Mansfied Report report says Shaping a Healthier Future programme threaten fundamental principles of the NHS and provide “no realistic prospect of achieving good quality accessible healthcare for all.”

Hammersmith and Fulham Council have issued this release on the Mansfied Report

One of the country’s biggest hospital shake-ups is deeply flawed, likely to exacerbate a deteriorating situation, a threat to the fundamental principles of a universal NHS and should be halted immediately, according to a landmark report from the Independent Healthcare Commission chaired by Michael Mansfield QC.

NHS North West London’s Shaping a Healthier Future (SaHF) programme has already seen the hugely controversial closures of two A&E departments, at Hammersmith and Central Middlesex hospitals and the closure of Ealing maternity unit. Further downgrading of Ealing hospital is planned, along with the closure and sale of the majority of Charing Cross hospital site.

The Independent Commission also uncovered shocking details of spiralling management and consultancy costs. At the same time, a crisis is developing in emergency services, with GP services clearly failing to meet demand across the region, contributing to a crisis in A&E performance.
Independent Healthcare Commission Chair Michael Mansfield QC said:

“The findings of the Independent Healthcare Commission for North West London are stark - the reforms, both proposed and implemented thus far, are deeply flawed. There is no realistic prospect of achieving good quality accessible healthcare for all, and any further implementation is likely to exacerbate a deteriorating situation.

“Our recommendations are equally stark. It is the view of the Commission that the Shaping a Healthier Future programme should be halted immediately, and that the affected councils should consider a legal challenge if it is taken forward in the current circumstances.”

“At the very core of any decent civil society is the imperative to ensure that the individuals and communities who make up that society have sustainable access to good quality healthcare. The response from North West London NHS, flowing top down from central government, has singularly failed to deliver on this imperative, with all indications pointing to a further deterioration in the future.

“It is crystal clear that the impact of fragmentation through privatisation is slowly eroding what was a National Health Service, a development that ran like a thread through much of the evidence given at our public hearings. In so many ways, the catalogue of failings, missed opportunities and profligacy we have seen in North West London act as a microcosm of a wider malaise across the English NHS. As such, though this report focuses on the NHS in North West London, it should act as a warning call to the top of government.”

Leader of Hammersmith & Fulham Council Cllr Stephen Cowan said:

“People across west London have been horrified to see their treasured NHS deteriorating so quickly – and so unnecessarily. They have protested, sent in petitions and begged local health chiefs to stop this madness, and are furious that local NHS bosses have ignored them for so long. My council colleagues shared this anger, commissioning the Independent Healthcare Commission, and in doing so keeping our pledge to fight for local health services.

“Today’s report from Michael Mansfield QC is a watershed moment. Rigorous, thorough, detailed and rightly independent, the review provides indisputable evidence that these changes to local health services are badly planned, hugely costly and causing life-threatening failures in local healthcare. The only sane decision is to put a halt to them right now.”

The reports key recommendations are:

• The Shaping a Healthier Future programme must be halted immediately
• North West London local authorities should consider their options for launching a legal challenge if a decision is taken to press ahead with the programme in the current circumstances.
• The report’s key findings are:
• Cutbacks are being targeted on the most deprived communities
• The public consultation was inadequate and flawed
• The escalating cost of the programme (£1bn) does not represent value for money and is a waste of precious public resources
• There is no business plan to show the reconfiguration is affordable or deliverable
• NHS facilities have been closed without adequate alternative provision being put in place
• The plans seriously underestimate the increasing size of the population in North West London and fail to address the increasing need for services

In today’s landmark commission report, Michael Mansfield QC also recommends that:

• Ealing and Charing Cross hospitals must retain full ‘blue light’ A&E services for the foreseeable future
• The decision to close Ealing maternity unit should be reversed with immediate effect
• The A&E department at Central Middlesex Hospital should be re-opened
• The National Audit Office should undertake a review of the value for money of the programme
• A new public consultation is needed as the proposals have changed significantly
• Substantial investment should be made in GP and out-of-hospital services, which are clearly overwhelmed and inconsistent.

Read the Independent Healthcare Commission for North West London's final report» (pdf 819KB)

Central Middlesex A&E Closure and the Pupil Premium under Scrutiny next week

There was considerable concern at the recent Health consultation at Bridge Park In Stonebridge, over the closure of Central Middlesex A&E and particularly about whether replacement facilities will be ready. There was also concern about the recent Requiring Improvement judgement on the Northwick Park A&E while Central Middlesex A&E received a 'Good'. The A&E closes on September 10th and a demonstration is scheduled to take place to mark its demise.

The Brent Council Scrutiny Committee at its meeting on September  9th, the day before the closure, will be questioning the professionals concerned.

