GP data share delay 'a small step in the right direction' but Brent Patient Voice says opting out is still advisable

Reacting to the announcement of a delay in implementaion of the NHS Digital GP Data sharing scheme, Robin Sharp, Chair of Brent Patient Voice said:

This is a small step in the right direction but the plans need a radical overhaul if they are to maintain confidence in the GP/patient relationship. Opting out is still advisable.

Professor Martin Marshall, Chair of the Royal College of GPs, responding to the news  of the pause that the college had campaigned for said:

We’re pleased that the Government has announced a delay to the GPDPR programme following the concerns that the College, the BMA and others have raised over the past few weeks.

It is essential that this time is used to properly communicate with the public and with clinicians so that patients and GPs have trust in the programme. In principle, improved and more secure sharing of data for healthcare planning and research purposes is a good thing. We have seen during the COVID-19 pandemic just how important the appropriate use of GP patient data is in responding to a health crisis, but it is also important in normal times to plan for better overall service provision and public health strategies, and enhanced understanding of diseases and treatments for serious illness.

We want to see a comprehensive campaign, led by NHS Digital and accessible to all members of the public, which should include every patient being communicated individually with, clearly articulating the benefits and risks of data sharing so that patients can make a genuinely informed decision about whether they are happy for their data to be shared - and if they are not, how they can opt out.

The safety and confidentiality of data in general practice is paramount to GPs and our teams. Surveys show that most patients are happy for their data to be used for legitimate planning and research purposes, but this must be built around trust. What data will be shared, with which organisations, how and why this will be done - and in particular, what safeguards that are in place to ensure data is not used inappropriately - must be communicated effectively with patients and healthcare professionals, so that they have trust in the programme.

Brent Patient Voice seeks information on Covid19 deaths in Brent

Robin Sharp (Chair- Brent Patient Voice) has asked  Councillor Hirani, Cabinet Member for Public Health, Leisure & Culture a number of questions about the impact of Covid19 in Brent. Cllr Hirani's answers are in italics. There is provision for him to ask a follow-up question at the Council meeting on July 13th.

1(a) What is the latest number of deaths in Brent from or related to Covid-19?

1(a) According to the latest Office for National statistics figures, the number of COVID-19 related deaths is 484 as up to the 19^th of June 2020. These are provisional counts of the number of deaths registered in Brent.

1(b) What is the latest number of “excess” deaths in Brent compared to the same period last year (i.e. from the start of the pandemic in the UK)

1(b) The provisional number of excess deaths from the beginning of the pandemic until May 31^st compared to the same period in 2019 is 482.

1(c) Is there any estimated breakdown of the number of these excess deaths that may be from Covid-19 and those arising because the person dying did not access care due to the NHS focus on Covid-19? Can ward level figures be supplied please?

1(c) It is likely the vast majority of excess deaths were due to Covid-19. There is no information available on deaths arising due to a person dying as a result of the individual not accessing NHS care.

2. In the case where ONS have supplied a breakdown of Covid-19 deaths at ward level for Brent have any contributory factors for especially high deathrates in particular wards been provisionally identified, such as presence of care homes, one or more super-spreaders, a special event where transmissions might have taken place?

2. The Office for National Statistics does not supply this level of detail. Where it supplies deaths at local level they are just a number of deaths in what is called a Middle Super Output Area, a unit of geography used by the Office for National Statistics. This can be converted into ward level information approximately.There is no individual detail on the cases or the likely source of infection

3. Do the deaths in Brent relate to the place of death, e.g. a hospital, or to the place of normal residence of the person who died?

3.The Office for National statistics (ONS) data for Brent residents relates to the place of normal residence.

4. Is there data showing how many died from Covid-19 in hospitals, in care or other residential homes and in the community?

4. Below is the provisional counts of the number of deaths registered in Brent, deaths involving the coronavirus (COVID-19), by place of death for which data are available. COVID-19 Deaths that occurred from 1st January 2020 up to 19th June 2020 but were registered up to 27th June 2020

“GPs are under pressure but help is at hand” says Royal College top doctor

Speaking at a Brent Patient Voice public meeting at the Learie Constantine Centre on last Thursday 15^th November, Dr Pauline Foreman, Medical Director at the Royal College of General Practitioners, said that GPs sometimes felt like hamsters on a wheel. Patients were unhappy at long waits for appointments. The NHS wanted GPs to send fewer people to hospitals. Visits to practices from the Care Quality Commission were quite scary, even though 90% of practices were rated good or outstanding. NHS England targets to replace retiring GPs were not being met.

