Industrial action at Northwick Park hospital has ended after GMB members accept a pay and conditions deal

 

I am a fairly regular patient at Northwick Park Hospital and always impressed by the undervalued support staff there. Many of them are employed by agencies as services are out-sourced as part of the creeping privatisation of the NHS. Outsourcing means poor wages and conditions and often precarious employment.

One such agency is Medirest, part of the Compass Group). Hundreds of hospital workers - including caterers, ward hosts and porters – have taken a total of five days of strike action in protest against Medirest at London Northwest Healthcare (LNWH) Trust.

The strike will end after workers voted to accept improvements to sick pay, annual leave and a pay increase of up to 25 per cent.

There were angry over disparities in terms between their terms and those of in-house contracted staff, including significantly worse sick leave, annual leave and pay entitlements.

In addition, last year’s NHS pay deal was not paid in full for many outsourced staff.

The new deal includes:

• All staff will be brought up to the London London Living Wage.
• An additional day of annual leave and an additional week of sick pay for Medirest contract staff.
• A one-off equalisation payment of up to £1,655 to address disparities in pay between different members of staff
• The trust to enter into negotiations with the GMB on equalising contractual terms when the contract reaches its end.
• Full recognition of the GMB across the whole of the NHS Trust, enabling the GMB to represent and negotiate on behalf of hundreds of members 

Bhimraj Rai, GMB Representative at Northwick Park, said:

Hundreds of low-paid staff will receive a pay rise of up to 25 per cent and fairer terms and conditions because GMB members have stood together for equal pay and equal terms.

GMB members have spent months negotiating and weeks on the picket line, but we have never accepted that workers should be paid less or receive different treatment for doing the same job.

Medirest has a responsibility to treat all its employees fairly.

We will keep fighting for all our members and keep campaigning for full equal terms.

Hundreds of Medirest members have joined the GMB since the start of this dispute and now, with full recognition, the union is stronger than ever.

A supporter of the strike action had explained the background to the strike before the settlement :

The main issue is a discrepancy between Agenda for Change and Medirest contracts, with the latter on lower rates of pay and much lower annual leave allowance as well as minimal sick leave and no carers leave. Bereavement leave has been reduced and is not allowed for siblings or in-laws.  Additionally they are denied the non-consolidated COVID payment; the reason given is that they are not NHS staff. They work equally and took equal levels of risk during the pandemic.

Agenda for Change staff were given their payments two weeks ago, in an effort to divide the staff and stop them joining the strike. Many of the staff are immigrants and there are multiple allegations of discrimination and unfair treatment, exploitation and bullying. Medirest are alleged to harass staff during sick leave. Despite having sick notes from doctors, they call staff at home to ask when they can return to work and send them to Occupational Health. When they return to work, they are placed on disciplinary measures, leading to dismissal in 3 stages regardless of medical circumstances. Staff are alleged to be bullied and intimidated, including for taking industrial action.

 

 

The mess staff are expected to clear up post-strike mess despite extra staff employed on strike days

 

The strkers  are asking for the same contract as Agenda for Change and also the COVID payments. However ideally they would like the contracts brought in-house so that they are directly employed by the NHS. It should also be noted that during strike days, the hospital are employing double the number of staff for the same work, which is not being done to the correct standards of hygiene e.g. for cleaning and food preparation, which puts patients at risk. The staff are expected to clean up this mess when they return to work after the strike and it is blamed on the strike, when actually twice as many staff have been employed during those days. The staff are working to those higher standards and penalised for any errors.

436 children under five admitted to Northwick Park and Barnet Hospitals with breathing difficulties according to latest (2023) figures

 From Mums for Lungs

A Freedom of Information request sent to London Northwest University Healthcare Trust and the Royal Free London NHS Foundation Trust reveals the scale of respiratory problems amongst the youngest children in Brent and Barnet. 

In 2023, the latest figures available, 436 children under five were dmitted to hospital with respiratory difficulties. Across 22  London hospitals surveyed, more than 15,000 children were admitted with serious breathing difficulties. 

 

 Baby grows Brent: credit Jonathan Goldberg. 

