STPs - throw a spanner in the works by supporting this legal challenge fundraiser

From Stop the Sustainability & Transformation Plans
 
The NHS must continue to provide comprehensive healthcare to everyone who needs it.
We are challenging the legality of new fixed, restricted NHS and social care budgets that cover an area’s whole population but won’t meet the public’s needs.

The fundraising page is here: http://bit.ly/999JudicialReview

Please give what you can. Every penny counts and we are so grateful for any donations. And only £135 to go to our initial target.

Please keep sharing and explaining to friends and family the importance of getting behind this campaign.

The lawyers are with us, the people at CROWDJUSTICE love our case. And we are glad to know we have public support in this big step forward.

We will keep you posted as the case develops, and will be updating and expanding the case information on our websites.

www.stopthestps.org.uk and www.999callfornhs.org.uk

Brent voluntary organisations face crisis as NHS Estate's Market Rent policy is implemented

The NHS Estates programme is scheduled to be completed by June 2017, according to their website which will mean 6 or 7 Brent voluntary organisations providing back-up health services will be faced with paying market rents from April 2017.

Many will not be able to afford them and will be faced with finding new bases despite the Sustainability and Transformation Plan being based on collaboration enhanced by location in the same premises.

At a previous Scrutiny Meeting, it was reported that The Willesden Centre for Health and Care (with its PFI legacy) was "presenting a particular challenge" but the Brent CCG also reported "that plans were in place" to sort it out.  The CCG agreed to "detail in its commissioning intentions how it will use the Estates strategy to support and enable the voluntary sector" (Agenda item 5, NHS  Estate in Brent, 23/11/16.)

Brent Advocacy Concerns, one of the voluntary organisations affected, has approached Brent Healthwatch and Brent CVS for assistance, so far without success. 

Assurances had been given when I raised the issue previously that assistance would be given to voluntary organisation to enable them to be part of contracted services. access grants to enable them to be able to pay market rents, improve their financial viability or to share sessional space at centres.  So far none of these options have resulted in concrete proposals.

Brent Advocacy Concern meet tomorrow lunchtime with the shadow of closure hanging over them with little information on which to plan their future.

Secret Plan to cut almost 8,000 NHS jobs and slash services in NW London.

From SoH  (Save Our Hospitals)

Plans to slash NHS jobs and services have been developed in secret by NHS bureaucrats and only been uncovered thanks to a Freedom of Information request by a Brent health campaigner.

This revealed the NW London Delivery Plan for the STP Oct 16 labelled "strictly confidential not for wider circulation" and unseen even by some of the councils involved.

The plans include

• The loss of 3,658 NHS jobs in NW London next year 17/18 - rising to 7753 job losses by 20/21
• Almost 50,000 planned admissions and 222,370 outpatient appointments cut by 20/21. Already patient waiting times for planned operations are at record levels - these plans will only make things much, much worse.
• The loss of 500 - 600 hospital beds with the closure of Charing Cross and Ealing as major acute hospitals
• A reduction in A&E attendances by 64175 in the next 5 years.

More very ill patients have arrived at the remaining A&Es in NW London this year than ever before - there is NO evidence that there will not be a need for these departments and acute beds in the future. Merril Hammer, Chair of Save Our Hospitals, said ‘These plans threaten patients' lives. We need more beds and more staff, not ongoing cuts.’

The cost of planning this massive cuts and closure programme is spiralling out of control with many millions pocketed by private management consultants. 

Faced with this crazy set of damaging proposals for NW London's health services it's no wonder Tracey Batten Chief Executive of Imperial NHS Trust (and the highest paid NHS CEO in London) resigned yesterday. Dr Batten is leaving her £340k job at Imperial to return to Australia. Imperial controls 5 hospitals across NW London. As Merril Hammer also said ‘Our campaign fears that Imperial management will spend months looking for a new CEO when they should be tackling the unprecedented A&E, bed capacity and treatment crises.’

Sources:

 

Re Jobs

STP Do Something Summary Appendix A Xcel spreadsheet plan for job losses of 7753 by 20 - 21

From 48258 now,

losing 3658 by 17/18, 

5222 by 18/19,

6592 by 19/20,

7753 by 20/21

Re Outpatients

STP Do Something Summary Appendix A Xcel spreadsheet

Cut by 222,370 by 20/21

Re Elective Admissions

STP Do Something Summary Appendix A XCel spreadsheet

Cut by 34,437 by 20/21

Re Non Elective Admissions

Source NW London Delivery Plan for the STP Oct 16 p8 

Cut by 64175 by 20/21

RE Costs

Source App A Excel spreadsheet Investment requirements tab:

Re non-recurring revenue costs now up to £303m on top of £845m of gross capital costs up to 20/21.