However GPs should be seen as irreplaceable specialists in the whole range of medical conditions. Being a GP offered an enjoyable career with a huge variety of challenges and the chance to interact with many different patients. “If GPs could be allocated 11% instead of 8% of the NHS budget under the new NHS Ten Year Plan they could do what they were expected to do,” she said. Help for struggling practices was at hand from the Royal College and others. “Any closure of a practice is a failure, both for patients and the NHS. It costs a great deal and is very upsetting.”

Her message was echoed by long-term Brent doctor and new Chair of Brent Clinical Commissioning Group (CCG), Dr MC Patel. He explained that in Brent there are around 2,300 patients per GP, as compared with a London average of 1,670. “We want to make Brent a borough of choice for GPs and other health professionals” he said. The good news was that after Brent took a stall at a recent nursing event 76 people expressed an interest in working in general practice in the borough. The CCG wanted to see all local practices collaborating under the umbrella of the new Primary Care Homes initiative.

“This could involve some patients going to neighbouring practices for long-term care, e.g. for diabetes, but they would still have their own GP at their regular practice,” said Dr Patel.

Questions from the audience recalled the days of the TV programme “Dr Finlay’s Casebook” demonstrating the value of the one-to-one personal relationship between GP and patient. The speakers agreed that this was still very important for long-term patients but recognised that the younger generation often wanted to access services quickly online.

Thanking the speakers for their very informative contributions, BPV Chair Robin Sharp said:

We as BPV and through our Practice Patient Groups are  keen to help practices in these difficult times. We look forward to working with the Royal College and Brent CCG to secure the best results for patients in Brent.

For further information contact: Robin Sharp, BPV Chair on 020 8969 0381 or robisharp@googlemail.com

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The stress & strains of being a GP - 'Who would be doctor?' Brent Patient Voice Debate November 15th 7pm Learie Constantine Centre

Dear Brent Patient Voice members and friends
“Who would be a doctor?” is the topic of our public meeting and debate on Thursday 15^th November next at the Learie Constantine Centre, 40-47 Dudden Hill Lane, NW10 2ET at 7pm (refreshments from 6.30)

We are focussing on the strains and stresses facing GPs. They are our first and principal port of call when we need to access NHS services. Yet

• Practices are merging or closing;
• Workload problems are leading to burnout or early retirement;
• The NHS wants GPs to do more to relieve the load on hospitals;
• Plans to boost GP numbers are way off target;
• Few GPs welcome extra admin and new organisational structures.

What are the answers?

• Will switching to digital help reduce workload?
• What does Primary Care Home mean for doctors and patients?
• How do new roles such as healthcare assistants, community pharmacists and nurse practitioners fit in?

We are fortunate to have recruited highly qualified speakers to lead our debate. They are Dr MC Patel, new Chair of Brent Clinical Commissioning Group, and long-serving Brent GP, and Dr Pauline Foreman, Medical Director for Practice Support at the Royal College of General Practitioners, and also a GP in Hertfordshire.

We look forward to seeing you on 15^th November. Please take this as notice of our AGM from 7 to 7.20pm that day, including reports, minutes and elections to the Steering Group. We urgently need someone to manage our communications and mailshots like this one. Please contact me at robisharp@gmail.com if you can help. I can also supply a flyer for this meeting if you can put up one in your surgery etc.

With best wishes

Robin Sharp
Chair BPV

Brent could lose Community Cardiology Service after February 2018 - the public have not been consulted

From Brent Patient Voice
 

We have learned that the Brent Clinical Commissioning Group  Community Cardiology Clinics at Wembley and Willesden are closing at the end of February. While we know that the CCG has been discussing the future of this service with local hospital trusts there is no information in the public domain. We have written as below to the CCG Chief Operating Officer, Sheik Auladin, to press for public consultation on this issue as required by the NHS Act
2006. A full response has been promised.

