Urgent meeting on NW London STP tomorrow Hammersmith Town Hall 7pm

From London Keep our NHS Public

Hammersmith and Fulham Council has announced plans for legal action against the NW London Sustainability and Transformation Plan  which aims to close first Ealing then Charing Cross Hospitals. Hammersmith & Fulhan  and Ealing Councils are the first to refuse to sign off the STP -  action we need replicated across England. In a step forward last Tuesday Hounslow Council passed a motion with all party support to retain acute services at Ealing and Charing Cross and a statement was signed by 5 councils including Harrow and Brent condemning the closure plan.The public meeting called by Hammersmith & Fulham Council tomorrow is vital in demonstrating the scale of public opposition and highlighting the need to protect local health services.

Notes from the Mansfield Enquiry

Guest blog by Peter Latham

On Saturday 28 March 2015 I went to Hounslow Civic Centre for the morning half of the NW London local authorities' Mansfield enquiry hearings into the impact of the NW London NHS 'Shaping a Healthier Future' project on healthcare for patients in NW London.

 

The main new thing I learnt was that the enquiry secretary Peter Smith told me that all the Clinical Commissioning Group and hospital trust NHS witnesses have declined to attend to give evidence until after all the 5 volumes of written evidence have been disclosed by the enquiry online next week. So any Clinical Commissioning Group or Healthcare Trust witnesses will be only be cross-examined at Brent Civic Centre on 9 May - after the General Election. 
Counsel to the enquiry is the barrister Katy Rensten instructed by a solicitors Birnberg Pierce.  She asked very easy leading questions for all witnesses critical of the Shaping a Healthier Future project.  There was no-one to cross-examine witnesses critical of the 'Shaping a Healthier Future' project.
The chairman of the enquiry Michael Mansfield QC asked a few well focused questions to each witness.   The other panel members are a retired Ealing GP Dr Stephen Hirst MBBS London 1974, and Dr John Lister (non-medical PhD) who is is a journalist academic with strong links to the National Union of Journalists and prominent in the pressure group 'Save Our NHS'.
It was clear from the panel questions that they are very interested in the same topics that the Brent CCG locality Patient Participation Group chairs criticise:

• weaknesses of the evidence for the original case for the 'Shaping a Healthier Future' project; 
• the failure to put in place the proposed community services to take the strain before the acute A/E departments were closed on 10.9.14;
• the lack of clarity for the public as to the demarcation between Urgent Care Centres and acute A/E;
•  the flimsy basis for the attempted implementation of the Shaping a Healthier Future projects with insufficient tendering procedure know-how.

It became clear to me that the panel and even some of the professional witnesses are not fully familiar with the full range of new NHS structures e.g. no-one was able to say where the funding for the Better Care Fund comes from - although it was thought that it involves no new money.  There appeared to be ignorance as to how limited the first tranche of implementation of Whole Systems Integrated Care is to be: in Brent just over 65s with at least one long term condition.

It became clear to me that some of the witnesses are failing to distinguish 2 quite separate issues: the political controversy over privatisation of NHS services, and the separate clinical and financial efficiency issue as to the merits of transferring more NHS out-patient services from the secondary hospitals into a community primary care setting.  This was particularly true of Professor Allyson Pollock of Queen Mary College who made a  very emotive politicised statement about destruction of the NHS by importing US style commercial privatisation.

The witness Hounslow Councillor Melvin Collins chair of NW London Joint Health Overview and Scrutiny Committee (JHOSC) was very critical of the NW London and CCGs long-standing secretiveness towards them with failure to provide requested information which he said made their work ineffective e.g. at a meeting on about 23 March Dr Mark Spencer had made it clear they would only get the business case for Whole Systems Integrated Care after the general election.

The 2 witnesses from Hounslow Council, their leader Steve Curran and cabinet member for Health and Adult Social Care Lily Bath, emphasised the shortcomings of their local CCG over SaHF and WSIC, but understandably had no criticisms of the local authority component of local health and social care other than emphasising their insufficient funding.

Consultant in Emergency Medicine Dr Julian Redhead, Chair of the Royal College of Emergency Medicine London Regional Board and with Imperial College and St Marys emergency trauma unit emphasised the shortage of appropriately qualified and experienced A/E staff as driving the need for centralisation of acute A/E services, and the need for a sufficient patient base to support specialist skills.  He gave rather vague oral evidence about the NHSE/Monitor 2009 patient base A/E funding cap with 30% funding disincentive for excess patients, and suggested that the whole way in which we pay for emergency medicine needs to be reformed: without making any specific suggestion in his oral evidence.

Medical practitioner Professor Allyson Pollock emphasised the transformation resulting from the repeal of sections 1 and 3 of the NHS Act 2006 by the Health and Social Care Act 2012 with the result that the Secretary for State no longer has a statutory duty to 'provide' health care  for the people of England, but only a duty to 'promote' such healthcare.  The duty transferred to the NHS Commissioning Board and local CCGs is only to meet the reasonable requirements of their population.  Public health has been carved out of CCGs and transferred to local authorities.  GP practices no longer have a specific territory.  She contended that we no longer have a National Health Service.  The present government are keen on the prime provider model which encourages sub-contracting so that we are importing US solutions and US problems.  Services are already falling away when specific services are not not specifically includedin contracts.  We are moving to the over-treatment and under-treatment of the over-expensive commercial insurance company US model whose algorithms focus on profitable premium fixing with no local accountability or local link.   She strongly proposed abolishing Foundation Trusts and the NHS internal market.  