L-R: Amandine Alexandre, Sally Toure, Tony Burch, Frances Holloway, Gourav Gourav, Ilaria Esposito, Agnieszka Szewera in Roundwood Park near Northwick Park Hospital. Pic credit: Jonathan Goldberg / Mums for Lungs.

 

The figures, obtained by air pollution campaigners, Mums for Lungs, have prompted calls to speed up the removal of all diesel vehicles by at least 2030, with some limited exceptions. 

Parents have been hanging baby grows that spell out ‘Clean Air Now’ near areas affected by high levels of pollution, all in breach of World Health Organization standards.

Across England as a whole, 15,328 children aged 19 or under were admitted into hospital for serious asthma attacks alone, according to Public Health England figures from 2022/23. For London, the figure is 2,705.

 

Amandine Alexandre, a parent who lives in Brent and trustee of Harlesden Neighbourhood Forum said,

 

Although air quality in Brent has improved since 2016, Harlesden High Street is bucking this trend. Thanks to our Breathe London monitoring station, we know that, most days, nitrogen dioxide levels still far exceed the air quality standards set by the World Health Organization in 2021. This is very worrying considering that NO2 irritates our lungs and weakens our immune system. Harlesden residents deserve cleaner air now.”

 

Harlesden Neighbourhood Forum, a charity responsible for implementing the local neighbourhood plan, was successful in bidding for a Breathe London community node in 2021. The solar powered pollution monitoring station was installed by Imperial College London in March 2022. (It was taken down by Brent council by mistake in the autumn of 2022 and was re-installed on March 30th 2023.) The data can be accessed live on Breathe London. It can also be easily visualised on Air Aware. 

 

The Breathe London Network was established in 2021 as a partnership between the Mayor of London, Imperial College London, and Bloomberg Philanthropies. It is making reliable air quality monitoring data more accessible to local communities by building a network of accurate and reliable air quality sensors across the capital.

 

Air pollution monitors in Brent and Barnet continue to show high levels of some of the most dangerous forms of pollution - including nitrogen dioxide (NO2) and particulate matter (PM 2.5). 

Due to the small size of many of the particles some of these toxins may enter the bloodstream and be transported around the body, lodging in the heart, brain and other organs. Exposure to PM 2.5 can result in serious impacts to health, especially in vulnerable groups of people such as the young and elderly. 

Short-term exposure to concentrations of NO2 can cause inflammation of the airways and increase susceptibility to respiratory infections and to allergens. NO2 can exacerbate the symptoms of those already suffering from lung or heart conditions.

Monitors in Brent  show levels of air pollution  in some cases close to the legal limits (23 - 33 μg/m3 NO2) and well for  PM2.5 above WHO guidelines for 2024 so far as well. 

 

Brent – Ark Franklin

Brent – IKEA

Brent – John Keble Primary School

Brent – Neasden Lane

 

NB. UK legal annual limit values:

NO2 = 40μg/m3, PM2.5 = 20μg/m3.  

WHO guidelines:

NO2 = 10μg/m3, PM2.5 = 5μg/m3

 Editor's note: The new North Brent Secondary School is due to open in Neasden Lane

 

Dr Anna Moore, a respiratory doctor who works in a London NHS Hospital, added: 

All the evidence shows that there is a clear connection between high levels of air pollution and respiratory conditions. These figures also demonstrate that there are hundreds of children who are in hospital with conditions that could be prevented. At a time when NHS resources are stretched thin, we need to urgently clean up our air, including completely phasing out the most heavily polluting diesel cars, trucks and vans and focus on infrastructure which enables safe walking and cycling as this is vital for long term health.

Jemima Hartshorn, Mums for Lungs, said:

Thousands of children are unable to breathe because of preventable air pollution, this must change. So many children are being admitted to hospitals with serious cases of asthma, and all the evidence shows that damaging lungs at an early age can cause lifelong health conditions. The next national Government, Mayors and local authorities must all use their powers to phase out diesel vehicles and protect children from painful and debilitating health conditions.

Road transport is the largest contributor to air pollution in London and it’s thought that air pollution contributes to around 4,000 early deaths each year in London. 

Mums for Lungs have written to the main political party leaders Rishi Sunak and Sir Keir Starmer calling for them to discourage people from buying diesel vehicles and to set a target for England to be diesel-free by 2030, with limited exemptions, alongside action on wood burning and creating more School Streets, which restrict car use at drop off and pick up. 

