Update on Charing Cross Hospital - Report from Imperial NHS Trust to the NWL JHOSC 23rd Jan 2018


On 23rd January 2018, the NW London Joint Health Oversight and Scrutiny Committee, chaired by Councillor Mel Collins of Hounslow, received the following report from Imperial College Healthcare NHS Trust as an update on Charing Cross Hospital for the JHOSC meeting.

It re-iterated many of the points made orally at an Open Evening at Charing Cross Hospital on 27th November 2017. It confirmed that Charing Cross is safe until at least 2021, and it is unlikely that any realistic NHS business plan can be formulated which includes its closure after 2021, according to current demand and foreseeable future projections for acute services.

I have selected the report from the papers, highlighted in red and changed to italics the most important paragraphs. Please forgive the double page numbering, which went wrong during my editing in Adobe Acrobat.

French hospital system in crisis: open letter signed by 1000 doctors and health professionals from France's top hospitals

This is a translation of an article in "Libération" published on Tuesday 16th January - "Hôpital - Mille signatures et une urgence" ("Hospital - one thousand signatures and one emergency"). The letter starts: "We, hospital doctors and health service managers...."

An appeal by Professors André Grimaldi and Jean-Paul Vernant and Dr Anne Gervais of the University Hospital Centre of Grenoble [one of the top ten hospitals in France] has been co-signed by over one thousand other hospital professionals throughout France, warning of crisis in the hospital system.

Further cuts of 1.6Bn Euros have been imposed on hospitals. Their budget for 2018 will only increase by 2% while their workload will increase by more than 4% (public hospitals spend 36% of all health-related expenditure). In order to balance the budget the tariffs in the list of "tariffs by activity" ("T2A") will be cut once again. In order to try to keep their accounts in balance hospitals are forced to increase their activity year on year while reducing the number of staff. Always "doing more with less" means worse working conditions leading to an exhausted and demoralised workforce and, in consequence, poorer quality care. As the minister of health conceded: "We have come to the end of this phase and this system. For example, with T2A the system was supposed to make public hospitals believe that they are [profit-making] enterprises".

The letter:

"We, hospital doctors and health service managers, putting aside political or union affiliations, support the aim of the minister for health to improve the relevance of care offered by reducing the unjustified diversity of medical practices, by reducing the number of prescriptions for unnecessary [diagnostic] investigations, by improving co-operation between social care and hospital care, by choosing ambulatory care wherever it does not compromise the overall quality of care and by building a truly local health service. From the hospital's point of view, this is only possible if five conditions are met:

Limiting the application of T2A [the tariff system] to standard, elective types of care;

Guaranteeing stable tariffs at a level which corresponds to the real costs of care;

Providing new ways of financing non-standard, emergency care, especially a complete episode of hospital care and, crucially, an annual allocation linked to activity in the hospital. This hospital-wide support would encourage professionals to organize more ambulatory care and develop aftercare by "telemedicine". An annual budget linked to activity would give doctors and paramedic teams some freedom of action while working with managers.

Maintaining in each unit a sufficient number of staff to guarantee safe and high quality care. Whenever it becomes necessary to reduce [rising] activity this should not entail an automatic suppression of posts.

Concentrating activity [on fewer hospitals] when this is relevant to the health needs of the regions concerned, while at the same time keeping the cohesion of the different medical specialties on different sites. François Hollande [past President of France] promised to abandon "T2A for every care". Emmanuel Macron [current President] has made the same promise. We MUST act now before it is too late!"


The first article:

This has never happened before. More than one thousand doctors and health service managers from all types of hospitals, local and University centres, all over France, have signed an appeal warning of the very serious situation in French hospitals, and taking aim at a system of finance, the "tarification by activity" ("T2A") in crisis and threatening the quality of care.

