NHS Estates siphoning of £2 million a year from Brent health and care budget

Willesden Centre for Health and Care

NHS England policy that health organisations should pay market rent for NHS Property means that Brent Clinical Commissioning Group is paying £2 million annually for spaces (voids) that are not being used, Cllr Nerva established at the Community and Wellbeing Scrutiny Committee on Wednesday.

The Willesden Centre, built under the Private Finance Initiative costs £6.5 million a year with a void of £1m and other property voids gives a total of £2m. PFI costs were higher with additional ad hoc charges.

Monks Park is a joint local authority - NHS PFI initiative and the rents have been too high for most user organisations.

It is of course banks and shadowy investment trusts that profit from PFIs. LINK 
 LINK   LINK

Source

Earlier this year, following the release of the Panama Papers it was revealed that Chris Hudson, a property developer and the owner of 100,000 British homes, helped finance the building of the Willesden Centre for Health and Care in a Public Private Partnership deal. He set up the Yarrow foundation in Panama, which records show transferred €85,000 into his personal account and made available €115,000 to buy a Boeing 747 jumbo jet.

The Brent Clinical Commissioning Group (CCG) has to pay the market rent for the spaces whether or not they are occupied.  This is money that could otherwise contribute to the health and care budget.  The CCG is attempting to gather all out of hospital services in one of three centres. Some hospital services were over crowded and could use any spaces released spaces on their sites.

Councillors were told that NHS Estate advisers were experts in their field:

Health estate is a market of its own own. Our advisers are expert at health provision. They may be more expensive than other properties and not economically viable for general office space, but there are benefits of proximity to other health users.

When a councillor asked why the CCG should pay for space it wasn't using Sarah Mansuralli, Chief Operating Officer of the CCG replied, 'You may well ask - but that is the policy.'

Cllr Lesley Jones asked if there was any discretion over voluntary organisations having to pay market rents, giving the example of Brent Carers forced out of the Wembley Centre by higher rents.
Mansuralli said she would like to support voluntary organisations but it was difficult to have space occupied by a voluntary organisation that even with a subsidy would not be able to afford the rent. The CCG could not subsidise fully and also close the financial void.  She was willing to look to see whether some space could be used on a sessional basis, when other users were not using it.

Mansuralli added that Brent CVS were working with voluntary organisations to help them develop the capacity to afford the rents.

The practical impact of this can be seen in the case of Brent Advocacy Concerns LINK who have sent me this email about their situation:

I attended the meeting with our NHS landlords last Tuesday and received a 'fair hearing' but they only told us what we already knew.  That at some point in the future we will be sent the rent and service charges that we will have to pay to stay in our office.  The manager present said that her 'pay scale' did not allow her to make the final decision on our situation.

I just had a phone conversation with a disabled lady from Brent.  She needed face to face advice to help her with filling out her PIP FORMS. She had tried the council first at the Civic Centre in Brent who could not help her and they sent her to Brent CAB, who after a whole morning could not help her either and they gave her our number.  I offered to help her if she could come to our office this afternoon but she wanted an appointment for next week which I could not offer her, as my own health issues might cause me to miss it.  I then told her to try Brent Age UK but she had already tried them without success.

So my question is, where in Brent can she get face to face advice, as she told me she has both physical and mental health issues?

It is clear that voluntary organisations provide an essential service, that in the long term saves the NHS money, but the operation of 'the market' means that they cannot be accommodated in NHS or local authority property due to the monetisation of these estates.

Given these examples the Scrutiny Committee's recommendation that the  'social value' of organisations should be taken into account when filling voids will appear to have little traction.

Cllr Rita Conneely  asked about joint working between the regeneration and planning teams and health.  She was told that the council's strategy and the local development framework explored section 106 opportunities regarding local health care.

Conneely said that some developments had been ear-marked for primary health use and then were not occupied by them. This had been a contractual agreement with developers and so we ended up losing valuable community space.  She was told that the CCG was aware that this had been the case in the past with the primary care estate. These had been small spaces but larger spaces were needed to deliver at scale and thus be sustainable.

Conneely pursued this issue stating that the NHS Estates document had not designated South Kilburn a growth area despite its regeneration. The original idea was that young families would move in but rents were so high that they were not available for starter families.  Sarah Mansuralli answered that plans were made around 'units' and health impact studies for each area using Wembley growth as a model.

The Committee recommended that the needs of South Kilburn as a growth area should be factored into plans.

