd for elective procedures – or to know just where they will be provided.

  • Finally, where is the evidence that there will be sufficient public beds in the new set up.

 

When asked whether she supported a moratorium, Dr Batten said this was a question best addressed to the CCG when a new Chief Officer is in post with the CCG as well as with the Secretary of State for Health. She said she wouldn’t oppose it, but it was not a matter for her or Imperial.

 

The meeting closed with agreement that we would not be meeting again for the foreseeable future but that we should keep open lines of communication.

 

 

Appendix C. Email communications between SOH chair and Daniel Elkeles about the CCG trip to US in Dec 2014

 

 

Dear Merrill



Thank you for your email, am sorry I wasn't able to reply on Friday.

 

The visit is part of the Whole System Integrated Care programme which is a partnership of 31 health and social care organisations in North West London.  

 

The programme have listened to patient frustrations about difficulties in finding their way through the system and repeating their story multiple times.  We want to improve that and provide the best possible care for the residents of NW London so the purpose of the visit is for clinicians in NWL to learn from others and be better informed to lead the improvements to care for our 2 million residents across North West London.    

 

North West London was awarded Integrated Pioneer status last year and each national Pioneer site was given £110,000 by the Department of Health to advance integration in their area. North West London already has a very ambitious programme to improve integrated care which has been cited nationally and internationally. We wanted to learn how we can improve care further by visiting innovative integrated care systems and organisations and meeting one of the requirements of the funding which was to learn about international examples of integration.

 

It was therefore decided that representatives of our partner organisations, including patient representatives, would go on a study tour of America funded by the award I referred to above.  The team will be visiting 9 sites over 5 days and each leader attending will be responsible for studying a different features and writing up what they learn to share within their organisations and across North West London to progress our own improvements in joining up health and social care.

 

The US was chosen as there are a number of organisations using innovative new care models and performance systems especially in relation to elderly care which is a key focus of the NW London early adopters.  I appreciate your point about the US having a private healthcare system but the organisations we are visiting have been specifically chosen because they are providing publicly funded care for elderly people and people who cannot pay for care themselves through the Medicare and Medicaid programmes, where reimbursement levels are broadly similar to those in the NHS. This includes organisations providing care in complex urban areas with high poverty rates like the Bronx and Baltimore. 



As Tracey said, and as I have confirmed, McKinsey are not funding the trip.  McKinsey were chosen to support the logistics of the trip due to their experience in arrange similar trips within the NHS and for their contacts within the kind of organisations we were keen to visit.

 

As I mentioned earlier, the trip is being attended by senior representatives of our partner organisations which includes patient representatives, CCGs, Trusts and local authorities.  The 22 people who went on the trip yesterday was made up of 2 of our lay partners, 2 Directors of Social Services, 2 psychiatrists, 7 GPs, 2 leaders from community health care providers, 2 clinicians involved in medical and nursing education and 5 managers from the whole systems integrated care programme.  

 

Finally, you referred to an "enquiry" around the A&Es.  Dr Spencer as you know is one of our Medical Directors and the review by NHSE is part of the normal course of regular reviews when a change to the system occurs.  We are also having regular calls with the acute Trusts and LAS to ensure close monitoring of demand and capacity within A&Es and work together to improve performance.

 

 Hope that this addresses your questions.

 

Daniel



Daniel Elkeles

Chief Officer

Central London, West London, Hammersmith & Fulham, Hounslow and Ealing CCGs


On 28 Nov 2014, at 15:11, Merril Hammer <This email address is being protected from spambots. You need JavaScript enabled to view it.> wrote:

Dear Daniel,

 

Further to my comments of yesterday, Save Our Hospitals has, this morning, had a meeting with Tracey Batten and some of her senior officers. Because of the concerns raised at the Imperial Board meeting by the public at her announcement of her attendance on this study tour, we asked her about these plans. As you will now know, Dr Batten has, because of the concerns of the community – notably SOH campaigners at the meeting –  rethought her position on this and decided not to take part in the study tour.

 

She also apologised for suggesting, at the Board meeting, that McKinsey were funding the tour. However, she did say that, although they are not funding the tour they are organising it. To some extent, this seems like wordplay. McKinsey are only engaged in this because they work help private companies make money from public health provision – something increasingly linked to current commissioning processes. Could you please clarify the role of McKinsey – and any other private corporations and providers – in this tour.

 

I understand that this ‘junket’ will cost the NHS £120,000. Can you please justify to me and to Save Our Hospitals campaigners, who can claim to represent a significant section of the local community, how this money can be spent on sending 23 (or is it now 22) NHS staff to America to look at a system, where provision depends on ability to pay and whose values are at variance with those of the NHS? And how can this expenditure be justified at time when the closure of two small A&Es in NW London has caused huge failures in the system, with Dr Mark Spencer having to call for an enquiry to see what’s gone wrong?

 

Could you also, as it is our NHS money, please inform us as to which NHS staff are taking part in this junket? While participants may be travelling economy class, this does not seem to us to be a necessary cost at the present juncture!

 

Yours sincerely,

 

Merril Hammer

Chair, Save Our Hospitals

 

 

From: Daniel Elkeles [mailto:This email address is being protected from spambots. You need JavaScript enabled to view it.]
Sent: 27 November 2014 18:37
To: Merril Hammer
Cc: Sarah Garrett (now Bellman); Philippa Jones
Subject: Re: Lilyville surgery

 

Dear Merril

 

Thank you for your email.  I will ask H&F CCG to check all practices to see if they have any misleading information on any websites / newsletters.