 

 

North West London Integrated Care Systems terminates Urgent Treatment Centre provider's contract at Central Middlesex & Northwick Park sites, along with others

 From the HSJ LINK , by Nick Kituno

An integrated care system has terminated a private provider’s contract to run four urgent treatment centres following performance concerns, HSJ has been told. 

Two local acute trusts were expected to take over from provider Greenbrook Healthcare this week, following the decision by North West London ICS.

The impacted sites include Hillingdon UTC, which is co-located with the Hillingdon Hospitals Foundation Trust, as well as the Ealing, Central Middlesex and Northwick Park sites that are near to the respective hospitals run by London North West University Healthcare Trust.

Two other UTCs on the patch, at St Mary’s and West Middlesex hospitals, are unaffected.

Greenbrook Healthcare is owned by the Totally plc group and its services provided to the NHS include urgent care, planned care and insourcing.

The ICS declined to say why the contract had been ended, but a senior source close to the situation told HSJ it followed performance and staffing concerns.

Winter and performance plans published by the ICS in July and October last year cited performance problems with its UTCs, although it did not mention particular centres.

A report in the summer cited “system wide actions to understand and address weaknesses in UTC performance”, while another in October said a “remedial action plan” was in place “submitted by Totally plc in July 2022, which includes specific actions on staffing performance and re-direction initiatives”.

In a joint statement, North West London ICS and Totally plc told HSJ: 

“As Greenbrook Healthcare approaches the end of its contracts with commissioners to provide urgent care services via UTCs at Ealing, Northwick Park, Central Middlesex and Hillingdon hospitals, and whilst we agree handover plans to the local NHS trusts, the delivery of excellent patient care remains our joint priority.”

The ICS tendered for the long-term running of the UTCs in November, saying at the time that the new providers expected to be in place from early 2023. The ICS has not yet announced the result of the tender. The £26m contract would run for three years and include an option for a further two.

North West London clinical commissioning group awarded a short-term contract to run the UTCs last year, pending the longer-term procurement exercise.

The developments in north west London follow the Care Quality Commission placing four UTCs run by a different independent provider in the North East London ICS in special measures last month, but this is not directly related to Greenbrook or Totally.

Questions have been raised about the workforce model of UCCs in London.

Quality Care Commission welcomes improvements at Northwick Park maternity services - rating improved from 'Inadequate' to 'Requires Improvement'

 From the Quality Care Commission

In October, CQC carried out an unannounced comprehensive inspection of the maternity department at Northwick Park Hospital, run by London North West University Healthcare NHS Trust*. This was to follow up on concerns identified during a previous inspection in April, when CQC told the trust to take urgent action to keep mothers and babies safe.

Following the October inspection, the overall rating for maternity services improved from inadequate to requires improvement. Safe, responsive and well-led remain as requires improvement. Caring remains good, and effective moved up from requires improvement to good.

Nicola Wise, CQC’s head of hospital inspection, said:

“I am pleased to say we saw a number of improvements in the maternity department at Northwick Park Hospital during our recent inspection.

“After our previous inspection, we were concerned there was a blame culture within the service which stopped incidents being escalated and improvements being made. This had improved, and staff are encouraged to give feedback and report incidents which are now being reviewed and learning shared, with improvements being tracked. We found a zero-tolerance policy regarding bullying and inappropriate behaviour, which was an improvement from our last inspection.

“Women using the service told us staff treated them with kindness. One person who had recently given birth, said that staff had gone above and beyond to provide safe care and treatment. They also respected people’s personal, cultural, social and religious needs. One woman who wore a hijab said that staff had respected them and their privacy regarding this.

“Following this inspection, we pointed out areas where further improvements need to be made. However, the interim leadership team is aware of the issues, and is committed to making the required improvements. Staff told us that senior managers were much more visible, and they were impressed by the change in approach from the leadership team, saying there was no longer a feeling of ‘them and us’. It is clear that leaders need time to fully embed the improvements in the maternity service and make permanent appointments to the team.

