Mansfield slams NW London hospital plans: Brent Patient Voice responds with proposals and asks 'Why is the NHS silent?'

 From Brent Patient Voice

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Brent Patient Voice welcomes the findings of the Mansfield Report. BPV Chair, Robin Sharp, said: “We are pleased that Mansfield endorses the extensive evidence that we and many other independent people submitted. Why has the NHS greeted it with silence?”  

The Report of the Independent Healthcare Commission for North West London under Michael Mansfield QC was published on 2^nd December. It brings no comfort for the NHS chiefs in our area – and none for patients either.

The Report says that the Shaping a Healthier Future programme is “deeply flawed”. Launching the Report Michael Mansfield said that the planned reforms provide “no realistic prospect of achieving good quality accessible healthcare for all and any further implementation is likely to exacerbate a deteriorating situation.”

The Commission calls for the programme to be halted, for the decisions to close the A&E Department at Central Middlesex Hospital and the Maternity Unit at Ealing Hospital to be reversed, for the increasing size of the population in NW London to be properly established and factored into future planning, for the so-called “Implementation Business Case” to be published and for there to be a new public consultation on the plans which they believe to have changed significantly. They suggest that the local authorities should consider seeking judicial review if the NHS press ahead with the programme in current circumstances.

However we are deeply disappointed that neither the eminence of Michael Mansfield nor the extent of public concern revealed by the evidence have moved the NHS authorities responsible for Shaping a Healthier Future to be sensibly open about the current state of the programme or its likely costs.

Commenting further, Robin Sharp said “Our fundamental criticism of the whole initiative is that the NHS in NW London has broken its promise in the consultation document that out of hospital services will be in place before changes are made to hospital-based services. Two A&Es and one Maternity unit have closed. Where are the openings to take their place?”

In order to be constructive we propose:

·      That the NHS should publish an intelligible version of the Implementation Business Plan for Shaping as it now stands, with outline costs, as is normal for any major public project;

·      That full consideration of the future of Central Middlesex Hospital be resumed, including the option of restoring its acute status with a fully-functioning A&E, bearing in mind the inadequacy of a stand-alone Urgent Care Centre there and the continuing intolerable situation at Northwick Park;

·      That Council officers be instructed to work with GLA statisticians to provide reliable estimates of the size of the current Brent population and growth rates, taking account of births, deaths, net migration and planned major developments;

·      That in collaboration with all partners Brent CGG produce a clear account of their Out of Hospital Strategy, including the role of the new GP networks, to restore confidence in this vital missing element of the Shaping programme;

·      That full and meaningful patient consultation and involvement should be integral to all future consideration of these proposals.

Brent Patient Voice  5^th December 2015

Visit the Brent Patient Voice website HERE

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.

Navin Shah issues challenge on A&E pressures

From Navin Shah Labour Assembly Member for Brent and Harrow

New figures have revealed the increasing strain London’s Accident and Emergency departments are facing. The increased pressure on A&Es follows the closure of wards across the capital. In the past year 199,693 people were forced to wait more than four hours at an A&E in London, this is an increase of 18% on the previous year when 168,604 people waited more than four hours.

The local A&E unit at Central Middlesex Hospital in Brent now operates at reduced hours with more suspected cuts to follow. Northwick Park Hospital in Brent, which is on the boundary of Harrow is the nearest A&E unit that is open for a twenty-four hour service. This will put so much pressure on Northwick Park Hospital with people waiting much longer hours at the A&E Department. Both Central Middlesex Hospital and Northwick Park Hospital fall under North West London, which has seen 12,778 people wait more than four hours over the past year.

Overall, two A&E units in London have been closed, two are to be “downgraded”, three are set to be closed and a further three are under threat of closure. In the past year all but one of London’s Hospital Trusts with A&Es failed to meet the key waiting time target of 95% of patients seen with 4 hours. In 15 out of 22 trusts this target was missed for over half of the last year. Navin Shah, local Labour London Assembly Member, is calling on the Health Secretary to urgently review the situation, and for the Mayor to lobby government for the resources that London’s NHS needs.

Navin Shah, local Labour London Assembly Member, said:

We were told that closing A&Es wouldn’t lead to longer waiting times, but the evidence shows that Londoners are waiting longer to be seen. In the past 12 months nearly 200,000 people across London and 12,778 people in North West London have been forced to wait for more than four hours at A&E. These figures are a damning indictment of the failure to properly plan our NHS services. 15 out of 22 Hospital Trusts have failed to meet this key target.

Last year we all celebrated the NHS’ 65^th Birthday, one year on the government’s botched top down reorganisation is putting severe pressure on our local services. Continuing to either close or downgrade London’s A&Es will make the situation even worse. NHS staff work hard to look after us all when we are at our most vulnerable, but they need the resources to be able to deliver the service we all expect. Central Middlesex Hospital now operates an 11 hour A&E service, which adds further pressure to Northwick Park Hospital’s A&E service. I am deeply worried that following these A&E closures, waiting times will continue to be high and Londoners will continue to suffer as a result.

