Hammersmith, Brent, Ealing and Hounslow Councils launch Independent Commission on the Future of our A&Es on 5th December 2014

 

The launch of the independent Commission on the future of our A&Es is a good time to reflect on the work Hammersmith and Fulham’s Labour council has done to protect the local health service. A key aspect of the May 2014 election campaign was anger over the previous Conservative administration’s decision to support the effective removal of both A&Es in the borough and the sale of most of the Charing Cross site to developers for conversion into luxury flats.

In the years before the election, nurse dedicated volunteers in the Save our Hospitals campaign leafleted residents, ailment ran street stalls and gathered tens of thousands of residents to raise awareness about the NHS’s dangerous closures plans. In its election manifesto, Hammersmith and Fulham Labour pledged to immediately reverse the Council’s position and to fight for the future of Charing Cross A&E and the borough’s health service.

The first step Labour took after winning the Council was to establish a Hospitals and Health Unit to coordinate an assertive and informed campaign against the closures. The unit conducts research, submits Freedom of Information requests, tracks the changing positions taken by health bosses and monitors the worrying impacts on A&E waiting times of those closures that have already taken place. It has also supported the other steps set out below.

The new administration met Imperial College Healthcare Trust to notify them of the Council’s firm opposition to the closures and make it clear that this was backed by the overwhelming majority of local residents. More important than these private meetings, however, was the use of the council’s new Policy and Accountability Committee that oversees health issues to publicly scrutinize Imperial’s plans. Health bosses were questioned by both councilors and the public, and it soon became clear that their plans lacked substance, and that Imperial could not explain how West London’s remaining A&Es would cope with closures. They were also unable to explain what facilities would stay in the small area of Charing Cross that wouldn’t be sold to developers, further undermining Conservative claims that the hospital had been “saved” in 2013.

The Council has also been making its voice heard in important forums outside the council. The renewed opposition to the plans has been put forcefully at meetings held by Imperial Board, the Hammersmith and Fulham Clinical Commissioning Group, HealthWatch and the North West London Joint Scrutiny Board. This has filled a gap left by the complete lack of public debate and scrutiny undertaken by the Imperial Trustees and other health authorities that should be challenging the lack of planning or consultation into one of the biggest upheavals ever seen to A&E provision in London. The administration has also written to Jeremy Hunt and the Chief Inspector of Hospitals at the Care Quality Commission to highlight Imperial’s lack of preparation for any A&E closures and its degrading financial position.

A key reason why Charing Cross has been chosen for demolition is the desirable land it sits on. Imperial has admitted in its business plans that it wants to sell most of the site to address its financial problems and spend on facilities outside of Hammersmith and Fulham. Bosses have evenly recently speculated about turning the main hospital tower block into flats. With a growing population in the Borough and across West London, this is incredibly short-sighted—once the site is lost to the NHS it will be almost impossible to replace. To recognize the importance of the Charing Cross site to the whole community, the new administration has set in train the process of changing the Local Planning Framework. Labour also made clear its opposition to the plans at a recent gathering of the world’s major property developers, MIPIM, in London.

H&F residents and their council cannot fight this battle alone. Across West London there is concern over the NHS’s reckless closure plans. For that reason, the H&F’s administration has joined forces with Brent, Ealing and Hounslow to establish an independent Health Commission, chaired by Michael Mansfield QC. The NHS failed to consult local residents properly on their plans—if they did, they would have seen just how much opposition they faced. The Health Commission will speak to residents and clinicians across the four boroughs and produce an independent view on the future of the area’s A&Es. This will ensure that whichever Government is in charge of the NHS after May 2015 will be presented with detailed, independent facts setting out the impact of West London’s proposed A&E closures.

These efforts have attracted considerable media attention, with highlights including:

There is still much to do to save our hospitals. Imperial and Jeremy Hunt have not given way, but they now face a broader, more forceful and better informed opposition than ever before.

 

Composition of the Commission:

Michael Mansfield QC last year chaired the Lewisham People's Commission, an inquiry into the proposals to close services at Lewisham Hospital. He has represented defendants in criminal trials, appeals and inquiries in some of the most controversial legal cases in the country.  He represented the family of Jean Charles de Menezes and the families of victims at the Bloody Sunday Inquiry. 

He chaired an inquiry into the shoot to kill policy in the North of Ireland and has represented many families at inquests, including the Marchioness disaster and the Lockerbie bombing.  He also represents the family of Stephen Lawrence.

He will be joined on the commission by Dr Stephen Hirst, a retired GP from Chiswick with extensive local knowledge and John Lister, researcher on the People's Inquiry into London's NHS in 2012 and Senior Lecturer in Journalism at Coventry University.