Cllr Hector raised doubts about the population data that was being used which apparently showed a decline in the population of Willesden and appeared to neglect the fringes of the borough. She was told that GLA data was used but it did not cover everything. Cllr Conneely asked if the CCG was looking at concentrations of older people in particular parts of the borough.  he was told that this was not easy because there was a diversity of population and age groups within single area. There was an annual review of GP surgery provision in terms of population growth.

The Committee Chair, Councillor Ketan Sheth, asked why three hubs had been chosen.  He was told that this was based on existing estates that could be expanded. Sarah Mansurali had spoken with Carolyn Downs, Brent CEO, about why Brent had three when some other boroughs have one, and others have five. There would be a review to see if this was appropriate.

The Committee recommended that much clearer consultation procedures on the use of NHS Estates should be adopted.

Early warning: During the meeting Cllr Hirani, Cabinet lead member for Community Wellbeing, seemed quite happy at the prospect of building on the Vale Farm playing fields when discussing the One Estate (combination of Council and NHS estates) strategy. Watch out!

A 2013 Panorama on PFIs as a scam can be found HERE

Health Partners Forum on Wednesday will discuss Brent STP

The STP is going to NHS England on Friday!

Are Brent residents adequately represented on STP proposals?

From 'Shaping a Healthier Future' to the 'North West London Sustainability and Transformation Plan' it is often hard to cut through the public relations and jargon to see precisely what is in store for the future of NHS services in our borough.

It is also hard to see who is representing our interests and how they are doing so.

Tomorrow morning the North West London Joint Health Overview and Scrutiny Committee LINK will be meeting at Ealing Town Hall. Our representatives are Cllr Ketan Sheth and Cllr Barbara Pitruzzella. Later tomorrow at 3pm Cllr Sheth is scheduled to have a scrutiny discussion with the the public at Costa in Central Square Wembley.  The Sustainability and Transformation Plan (STP) is not on the agenda of topics (see posting below).

Tomorrow's NW London Joint Health and Overview and Scrutiny Committee will be finalising the draft for the STP submission to NHS England a week later on October 21st.

Cllr Matt Kelcher, then our representative as Chair of the single Brent Scrutiny Committee,  sent his apologies to the last meeting in May, despite it being held at Brent Civic Centre.

The leaders of Ealing and Hammersmith and Fulham Councils have refused to  endorse the STP due to concerns over the future of Ealing and Charing Cross Hospitals. No reservations are recorded from Brent Council LINK


 
There are no elected Brent representatives on the Joint Health and Care Transformation Group. Dr Ethie Kong from the Brent Clinical Commissioning Group and Carolyn Downs, Brent Council CEO are members:

To its credit Brent Patient Voice  has raised issues about the STP and their concerns are clear in this August 2016 letter to the Guardian which unfortunately was not published:

We in Brent Patient Voice are pleased that the Guardian, 38 Degrees and the BBC have at last caught up with the huge threat to the NHS represented by the Sustainability and Transformation Plan (STP) process. In fact the NW London STP of 30 June has been in the public domain since 5 August and signposted on our website www.bpv.org.uk . We have been posting stories about this semi-secret initiative since the end of May, including an earlier version of the Plan submitted in April. Despite what spokespersons for the NHS are saying today, the NW London STP has not been prepared by clinicians or councillors, but by NHS and local government officials without any public debate. There are no clear proposals for consultation or public meetings arranged.
 
While today’s reports focus on the potential for hospital closures, these are essentially the highly controversial proposals issued in 2012 and misnamed Shaping a Healthier Future. So far these have been implemented by the closure of A&E Departments at Hammersmith and Central Middlesex Hospitals and the Ealing Maternity Department. As a result A&E waits at both St Mary’s Paddington and Northwick Park Hospitals are among the worst in the country and acute beds are under enormous pressure. This is the context for STP proposals to remove 592 acute beds which was mentioned in an early summary but has now been expurgated for fear of frightening the horses.

However what is new and barely understood at all by the public or even the GPs who will be at the heart of it is the “transformation” aspect of the STP. GPs are being paid to form themselves into legal companies called “federations” in order to be awarded (with other providers) single contracts to provide all primary services in, say, a borough. The jargon title for this concept, Accountable Care Providers, comes straight out of the American healthcare system textbook but it is completely untested at the scale envisaged in the STP. Ordinary GPs who can barely cope with patient demand for routine care have no idea what it is all about. Is not NHS chief Simon Stevens intelligent enough to see that such a major upheaval, even if justified (which we doubt), cannot be implemented safely and produce savings in the space of two years?