“We will continue to monitor the service to check that improvements are made and fully embedded, however, we recognise that all hospitals and healthcare professionals are under extreme pressure at the current time, and they need to be given the space to focus on delivering safe care to patients and supporting staff through this difficult period.”

Inspectors found the following during this inspection:

• The service did not always have enough midwifery staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm and to provide the right care and treatment. Waiting times were longer for women across maternity services when staffing levels were low, though staff were encouraged to report delays as incidents. The birth centre was closed due to staff shortages. Staff shortages also impacted on home visits and clinics provided by community midwives
• Compliance with mandatory staff training was 84%, which did not quite meet the trust’s target of 85%, although it was an improvement
• The service had one never event in September. Never events are serious, largely preventable patient safety incidents. A swab was left inside a patient when they were being induced, even though two members of staff had signed a document showing that the correct number of swabs had been counted following the procedure. Learning from this event was shared across the trust
• The department’s policy was to admit women on their third call in 24 hours to explore any concerns. However, there was no system of recording the time at which women with concerns had previously called
• Some equipment on the resuscitation trolleys was out-of-date and cold cots** in the bereavement suite had been out of operation for two months, as the cooling system had failed, even though this had been reported to the trust
• Inspectors found an open trolley on the delivery suite which contained two drugs vials, presenting a risk that unauthorised people could have access to the vials
• One-to-one antenatal appointments with community midwives were not always being recorded. Inspectors also saw loose paperwork relating to patient assessments which could become detached from women’s notes so information could be misplaced
• Women who were attending the service to have their pregnancy terminated often had to wait for 45 minutes for their appointment in the same waiting room as women attending antenatal and postnatal clinics, which could be distressing for them
• Antenatal classes had been reduced as a result of the logistics of providing classes during the COVID-19 pandemic and staff availability, which meant women did not have access to information that could help them improve their health and wellbeing during pregnancy. Online classes had been planned, but these had not been implemented.

However:

• New interim leaders had the skills and abilities to run the service. The new managers understood and managed the priorities and issues the service faced. However, the trust needed time to embed this improved leadership and also to forge a period of stability by making permanent appointments to the leadership team
• In response to external reviews of the service, managers had produced a maternity improvement plan, which was reviewed and updated weekly
• There had been improvement in doctors, nurses and other healthcare professionals working together as a team to benefit women
• Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. It was easy for people to give feedback and raise concerns about the care they received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff
• Work was in progress to ensure staff completed and updated risk assessments for each woman and took action to remove or minimise risks
• The service had recently employed an audit midwife and a risk midwife to ensure monitoring of patient outcomes and benchmarking of service
• Work was in progress to monitor domestic abuse being assessed at all antenatal appointments
• The service had information boards which carried updates for staff on the maternity risk register. Policies and clinical guidelines were up to date and had dates for review
• The service made sure staff were competent for their roles. Managers appraised staffs’ work performance and held supervision meetings with them to provide support and development
• Staff understood and respected the personal, cultural, social and religious needs of women and how they may relate to care needs. 
  

On Twitter Cllr Ketan Sheth, chair of Scrutiny where he has done much to hold local NHS services to account, said: 

 Pleased to see the Care Quality Commission have upgraded London NW University Healthcare NHS Trust's Northwick Park maternity service to Requires Improvement and rated the service as Good for caring & effective. This is welcome progress for our local maternity service.

The full report is available HERE

 

Care Quality Commission finds 'poor culture' at Northwick Park's Maternity Department amidst multiple allegations of bullying. Emergency Dept more positive but the hospital still requires improvement

From the Care Quality Commission

The Care Quality Commission (CQC) has told London North West University Healthcare NHS Trust that it must make improvements at Northwick Park Hospital, following an inspection of the maternity service and the emergency department.

CQC carried out an unannounced focused inspection of the maternity service in April in response to information of concern received about the care of mothers and babies in the department. Following the inspection, the overall rating for the maternity service went down from requires improvement to inadequate. The ratings for the safe and well-led domains also went down from requires improvement to inadequate. The caring, effective and responsive domains were not rated during this inspection.

Inspectors also carried out an unannounced focused inspection of the emergency department to follow up on concerns regarding the quality and safety of the service and found that significant improvements had been made. At the time of the inspection in April, the department was under adverse pressure due to the COVID-19 pandemic. The emergency department was not rated during this inspection, so the previous rating of requires improvement remains in place.

