Sunday 29 March 2015

Notes from the Mansfield Enquiry

Guest blog by Peter Latham

On Saturday 28 March 2015 I went to Hounslow Civic Centre for the morning half of the NW London local authorities' Mansfield enquiry hearings into the impact of the NW London NHS 'Shaping a Healthier Future' project on healthcare for patients in NW London.
The main new thing I learnt was that the enquiry secretary Peter Smith told me that all the Clinical Commissioning Group and hospital trust NHS witnesses have declined to attend to give evidence until after all the 5 volumes of written evidence have been disclosed by the enquiry online next week. So any Clinical Commissioning Group or Healthcare Trust witnesses will be only be cross-examined at Brent Civic Centre on 9 May - after the General Election. 
Counsel to the enquiry is the barrister Katy Rensten instructed by a solicitors Birnberg Pierce.  She asked very easy leading questions for all witnesses critical of the Shaping a Healthier Future project.  There was no-one to cross-examine witnesses critical of the 'Shaping a Healthier Future' project.
The chairman of the enquiry Michael Mansfield QC asked a few well focused questions to each witness.   The other panel members are a retired Ealing GP Dr Stephen Hirst MBBS London 1974, and Dr John Lister (non-medical PhD) who is is a journalist academic with strong links to the National Union of Journalists and prominent in the pressure group 'Save Our NHS'.
It was clear from the panel questions that they are very interested in the same topics that the Brent CCG locality Patient Participation Group chairs criticise:
  • weaknesses of the evidence for the original case for the 'Shaping a Healthier Future' project; 
  • the failure to put in place the proposed community services to take the strain before the acute A/E departments were closed on 10.9.14;
  • the lack of clarity for the public as to the demarcation between Urgent Care Centres and acute A/E;
  •  the flimsy basis for the attempted implementation of the Shaping a Healthier Future projects with insufficient tendering procedure know-how.
It became clear to me that the panel and even some of the professional witnesses are not fully familiar with the full range of new NHS structures e.g. no-one was able to say where the funding for the Better Care Fund comes from - although it was thought that it involves no new money.  There appeared to be ignorance as to how limited the first tranche of implementation of Whole Systems Integrated Care is to be: in Brent just over 65s with at least one long term condition.

It became clear to me that some of the witnesses are failing to distinguish 2 quite separate issues: the political controversy over privatisation of NHS services, and the separate clinical and financial efficiency issue as to the merits of transferring more NHS out-patient services from the secondary hospitals into a community primary care setting.  This was particularly true of Professor Allyson Pollock of Queen Mary College who made a  very emotive politicised statement about destruction of the NHS by importing US style commercial privatisation.

The witness Hounslow Councillor Melvin Collins chair of NW London Joint Health Overview and Scrutiny Committee (JHOSC) was very critical of the NW London and CCGs long-standing secretiveness towards them with failure to provide requested information which he said made their work ineffective e.g. at a meeting on about 23 March Dr Mark Spencer had made it clear they would only get the business case for Whole Systems Integrated Care after the general election.

The 2 witnesses from Hounslow Council, their leader Steve Curran and cabinet member for Health and Adult Social Care Lily Bath, emphasised the shortcomings of their local CCG over SaHF and WSIC, but understandably had no criticisms of the local authority component of local health and social care other than emphasising their insufficient funding.

Consultant in Emergency Medicine Dr Julian Redhead, Chair of the Royal College of Emergency Medicine London Regional Board and with Imperial College and St Marys emergency trauma unit emphasised the shortage of appropriately qualified and experienced A/E staff as driving the need for centralisation of acute A/E services, and the need for a sufficient patient base to support specialist skills.  He gave rather vague oral evidence about the NHSE/Monitor 2009 patient base A/E funding cap with 30% funding disincentive for excess patients, and suggested that the whole way in which we pay for emergency medicine needs to be reformed: without making any specific suggestion in his oral evidence.

Medical practitioner Professor Allyson Pollock emphasised the transformation resulting from the repeal of sections 1 and 3 of the NHS Act 2006 by the Health and Social Care Act 2012 with the result that the Secretary for State no longer has a statutory duty to 'provide' health care  for the people of England, but only a duty to 'promote' such healthcare.  The duty transferred to the NHS Commissioning Board and local CCGs is only to meet the reasonable requirements of their population.  Public health has been carved out of CCGs and transferred to local authorities.  GP practices no longer have a specific territory.  She contended that we no longer have a National Health Service.  The present government are keen on the prime provider model which encourages sub-contracting so that we are importing US solutions and US problems.  Services are already falling away when specific services are not not specifically includedin contracts.  We are moving to the over-treatment and under-treatment of the over-expensive commercial insurance company US model whose algorithms focus on profitable premium fixing with no local accountability or local link.   She strongly proposed abolishing Foundation Trusts and the NHS internal market.  

The chairman of the enquiry Michael Mansfield QC asked Professor Pollock whether she had researched the vested interests of members of the House of Commons and House of Lords who had spoken in favour of the model of the 2012 Act.  She said that she had not researched this but that many did have such vested interests e.g. Alan Milburn.  She said that the last leader of the NHS had described it as being in 'managed decline'.

Peter Latham,  Chairman Willesden Patient Participation Group.

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