Dear Sheik,

BRENT COMMUNITY CARDIOLOGY SERVICE RE-COMMISSIONING: PUBLIC INVOLVEMENT AND CONSULTATION.

Peter Latham has not yet received any acknowledgement or reply to his letters to you dated 29 November and 5 December 2017 about the future of the Community Cardiology.

We have seen the email letter from Brent CCG dated 30 November 2017 notifying Brent GPs that the current NHS Brent Community Cardiology Service provided by Royal Free London NHS Foundation Trust (RFL) from both Willesden Centre for Health and Care and Wembley Centre for Health and Care will come to an end on 28^th February 2018 with no further extension. RFL are not accepting new patients for this service after 4 December 2017.

Brent Patient Voice are very concerned at the short time now left before the end of the current RFL provider contract for the Brent Community Cardiology Service on 28 February 2018. Brent CCG do not appear to have published anything about their proposals for commissioning such NHS Brent cardiology healthcare services after the end of this contract.

Clearly a number of questions arise. They include the location or locations of replacement clinics, whether equivalent resources will be transferred to new providers, what will happen to patient records and to cases in progress. This list is not exhaustive.

We feel that we must now formally remind Brent CCG that under section 14Z2 of the NHS Act 2006 as amended it would be unlawful for Brent CCG to develop or consider changes in the commissioning arrangements where the implementatiom of the proposals would have an impact on the manner in which the services are delivered to patients or the range of services
available to them without full public involvement and consultation by the CCG.

Please now arrange for someone to respond to acknowledge receipt of this letter and to say how and when Brent CCG propose to inform us as to their proposals for NHS Brent cardiology services after the end of the current RFL contract and for involving the public under the terms of s.14Z2 before final decisions are taken.

Yours sincerely

Robin Sharp
Chair Brent Patient Voice

Wise to start 'Choosing Wisely' prescribing policy engagement again North West London CCGs told

Brent Patient Voice has written to Clare Parker, Chief Officer of the Collaboration of North West London Clinical Commissioning Groups, raising vital issues about the 'Choosing Wisely' engagement on prescribing policies in the eight North West London CCGs.

Here is the letter:

The Steering Group of Brent Patient Voice (BPV) has asked me to write to you urgently about the confusion surrounding the current phase of the “Choosing Wisely” engagement process relating to prescribing policies with the 8 NW London CCGs. The Collaboration of NWL CCGs which you head appears to be leading this process.

The history of this exercise seems to be as follows:

On 19 June Christian Cubbitt for the Collaboration informed BPV that there was an engagement exercise ending 30 June about achieving savings via proposed changes to prescribing arrangements in NW London. We learned that the exercise was deemed to have begun on 12 June, though we have seen no evidence that emails or letters were sent to anyone in the week beginning 12 June, either by the Collaboration or Brent CCG. When we asked Brent CCG in the pre-Governing Body questions from the public session on 2 August why BPV as a body and various individual members who are on the CCG engagement lists had not received notification of the exercise before Christian’s message of 19 June they could not provide an answer. It is not credible to suggest that both BPV and individual members had dropped off the CCG list accidentally. Therefore in our view the effective time allowed for the engagement was 2 working weeks. This was totally inadequate on any conceivable scenario.

However the scenario itself was also deeply flawed for two main reasons.

The first was the absence of information about the existing situation needed as context for a rational judgment about changes which were claimed to be capable of saving over £10 million. We pointed out - and others have done so - that the public would need to know the annual prescribing expenditure on each of the medications listed as not to be prescribed or as suitable for private purchase instead of NHS prescription, accompanied by a clinical assessment of short term and long term medical conditions where savings could be made without risk to patient safety. Manifestly no individual patient reading the questionnaire was likely to have personal experience of more than a small percentage of the medications and would therefore need to know the wider potential impacts before answering the questions.

Secondly the theme suggesting that GPs could ask patients if they minded paying for all or any of these medications out of their own pockets raised obvious issues about ability to pay which were directly affected by a person’s economic situation. There was no indication of any attempt to ensure that the questionnaire would reach a representative selection of individuals in recognised socio-economic groupings or requirement that respondents should indicate what their income bracket or situation in respect of benefits might be. 