The Agenda states: 

The Scrutiny Committee will receive an up-date on the arrangements in place for the closure of the A&E unit at Central Middlesex Hospital, and Brent changes to related services, to ensure a high quality of health care is accessible to residents.  This will reflect recent concerns raised following  Care Quality Commission inspections at Northwick Park Hospital.  Senior Representatives from the Northwest London Hospital Trust and the Clinical Commissioing Group will be at the meeting to answer questions.

After its widely criticised lack lustre perfomance at its first meeting, the Scrutiny Committee is reportedly determined to up its game.

At the same meeting a Pupil Premium Task Force will be set up. Task Forces, with a specific remit, are one of the ways the Commmittee will carry outs its work.    The Pupil Premium is the extra money schools get for enhancing the educational opportunities for disadvantaged pupils and now forms  a substantial part of the budget of many Brent Schools.

The purpose of the task group will be to focus on analysing the current use of the Pupil Premium Grant, the outcomes which are being achieved in comparison with national performance and to promote best practise.

This will include:

• How eligible pupils in Brent have been performing since the premium was introduced

• How schools in Brent have been spending, managing and monitoring the Pupil Premium

• The possible lack of correlation between schools with the highest number of eligible pupils and the schools making best use of the PPG

• Identifying good practices in Brent schools, across the UK and learning from national organisation such as the Education Endowment Foundation (EEF)

• How could schools in Brent spend the premium more effectively to raise pupil attainment

• The Future of the Pupil Premium in Brent - future funding, changes for September 2014

It will be interesting to see who is on the Task Force and whether the Scrutiny Committee goes out to teachers, parents and pupils for members of the force. It would be too easy also to just see things in terms of extra 'booster classes' rather than the enrichment activities that some schools have found really increase children's enjoyment, motivation, confidence and thus their achievement.

Barry Gardiner: Central Middlesex A&E closure 'devastating'

This is the exchange between Barry Gardiner, MP for Brent North and Jeremy Hunt following the latter's announcement of the closure of Central Middlesex A&E in Parliament yesterday:

Barry Gardiner (Brent North, Labour)

This decision is devastating for my constituents. The Secretary of State will know that in the last winter period, Northwick Park hospital and Central Middlesex hospital, which comprise the North West London Hospitals Trust, were the worst-performing hospitals when it came to meeting A and E targets not only in London, but in the country. The trust scored 81.03%. That is an appalling record. What he has done today, by announcing the almost immediate closure of Central Middlesex, can only make that much worse. The College of Emergency Medicine has said that his reconfigured hospitals should have at least 16 consultants in their emergency departments, but his decision will give them 10—and that is not for major trauma centres. Will he elaborate on what he will do to bring the number of consultants up to the level required by the college?

Jeremy Hunt (South West Surrey, Conservative)

Has the hon. Gentleman, who is so against these proposals, not noticed the proposals for more emergency care doctors, more critical care doctors and more psychiatric liaison support for A and E departments, which will reduce pressure on A and Es and mean that people admitted through A and Es for emergency care will not have a 10% higher chance of mortality if they are admitted at weekends? His constituents will be among the first to benefit from that. I would caution him, therefore, against saying that this is devastating for his constituents. We were reminded in Prime Minister’s questions earlier of how Labour suffered from predicting massive job losses, when in fact there was an increase in jobs. This announcement is good news for the hon. Gentleman’s constituents, and he should welcome it

Mapping deprivation in Brent - a useful tool

Click on image to enlarge

Ben Goldacre has helpfully tweeted a link to the Open Communities Interactive map which shows comparative deprivation in the country LINK

You are able to drill down into particular areas and the above illustration shows Brent and surrounding area with Harlesden at the centre.

The map should be useful for the campaigns around housing, health and hospital closures.

Brent Labour shrinks from supporting Ealing on hospital reorganisation

A motion referring the Shaping a Healthier Future proposals to the Secretary of State, moved by Cllr Claudia Hector, failed to find a seconder at tonight's Brent's Health Overview and Scrutiny Committee.  The proposals will mean the closure of Central Middlesex A&E.

At the Labour councillors' pre-meeting an alternative motion was amended so that it read that the Committee 'noted' Ealing Council's decision to refer the proposals in case it should appear that Brent Council supported their action. Instead the anodyne motion from Cllr Pat Harrison, seconded by Cllr Helga Gladbaum, said that 'it was right'  that the proposals should be 'thoroughly examined'  and sought assurances that services would not be  reduced or closed  unless changes in infrastructure had 'proved to deliver successful outcomes for residents'. This was passed with Lib Dem support from Cllr Ann Hunter.