The overall rating for Northwick Park Hospital remains unchanged and is requires improvement.

Nicola Wise, CQC’s head of hospital inspection, said:

“We were very concerned by our findings at Northwick Park hospital’s maternity department. There was a poor culture overall and there were multiple allegations of bullying amongst the staff. This is completely unacceptable. Nobody should have to work in an environment where they feel intimidated.

“Staff told us about one consultant who refused to help a junior midwife when asked, and other consultants who went home instead of discharging patients. We were also told about staff shouting at each other, and a midwife shouting at a patient because she could not understand English. A member of staff shouted at one of our inspectors, after mistaking them for a colleague.

“Some staff said they had raised concerns about the poor attitude amongst the senior management team, but that leaders did not listen. Other staff said they were frightened to speak out, for fear of repercussions, and some claimed they had been told by management only to say good things when asked. The knock-on effect of working in such an environment, is that when things go wrong, the fear of being blamed prevents people from raising concerns and reporting incidents, so lessons are not learnt and shared amongst the wider team.

“The executive leadership team is aware of the concerns our inspectors highlighted and we are assured that the team is implementing improvements while seeking support from stakeholders in the local healthcare community. We will keep a close eye on progress and will reinspect to ensure that improvements have been made and fully embedded.

“The situation in the emergency department was more positive. In general, it was well run, with enough staff with the right skills, qualifications, training and experience to keep people safe and provide the right care and treatment. However, nursing vacancies remain a challenge, although the leadership team was in the process of recruiting staff in order to improve the situation. We also pointed out a potential risk in the department that senior leaders were not aware of and need to address.”

Inspectors found the following areas of concern in the maternity department:

• The leadership team of the maternity service at Northwick Park Hospital had been recently established and because they had only been in post for a short time, the new team did not yet have a proper governance structure in place, and was therefore unable to provide assurance that they had the skills and abilities to run the service, or to implement meaningful changes that improved the safety of the service
• Not all leaders were aware of challenges to the service. Some did not know what was on the risk register and there were some longstanding issues that had not been addressed. Staff reported that not all leaders were visible, and they felt leaders did not act in a timely way to address the issues in the service
• The trust reported 13 serious incidents between March 2020 and March 2021, which included eight perinatal (baby) deaths over a five-week period, during July and August last year, which is a very high number over such a short period. The trust escalated this to the North West London Integrated Care System (ICS) for an external review and the trust had an improvement plan in place to address issues identified in the ICS report
• Doctors, nurses and other healthcare professionals did not always work well together as a team or support each other to provide good care. Most staff that inspectors spoke to had concerns about staffing levels and the high use of agency staff. Staff often had to miss lunch breaks as a result of insufficient staff cover
• The trust was unable to provide assurance that it had effective systems in place to ensure that medical and midwifery staff had the competence, skills and experience to safely care for, and meet the needs of, women and babies using the service
• Mandatory training did not meet the trust’s target. Although staff understood how to protect women from abuse, safeguarding training compliance was not always meeting the trust target and domestic violence assessments were not always documented
• Staff did not always complete and update risk assessments for each patient and did not always remove or minimise risks
• The service did not always manage patient safety incidents well. Incidents were not always reported in a timely way or lessons learned shared amongst the wider service
• During the inspection, concerns were raised regarding delays in the induction of labour for women and an allegation that some women were waiting more than 72 hours to be induced. The trust had completed an audit of patient records in April which showed that half of the women were induced within 48 hours, but the other half experienced delays.

In the emergency department, inspectors found:

• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff
• The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. The service had enough medical staff to ensure safe care was provided at all times
• Staff felt respected, supported and valued and they were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff, could raise concerns without fear
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so
• The service generally controlled infection risk well. Staff wore the right personal protective to keep themselves and others safe from cross infection. Patients had an assessment of their infection risk on arrival at the department and staff allocated them to the correct areas
• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service
• Patients could access the service when they needed and were able to access treatment promptly. The trust had significantly improved its patient handover and treatment time performance
• However, senior leaders were not aware of all the risks in the department. Staff were responsible for changing the filters on masks, but the leadership team did not monitor, or have oversight of this. In addition, patient safety checklists were not consistently filled all records that were reviewed.