1.    Navin Shah is the Labour London Assembly Member for Brent and Harrow.

Figures for 2013/14 taken from here: http://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/weekly-ae-sitreps-2013-14/ and for 2012/13 from here: http://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/weekly-ae-sitreps-2012-13/

Rally and rhetoric at WL People's Assembly but strategy needed

Owen Jones gets into his stride (Photo: Simerjit Gill)

 

About 100 attended the Assembly (Photo: Simerjit Gill)

Last night's West London People's Assembly was certainly a lively affair with many passionate speeches but I was a little concerned when I saw the chair of the meeting and 5 speakers on the platform. There was some anxiety at the main People's Assembly at Central Hall that it would be more of a rally than an organising meeting. In the event it was a bit of both. I was concerned that this local assembly, covering Brent, Hammersmith  & Fulham and Ealing, would also be more of a rally, although surely that must be where we  analyse and prioritise  local issues and our strategy?

Although speakers were keen to say they would not just describe how awful things are it inevitably becomes the main theme topped off with rousing calls for action and unity. This certainly raises morale but doesn't get down to the nitty gritty. Advertising trains and coaches for the Tory Party demonstration on September 29th is important but what are the next steps in keeping our local A&Es open or fighting the privatisation of our schools? How relevant is it to organise across boroughs when local councils, even of the same political complexion, are dealing with the cuts in such different ways?

 Next month there will be a founding meeting of the West London People's Assembly where its structure will be decided and officers elected and perhaps these issues will be discussed then.

As a common issue across the boroughs, and of course a national issues, the future of the NHS was prominent in the speeches and contributions as was the general theme of the poor being made to pay for the bankers' crisis, and the demonising of the poor by politicians and media in an effort to divide and rule. The focus on the real human stories behind austerity made us both more angry and more determined.

It was good that the Campaign Against Climate Change shared the platform with UK Uncut, hospital campaigners and trade unionists. Suzanne Jeffrey for CaCC made some telling points comparing  the economic and climate crises.

She said government and bankers knew the system was a sham but pretended there was no problem  or indeed that they were creating the problem, and when the crisis broke blamed it on over spending in the public sector and making the poor pay. Government and industry similarly pretended  there was no problem with climate change, denying their role in creating and increasing the problem, and then shifted the responsibility on to ordinary people and their life styles, or even worse on to people in developing countries.

Having just returned from the Green Party it was interesting to note that many of the solutions that Owen Jones proposed in his summing up are in fact Green Party policy.

Gareth Thomas and Barry Gardiner press for Northwick Park expansion before A&E reconfiguration

From the parliamentary debate on A&E waiting times:

Stephen Pound (Ealing North, Labour)

I am grateful to my hon. Friend and neighbour for giving way. In view of what he has just said, does he think that the best possible prescription is that currently recommended by the Government whereby the existing A and E departments at Ealing, Park Royal, Hammersmith and Charing Cross all close? Does he think that will improve waiting times in A and E departments?

Gareth Thomas (Harrow West, Labour)

My hon. Friend, as ever, is ahead of me. He makes the perfectly reasonable point that if the Northwick Park and Central Middlesex A and E departments are not achieving the 95% target now, how can our constituents have any more confidence about reaching that target should the Central Middlesex and Ealing hospitals close?

Barry Gardiner (Brent North, Labour)

As my hon. Friend knows, Northwick Park is just in my constituency and we share that border. Does he agree that whatever the future configuration of hospitals in north-west London, it is absolutely essential that the A and E unit at Northwick Park is expanded to cope and that that should happen before any reconfiguration?
.....

Gareth Thomas (Harrow West, Labour)

I share the view of my neighbour and hon. Friend Barry Gardiner. We need that expansion to go ahead, and to go ahead soon.

Central Middx and Northwick Park A&Es overwhelmed

Campaigners lobby Sarah Teather over the closures

The Evening Standard today reports that  Maeve O'Callaghan-Harrington, head of emergency planning at NW London Hospitals Trust, emailed local GPs  last week advising them that the casualty units at Northwick Park and Central Middlesex  were full. 

Northwick Park had 19 patients waiting for beds and patients were also waiting for beds at Central Middlesex. Central Middlesex A&E is already closed overnight and would be closed completely under the 'Shaping a Healthier Future' proposals. Central Middlesex A&E patients will be expected to go to Northwick Park instead and that is also where patients from the Urgent Care Centre would be transferred if the UCC cannot treat them.