Robin Sharp CB, Chair Brent Patient Voice

'Transformation' of health & care in Brent - Public Meeting

From Brent NHS Clinical Commissioning Group

You are invited to a public meeting and workshop to discuss our plan to transform your health and care system. The five year plan is a collaboration between Brent CCG, Brent Council and NHS providers in the borough.

This event will take place on Monday 26 September from 6.30pm at Brent Civic Centre, Engineers Way, Wembley, HA9 0FJ

Last year the government outlined a new approach to help ensure that health and care services were built around the needs of local populations. To do this, every health and care system in England was asked to produce a multi-year plan.

To develop and deliver plans locally, 44 'footprint' areas throughout the country were established. Brent sits within the North West London (NWL) footprint which is being coordinated by the NWL group of Clinical Commissioning Groups (CCGs). The plans are being developed in partnership with the eight Local Authorities and NHS providers in the area.

Cllr Krupesh Hirani, Cabinet Member for Community Wellbeing said:

Residents' opinions' are absolutely key to the successful development and delivery of Brent's plan, especially in delivering the long-term outcomes we want to achieve for our patients and the wider public. The development of future services that will better enable this vision to become a reality will rely on strong and consistent patient and public engagement throughout the process.

In order to hear your views, we encourage you to come along to the event on Monday 26 September.

Dr Ethie Kong, Chair of Brent CCG said:

Join our conversation in making health services work in a sustainable and efficient way across the borough. We are committed to an NHS that fits residents' needs, so come along and tell us what you think of the work we have done so far. We look forward to working with the patient and public to continue to shape our health strategy over the coming years. 

  Register your interest HERE

Reprieve for Brent sickle cell project

Photo: Kilburn Times

Previous articles on Wembley Matters drew attention to the possible closure of the Brent Sickle Cell project LINK LINK.  The Brent Clinical Commissioning Group met yesterday and heard representaions on the issue. In this guest blog, written in a personal capacity, Nan Tewari reports on the outcome.

An Appeal - There is long-term condition called ‘failure to listen to the public’ that has infected the statutory sector. This long-term condition needs a long-term view and massive reserves of determination to overcome its more deleterious effects. Your time and your determination will help find a cure. Please (continue to) give generously…...

In a real instance of ‘you said, we did’, Brent CCG (clinical commissioning group) listened to patient and public representations and granted a short reprieve for the BSCASS (Brent Sickle Cell Advisory Support Service) project hosted by the Sickle Cell Society.

Brent Patient Voice (bpv.org.uk) has been very concerned about the real danger of existing users and those in the pipeline being left ‘high and dry’ if the CCG were to have gone ahead and closed the BSCASS project without an adequate, culturally specific, alternative being put in place. BPV has been in extended correspondence with the CCG solicitors DAC Beachcroft in the matter.

Brent CVS will be hosting a focus group on Thursday 15 September from 1 p.m. to 3 p.m. at their offices in Wembley Park (no change of heart on time or venue, unfortunately!). I would encourage anyone with the sickle cell condition or with experience of the condition or in a risk category, to attend and contribute to the discussion.

This will be followed by a meeting between Brent CCG and Brent council’s chair of Health and Well-Being, Cllr Krupesh Hirani on 20^th September.

Brent CCG has pledged to continue the existing BSCASS project until the outcome of the two meetings. The CCG has also said it will give 3 months’ notice of decommissioning to the project which had previously been lacking.

I am hoping the outcome will be one that establishes a sensible, alternative plan. This will need to satisfy the CCG’s concerns over duplication of spending whilst equally satisfying the need for a culturally sensitive support service that can raise awareness in the wider health and care sectors, e.g. GPs, social services and voluntary sector providers, of how people can be assisted to minimise sickle cell crises and avoid hospital admissions.

The huge effort put in by Brent Patient Voice and the weight of public opinion on this blog in the Brent and Kilburn Times on Facebook and on Twitter, has paid off.

Notably, Barry Gardiner, MP for Brent North and Dawn Butler, MP for Brent Central each made strong, written representations to Brent CCG on the matter when BPV raised it with them.

My personal thanks to Martin Francis, Philip Grant, Ann O’Neill (Brent Mencap) Lorraine King (Brent and Kilburn Times) Harlesden Methodist Church and not least, to my colleagues in Brent Patient Voice.

Barry Gardiner's letter is HERE

Find out about the new Call 111 service (non-emergency NHS phone line)

From Brent Clinical Commissioning Group

We are ready to update local people on our plans for a new NHS 111 service in the borough. We would like to invite local people to a public event where we can set out how the new system is going to work across North West London and get your views about our plans.