 

Maternity unit at Ealing Hospital will close as soon as possible

 

No decisions on timings have been made yet but it could be any time from next March

 
 

The maternity unit at Ealing Hospital will close as soon as possible, it has been confirmed by the borough’s Clinical Commissioning Group (CCG).

Ealing CCG’s governing body agreed the earlier closure, which could be as soon as March 2015, in a meeting held yesterday (October 9).

Oliver New, Chair of Ealing Save Our NHS, said the CCG’s decision was predictable despite the fact the unit’s record is excellent and one of the alternative maternity units, at Northwick Park Hospital, was recently criticised by the Care and Quality Commission.

He said: “Women in Ealing will now have to cope with maternity services from outside the borough. 

Eve Turner from Ealing Save Our NHS added: “This is a dreadful decision from the point of view of women in Ealing.

“The proposed replacement maternity services will be a dogs dinner compared to the fantastic service which we have now, with its brand new birthing unit being scrapped at a huge cost.”

The CCG say the decision to close the unit, made in February 2013 and part of the Shaping a Healthier Future programme designed to improve NHS services for north west London, was due to an increasing birth rate and a rise in the number of women with complex healthcare needs during pregnancy.

They said the need for increased consultant presence in order to reduce maternal mortality and poor outcomes could be solved by consolidating specialists into fewer units.

Leader of Ealing Council, Julian Bell, said: “This decision driven by financial reasons is another blow to Ealing.

“It cannot be right to close a newly refurbished maternity unit that cost tax payers £2 million when our birth rate has increased by over 30 per cent in the last 10 years.

“Having to give birth outside the borough will increase the risks and dangers to mothers and babies as they travel further. We will continue to fight to the bitter end against this mad and bad decision.”

Dr Mohini Parmar, Ealing GP and Ealing CCG Chair, said: “Having heard the clinical evidence, Ealing CCG Governing Body has unanimously agreed to move forward with planning the transfer of maternity and interdependent services from Ealing Hospital as soon as possible.

“These plans are about improving care for women across north west London and we can do this by increasing consultant cover and investing in six maternity units rather than the current seven.

“It is important to note that no decision on the timing of these changes has been made. The final decision will only be made when we have full assurance from all the Trusts, which will look after Ealing mothers and children in the future.

“We will work with all the CCGs and Trusts to get the necessary services in place and assurance we need to ensure the safe transfer of services.”

 

 

Monday's strike is a symptom of an NHS in intensive care

The strike is a symptom of an NHS in intensive care

Even the Tories admit their reorganisation was disastrous. Frontline staff are paying the price
NHS strike ‘NHS staff anger is as much about the £3bn of public money wasted in the Tories’ chaotic reorgnisation as the calculated insult of being denied an asked-for below inflation wage increase.’ Photograph: Andy Rain/EPA

Nurses, midwives and others striking on Monday were making only a token gesture, designed to shock, not harm. But their work to rule will push up NHS debt, meaning expensive agency temps must be hired. Though nurses finally snapped after a five-year pay freeze that has meant a 15% cut, pay is only part of the story: the nursing shortage causes intense pressure. Staff are caring for too many patients but get blamed when they can’t care well enough, despite more nurses hired.

However pay is also a token of respect – ask any CEO. To deny a below-inflation 1% was a calculated provocation, muddied by a spurious claim that nurses shouldn’t be paid more as they gain experience. Their anger is as much about the £3bn waste of money in a chaotic reorganisation even cabinet ministers now call a disaster. Does the health secretary hope prodding them into a strike will turn public opinion against NHS staff? Politicians who pit themselves against nurses tend to lose the argument.

Peel back the truth about the great nursing shortage and you find another reason why the government’s Health and Social Care Act fragmentation of the NHS makes no sense: it has set trusts to compete fiercely against each other for income, staff and patients in a sham health “market”. Recently I visited Watford general hospital, one of the majority of trusts up to its neck in debt, caught out by flat funding, 8% more patients admitted through A&E last year than the year before and intense pressure on the quality of care. Its website gives a grim summary of its latest Care Quality Commission (CQC) inspection, with a thick X for four out of the five key standards, including not enough nurses. In a hurry, it has hired an extra 160 – and its debts rose to £14m. How many nurses should there be on a ward? The National Institute for Health and Care Excellence (Nice) is considering that difficult question: a rule of thumb ratio of one for every eight patients is uncertain, as the frailty of patients varies so widely.

Here is the classic Jeremy Hunt squeeze: he sends in a beefed-up CQC to dish out savage judgments, while administering an ever tighter tourniquet to NHS finances. He uses the Mid Staffs scandal ceaselessly, claiming he is “looking under the bonnet” as he pins on his noticeboard his worst cases. He was at it again on Monday, conveniently diverting blame away from the harshest ever NHS budget to those struggling to keep the service afloat. By law trusts are not theoretically allowed to fall into debt, yet Hunt has ordered every ward to say how many nurses are on duty to increase their number.