In addition it is our view that an Equalities Assessment should have been carried out before the engagement was launched to ensure that it was organised in such a way as to secure that groups with protected characteristics would be reached.

As things stand we have no idea as to the geographical location (even by borough), socio-economic class or long-term medical situation of those who responded to the first online and hard copy exercise. While much material in response to the online survey was available to read (some 300 plus responses), the same does not apply to the 800-900 written replies. We question whether some of the key objections given in the online response were adequately summarised in the papers submitted to Brent CCG GB on 2 August. For the written responses from individuals we have no idea whether these were tick box responses and where they came from.  

Following this deeply flawed sequence of events Brent CCG considered proposals on Choosing Wisely at the Governing Body meeting on 2 August. Among the papers before them was an EQIA from PHAST which contained a series of negative findings about the impact of the proposals on protected groups. No reference was made in the discussion of the item to the nature of these findings but only to the arrangements for the public EQIA Validation event in Harrow on 8 August. The decision was to go ahead with the proposals subject to the outcome of the 8 August meeting. In BPV’s view the decision was defective because no reason was given for ignoring the negative findings of the EQIA. There was also no reference to the National Health Act which determines who should be exempted from prescription charges.

At the EQIA event there was no attempt to “validate” (i.e. check against reality) the EQIA document as laid before the Brent CCG GB. Instead participants were grouped by tables and invited to consider issues under the Equalities Act. Despite this unsatisfactory procedure participants (including several from BPV and pharmacist representatives) contributed what they considered to be relevant concerns about the proposals which they insisted on having recorded. I am to ask for a record of the meeting and in particular the contributions made by participants. Can you please specify a deadline as to when this will be available and on the Collaboration website?

Now to the crux of the matter as far as this letter is concerned.

During the course of the “validation” meeting and apparently on the basis of decisions taken before it began, the Chair, lay member Angeleca Silversides, announced that there would be a further engagement exercise based on modified proposals and “Easy to Read” questionnaires, some copies of which were handed out. A new deadline of 15 September was mentioned. We have learned that Ealing CCG has written to its stakeholders about this exercise with a copy of the new leaflet. In Brent we have heard nothing.

BPV are taking the view that this new or extended engagement has not been communicated by the Collaboration or Brent CCG to those who received the earlier notifications or to those who responded to them, in so far as different. An announcement at a meeting attended by a small fraction of the 2,000,000 people affected cannot be regarded as a satisfactory communication for the purpose. Nor is it clear if this is a revised proposal on which all are invited to comment irrespective of any previous input.

Can you please say urgently therefore:

1. What is the status of this further exercise?

2. Does it replace the first round of engagement and responses to it?

3. If not are people who responded to the first round to respond to this one?

4. If the proposals have been modified how can the two sets of results be amalgamated?

5. Why has the new questionnaire and an explanation not been sent to all stakeholders in NW London and all who responded to round one?

6. What is the status of GB decisions which in the case of Brent envisaged an August start to the new arrangements? (Presumably Ms Silversides has no power to set them aside.)

In view of all these uncertainties would it not be preferable to draw a line under what has happened so far and start afresh with a planning group involving pharmacists, GPs and patients to produce a properly explained and representative survey of prescribing arrangements and possible improvements to them? 

The challenges facing our local NHS hospitals - top managers address public meeting

From Brent Patient Voice 

I’m writing to extend a warm invitation to a forthcoming BPV PUBLIC MEETING on 12 September at 7pm at the Learie Constantine Centre, Dudden Hill Lane, NW10 2ET. (Refreshments from 6.30pm.)

The topic will be a presentation on the challenges facing the London North West Healthcare NHS Trust (i.e. Northwick Park, Ealing, Central Middlesex and St Mark’s Hospitals). As you will be aware these challenges are daunting. The flow of thousands of patients through the doors does not decrease. While some highly commended clinical  services are being provided, waiting times in A&E and for some types of appointment are falling seriously short. In addition the Trust is required to close a deficit of around £49.5 million. We are fortunate to have secured two members of the top management team to tell us how the Trust is coping. They are Dr Nigel Stephens, Deputy Medical Director and leading cardiologist, and Simon Crawford, Director of Strategy. We are also asking a GP, Prof Paul Thomas, Editor-in-Chief of the London Journal of Primary Care, to comment on how links between hospitals and GPs can be improved to benefit patients.