This event is part of a series of events North West London CCGs have held to develop the specification for the new service and find out how the service should be accessed by patients.

14 June (5pm - 9pm)

Sattavis Patidar Centre

Forty Avenue, (Junction with The Avenue)

Wembley Park,

Middlesex,

HA9 9PE.

Book  your place HERE

Brent CCG A&E Ad ruled misleading and potentially harmful in victory for Brent Patient Voice

Congratulations to Brent Patient Voice in succeeding with their complaint to the Advertising Standards Authority regarding Brent Clinical Commissioning Group's poster telling residents to use A & E only for 'life threatening emergencies':

This is the full finding:

Ad

A poster and claims on the advertiser's website www.rightcare4u.org.uk, seen on 5 October 2015:

a. The poster stated "For emergency use only ... A&E is for life-threatening emergencies only ... Other NHS services are available that will help you more quickly. For more information visit: www.rightcare4u.org.uk".

B. The website stated "For emergency use only ... A&E is for life-threatening emergencies only ... If you use A&E when you could get help somewhere else, you are taking NHS staff time away from life-threatening cases. Other NHS services are available that will help you more quickly ...".

Issue

Brent Patient Voice challenged whether the claim "A&E is for life-threatening emergencies only" was misleading and potentially harmful, because patients with serious medical conditions/injuries that were not necessarily life-threatening may be wrongly discouraged from going immediately to their nearest hospital A&E.

CAP Code (Edition 12)

1.33.13.3

Response

Department of Health trading as Brent Clinical Commissioning Group (BCCG) explained that the ads focused specifically on diverting unnecessary cases away from local A&E departments to more appropriate settings, such as Urgent Care Centres and Minor Injuries Units. They said the primary aim of the ads was patient safety. They had based the core message on nationally available NHS information, in particular the NHS Choices website. They provided an extract from that website which listed some examples of life-threatening emergencies and included loss of consciousness, persistent severe chest pain, breathing difficulties and severe bleeding that could not be stopped.

BCCG said that in contrast to A&E departments, Urgent Care Centres could treat sprains and strains, broken bones, wound infections, minor burns and scalds, minor head injuries, insect and animal bites, minor eye injuries and injuries to the back, shoulder and chest.

BCCG said they had received clinical approval for the campaign. They accepted that there may be a few exceptions, for example, the ones cited by Brent Patient Voice, regarding some specific situations which might require A&E treatment in non-life-threatening situations. They said that was why there were well-established protocols in place in order to safely refer all patients requiring A&E treatment who presented at Urgent Care Centres. They believed the question was one of risk and, in the case of the ad campaign, communicating clearly to a whole patient population about the appropriate use of A&E overall, given the potentially serious and significant impact on those patients who genuinely required A&E treatment by those patients who would be better off (both for themselves and others) reporting to non-A&E services. They said it was important to emphasise that it was not their intention to present misleading information. They were seeking to educate people who might consider going to A&E for situations which were non-life-threatening and who could be treated more appropriately elsewhere.

They offered to remove the word "only" from the claim, in order to provide for those few situations which might require A&E treatment for non-life-threatening emergencies in the context of the A&E service overall being for life-threatening situations, as set out on the NHS Choices website. They believed their amendment was a reasonable and proportionate response to the complaint.

Assessment

Upheld

The ASA understood from Brent Patient Voice and BCCG that there were certain medical conditions and injuries that were not life-threatening but nevertheless required treatment in A&E, for example, some broken bones (e.g. ankle), facial injury requiring maxilla-facial surgery, saddle paraesthesia and serious eye injuries. We understood that those conditions and injuries could not be treated in Urgent Care Centres or Minor Injuries Units. We acknowledged that the intention behind the ad campaign was to encourage the appropriate use of A&E services, so as to ensure the proper allocation of NHS resources and patient safety, and was not to deter individuals from accessing A&E services if they genuinely required them. However, we noted that the claim "A&E is for life-threatening emergencies only" was an absolute claim, even though there were exceptions, and we were concerned that individuals presenting with the conditions listed above might be deterred from seeking urgent treatment at A&E as a result of seeing the ads. We considered that the amended claim, which omitted the word "only", did not resolve the complaint because there were certain conditions and injuries that were not life-threatening but which nevertheless required treatment in A&E. For those reasons, we concluded that the claim "A&E is for life-threatening emergencies only" was misleading and potentially harmful.

