Most of central London hospital to be sold off, plans reveal - The Guardian

Charing Cross hospital to be cut to 13% of current size and services diverted to facilities around the city, documents show.

https://www.theguardian.com/society/2017/jun/16/most-of-central-london-hospital-to-be-sold-off-secret-plans-reveal

Published on Friday 16th June in The Guardian.

"Almost all of a central London hospital is to be sold and its services diverted to already stretched facilities around the capital under plans for NHS modernisation seen by the Guardian.

Charing Cross hospital, a flagship NHS facility in the heart of London, is to be cut to just 13% of its current size under proposals contained in sustainability and transformation plans published last year in 44 areas across England.

Many of the officially published plans lacked precise detail about how local services would change, but internal supporting documents seen by the Guardian reveal the scale of the closures at the London site.

The proposals claim much of the care currently offered at Charing Cross can be transferred to “community settings” such as local GP services, but health campaigners and clinicians say the transformation could endanger patients.

The documents include a map detailing how 13% of the current hospital site will remain, with the rest of its prime real estate in central London sold off. The plan is to introduce the changes after 2021.

The NHS chief executive, Simon Stevens, is thought to be taking a particularly keen interest in what happens at Charing Cross. The site has become a battleground over planned closures of local services, and if the radical changes are adopted here it may be easier to introduce them across the rest of England.

NHS chiefs have stated as recently as March that “there have never been any plans to close Charing Cross hospital”, and in March 2015 the then prime minister, David Cameron, said it was “scaremongering” to suggest that the Charing Cross A&E departmentwas earmarked for closure. The health secretary, Jeremy Hunt, echoed the claims.

However, in the internal NHS documents the apparent downgrading of Charing Cross is outlined in great detail.

The plan is to axe 10 major services at Charing Cross – 24/7 A&E, emergency surgery, intensive care and a range of complex emergency and non-emergency medical and surgical treatments. The remaining services would be a series of outpatient and GP clinics, X-ray and CT scans, a pharmacy and an urgent care centre for “minor injuries and illnesses”. Around 300 acute beds will be lost.

The internal documents state: “The significant impact of reconfiguration on inpatient activity will be the movement of activity from Charing Cross and Ealing.”

The plans have sparked a row between the borough where Charing Cross is based – Labour-controlled Hammersmith & Fulham council - and the NHS North West London Collaborative of Clinical Commissioning Groups, which is driving the changes.

Stephen Cowan, the leader of the council, has accused the NHS chiefs of deliberately misleading the public about the Charing Cross plans.

“It’s like demolishing someone’s house only to tell them they have in fact not lost their house – because they’ll be given a new garden shed which will be called their ‘local house’,” said Cowan.

He said NHS chiefs had rebranded the urgent care centre for minor injuries and would be run by GPs and nurse practitioners as a local A&E.

“That still constitutes the demolition and closure of Charing Cross hospital in its current form. No one would see what is left as a hospital in any generally accepted definition of the word,” Cowan added. “A ‘local hospital’ is a clinic. A class 3 A&E is an urgent care clinic.”

A spokeswoman for North West London Collaboration of Clinical Commissioning Groups said: “We are still committed to taking forward changes as agreed by the secretary of state in 2013. We have been clear that we will have local services in place to meet demand and deliver the necessary services for patients before we make any changes to Charing Cross.

“Our current focus is on delivering those new and improved services for local people. We have been clear that no changes will be made before 2021 and that for Charing Cross we will bring forward a strategic outline case in the future which sets out the capital requirement for making these changes and that remains our intention.

“As we look at changes to Charing Cross hospital we will of course continue to work closely with the council and value their important input into these discussions.”

NHS officials have accused Hammersmith & Fulham council of breaching the code of recommended practice on local authority publicity by circulating flyers to residents in March of this year warning of the closure of Charing Cross as a major hospital.

The council delayed replying due to election purdah but Cowan has recently drafted a response to NHS chiefs accusing them of “playing fast and loose with the English language” and demonstrating “a contempt for the public who you evidently hope are taken in by such misrepresentation”.

In the letter, Cowan adds that the published plans for the future of the hospital have avoided mentioning much of the detail contained in the confidential plans.