It is almost unprecedented for doctors and other medical personnel to rally to a single movement ["mobilisation"] with the same sense of urgency and fear, whereas under ordinary circumstances they are usually concerned with their own job and type of work. "2018 will be the year of danger and uncertainty" says an older union member. "The unions didn't start this, although they do fully support it". This letter, which is a petition, was drafted after the minister for health, Agnès Buzyn, gave an interview to Libération in December. She described without understatement the hospital crisis: " "We have come to the end of this phase and this system. With T2A the system was supposed to make public hospitals concentrate on profitable activities, believe that they are [profit-making] enterprises [...] We nearly made hospitals lose their compassion and sense of vocation by making teams believe that they should only do profitable business. Hospital teams were distressed by this sea change. And we have reached the logical end".

"Double speak"

Is T2A the mother of all evils? The hospital professionals have focused their anger on it. Invented more than 10 years ago, this system meant to finance hospitals according to their activities


Blind Councillor asks most searching questions: how NHS can close hospitals as NW London population "explodes"?

On 5th December I attended the NW London Joint Health Overview and Scrutiny Committee, chaired by Cllr Mel Collins from Hounslow. Mr Collins is nearly blind, but that doesn't stop him taking to task the Accountable Officer of the NW London STP, Clare Parker and her PR adviser, Christian Cubbitt! Councillors from Hammersmith, Westminster and Richmond (affected by NW London STP) took part and asked questions.

Cllr Collins chaired the meeting. And he didn't fail to give them, politely, a hard time. From the NHS Dr Susan Le Broy (a geriatrician), Clare Parker, Rob Larkin (AO for Brent, Harrow and Hillingdon) and Juliet Browne presented reports (here: http://ealing.cmis.uk.com/Ealing/Document.ashx?czJKcaeAi5tUFL1DTL2UE4zNRBcoShgo=dV4T9WtjFjixSaMFY5OQ7E%2bbDgs2vGpi2LVHdZOZFUaO0v6DQp5gWQ%3d%3d&rUzwRPf%2bZ3zd4E7Ikn8Lyw%3d%3d=pwRE6AGJFLDNlh225F5QMaQWCtPHwdhUfCZ%2fLUQzgA2uL5jNRG4jdQ%3d%3d&mCTIbCubSFfXsDGW9IXnlg%3d%3d=hFflUdN3100%3d&kCx1AnS9%2fpWZQ40DXFvdEw%3d%3d=hFflUdN3100%3d&uJovDxwdjMPoYv%2bAJvYtyA%3d%3d=ctNJFf55vVA%3d&FgPlIEJYlotS%2bYGoBi5olA%3d%3d=NHdURQburHA%3d&d9Qjj0ag1Pd993jsyOJqFvmyB7X0CSQK=ctNJFf55vVA%3d&WGewmoAfeNR9xqBux0r1Q8Za60lavYmz=ctNJFf55vVA%3d&WGewmoAfeNQ16B2MHuCpMRKZMwaG1PaO=ctNJFf55vVA%3d

Christian Cubbitt was sitting on a spectator's chair behind Ms Parker, but was noticed by Cllr Collins.

In particular Mr Collins wanted proper evidence, not anecdotal evidence from pilot studies ("Vanguards"), of what impact the reduction in acute beds and removal of services at Ealing Hospital (ca 500 beds) will have on the existing population of Ealing, Harrow, and Hounslow, including Brentford (his ward) - all these residents are currently referred to Ealing Hospital. The NHS management team concentrated in their papers on the plans for the over 65 year-olds, and for diabetes patients (papers were about how new care pathways would keep them out of hospital), but what about all the younger or other patients? Moreover there is a huge increase in population planned in Ealing and Hounslow: new developments are nearing completion, others have planning permission and when redevelopment along the "Golden Mile" along the A4 is completed there will be 10,000s more patients. Mr Collins wanted to know why there seemed to be NO provision for that increased population?! This increase will impact on Hillingdon and West Mid hospitals. "It's going to explode!" said Collins.