The motion was in stark contrast to the earlier passionate call for arms from Sarah Cox of Brent Fightback and Brent SWP who told the Labour councillors that they were heirs to the creators of the National Health Service and, reflecting the commitment of the recently released Spirit of 45,  it was not too late for them to stand up for the NHS, and for the people of Harlesden and Stonebridge, and refer the  decision to the Secretary of State.

Her speech was loudly applauded by Lib Dem councillor Barry Cheese, who went on to make his own heart-felt intervention from first hand sources about the inadequacies of the ambulance service at Northwick Park. He had been told by ambulance workers that two stroke victims in separate ambulances had been delayed treatment because the vehicles had been behind 12 ambulances already on the hospital ramp. As presentations continued he repeatedly called out condemning privatisation. He seems to have moved to the left of the Labour group - which, let's face it, isn't hard.

There was a tedious presentation from NW London NHS on 'Improving Healthcare for people in Brent' that nearly had Cllr Gladbaum chewing the carpet in frustration.  However,  embedded in it was the tiniest hint that there may be slightest of chances that the Central Middlesex A&E decision may only be about 98% final.

One slide read:

CENTRAL MIDDLESEX A&E

• The NWL Hospitals Trust has set up a project board to consider future  options for the A&E (includes senior representatives and clinicians from the trust and stakeholders)
• Commissioners expect to be fully involved in any decisions regarding the future of the A&E and would require reassurance regarding any future change in services around:

The reasons for any changes and the evidence behind this view
The likely impact on neighbouring services (eg Northwick park and Imperial)
The alternatives that had been considered
The monitoring that would be put in place
The involvement of stakeholders inc the OSC

The litmus test is whether a change of service would be safer that the current service

I read this as an opportunity for campaigners to continue to put on the pressure and make the case for the retention of the A&E. What we should also be saying though is that the 'current service' at Central Middlesex needs to be strengthened and its running down halted. This view is somewhat reinforced by news that the number of ambulances being directed to Central Middlesex had increased recently.

So let's not give up just yet - keep up the pressure.

Health and housing on the agenda tonight

Brent's Health Overview and Scrutiny Committee will be asked by local campaigners to refer the proposal to close Central Middlesex A&E to the Secretary of State at this evening's meeting. Ealing Council has already taken this step which has drawn an irritated response from NW London NHS:

Ealing Council has asked the Secretary of State for  Health to consider the programme. This is a shame, as  this process normally takes a few months and will d elay implementation of much needed improvements to local services which the majority of clinicians, local GP s and other local councils want to see go ahead.

Of course many residents think it is a 'shame' that we may lose out local A&E, especially when the alternative facility, Northwick Park, is already over-loaded.  A local resident has written to Brent Council leader Muhammed Butt putting her views:

Dear Cllr. Butt,

I am a resident of Brent and Brent should be fighting on behalf of their residents to keep all four Hospitals A&E departments open.  Urgent care centres are not acceptable they are not manned by many doctors or nurses, and are no alternative to an A&E unit.   How far will Brent residents have to go to the nearest A&E dept? will they be seen? How long will they have to wait?  This will put their lives at risk.  

 

St Marys Hospital Paddington, Northwick Park Middlesex A&E depts. are already full with the present numbers they deal with, how will closing four A&E's in North West London help the people of Brent?.

I have had two operations this year in Charring Cross Hospital, this hospital is to be sold off for real estate. Charring Cross Hospital services the people of Brent, I was sent there as St Marys Paddington do not have the facilities or the beds to cope.

The NHS was founded by the labour government in 1948, I expect a labour council to look after all its residents North and South of the borough and back Ealing borough council in fighting to keep all four A&E departments open. Emergency's, Maternity and the Ageing population are all at risk

Yours sincerely

Margaret von Stoll

Apart from the important issues of the future of Accident and Emergency services in the area and the Shaping the Healthier Future proposals, the Committee will also discuss and question NHS officers on failures in local pathology services:

A serious incident was logged in December 2012 after a concern was raised by a GP about the new system. It became clear that this was not an isolated case, and another GP complained of spurious results, missing results and samples not  processed. It was further identified that training for GPs had not taken place and that  alleged meetings with GPs had not in reality occurred. A number of issues have now been identified with different test results and these are listed in the report.

 As as health campaigners are attending the Committee, housing campaigners will be at Mencap in Willesden High Road for a meeting starting at 6.30pm to discuss strategies for dealing with the deepening housing crisis in the borough. Details were published earlier on this blog and can be found HERE

Action needed to save Central Middlesex A&E

It is sometimes thought that only the residents in the south of Brent and neighbouring areas of Ealing are concerned about the closure of Central Middlesex Hospital. However residents in the north of the borough, served by Northwick Park Hospital A&E are also affected as this Guest Blog shows:

I hear that Ealing Council's scrutiny panel has voted unanimously to refer a decision to downgrade A&E departments in north-west London to an independent panel and wonder what you think about the decision to close the A & E departments?