UPDATE: First phase of Northwick Park development at planning tonight - it may be another marathon

 

Overall view of the context of the site that will be developed (outlined in red)

The site now (slightly right of centre)

Masterplan view of the whole site as it will be - this application in foreground left

UPDATE: APPLICATION APPROVED UNANIMOUSLY

 

The first major section of the Northwick Park development comes up at tonight's Planning Committee. If the last meeting was a marathon tonight's may necessitate committee members and officers bringing in their sleeping bags!

The overall Northwick Park master plan is a development shared between partners Brent Council, University of Westminsters, Northwick Park Hospital (NHS) and Network Housing as part of the One Public Estate government sponsored initiative.

This particular site will be familiar with visitors to the hospital who approach from Northwick Park station. They will know the chimney of the energy unit, low buildings, the hospital social club, nursery and some housing on the left side of the ring road as you approach along the footpath.

All will be swept away eventually and replaced with tower blocks ranging from 5-6 storeys to 12-13 storeys, a new nursery building and some small shops. The social club appears unlikely to survive unless space is found on the hospital site and in any case the hospital is said to want to discourage the consumption of alcohol - pity the poor hospital works after an intensive shift!

The Planning Committee will be told that there were just 10 objectors to the scheme and the officers' report dismisses each of them in turn. See LINK.

 

The proposal:

Full planning permission for demolition of existing buildings and structures on the site, all site preparation works for a residential led mixed-use developmentcomprising 654 new homes, associated car and cycle spaces, a replacement nursery, retail space, associated highways improvements, open space, hard andsoft landscaping and public realm works.

 With Cllr Maurice on the committee you can bet parking will take up a lot of  the time and here it is not just a matter of parking for the new residents but also parking for hospital workers themselves. The tenure of the housing will also be an issue with another Brent development with a significant amount of shared ownership despite recent publicity over drawbacks to such schemes:

Out of the 654 units, 409 will be private -

Affordable housing: Provision of 245 affordable units comprising: 

a. 70 units for affordable rent at London Affordable Rent levels and 26 units for affordable rentat London Living Rent levels, in accordance with the Mayor of London's Affordable HousingProgramme 2016-2021 Funding Guidance (dated November 2016) or the necessaryguidance as it is updated and subject to an appropriate Affordable Rent nominationsagreement with the Council, securing 100% nomination rights on first lets and 75%nomination rights on subsequent lets for the Council.

b. 38 units for affordable rent at rent levels not exceeding 80% of current market rents, andsubject to an appropriate Affordable Rent nominations agreement with the NHS Trust and the Council, securing 100% nomination rights on first lets and 75% nomination rights onsubsequent lets for the NHS Trust and cascaded rights for the Council. 

c. 111 units for Shared Ownership, (as defined under section 70(6) of the Housing &Regeneration Act 2008, subject to London Plan policy affordability stipulations that total housing costs should not exceed 40% of net annual household income, disposed on a freehold / minimum 125 year leasehold to a Registered Provider, (and subject to anappropriate Shared Ownership nominations agreement with the Council that secure sreasonable local priority to the units). The condition in brackets has been removed in a supplementary report. 

Concerns over the environmental impact of the scheme, impingement on Metropolitan Open Space, housing tenure, the proportion of amenity space, over-shadowing, the impact on views (especially from Harrow-on-the-Hill) are all, as usual, judged on balance to be tolerable given the 'benefits of the scheme.'

Officers judged that capacity in local primary and secondary schools is sufficient to cater for the increased population.

The webcast of the meeting starts at 6pm tonight: https://brent.public-i.tv/core/portal/webcast_interactive/531655

Action promised on BAME access to GPs as Brent's Covid19 response comes under scrutiny

Melanie Smith, Brent Director of Public Health, told last night's Community and Wellbeing Scrutiny Committee that during the early months of the Covid19 pandemic many in Brent's BAME community felt disempowered and lacking in agency. Lessons had been learnt and Brent had realised the importance of engaging with the many different BAME communities in Brent and their community leaders. They had concentrated on Alperton and Church End which had the highest number of cases.  Messages had to be consistent and make sense to the communities concerned, for example over shielding in multi-generational households.