After the presentations and an interactive discussion, we’ll move for the last half-hour to the BPV AGM, including elections.

We very much hope to see you there.

Robin Sharp

Chair Brent Patient Voice

'Heartless and irrational' decision to close Brent Sickle Cell Service

Following the news LINK that Brent Clinical Commissioning Group have decided to stop the funding of the Brent Sickle Cell Advice and Support Service (SCASS), which was temporarily reprieved by widespread protests, including that of Dawn Butler, MP for Brent Central and Barry Gardiner MP for Brent North, Robin Sharp of Brent Patient Voice has sent me the following comment:

Brent Patient Voice (BPV) is dismayed by the decision of the Brent CCG Governing Body on 30 November to withdraw support from the Brent Sickle Cell Advice and Support Service.

This decision was originally made by the Governing Body on 2 July and only paused because BPV challenged the way it had been taken. At the time the Service was faulted based on data from only the first nine months of operation which was totally inadequate for demanding targets to have been met. There had been delays in recruiting staff and long term sickness had affected one of the workers. The independent evaluation report was very positive about the quality of the Service and the benefits to those who had used it. It suggested that based on trends from when it had become fully operational it would have met targets within a few months. We were shocked when we saw letters from the CCG to local MPs suggesting it was cheaper for Sickle Cell patients to have traumatic episodes requiring treatment in A&E than to be helped to avoid such trauma by the Advisory Service.

In our view and based on the evaluation report, the Advice and Support Service has been valuable in helping Sickle Cell sufferers to cope with social issues such as housing, benefits and employment by explaining to providers of these services the special features of Sickle Cell. Indeed we heard that Sickle Cell groups elsewhere were interested in it as a model.

The Governing Body in September agreed to review the situation and a so-called Focus Group was hosted by the Council for Voluntary Service on 15 September. This was attended by Sickle Cell representatives and patients as well as several members of BPV. In our view the weight of opinion in this meeting was strongly in favour of a service with the main characteristics of the existing BSCASS. The CCG ignored these views and decided to proceed with their preferred option of referring Sickle Cell patients to Care Navigators in the Whole Systems Integrated Care programme. These Navigators are only just beginning to operate and will have large caseloads across the spectrum of elderly vulnerabale patients. We have severe doubts as to whether they will be able to offer any practical help to Sickle Cell patients.

Speaking personally I see this decision as heartless and irrational.

Cllr Muhammed Butt, leader of Brent Council with Dr Ethie Kong, Chair of Brent CCG

This is the document BSCASS  presented to the Brent CCG in July this year to appeal against the earlier decision to stop funding them:

 

Vital public meeting on changes in GP Practices - Thursday December 1st

 From Brent Patient Voice

From cottage industry to the new world of Brent’s Accountable Care Partnership: Our GP Practices are destined for change

We look forward to seeing you at the Learie Constantine Centre, Dudden Hill Lane, NW10 2ET on Thursday 1st December from 6.45 onwards.

While commentators and the media are just waking up to the fact that the emerging NHS Sustainability and Transformation Plans are a cloak for massive and damaging cuts to services, we in BPV are attempting to shed some light on the plans for transforming General Practice.

Hence the title of our event is “From cottage industry to the new world of Brent’s Accountable Care Partnership: Our GP Practices are destined for change.” Our speaker, Dr Julia Simon, has recently left NHS England and thus is specially qualified to give an insider’s perspective on The NHS Five Year Forward View and the reasons why it promotes Accountable Care Partnerships.

What concerns us most is the NHS’s failure to explain properly what the changes to General Practice they envisage really mean so that the public and indeed doctors themselves can debate the pros and cons.

All this, of course, is against the background of the Chancellor declining to put more money into the NHS and social care when the leadership and the experts are pointing out that shortages of money and qualified staff mean it cannot deliver the service required for very much longer.

Alarm bells should ring! 'NW London NHS 'Transformation Plan' to be discussed on Monday at Brent Civic Centre

From Brent Patient Voice LINK

For the first time since the local NHS and Council bureaucracies started drawing up the NW London Sustainability and Transformation Plan (STP) in January of this year, they are going to allow members of the great unwashed British public to discuss it in a face to face meeting on 26 September.