If Central Middlesex, Ealing, Charing Cross and Hammersmith A & E departments are to close what impact is this going to have on the whole of densely populated and hugely congested West London????

Ealing Council are campaigning hard against this decision and so far I can only see Navin Shah, London Assembly member for Brent and Harrow (see this LINK) campaigning against the closures I can’t understand why the local councillors and our MP Barry Gardiner* are not campaigning against the closures too?

Navin Shah's press release LINK said:

A&Es will be forced to cater for an extra 120,000 residents on average each. In 2010 there were 32 A&E departments in London, but only 24 would remain under these plans."

"The 32 A&E’s served a population of 8.17million Londoners, an average of 255,000 people each. Reducing to 24 A&Es will mean they have to cover 340,000 each, with London’s population due to rise to 9million by 2020. This will increase the number of people each A&E is due to cover to 375,000 residents - an increase of 120,000 for each A&E. This assumes that no further closures take place.

As you know in recent years every single bit of space in Wembley has had flats built on it, bringing more and more residents to Wembley and more and more traffic congestion.  Add to this the new designer outlet and French school coming to Wembley Park - these will both bring more people and more traffic to the area.

What about Wembley Stadium with 90,000 capacity plus staff and Wembley Arena with 12,500 capacity plus staff, these bring another 102,500 plus people to the area when both venues are holding events - should there be a major incident when both venues are full to capacity how would Northwick Park A & E cope???  How would emergency vehicles cope with getting people through Wembley to Northwick Park or through to the other remaining A & E departments???  When the stadium was opened traffic schemes were put in place to get people away from the stadium to the North Circular to try and stop the congestion in Wembley so would it not make sense to keep Central Middlesex A & E open???? 

Also we hear that Central Middlesex A & E will close this June well before the new larger A & E is supposed to open at Northwick Park – how can this be allowed to happen when it clearly says that the A & E departments will close in the next 2-3 years after the new larger A & E departments are open???

My friend recently broke his toe and went to Northwick Park A & E at 10.00pm on a Monday night and was told he would have to wait 5-6 hours before he was seen – he decided not to wait and went back the next day and had to wait 4 hours to be seen.  How will Northwick Park A & E cope when everyone has to go there?  Will the hospitals be reducing parking charges for people that have to wait for hours and hours in the A & E departments to be seen??? Will there be improved public transport - if you have to go there in the middle of the night there will be no public transport available.

What impact will all the extra traffic have on the area with people having to travel further for treatment - not very good for the environment!

*Barry Gardiner says Central Middlesex A & E is not in his constituency but a lot of the people who will be affected by its closure are his constituents!!!

 Since this guess posting was sent to me Cllr Lincoln Beswick  (Labour, Harlesden) has written in the Brent and Kilburn Times regarding the closure of Central Middlesex A&E and other Coalition policies::

All these areas that this affects must stand up, be more forceful, challenge nationally elected members and jointly have a march for freedom from this atrocious, blatant, obvious and odious decision. Those elected and in opposition should not stay silent on these issues.

This requires joint action by all those who are affected - elected politicians, health service, trade unionists, general community and media services

A first practical action will be if Brent Council decides to refer back the decision to close Central Middlesex A&E at the meeting of the Health Partnerships Overview and Scrutiny Committee at its meeting on Tuesday March 19th 7pm Brent Town Hall. LINK

The public can request to speak at the meeting. The contact is: 

Lisa Weaver, Democratic Services Officer  (020) 8937 1358 Email: lisa.weaver@brent.gov.uk

Candlelit vigil marks start of week of action to save our hospitals

Campaigners marked the beginning of the Week of Action to Defend London's NHS with a candle lit vigil outside Central Middlesex Hospital tonight. The Central Middlesex A&E is threatened with closure under the Shaping a Healthier Future proposals. People from Brent, Ealing and Hammersmith and Fulham joined in the vigil. Sarah Cox from Brent said that it was important that people across the three boroughs stayed united to guard against any attempts at divide and rule.

On Tuesday February 19th NHS NW London will be meeting at Central Hall Westminster to make decisions on the closure of A&E departments and many other services at Central Middlesex, Ealing, Charing Cross and Hammersmith hospitals. There will be a demonstration outside Central Hall from 8.30am.

Join Save Central Middlesex A&E March on Saturday