The Standard reports Andy Burnham, shadow health secretary as commenting:

As this email shows London A&Es are struggling as it is and it is not at all clear how the Government can close so many without putting lives at risk. The planned closures in northwest London look drastic and the onus is on the NHS and the Government to provide clinical evidence for how they can be justified.

Local NHS campaigners have repeatedly drawn attention to the pressures on Northwick Park even before the closure of Central Middlesex A&E  and the absence of any kind of risk assessment on the possible repercussions for the safety of patients if the closure takes place.

Don't let the ConDems make a casualty of our NHS

Hospital campaigners from Brent, Hammersmith and Fulham and Ealing converged on the NW London NHS headquarters in central London today to hand in petitions containing thousands of names opposing the closure of A&Es across West London. Some campaigners wore bandages to dramatise the threat to local people.

The consultation on Shaping a Healthier Future ends at midnight tonight. www.healthiernorthwestlondon.nhs.uk  for the online consultation form  or e-mail to consultation@nw.london.nhs.uk

Debate NHS changes in Stonebridge tonight

Dr Mark Spencer, proponent of 'Shaping a Healthier Future' will be debating with Graham Durham, of the Brent Patients Association, an opponent of the plans,  at this meeting tonight.

Trolley queues at over-stretched Northwick Park A&E

Brent Green Party member, Pete Murry, was recently admitted to Northwick  Park Accident and Emergency ward. In the following Guest Blog Pete reflects on his experience which raises issues of concern for what the future holds if Central Middlesex and several other neighbouring A&Es close.

At about 7.30 pm on Monday 9^th July 2012, I was told by a member of the STARRS District Nurses, (based at Central Middlesex Hospital), that based on my blood tests, STARRS and my GP had decided to have me hospitalised by ambulance. I assume that this was because my mobility was very restricted at the time and that this was the quickest way to get me to hospital.

The ambulance arrived at my house in Dollis Hill at about 8pm.  I asked the ambulance crew if I would be going to Central Middlesex Hospital, as this was where I had gone when I had been hospitalised previously. I was told I could not go there as the Accident and Emergency Department CMH closed at 8.30pm. It was therefore decided to take me to Northwick Park Hospital in Harrow.

The ambulance arrived at Northwick Park Accident and Emergency at about 9pm. I was wheeled into the hospital lying prone on a stretcher accompanied by two ambulance men, the three of us immediately joined a queue of other potential A and E patients on stretchers or wheelchairs, each also accompanied by ambulance crews and sometimes also by friends and/or relatives. As far as I could make out in the queue in front of me consisted of about six or seven patients and others were frequently joining the queue after me.

I don’t recall any of the other patients in the queue shouting out, crying or giving any indication of being in great distress, so I have no idea if there was any procedure for emergencies to go to the front of the queue. If such procedure existed it would have made the wait of the “more routine” patients longer.

The restriction that was causing the queue seemed to be the number of available curtained –off A&E treatment areas available, until one became vacant, patients had to queue. When an earlier a patient was moved out of one of these treatment areas, a patient from the queue could be moved into it and also then be formally transferred from the care of the ambulance crew into that of the A and E Department.

I don’t know, but I assume that as well as arriving at Northwick Park A and E by ambulance, potential patients may have been arriving by other means.

By about 9.55pm, I was at the head of the queue, at this stage the member of A and E personnel in charge of handover ‘re-designated’ two Gynaecology rooms as being empty spaces available for A and E admissions.  I was wheeled into one of these rooms by about 9.58pm.

The ambulance crew who had had charge of me until then explained that if a patient was logged as waiting for one hour, this became logged as an “incident”, which apparently meant extra paperwork for both the ambulance crew and the A and E staff.

Within about 15 minutes I was moved from the Gynaecology room to one of the curtained –off A and ;E treatment areas and the use of the Gynaecology rooms seems to have been a temporary ad-hoc measure to deal with the queues of ambulance patients, but it was taking place at 9pm on a Monday night when there were no adverse conditions or unusual events adding to the number of potential A and E admissions.

After my wait in the queue, I was not fully tested and assessed in A and E and transferred to a ward until about 2am, but I think I was dealt with as promptly as possible by the A nd E staff. My concern is how much of the initial wait before I was assessed by Aand E was due to Northwick Park A and E having to deal with extra cases such as mine who might otherwise have gone to Central Middlesex Hospital.

 

It seems that the run down of Accident and Emergency  facilities at CMH, (let alone their total closure), may displace demand onto other facilities which may not have the capacity to deal with them promptly. Further more the reduction or closure of CMH Accident and Emergency  a ‘self-fulfilling prophecy’ in regard to ambulance admissions, because ambulance patients have to go where they are taken, which may not necessarily be the nearest or best source of treatment.

If an ambulance can’t take a patient to a closed facility does this show a lack of demand for the facility that has been closed?