 

With regard to the comments Tracey made at the Board meeting yesterday they are not quite accurate.  This is the statement that we have issued today in response which I hope clarifies the position 

 

 

"The purpose of the visit is for clinicians in NWL to learn about how they can improve care for their patients.  They will all gain a better understanding of how others are approaching integrated care, share that with others and be better informed to lead the improvements to care for our 2 million residents across North West London.

 

"This is part of a national initiative, funded by the Department of Health, to help drive more joined up health and social care.   In North West London we have listened to patient frustrations about difficulties in finding their way through the system and repeating their story multiple times.  We want to improve that and provide the best possible care for the residents of NW London and beyond.  We are therefore using our Pioneer funding to support our already ambitious programme and to learn from international examples of integration."

 

We have tried to keep costs as low as possible such as flying on a Saturday which is the cheapest day to fly and economy.

 

There are some amazing integrated care models in operation in the USA and we can learn lots from them to help us deliver the out of hospital care that we aspire to.

 

Daniel 


Daniel Elkeles

Chief Officer

Central London, West London, Hammersmith & Fulham, Hounslow and Ealing CCGs


On 27 Nov 2014, at 14:48, Merril Hammer <This email address is being protected from spambots. You need JavaScript enabled to view it.> wrote:

Dear Daniel Elkeles,

 

Thank you for responding to my message about the information on A&E services sent around by my GP. I understand from Imperial that they have promised to send a corrective email and to ensure their website carries corrected information. Although I have had an apologetic email from the surgery, I have yet to see the corrective email sent to recipients of the first one.

 

This issue is so serious – how can a surgery get this information wrong? – that I would, on behalf of Save Our Hospitals, like to know what further steps you are taking not only to correct this misinformation but to ensure that incorrect information is not being propagated by surgeries, GPs and other staff in GP practices. Could you please keep me informed.

 

Can I also take this opportunity to raise with you another issue which I heard about at the Imperial board meeting yesterday. I am deeply concerned, as were most of the public at the meeting, to learn that the CCG has arranged to send the CEO of Imperial and other NHS officials on a lengthy ‘study tour’ to America, funded by McKinsey, according to Dr Tracey Batten. Using the privatised, for profit, American system as the basis for looking at out of hospital provision is quite disturbing. That McKinsey should fund this is even more alarming – McKinsey is a company that works to help private corporations gain access to public health sectors and the prime interest is to increase profits from health provision.

 

Merril Hammer

 

 

 

 

"Liberating" the NHS: source and destination of the Lansley reforms (Reynolds, Lister, Scott-Samuel and McKee) August 2011

For the background to the 2012 Health and Social Care Act please read "Liberating the NHS: Source and destination of the Lansley reforms" by Dr Lucy Reynolds, for sale Dr John Lister, Dr Alex Scott-Samuel and Professor Martin McKee, 29th August 2011

 

 

A & E waiting times week ending 30th November 2014: worst ever!

 

The tone of this e-mail is a little "tongue-in-cheek" - but the statistics quoted are unfortunately all too true.
 

---------- Forwarded message ----------
From: <This email address is being protected from spambots. You need JavaScript enabled to view it.>
Date: 5 December 2014 at 17:30
Subject: Worst Again
To: This email address is being protected from spambots. You need JavaScript enabled to view it.
Cc: This email address is being protected from spambots. You need JavaScript enabled to view it., diagnosis This email address is being protected from spambots. You need JavaScript enabled to view it., levitra This email address is being protected from spambots. You need JavaScript enabled to view it.


Dr Spencer,

 

It is reported that you have gone on the £120,000 junket to America.  I continue to hope not.  Quite what you would have expected to discover there after you spent over £3.5 million on McKinsey's advice for Shaping a 'Healthier' Future it is hard to imagine.  I look forward to a full and costed report of the findings.

 

Many people feel that your time would have been better spent in dealing with the increasing A&E crisis in NW London.  'Crisis' has ceased to be the appropriate word;  it is a catastrophe.

 

It now almost goes without saying that in the week ending 30 November London North West Healthcare was the worst Trust in the country for Type-1 waits at 65.7%, over 5 percentage points worse than the next.   And it was the 14th worst for 'All attendances', out of some 280.

 

And that week the North West London Sector was the worst in the country, if it were taken as an 'Area Team' of its own – which it could easily be, given its size and activity levels.  As you know, there are 25 Teams including London and NW London was 6.9 percentage points lower than the worst of those for Type-1s, at 79.9%.  Against the 95% target for 'All attendances' it was the worst again, managing 91.2% compared with 96.5% for the rest of London.

 

So, instead of swanning off to the States, all you had to do was to talk to your colleagues in London to find out how to run A&E services.  30% of all London Type-1 waits occurred in the area under your supervision.  So, when you said 'We think there are many other factors going on across London,' you failed to point out that you were attracting more than your fair share of whatever you think these might be.

 

There again, I am not aware that any other London Sector has decided to axe 2 of its central A&Es, reduce bed capacity (until the recent frantic reversals) and invite ambulance crews to telephone for an appointment to deliver a casualty to a 'Major Hospital'.

 

Your position is increasingly untenable.

 

Colin Standfield