Cllr Krupesh Hirani, Chair of Brent’s Health & Wellbeing Board, responding to a BPV Steering Group Member, writes:

I am hosting a Public Engagement event where anyone can attend on Monday 26th September at 6pm (Brent Civic Centre – Grand Hall).

The Health and Wellbeing Board is on Thursday 6th October at 7PM (Brent Civic Centre – Boardroom). 

The Plan claims to be able to save £1.3billion from the NW London health budget by 2020 and at the same time make lots of improvements to your care. Do you believe it?

Meanwhile in another part of the wood the Chief of NHS Providers (hospital trusts around the country) says “the NHS can no longer deliver what is being asked of it for the funding available.” Observer 11.09.16. It seems he has not heard of the STPs – or does not believe in them.

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

Race & Public Health: Are black communities getting a fair deal? April 19th

Race and Mental Health: are black communities getting a fair deal? Public Meeting April 19th

From Brent Patient Voice and Brent MIND

For the first time since our launch in February last year Brent Patient Voice is holding a face to face meeting in public. This email is a warm invitation to colleagues who have not so far joined us as members to take part in the discussion of an important local health topic. We will also be holding our first AGM.

We are delighted to say that Brent MIND has agreed to partner us in this event which will be, as before, at the Learie Constantine Centre, 40-47 Dudden Hill Lane, NW10 2ET from 7-9pm on Tuesday 19th April.

The main speaker will be Dr Aggrey Burke, formerly Senior Lecturer and Consultant Psychiatrist at St George's Hospital London. His title will be "Race and Mental Health: are black communities getting a fair deal?" He has amplified this title further with the words: "The interaction of stigma, racial exclusion, mental illness and offender behaviour". Dr Burke has also asked us to mention that he is now involved in voluntary activities in London and the Midlands. We imagine that his presentation may be somewhat controversial, but we are convinced that this is an important topic within the community of Brent.

We hope that Brent MIND colleagues will speak briefly about their work in general and in this specific area of concern.

The main meeting will be followed by the first AGM of Brent Patient Voice at around 8.30pm. We will present reports of what we have been up to and seek democratic legitimacy by holding elections. In particular we need members to join our steering group to help with communications, the website and membership matters. More details will follow on the AGM. Do let me know if you are interested in joining our group or just go to "membership" on our website.   http://www.bpv.org.uk/membership/

As you know we are a very small voluntary body doing our best to work constructively with the local NHS on behalf of patients. PLEASE DO JOIN US IF YOU CAN ON THE 19TH TO ENSURE THAT BPV'S PRIORITIES ARE THOSE OF ITS MEMBERS AND THE PUBLIC.

To help cater for the event please email your intention to attend:  mailto :info@bpv.org.uk

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.

Causes for concern in Brent NHS provision

Peter Latham, Chair of Willesden Patient Participation Group and Member of the Steering Group of Brent Patient Voice, has given permission to Nan Tewari for this extract from his November 2015 Newletter to be published on Wembley Matters as a Guest Blog. It gives an interesting, and at times worrying, insight into current developments in local health provision.

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The national NHS news remains worrying.  Today we have news of junior doctors voting on a strike.  A new OECD report says that Britain now comes low in the international league tables for most categories of national healthcare.  Male expectation of life at birth comes 14^th out of 34, and 24^th for women.  Cancer 5 year survival rates are 21 out of 23 nations for cervical cancer, and 20 out of 23 for both breast and bowel cancer.  For surviving a heart attack we come 20^th out of 32 nations, and for surviving a stroke 19^th out of 31 nations. For unnecessary hospital admissions for asthma or lung disease due to poor care at home we are ranked 22 out of 34 nations.   The OECD estimate that to bring the NHS up to just OECD average performance would require an extra 26,500 doctors and 47,700 extra nurses at a cost of an extra £5 billion per year.  Britain currently spends £2,100 per person on healthcare, slightly below the OECD average.  Another report this week suggests that one quarter of all cancer diagnoses are made only when the patient goes to A&E already having symptoms so that their average survival time is poor. 

At our local Brent level there continues to be much paper activity at Brent CCG but not very much to report about actual changes put in place.