Charing Cross is thought to be one of five London hospitals that a recent government-commissioned review – by a former University College London hospital chief executive, Sir Robert Naylor – identified as each being worth more than £1bn if sold.

The NHS in England is gearing up to start selling off billions of pounds worth of land and property in order to free up cash to tackle what Naylor estimated to be a £10bn backlog of repairs to sometimes crumbling old buildings.

The Health Service Journal disclosed last week that the Department of Health was preparing to create six regional public/private partnerships covering all of England that would oversee such sales. The plan, codenamed Project Phoenix, would see the proceeds from asset sales being shared between NHS organisations and private firms. Under the plan, London and the south-east would comprise one giant, and very valuable, area."

[my bold and underlining]

This is it. This is the "fire sale" of all NHS assets which the Naylor report of March 2017 planned. Public Private Partnerships offer lucrative deals for one side only, the private sector. The NHS will be crippled with £6 billions of debt which it has no means of repaying.

It doesn't have to be this way. As any child knows interest rates are at historic lows. The Government could borrow at 0.5% interest or less. There is NO commercial reason for "mortgaging" OUR NHS assets at astronomically high rates of interest. This Government is unable to say out loud ANY reason for this deal. The real reason is, of course, that they want to control and starve the NHS of funding, all the better to allow the private sector to "eat it"!  It is about a neo-liberal ideological choice.

Guardian Hospitals enquiry: "Is an NHS community hospital near you being closed or downgraded?"

In "The Guardian"'s Society section there is a questionnaire asking about the UK's experience of "downgraded" or "threatened" hospitals: https://www.theguardian.com/society/2017/jun/13/is-a-community-hospital-near-you-being-closed-or-downgraded?CMP=share_btn_tw

This is a very worthwhile exercise, because the more responses they receive the better the issue can be INDEPENDENTLY assessed and analysed. I urge anyone who finds this page to complete the short questionnaire.

Thank you!

Capped Expenditure Process: New national savings drive will 'challenge the values' of NHS leaders

From Health Service Journal (paywall) - 5th June 2017 -  DAVE WESTLAWRENCE DUNHILLBEN CLOVER, ALLISON COGGANhttp://tinyurl.com/yacgxafx

 

Closing wards and services, blocking choice of private providers, systematically extending waiting times, and stopping some treatments are all being considered under a national programme targeted at the health economies with the highest overspends.

The controversial measures are currently being discussed privately by national NHS England and NHS Improvement officials, with senior local NHS leaders, as part of the new “capped expenditure process”. The principle of the process, introduced this year, is to “cap” NHS spending in the targeted areas so that they meet ”control total” budgets in 2017-18.

NHS leaders from areas covered by the CEP have been told to examine “difficult decisions” and “think the unthinkable”, including modelling changes which are normally avoided as they are too unpleasant, unpopular or controversial. HSJ has spoken to senior officials in most of the areas.

One chief executive said it was the most extreme and difficult NHS finance process they had experienced, and that the some of the options - if pursued - would “challenge the value base” of NHS leaders.

Ideas under consideration across several areas include:

  • Limiting the number of operations carried out by non-NHS providers so the funding stays within the NHS. Considerations differ between areas but include both limiting patients’ choice of providers, and reducing work which is outsourced by NHS trusts. In some cases it would require the NHS to find the capacity to carry out more operations.
  • Systematically drawing out waiting times for planned care, including explicit consideration of breaching NHS constitution standards. Some plan to target delays at specialties/areas where waits are currently lower than average.
  • Stopping NHS funding for some treatments, including extending limits on IVF, adding to lists of “low value” treatments, and seeking to delay or avoid funding some treatments newly approved by the National Institute of Health and Care Excellence.
  • Closing wards and theatres and reducing staffing, while seeking to maintain enough emergency care capacity to deal with winter pressures.
  • Closing or downgrading services, with some considering changes to flagship departments like emergency and maternity - though these would normally take too long to deliver savings this year.
  • Selling estate and other “property related transactions”.
  • Stopping prescriptions for some items, as suggested by NHS Clinical Commissioners earlier this year.