Confirming that access to primary healthcare was a major issue, Cllr Abdi Aden, who is of Somali background, said that many in the community who had been feeling sick had problems making appointments with their GP.  They had waited for hours in a queue at the medical centre only to give up and go home without receiving any help.

Cllr Mary Daly backed up the claim. Chair of the Committee, Cllr Ketan Sheth, interjected to say that many in the BAME community still suffered from a poor GP offer.

Dr MC Patel, chair of Brent CCG and NW London NHS lead on inequalities, offered to go with Cllr Aden to the surgery to address the issue of practices not affording access. He said unnecessary denial of access should not be tolerated.  He offered to talk to groups of 5 or so from the community to listen to their experiences and take action. 

Government guidelines recently issued should mean more face to face appointments with GPs rather than on-line arrangements which discriminated against those without internet access or lacking in English language,

Earlier in the discussion the high rate of BAME Covid deaths initially had been attributed to people not going to their GPs early enough. A speaker from Brent Healthwatch said that many residents had been hesitant about going to Northwick Park Hospital and were wary about getting infected there. Cllr Janice Long asked if late admissions to hospital was the cause of the higher death rate in Brent. She pointed out that there was only one medical centre in hard-hit Church End and asked what was being done to encourage people to go to their GP.

Cllr Ahmad Shahzad pointed out the structural issues affecting the BAME community including lack of opportunity and poor housing and said the death toll must not happen again - the Council had to safeguard the population. He said Public Health England and the BMA had been side-lined by the government.

Dr MC Patel said Brent CCG and NW London NHS were looking at devising an additional shielding list for Brent, that would include more people than the government list, and give them appropriate advice. The initial list did not include ethnicity as a factor and experience of the first wave means more needs to be done to include the BAME community, especially those with underlying conditions. Once offered it would be up to the individuals concerned to decide whether to be included in the vulnerable list.

Recently elected councillor, Gaynor Lloyd, said the elephant in the room was whether people would isolate as a consequence of being included in the list. She expressed doubt about a proposal to educate landlords about Covid19 and the risks stating, 'we all know about some landlords.'

 Dr MC Patel said that this was an opportunity for the local authority and health to work together. Joint work and shared commitment were necessary to make things happen and for 'Brent to do it differently.' He cited the response on care homes as being one example of success and said local hospitals had done well.  There was now a clear message to GPs to see patients face to face if that is what they wanted and the CCG were also looking at hot hubs for Covid patients.  It was a matter of 'making the best of what we've got.'

Simon Crawford of NW London Hospital Trust said that the emergency pathway at Northwick Park Hospital was now 85% of the pre-Covid level. Segregated pathways at A&E meant there were clear pathways for non-Covid patients. Presently there were 12 Covid patients in the hospital, a slight increase compared with 8 or so recently.  Patients' temperatures were taken when they first entered the hospital. Patients due for an operation were tested 3 days before the operation was due.  He emphasised, 'We are open for business. If you have an appointment, keep to it!'

He said that Northwick Park had been the busiest hospital in London at the peak and had been supported by other hospitals There had been positive coverage recently and they had been innovative in going with oxygen treatment rather than ventilating machines.  He said that Northwick Park had never run out of oxygen, contrary to reports.

The Trust has signed private sector contracts with Clementine Hospital and the London Clinic. Cancer referrals that had dropped by 50% were now coming back.

Cllr Neal Nerva, recently appointed to the Cabinet as lead member for Public Health, Culture and Leisure, said he was going to introduce a political dimension into the discussion.  Testing had become a matter of private competition and local government had been side-lined. Cllr Shahzad had been right about Public Health England being side-lined and there was also the failings of Test, Track and Trace.

Despite this, he said, the Council could not stand back, too many people were at risk in Brent.  He expressed confidence in the NHS and said people need to be seeking help for non-Covid conditions. The Alperton and Church End meetings showed the need for a wider Brent policy on social distancing and engaging with BAME communities.  Structural issues such as Housing, jobs, co-morbidities, learning for the Covid19 experience, would feed into the Council's new Health and Wellbeing Strategy.