The ads breached CAP Code (Edition 12) rules 1.3 (Social responsibility), 3.1 and 3.3 (Misleading advertising).

Action

The ads must not appear again in their current form. We told Brent Clinical Commissioning Group to take care not to inadvertently make misleading and potentially harmful claims about the scope of A&E services in future.

Brent hospital proposals must come under intense scrutiny on Thursday

Days after NHS England announced an inquiry into why waiting times at Ealing Hospital and Northwick Park A&Es have the longest waiting times in the country, LINK, Brent's Scrutiny Committee on Thursday will be examining several important aspects of local health care.

Representatives of the North west London NHS Hospital Trust will be questioned about progress on the recommendations of the Care Quality Commission's (CQC) critical  report on Northwick Park Hospital.

The report LINK sets out the issues to be examined clearly:

CQC made specific recommendations for improvement at Northwick Park Hospital concerning A&E and related services. These are set out below:-

• Ensure that there are appropriate numbers of staff to meet the needs of patients in the A&E department, surgical areas and critical care.

• Ensure that there are systems in place to assess and monitor the quality of services provided in A&E, critical care, surgery and maternity to ensure that services are safe and benchmarked against national standards.

•Review the coping strategies within A&E during periods of excessive demand for services.

•Empower senior staff to make changes to ensure that patients are safe in A&E in maternity.

•Review discharge arrangements in A&E and critical care to avoid re-admission to these areas.

Given the significant number of areas requiring improvement in the current A&E provision at Northwick Park Hospital reassurance is sought from the senior management concerning implementation of actions and the safety of the A&E services available to Brent residents.

Another area to be examined is the proposals from Shaping a Healthier Future and Brent NHS to close maternity and other associated services at Ealing Hospital. 

The committee is recommended to question representatives of the Brent Clinical Commissioning Group on:-

•the robustness of their modelling assumptions and assurance plan;

•the timescale for their implementation; and

•what contingency plans are in place in case any of the proposals turn out not to be possible or feasible

A puzzling aspect of the report LINK is the timing. This meeting is on November 26th and it looks as if key decisions on this issue are actually to be made by the CCGs on the same day:

The next stage of reconfiguration is the changes to maternity services and the inter dependent services at Ealing Hospital. Brent Clinical Commissioning Group is due to make a decision on delegating the decision on timing to Ealing Clinical Commissioning Group, along with the other CCGs across North West London, on 26thNovember 2014. Ealing Clinical Commissioning Group is due to make a decision on the timings of changes to maternity services, and the interdependent services at Ealing Hospital on 26^th November 2014.

One can only wonder if what the Scrutiny Committee thinks will have any impact given this timetable.

The report's authors reach a soothing conclusion:

The impact on Brent residents and NHS services of changes to maternity and inter-dependent services at Ealing Hospital is not expected to be significant. Local services have the capacity to receive additional activity from Ealing without causing a negative impact on accessibility for Brent residents

The final health report to be considered is on the future use of the Central Middlesex Hospital site LINK. Current proposals are:

•An elective orthopaedic centre.

•Mental Health inpatient facility relocated from the site at Park Royal.

•A GP and primary care ‘hub’.

•A Genetics laboratory relocated from Northwick Park Hospital.

•Relocation of rehabilitation beds currently at Willesden.

This is a crowded agenda with lots of 'suits' from Brent NHS Health, the Clinical Commissioning Group abd Shaping a Healthier Future attending.  At previous meetings the chair has seemed irritated by the searching questions posed by Cllr Mary Daly and tried to hurry through proceedings with so many of the scrutinised wanting to speak.

In fact Daly's interventions seemed based on the fact that, unusually, she is a councillor who has done her homework as well as being someone passionately committed to the health of local residents.

I hope that at this meeting, however inconvenient, she gets a fair hearing. I also hope, for the sake of the public, microphones are installed to get over the acoustic problem in the committee rooms as well as the suits' mumbling.

If all that Health material is not another there is a major and very interesting report  LINK by a Task Group on the Agenda.The Task Group, chaired by Cllr Neil Nerva, looked at promoting electoral engagement following the introduction of Individual Electoral Registration and is packed with information and ideas. The most innovative of which is the involvement of the campaign group Hope Not Hate.

Once again such a crowded and complex agenda raises the issue of the wisdom of reducing Brent Council's scrutiny committee to just one. This was a hasty decision made at the beginning of the administration with no prior consultation which took many Labour councillors by surprise.

These are decisions about vital issues, at the extreme perhaps a matter of life or death, and must have proper scrutiny.