I thought this posting on the Brent Council website LINK by Cllr Kruoesh Hiran, Cabinet member for Adults, Health and Wellbeing,  deserved a wider audience. It sets out Brent Council's response to the Mansfield report.
Following a year long investigation into health service changes 
across five London boroughs the Independent Healthcare Commission for 
North West London reported its findings earlier this month.
The Commission, which was chaired by one of the UK’s leading lawyers 
Mr Michael Mansfield QC, was jointly commissioned by the boroughs of 
Brent, Ealing, Hammersmith & Fulham, Harrow and Hounslow. Naturally,
 as the democratically elected representatives of local people, we 
shared serious concerns about how A&E and other health services were
 changed across our boroughs.
However, it is important to also note that our concerns are not 
solely focused on A&E. One of the main issues here in Brent is the 
outdated population estimates underpinning the original plans. Yes 
A&E is a barometer of how the NHS is performing but it is clear that
 there is a wider system problem.
The Mansfield report highlights social care funding cuts and the 
significant cuts to local government. A good NHS needs a properly funded
 social care system. But the funding cuts to councils have reduced local
 authorities’ ability to provide more preventative services. It is the 
same problem emerging with Public Health funding.
Naturally when you are looking at a report, which affects two million
 people across North West London, there will be some issues more 
relevant than others to Brent’s 320,000 population.
First let’s turn to the main findings in the report:
- there is still no completed, up to date business plan in place that 
sets out the case for delivering the Shaping a Healthier Future 
programme (SaHF), demonstrating that the programme is affordable and 
deliverable
- there was limited and inadequate public consultation on the original
 SaHF proposals and those proposals themselves did not provide an 
accurate view of the final costs and risks to the people affected
- the escalating costs of the programme do not represent value for money and is a waste of precious public resources
- NHS facilities, delivering important public healthcare services, 
have been closed without adequate alternative provision being put in 
place
- the original business case seriously underestimates the increasing 
size of the population in North West London and fails to address the 
increasing need for services.
The report also makes it clear that we are now looking at a £1.3 
billion project while the original proposals were predicating a saving 
of over £200 million a year. A continued lack of investment in the out 
of hospitals strategy, while still implementing the A&E closures 
programme has led to unacceptable standards and low performance within 
A&E.
We are supportive of a good out of hospital strategy. It is in all 
our interests as it is generally better to have good health services 
closer to home. However, those services need to be in place before 
hospitals are reconfigured.
This is combined with a lack of bed capacity at Northwick Park and 
the delays in resolving this situation have been ongoing for the past 
year. Residents still consistently report problems with accessing GP 
appointments in a timely way and this inevitably leads to people 
presenting at A&E, while the use of urgent care centres is below 
capacity.
What was truly shocking to me in the report was the statistics on 
Northwick Park hospital where performance has been consistently poor 
since September 2014. A key graph in the report shows London Ambulance 
Service ‘black breaches’. These are where an ambulance has taken more 
than an hour to take a patient to A&E. In Northwick Park there were 
633 such breaches compared to 106 at Hillingdon. Especially relevant is 
the fact that the London Ambulance Service has just been placed into 
special measures as, if you close A&Es, you are clearly more reliant
 on this service.
In summary, the SaHF plans really need to go back to the drawing 
board. We want greater local authority involvement in the actual 
decision making process and designing of services. While it is clear 
that mistakes have been made Brent Council wants to take this forward in
 a positive way.
Co-production is a good example where there is potential. There has 
been a recent decision to involve a Health and Wellbeing Board 
representative in local primary care. I am now Brent’s representative 
and although it has been a slow process to get here, I think we are now 
moving in the right direction.
In the meantime, we will thoroughly explore all of the 
recommendations in the Mansfield report
including the possibility of 
joining a Judicial Review after careful consideration and assessing the 
impact on Brent residents.
Finally, it does not give me any pleasure to write about the findings
 in this report but please do be reassured that Brent Council will 
continue to do our very best to help support our local NHS partners to 
learn the lessons from it and ultimately to deliver a good and more 
fully integrated NHS for all Brent residents.