Nurses take three years to train, so where do you find some in a hurry? Watford’s chief executive, Samantha Jones, is one of hundreds of managers frantically sending recruiters abroad to trawl for them. She’s been hunting in Portugal, Italy and Spain. Others try Romania and the Philippines, while agencies say Ireland is drained of nurses, as squads of trusts compete to entice them. I spoke to one agency who described “so much competition, all of us fishing in the same pools for nurses for different hospitals”. What does it cost? The agents get paid £3,000 a nurse, some seeking 300 nurses for one hospital. Why not save money with a single recruitment system? Because there is no longer a “national” in the NHS: it’s every trust for themselves.

Last year about 6,000 foreign nurses were imported, a number rising fast. But the NHS lost over 4,000 nurses, as they emigrated to better paid, less stressful work in Australia, the US and New Zealand, all higher health spenders per capita. Britain loses its most experienced nurses in exchange for far less experienced staff who need tuition in clinical English.

If you think there must be a shortage of British people willing to nurse, you would be wildly wrong. This was another government madness: nurse training places were cut from 20,829 in 2010 to 17,219 in 2013. There is no lack of applicants: 226,400 applied last year, well over 10 per place, double the number trying for each Oxbridge spot. Peter Carter, head for the Royal College of Nursing, reckons more than half are well-qualified applicants with the right attributes to be good nurses. But training places were cut to save money, despite rising need. Each year 10% of nurses quit or retire, but government attempts to woo leavers back are hampered by a lack of “back to nursing” refresher courses – and too few flexible rotas for mothers wanting part-time shifts. Nurses are escaping to work flexibly for agencies and hired back to the NHS at huge cost. Temp nursing agencies charge a fortune – up to £1,800 for a 12-hour Sunday night shift for a neonatal temp; the agency takes 20% of that. Luckily, most nurses stay in the NHS despite years of falling pay – but Hunt’s sudden withdrawal of an expected 1% rise smacks of deliberate political confrontation.

The day I visited Watford general, 77 of its 600 beds were taken by elderly patients with nowhere to go, costing a small fortune, not needing medical treatment but with no care plan to look after them at home. Nationally there are 26,000 “bed blockers”, caused often by the lack of district and community nurses: in 2003 there were 12,000 district nurses, but now there are just 7,500 – a 47% cut. It’s the same story with community mental health nurses, who help keep patients well at home. Diabetic nurses, who keep diabetics out of hospital, are cut. School nurses, who detect problems early, often have to cover 10 schools. For all the talk of community investment to save hospital admissions, the facts show short-sighted cuts causing higher costs.

With such competition and so many emigrating, nurses should be in a remarkably powerful bargaining position – if ordinary laws of the market worked. But market logic never seems to apply to middle and lower earners. Some in the NHS get large bonuses to retain them, such the John Radcliffe hospital’s CEO who gets a £30,000 bonus on top of his £215,000 pay. His local Tory MP’s defence was that “there should be performance related pay for key people” – but what an affront to all the other NHS “key people”. It’s a microcosm of warped rewards across the whole country where even the remaining unionised workers fail miserably to hold on to their slipping standard of living. If not nurses, then who has any hope of protection from a government bent on diminishing and denigrating the public realm?

Big Data and the Care.Data project

Robin Burgess, check NHS England's Regional Head of Intelligence for the London region, gave a talk and question and answer session at Ealing Town Hall on Thursday 16th October to a group of about 20 people, consisting of members of the public, some rather specialist lay members and some journalists.


This is the NHS's unrevised plan to upload medical records from GPs' surgeries and hospitals to a central Health and Social Care Information Centre (HSCIC). I say "unrevised" because, despite the outcry 6 months ago about this scheme by David Davies MP and others, the only thing to change is that Jeremy Hunt and Tim Kelsey, NHS England's national director for patients and information (a former journalist) have agreed to send a letter to every patient in England and Wales advising them that this uploading is about to happen and that, by the way, they can object if they want.

A statistician, Dr Emmanuel Lazaridis, asked a basic Statistics question: "Whole databases are subject to enormous bias. Why is the NHS setting up this Big Data database rather than a number of  smaller registries which, when interrogated, will give a somewhat less precise answer due to sampling errors, but an answer which is not subject to bias?" To which Mr Burgess replied lamely: "I have a lot of sympathy for your position".


I reminded everyone that the NHS's record at keeping data safe was lamentable.

Overall, it seems that the NHS's patriarchal and bureaucratic "We know better than you" attitude is alive and well.