At the Brent CCG Governing Body meeting on 4 November 2015 the Deputy Chair Doctor Sarah Basham announced that the Brent CCG Chief Financial Officer Jonathan Wise is leaving.  She did not give any reason and did not announce a replacement.  This is unfortunate at a time when Brent CCG have moved from an annual financial surplus to Mr Wise’s report of an underlying financial deficit of about £1.3 million as at September 2015.  The CCG has filed a financial recovery plan as required by NHS England by 31 October 2015.  This needs to be set in the context of an annual budget of about £375 million.

Brent Community Cardiology Service & other Brent Planned Care projects.

The new Brent Community Cardiology Service provided by Royal Free London NHS Foundation Trust that started in March 2015 at the Willesden and Wembley Centres for Health and Care is improving on many of its early problems.  There are now clinics at both centres each weekday.  More specialist cardiologists have been appointed although not all have started yet.  There was a gap in the contract specification with no provision for diastolic heart failure.  The CCG has now decided to issue a contract variation to cover this when the projected volume of patients and their needs have been clarified.

I have been appointed as a patient representative on the monthly contract review group for this service.  The main continuing concern for patient safety is on the 14 day contract maximum waiting time for urgent cases from GP referral to first offered appointment.  Mr Robin Sharp Interim Chair of Brent Patient Voice has waived doctor/patient confidentiality in the public interest to reveal that when referred by his GP for atrial fibrillation in June 2015 his first offered appointment was with a 62 day wait.  No explanation has been given. At the monthly meeting on 4 November with an agenda item for waiting times as at 30 October no figures were published for current waiting times.  It was said by Brent CCG that the figures will only be published after they have been verified. So patients have no confirmation that all or any patients assessed as urgent are being offered a first appointment within 14 days.  I requested the figures ‘subject to verification’ but this was refused.  Brent Patient Voice will now report this problem to Healthwatch Brent with a view to notification to the Care Quality Commission.

At the Brent CCG Annual General Meetings on 2 September and re-run on 14 October in answers to my questions the chair Doctor Etheldreda Kong confirmed that the 2012 ‘Planned Care’ business case for transferring about 13 specialist adult out-patient services out of hospital in 5 ‘Waves’ into new community clinics under the slogan ‘Better Care Closer to Home’ has been discontinued after the introduction of just the Wave 1 new ophthalmology service provided by the commercial provider BMI (who run the commercial Clementine Churchill Hospital at Sudbury Hill), and the new Brent Community Cardiology Service provided by the Royal Free whose problems are reported above.  

This project has been currently replaced by much less ambitious schemes e.g. just for physiotherapy instead of the major Wave 2 new integrated multi-disciplinary, musculo-skeletal (MSK) service project for which the procurement was discontinued in March 2015 following which  Brent CCG estimated  £713,000 had been spent on it.

Brent CCG A&E Advertising Campaign: “A&E is for life-threatening emergencies only”.

This advertisement has cropped up at bus stops in the borough etc and also carried the Brent Council logo.  Brent Patient Voice has complained that it is false and misleading and made a complaint to the Advertising Standards Authority.  BPV has given examples of non life-threatening emergencies that justify admission to hospital through A&E e.g. a penetrating eye injury.  Brent CCG has not challenged this and it is notable now that the wording on the Brent CCG website headline slide show has now been altered to say ‘A&E is for emergencies only’.

Brent CCG Whole Systems Integrated Care (WSIC) Project with Brent Council

This imposing sounding project has run into difficulties from lack of funding.  It proposes an integrated care plan just for elderly people with one or more long term conditions such as heart failure or asthma. Part of the aim is to reduce the need and cost for unplanned hospital admissions.  A WSIC pilot in part of the borough was planned to make sure the systems would work.  This pilot has now been abandoned for lack of funds.  The current proposal is to start the scheme across the whole borough in April 2016 without this pilot testing.

Brent CCG Commissioning Intentions 2016/17.

At the Governing Body meeting on 4 November the ‘final’ draft Commissioning Intentions (local health services purchasing plan) 2016/17 was approved.  The plans can be found on the Brent CCG website and include feedback from the patient involvement and consultation events including the Health Partners Forum on 7 October 2015.  I have been unable to discover the closing date for the online patient survey.