All in all it was a useful discussion, although much more needs to be investigated and acted upon. The trio of councillors, Daly, Long and Lloyd, looked particularly effective as scrutineers.

BBC London's report on Northwick Park Hospital's Covid19 response

Northwick Park and Central Middlesex hospitals still require improvement - some child services 'Inadequate'

The Care Quality Commission inspected the London NW University Healthcare NHS Trust, which covers Central Middlesex Hospital and Northwick Park Hospital, in the summer.  The report has now been published and makes worrying reading.

Of most concern will be the red light 'Inadequate rating' for three areas of Services for Children and Young People at Central Middlesex Hospital.

The Commission said:

·       We found a lack of clarity over where the overall responsibility and accountability of children and young people services lies within Central Middlesex Hospital. We also found a lack of clarity for how and where this service feeds into the trust. 

·       Governance in children and young people services at Central Middlesex Hospital was weak. The risk register for the recovery ward was out of date. There was a lack of up to date policies and associated audits demonstrating that the care being delivered was compliant [with] national standards and best practice. We were not assured that the service was guided or supported via a paediatric surgical network. 

·       There was no clear evidence that areas from the last inspection for children and young people services had been addressed or necessary improvements made. 

·       In medical care, risks were mitigated and managed but there had been limited action to address risks directly.

·       The senior leadership team for medical care at Central Middlesex Hospital recognised the sometimes poor relationship between its staff and local authority staff, but there had been no action to address this

There were many issues regarding safety. The report says:

·       Our rating of safe stayed the same. We rated it as requires improvement because: 

·       The trust provided mandatory training in key skills however there was some confusion among midwifery staff as to the correct length of mandatory training and its content. Compliance rates for mandatory training and safeguarding training were below trust targets in the surgical services at Northwick Park Hospital and Central Middlesex Hospital. Not all clinical staff in children and young people services at Central Middlesex Hospital caring for children were trained to safeguarding level three however, plans were in place to ensure all staff received this training. 

·       In medical care at Central Middlesex Hospital, some staff did not always report incidents and, in particular, near misses. 

·       The trust did not always control infection risk well. Hand hygiene was not consistently being undertaken in maternity services. In children and young people services, the Rainbow Unit at Central Middlesex Hospital was found to be untidy and we could not be assured that children’s toys were regularly cleaned. 

·       Due to capacity issues in the emergency department at Northwick Park Hospital, patients were still being cared for on trolleys in the corridor which meant private conversations could be overheard. 

·       At our last inspection we found that the clinical decisions unit (CDU) was being used inappropriately to treat level two patients. Whilst the service assured us that this was no longer the case we did find that the area was being used as overflow for patients requiring inpatient beds and patients within the CDU could be there for over four hours and sometimes up to three days. In children and young people services at Central Middlesex Hospital, staff we spoke with in Recovery Stage One told us that children were cared for in a mixed four bedded recovery bay with adults. 

·       Staff at Central Middlesex Hospital did not use a nationally recognised tool to identify deteriorating patients, such as Paediatric Early Warning Signs (PEWS) or a validated acuity score system to assess patients. We were told that not all medical staff had European Paediatric Life Support (EPLS) or Advanced Paediatric Life Support (APLS) training. There was no paediatrician available on-site at Central Middlesex Hospital. Staff had to refer to the consultant of the day or week, who was based at a different hospital in the trust. Some staff were not aware of this arrangement. 

·       Some medicine storage areas did not meet national guidance for security for controlled drugs in the Northwick Park surgical service. 

However:

• Mandatory training compliance rates at Northwick Park and Ealing emergency departments had improved. Staff monitored patients who were at risk of deteriorating appropriately.

 The Commission fournd 'Outstandin Practice' in Urgent and Emergency Care at Northwick Park Hospital:

In Urgent and emergency care at Northwick Park Hospital-

The department had developed a patient sepsis video for parents whose children attend the paediatric emergency department with a fever or suspected infection. The video was a four minute video aiming to educate parents about the warning signs to look out for sepsis. 

The department had done a rotational shift with the local mental health trust. The purpose of this was for staff to get an ideas how the other service was run, learn and share knowledge and understanding to improve the way they worked together.

FULL REPORT HERE

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