Can we afford to close any more A&E departments ? Evidence from North West London

Research paper by Dr Gurjinder Singh Sandhu, published by the Centre for Health and the Public Interest on 19th April 2017. You can read it here (14 pages).

The following graph shows that the closure of Hammersmith and Central Middlesex A&E departments in Sept 2014 caused a very serious decline in the performance of the remaining A&E departments, that they recovered only a little in the summer months and that the trend is downwards.

 

Dr Sandhu has provided unequivocal evidence using statistics from NHS and other public bodies (Jan 2012- Jan 2017) for the Mansfield Commission findings that SaHF, and by extension the NW London STP, can be shown to fall foul of (1) equalities (BME) legislation and (2) discrimination on grounds of age. 

 

"Conclusions

Since the closure of Emergency Departments in North West London in September 2014, each successive winter has seen deterioration in Type 1 A&E Performance. For some hospitals there has been no recovery over the summer months and emergency care has been in perpetual state of crisis. Ambulance response times are deteriorating, A&E units are unable to offload ambulances, and patients are waiting longer on emergency department trolleys to be assessed, treated and bedded where necessary. For time- sensitive conditions such as sepsis, respiratory failure, kidney failure and the unconscious patient, all this lost time equates to cellular death and eventually patient deaths. A lack of critical care and high dependency unit beds for the sickest patients is the greatest cause for concern.

In North West London A&E closures have also had significant effects on the performance of neighbouring A&E departments. STP footprints are not isolated: the STP for South West London also proposes to downgrade one of five A&Es, which will have a knock-on effect on North West London, and vice versa.

There has been a lack of equality impact assessment on the effects on deprived communities and the elderly in the NW London STP plan. Poverty is shifting from the centre of London to the outskirts, yet across London it is in these areas that clinical networks between a hospital, GPs and social care are being dismantled.

Whilst isolated deaths due to pressures on the emergency system have been reported by the media, disinvestment in NHS and social care services has been explored in one recent study as a factor contributing to nearly 30,000 extra annual deaths in 2015. The authors* expressed significant concerns that a pattern of rising mortality each year is emerging and called for further in-depth scrutiny of what caused this marked increase in mortality. Despite a dangerous deterioration in A&E performance since the closure of two local A&E Departments, the North West London STP still envisages closing a further two A&E units at some point in the future. Future planning needs to learn lessons from the reconfigurations that have already taken place and not continue with A&E closures based on assumptions which have not been borne out in reality."

 

* Prof Martin McKee, Lucinda Hiam, Prof Danny Dorling and Dominic Harrison.

 

 

Private firms receive £2.3m to draw up STP plan for North Central London

Peter Blackburn for BMA 19th January 2017

 

Private firms have been paid a ‘shocking’ £2.3m to draw up controversial plans which will cut health and social care spending by more than £1bn in a part of London.

According to health leaders drawing up the North Central London STP (sustainability and transformation plan), six-figure sums were paid to eight different companies – including accountants Deloitte and management consultants McKinsey – for services stretching from ‘administrative support’ and ‘financial modelling’ to ‘communications support’.

A firm called Consultants Methods Advisory Ltd, which describes itself as ‘shaping public services for the digital age’, racked up the biggest costs, invoicing £617,850 for ‘programme management office and strategy support’.

Doctors leaders described the figures as ‘appalling’.

BMA council chair Mark Porter said: ‘While hospitals fall into crisis, social care hits rock bottom and the Government blames hard-working GPs for its political choice to underfund the NHS, every penny of health service money becomes more desperately valuable and doctors will find it galling to see that so much vital resource has been handed to consultancy firms for their part in failing plans which, ultimately, may never come to fruition, while frontline staff struggle to provide safe patient care in a service increasingly becoming unfit for purpose.’

 

Pick and choose

Read more ...

The internal market: The billions of wasted NHS cash no-one wants to mention

by Caroline Molloy  - published 10th October 2014 in OpenDemocracy/OurNHS....

.....and STILL relevant

 

As calls mount for the NHS cash crisis to be 'solved' by charging patients, there is one pot of money that sits glistening and untouched...

Calls to solve the NHS cash crisis by charging patients have mounted this week, with the NHS Confederation calling for £75 a night ‘hotel fees’ for hospital stays, or much longer waiting lists.

But there is one pot of money that sits curiously unexamined, glistening and untouched.

It’s the cost of the NHS ‘market’ itself. Administering the hugely expensive artificial ‘marketplace’ created by successive governments to allow both NHS and private ‘providers’ to compete with each other to offer services to NHS and other ‘purchasers’.