Clare Parker protested that her team had a different interpretation of "population growth" (!?)

Collins asked her to go away and consult with her own team, with London Ambulance Service and with officers from the Local Authorities concerned to consider (1) the impact of closing Ealing Hospital on the entire existing population, and (2) the impact on the future, much bigger population after completion of redevelopments in west London boroughs. He asked her to produce a report for the March JHOSC meeting (date to be confirmed).

Secondly, in August the Royal College of Nursing wrote a letter to Cllr Collins complaining of changes to skills and working patterns required by the STP which nurses had had no hand in shaping and were not consulted about: Mr Collins said that the response from the NHS team was too vague and didn't answer specific points raised. He said: "It is critically important to get nurses' concerns taken seriously, as they will be the ones implementing the changes". Ms Parker claimed that there had been consultation with Royal Colleges, but didn't say whether specifically with RCN. She claimed that there is a generic issue of pressure on staff which is very difficult to mitigate. The NHS needs to balance quality, finance and performance. The future conversation is on "long term sustainability". Collins said that he would draft a response to the RCN and send it to JHOSC members. Dr LeBroy wanted to respond to the letter point by point. This was not a satisfactory response.

Grave concern over plans to allow US-style bodies to operate in the NHS

From the BMJ website for Press Releases, 15th November 2017: "Grave concern" over plans to allow US-style bodies to operate in the NHS

Author contact:

Professor Allyson Pollock, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK

Tel: +44 (0)7976 978 304

Email: This email address is being protected from spambots. You need JavaScript enabled to view it..uk


“Grave concern” over plans to allow US-style bodies to operate in the NHS

Experts say Health Secretary must consult properly on this major change


It is of grave concern that there has been no public consultation on government plans to enable accountable care organisations (ACOs) to operate in England, say experts in The BMJ today.


ACOs were conceived in the US in an effort to improve care and reduce growing health care costs. They involve government and private insurers awarding large contracts to commercial providers to run and provide services.


When large groups of providers are given a lump sum to provide care, the theory is that they will provide care that is better coordinated and without the incentives for overtreatment or unnecessary treatment that exist with fee for service arrangements.


But Allyson Pollock and Peter Roderick at Newcastle University argue that ACOs represent “a major and deeply worrying reorganisation of health services,” including what the government refers to as a “dissolution of the boundaries” between health and social care.


If ACOs are allowed to operate, they warn that “multi-billion pound health and social care budgets, including GP and public health budgets, can be given to ACOs under commercial contracts for up to 10 or possibly 15 years.”


They point out that the Secretary of State for Health, Jeremy Hunt, has consulted on some technical changes which would define “ACOs” and enable them to operate under contract. “But so far, there has been no public consultation about whether the law and the NHS should undergo this major change.”


NHS England (NHSE) says it intends to consult on a standard model contract for ACOs in 2018. “But if Hunt’s changes are brought in before then, the legal framework would facilitate ACO contracts to be brought in before the public consultation,” they add.


Hunt’s consultation failed to address many issues, they write. For example, why ACOs are necessary to achieve the stated policy objectives, and why the powers already given by Parliament to integrate services are insufficient to achieve the policy objectives.


In addition, nothing was said about how the ACO would be prevented from walking away from the contract or the applicability of freedom of information and human rights laws, and whether ACOs would be amenable to judicial review.


“Introducing ACOs is so fundamental that the proper way to do so would be for the proposals and their justification to be set out openly and clearly, as in a White Paper, and to invite wide public and professional responses – including in Scotland and Wales where the impact of ACOs is entirely unknown,” argue the authors.


“It is of grave concern that this has not been done to date. It is still open to Jeremy Hunt to do so.”


Further details - such as the fact that ACOs have in some cases not even saved any money and may have actually INCREASED expenditure in the USA - and important references are in an earlier press release in the BMJ: Jeremy Hunt must consult properly on accountable care organisations