Hydrotherapy Pool staff were told not to speak to patients about closure plans collective grievance reveals - HEART principles contradicted

 

 The Trust's HEART principles explained

 

Staff at Northwest London University Hospitals Trust have lodged a collective formal grievance against the management over the closure of the Hydrotherapy Pool at Northwick Park Hospital. The grievance claims that the Trust did not follow its own HEART principles (Honesty, Equity, Accountability, Respect and Teamwork).

 

They believe the Trust failed to be truthful and open having instructed staff to not tell patients about the closure contrary to the Duty of Candour. That failure to properly inform patients and stakeholders worsened the situation when patients asked for information and had to be refused even when there was highly visible campaigning about the closure and an online petition.

 

 The Trust's determination to close the facility regardless was revealed in a letter to Barry Gardiner MP from Pippa Nightingale the Trust CEO. Confirming the closure, a month later than planned, on August 30th she wrote (my emphasis):

 

 We are engaging with our Patient and Carer Participation Group about the pool closure and will take into consideration any concerns that are raised through that forum. While this discussion will not impact upon the decision, it may affect the way in which we manage or communicate the change.

 

Part of that communication is to inform patients about other local hydrotherapy providers including the Royal National Orthopaedic Hospital. Nightingale claims this is a larger facility with accessible steps and a hoist.

 

Staff respond:

 

RNOH does have a hydrotherapy pool, but it does not provide instructor led classes for self-funders, the capacity required to take any further patients and lacks the required transport network for patients. It is not in a position to provide similar services to those provided at NPH. The statement that the Trust may develop partnerships with public/private pools is vague and ignores the established fact that these pools are not at the required temperature for patients with disabilities.

 

Current charges for self-funded classes are double the price at RNOH compared to Northwick Park. The department recognizes the higher than average poverty levels in Brent and the large number of patients on low incomes in Harrow and have consistently reviewed their pricing strategy in order to keep it financially sustainable for the Trust whilst still affordable for the communities it serves. 

 

Our own discussions with RNOH indicate they are not in a position to increase their capacity to take on more patients and are not able to offer classes on the scale that NPH currently does.

 

The grievance notes:

 

Local authorities have the right to scrutinise NHS service changes. If a local authority deems a proposed change to be substantial, it can require a formal consultation.

 

The leader of Brent Council has expressed concern about the closure and the fact that the Council were not made aware, nor patients consulted.  We are unaware of any opportunities that the local councils, GPs or patient groups have had to review and scrutinise the proposals to close the pool.

 

The grievance challenges key aspects of the Trust's case on finance as well as the Equality Impact Assessment and Health Inequalities Assessment:

 

The QEIA labels gender and religion impacts as “neutral”, despite the closure disproportionately affects women, including the only women-only hydrotherapy sessions in the area—essential for cultural and religious inclusivity. This overlooks clear equity implications and may not be compliant with the Equality Act 2010.

 

The grievance document concludes:

 

Conclusions

As already demonstrated above, the Trust’s actions to date have repeatedly shown little or no adherence to the Trust’s own values of Honesty, Equity, Accountability, Respect and Teamwork.

Of particular importance is the lack of honesty in communicating with the public, the unequitable treatment of patients with disabilities for whom hydrotherapy may represent their only safe and effective form of exercise, the lack of accountability of the executive team when invited to discuss the proposed changes, the lack of respect demonstrated to patients, staff and local communities and a complete lack of teamwork in regard to finding a workable resolution.

Whilst we understand the difficult financial position that the Trust is in and appreciate that difficult decisions must be made, we believe there is no apparent immediate or longer-term financial gain from this action. Even if there were any financial gains these should not, in keeping with the ethos of the Francis Report, be placed at greater importance than the long-term health of our patients.

We recognise that the Trust needs to increase activity in key areas like cardiology but there is no evidence that closing the hydrotherapy pool will improve activity in these areas. Contrary, evidence would suggest that closing a major provider of exercise opportunities to those at higher risk of cardiovascular disease (such as older patients and those with rheumatological conditions) would increase the overall strain on those services.

The Government’s 10-year plan emphasizes the importance of physical activity and seeks to integrate it into the lives of individuals, particularly in areas with high levels of health inequality. The self-funded classes delivered in hydro offer a perfect example of what this means in practice delivering high quality care to the community to assist patients with chronic conditions manage their health independently.

Although we accept that within that 10-year period it may be preferable for similar services to be offered in the community, such services do not currently exist and to withdraw the services currently offered without mitigating against this appears to be a breach to the Trust’s duty of care to its communities.

In summary, we are seeking:

That the hydrotherapy service is maintained as is, until an evidence-based review is undertaken, with financial transparency and relevant clinical input. This will involve physiotherapy team managers, consultants, and patient representatives, and if needed should be able to investigate alternative models to keep the service open - while not compromising the essential reform needing to be undertaken elsewhere in the trust.

That the Trust recognises that it has acted in a way that contradicts Trust values, damages trust from staff and patients, and demanded that staff act in a way that we perceive as in conflict with the HCPC standards that we are required to abide by. We want to see a commitment to do better – and an apology to affected patients.

 

LINK TO THE PETITION AGAINST CLOSURE