No-one knows the exact cost of this bureaucratic ‘marketplace’. A recent estimate by rebel Lib Dems put the figure as high as £30billion a year. Dr Jacky Davis and other doctors and campaigners including the National Health Action Party have put it at £10billion a year. The Centre of Health & the Public Interest put it at a ‘conservative’ £4.5billion a year.

Even the most conservative of these estimates is a yearly amount which would, if re-directed away from useless market activities, fund both the £2billion annual NHS shortfall and free critical social care to everyone, which the Kings Fund’s Barker Commission recently said would cost  ‘substantially less’ than £3billion a year.

Despite fierce urging from expert MPs to look at what the ‘market’ costs the NHS more closely, the government, mainstream media, think tanks and policy makers have dismissed, ignored and even suppressed this information, with unevidenced assertions that ‘modern healthcare systems’ need vastly expensive bureaucracy, market or no market.

Successive governments wedded to ‘market reform’ have refused to produce useful figures that would definitively establish the cost of the NHS market. It has been left to academics, MPs and activists to try and fill the void, through historical and international comparisons, as well as tentative attempts to cost different activities that are forced on the NHS by the ‘market’.

 

Hiding the figures

In 2010 the Health Select Committee found that running the NHS as a ‘market’ cost the NHS 14% of its budget a year.

Read more ...

NAO report on health and social care integration 8th Feb 2017

 

For the last two years (since April 2014) NHS England has run a number of experiments (called "Pioneer" programmes), including in NW London, to try to integrate health (hospital) and social care, which is essential for reducing demand for hospital services and is a central part of "Sustainability and Transformation Plans" for the 44 "footprints" of England.

The National Audit Office published its findings on Wednesday 8th Feb. It said: "Integrating the health and social care sectors is a significant challenge in normal times, let alone times when both sectors are under such severe pressure. So far, benefits have fallen far short of plans, despite much effort." "Nearly 20 years of initiatives to join up health and social care by successive governments has not led to system-wide integrated services" "The Departments [of Health and Local Government] have not yet established a robust evidence base to show that integration leads to better outcomes for patients" and finally "There is no compelling evidence to show that integration in England leads to sustainable financial savings or reduced hospital activity".

Trying to mix health and social care is like trying to mix oil and water, due to the different funding and cultures.

See NAO report: https://www.nao.org.uk/wp-content/uploads/2017/02/Health-and-social-care-integration.pdf
And BBC news: http://www.bbc.co.uk/news/health-38894593

 

STP finance figures in spreadsheets and Delivery Plan "incorrect" - or not?

At a presentation to Kensington and Chelsea Healthwatch members and residents on Tuesday 31st January, the STP team were challenged by Merril Hammer, Chair of Save Our Hospitals, about the figures revealed recently by a FOI request to NW London CCGs. The finance figures were contained in a "workbook", a set of spreadsheeets submitted with the Oct 2016 STP. Merril referred to the plans for the loss of 3,658 NHS jobs in NW London next year 17/18, rising to 7,753 job losses by 20/21.

When NHSE, an executive body of the Dept of Health, publishes information, especially as a result of a Freedom of Information request, the public has a right to be able to rely on its contents.

But in the question and answer session Christian Cubbitt, Director of Communications for NHS NW London Collaboration of CCGs, publicly retracted the figures. He said that they were "incorrect" and that there would not be nearly 8,000 job losses. He said that the "correct" figures would be produced, but did not give any deadline.

Given that the objective of the STP is to find £1.3Bn of savings and that the template of the STP is set by the Dept of Health, it is impossible that the final numbers will be very different from the ones just published, using the same categories. SOH and its advisers have looked closely at all the pages in the workbook, including the "solutions" which are the balancing figures between the "Do Nothing" and the "Do Something" scenarios. Most of the solutions include words like "these costs have not been finalised". For Solution 4 (NHSE Specialised Commissioning) it says: "We have not yet developed the "solution" for closing the gap, however it is assumed that this gap will be closed. This is a placeholder".

The Delivery Plan is obviously nearly right too.

The denial by NW London CCGs is a clumsy attempt to limit the harm after the release of highly damaging information which should not have been disclosed on the grounds that its release would prejudice incomplete development of the plans. But then the FOI request would probably have been forwarded to the Information Commissioner and SOH would have made a big fuss about the refusal and about the fact that the figures were still being worked on three months after submission to NHSE on 21st October as a "final" version.

That is why the current dispute about the status of the information produced by the NHS's NW London Collaboration of Clinical Commissioning Groups reveals even more than the figures themselves

Brent Patient Voice have discussed the huge cuts in "Losing the power to shock".

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