The chairman of the enquiry Michael Mansfield QC asked Professor Pollock whether she had researched the vested interests of members of the House of Commons and House of Lords who had spoken in favour of the model of the 2012 Act.  She said that she had not researched this but that many did have such vested interests e.g. Alan Milburn.  She said that the last leader of the NHS had described it as being in 'managed decline'.

Peter Latham,  Chairman Willesden Patient Participation Group.

Butt suggests combined West London Authority as 40% central staffing cuts sought in Brent budget

The  Report for the First Reading Debate on the Council Budget LINK was up on the Council website by 23.45 last night. It includes a section on the Borough Plan Consultation which is fast work as the consultation only closed at 5pm yesterday.

Full Council was changed from November 17th to December 8th ostensibly to enable a report on the Borough Plan to be made.

The report states (4.3)

Between 16 September and 28 November the council, with its partners undertook a major consultation exercise to gather information on local people's views of:

• The area where they live
• Their aspirations for the future of the borough
• Their spending priorities, including those services they felt should be protected and areas where they felt we could do less
• What more they, the community group, or others could do to help build strong communities in Brent in the context of shrinking public resources 

Brent in 'secret' discussions to merge legal department with 8 other boroughs

From Islington Tribune LINK - merging of legal departments of nine London boroughs, including Islington and Brent:

'...secret discussions...have taken place between nine London boroughs, including Camden and Islington, about effectively "privatising" the Town Hall's legal department.

'Tens of thousands of pounds have so far been spent on consultants looking into the proposals - and will "cost far more" if it goes ahead.

'According to leaked documents obtained by the  Islington Tribune the plans would be presented to new councillors as a "fait accompli" after tomorrow's local elections.

'Under the plans Islington, Camden, Hammersmith and Fulham, Kensington and Chelsea, the City of London, Harrow, Hounslow, Brent and Waltham Forest, would merge their legal teams with each authority specialising in one area'

But

'Breaking up legal services would dilute the quality of work already achieved... there will be major data protection and IT compatibility issues...much money and time has been spent on the project to date and much more will be spent in the future - £150,000 so far to Kennedy Cater solicitors who are acting as consultants...the joint services plan has already been approved so that members are presented with a fait accompli after the election'.

Brent to 'Carry on Regardless' despite super-contract drop-outs

I reported on November 1st that the Communications Department at Brent Council had refused to talk to me about the future of the four borough supercontract for the public realm after the withdrawal of Barnet and Richmond councils.

The current edition of the Kilburn Times has followed up the story. A Brent Council spokesman told them that 'ideally' they would like to join forces with other boroughs but would press on with the contract regardless.

The Brent Executive has already delegated powers to spend £6m on a new depot to Andy Donald. Director  and Cllr George Crane. lead member for Major Projects and Regeneration

Brent to join with other boroughs to out-source 'Public Realm' including waste and parks maintenance

In a report to go before the Executive on October 15th LINK officers are recommending that the Council join with Barnet, Hounslow and Richmond in a 'super contract' see my previous blog HERE that will cover:

• Household waste collections and recycling
• Street Cleansing operations
• Graffiti clearance
• Winter maintenance
• Cleansing of public conveniences
• Grounds maintenance to parks and open spaces (including Brent Housing Partnership HP estates)
• Grounds maintenance to cemeteries and grave digging
• Highway verges and shrub beds
• Playground inspection and maintenance
• Warden service
• Commercial waste

Brent's contract with Veolia ends on March 31st 2014. The contract, across the 4 boroughs and BHP which may not all buy into all the services, would be worth £700m over the 16 year contract period..

In a controversial move the report recommends:

The Executive to give approval to an exemption from Contract Standing Order 88 to allow an advert to be placed and a pre-qualification process to be run without the approval of evaluation criteria and certain other pre-tender considerations, subject to approval of such matters at a future Executive

And further recommends, as a consequence of the problem of the lack of a Brent Council depot when the last contract was awarded to Veolia, that the Council acquire a depot. Andy Donald Director of Regeneration and Major Projects, appears to be leading on this:

That the Executive agree to an amendment of £6.2m to the Council’s capital budget for 2012/13 to procure a new depot as set out in section 3.6 of the report. If a suitable site is identified, due to the reasons set out in paragraph 3.6.6, that the final terms of any acquisition including the purchase price be delegated to the Director of Regeneration and Major Projects and the Director of Finance and Corporate Services in consultation with their respective Lead Members. Such purchase price to be contained within the amendment to the Council’s capital budget as set out within this report

As a lay person it seems to me that this is not a particularly transparent or accountable  process when the Executive is not fully involved in an exceptionally large contract.

The proposal has come as a surprise to people in Barnet where a large number of staff are involved. In Brent waste management and recycling are already out-sourced to Veolia and it is the Parks and Sports staff who are most affected. The report states:

For Brent, whilst the majority of staffing implications are for staff currently employed by the current contractor, there are implications for existing Brent staff in Sports and Parks and Highway Operations. The proposal is that in excess of 50 council staff providing grounds maintenance and a number of staff in other services are transferred to the successful provider. In addition, if the decision is to create a single client arrangement a small number of staff in waste and recycling would be affected,

TUPE will apply and presumably this will also be the case for the cleaning and grounds maintenance contractors currently employed by Brent Housing Partnership, which also comes under Andy Donald's umbrella.