 

Leaders in the areas have been told to first consider whether they can make further efficiencies by normal means, such as reducing follow-up appointments or unnecessary referrals. But all of those HSJ spoke to - covering more than half the areas involved - said they were also putting forward new “difficult decisions”.

Meetings to discuss the CEP proposals with regional and national officials, including NHSE and NHSI finance chiefs Paul Baumann and Bob Alexander, took place throughout last month. No proposals have yet been formally approved or rejected, sources said.

Decisions are expected after the general election, and some of the officials involved have been told they will be put to the new ministerial team. There is no expectation of details being made public until after the election. 

About 14 health economies - most of which are sustainability and transformation partnership ["STP"] areas - are subject to the process. They were chosen because they were expecting to fall substantially short of their “control total” financial targets in 2017-18.

They include:

  • Bristol, South Gloucestershire and North Somerset;
  • Cambridgeshire and Peterborough;
  • Cheshire (Eastern, Vale Royal and South)
  • Cornwall;
  • Devon;
  • Morecambe Bay;
  • Northumbria;
  • North Central London;
  • North Lincolnshire;
  • North West London;
  • South East London;
  • Staffordshire;
  • Surrey and Sussex;
  • Vale of York and Scarborough and Ryedale.

 

The programme comes amid the longest ever sustained squeeze on the NHS budget, and with lower spending growth in 2017-18 than last year. These areas report gaps between plans and targets running into hundreds of millions of pounds, but NHSE and NHSI have not made public the total national gap.

Several sources complained that the national process - which is likely to require some 2017-18 contracts to be reopened - had run more than two months into the financial year, rather than being completed earlier.

Many also said that, while they had put forward “difficult decisions”, there were no sensible options which would save significant sums during 2017-18, without storing up problems for the future.

There is also debate over whether it is fair to target health economies based on their “control totals” - which require some to have surpluses and are based partly on past performance - rather than looking at absolute surplus or deficit.

An NHS England spokeswoman said: “Within their fair share of the NHS budget, local doctors and hospitals are planning how best to deliver services to patients focussing on the priorities of the public, including modern cancer care, expanded mental health and convenient GP services.

“While many options will have been considered locally, the choices of which options to pursue are still to be evaluated and agreed and would require national sign-off in due course.”

 

Manifesto: Tories open to legislation to curb internal market

From Health Service Journal - 18th May 2017

 

The Conservative manifesto says the party is open to introducing health legislation if the NHS’s leaders ask for it to help deliver the Five Year Forward View, for example to create new integrated care models.

It also commits to “review the operation of the internal market and, in time for the start of the 2018 financial year, we will make non-legislative changes to remove barriers to the integration of care”.

Health secretary Jeremy Hunt told HSJ that the “internal market is too bureaucratic”, and indicated that changes could include a shift to capitation funding, under which providers receive budgets for the care of their entire population, eliminating some commissioner functions.

The manifesto states: “We will hold NHS England’s leaders to account for delivering their plan to improve patient care.

“If the current legislative landscape is either slowing implementation or preventing clear national or local accountability, we will consult and make the necessary legislative changes.

“This includes the NHS’s own internal market, which can fail to act in the interests of patients and creates costly bureaucracy.”

Over the past year senior NHS figures, including NHS England chief executive Simon Stevens, have indicated that parts of current NHS legislation, including the Health Act 2012, can make it more difficult to develop integrated care and new contracting and organisational models.

Potential options for legal change range from changing competition and/or procurement law; merging NHS England and NHS Improvement, and potentially other quangos; to creating new NHS structures locally or regionally – potentially eliminating or dramatically reforming the commissioner/provider split.

The NHS has begun work on developing accountable care structures, but is at a relatively early stage. Many of those involved see it as very difficult within current legislation and rules.

NHS England is currently working to prepare to announce next steps for the NHS’s first “accountable care systems” shortly after the general election, with up to nine areas of the country

Comment:   Abolishing the market and purchaser/provider split once new Accountable Care Organisations are in place will cement the regional nature of ACOs and will facilitate capitated funding.  The final step in the regionalization and privatization of the NHS will have been completed.

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