Brent Central LP calls on Brent Council to oppose STP alongside Ealing & Hammersmith Councils

At a crowded meeting in Harlesden, the Labour Party in Brent Central condemned the cuts being made to the NHS services that people in Brent depend on. Labour Party members voted unanimously to call for Brent Council to reject the plans drawn up by NHS officials to reduce hospital services across northwest London.  The motion requested that the Council's Labour Leader, Cllr Muhammed Butt discontinues any negotiations over the Sustainability and Transformation Plan (STP) and any other proposed cuts to the NHS budget.  The meeting also called for unity with Hammersmith and Ealing Councils who have also opposed STP.

NHS bosses across England are required by the Department of Health to produce these plans, known as “Sustainability and Transformation Plans” or STPs. The plans rest on the idea that large numbers of patients could be looked after more cheaply in the community instead of in hospitals. However, doctors at the meeting said that GPs and other community services are already stretched to breaking point and would not get enough extra staff or money to take on the additional work this would involve.

The plans include closing the 24/7 A&E Departments at Charing Cross Hospital and Ealing Hospital, turning them into Urgent Care Centres.

In 2014, when Central Middlesex Hospital had its A&E Department downgraded to an Urgent Care Centre, Northwick Park Hospital was supposed to take on all the extra emergency patients. Instead patients waited far longer to be seen because Northwick Park was overwhelmed by the needs of the extra patients. Not enough had been done to prepare Northwick Park Hospital for the surge, and funding and staff numbers were nowhere near enough to handle the number of people coming through.

The NHS is already in crisis over long-term funding cuts imposed by the Government, and the plans for further cuts to hospital services are a serious threat to the health of the public, health campaigners told the meeting.

Butt said that Brent Council had not accepted the STP and has demanded assurances on funding and risks from the Government before it could be agreed. Brent Council is currently considering their next steps relating to the plans covering the borough.

At the Health and Wellbeing Board on Tuesday Cllr  Krupesh Hirani said that it was the issue of the adequacy of out of hospital services that kept him awake at night.

Brent CCG takes another step towards endorsing STP this afternoon after Brent Council gives its approval to strategy

Brent Clinical Commissioning Group is set to move forward on the the controversial Sustainability and Transformation Plan this afternoon at a meeting starting at 2pm at the Chaplin Road Centre.

The public can attend. Tickets HERE

The Governing Body will receive this statement from the Brent Health and Wellbeing Board:

Statement from the Brent Health and Wellbeing Board

The Brent Health and Wellbeing Board supports the priorities set out in Brent CCG’s Commissioning Intentions 2016/17 especially their linkages with the Sustainability and Transformation Plan and their ability to address the real health needs of Brent residents. The Board will support the CCG in ensuring the delivery of these priorities results in high standards of care and enhanced access and that integrated care offers the best possible outcomes for Brent. 

Cllr Krupesh Hirani, Chair of Brent Health and Wellbeing Board

Meanwile, perhaps rather late in the day, Brent Central Constituency Labour Party is holding the following meeting:

The Future of Local NHS Services

Dear Brent Central Labour Party member,

Happy new Year!

You are invited to attend our first Brent Central Labour Party General Committee meeting of 2017.

All members are encouraged to attend, although only delegates to the General Committee will be entitled to vote. 

Date:   Thursday 19th January
Time:   7.30 - 9.30pm
Venue: Christchurch Nursery, St Albans Road, Harlesden NW10 8UG

NW London STP: 'Change is needed - but not like this'

From Brent Patient Voice LINK

This was the theme elaborated by Dr Julia Simon, former NHS high-flyer, when she addressed a packed and lively BPV public meeting last Thursday 1^st December at the Learie Constantine Centre, NW10.

BPV Chair, Robin Sharp, explained that big changes to the way in which GPs relate to their patients were hidden away in the recently published NW London NHS Sustainability and Transformation Plan (STP). Essentially the Plan was about cutting £1.4billion from local health and social care service over the 5 years up to 2021, including previously announced proposals to “reconfigure” hospitals and cut beds. What was new was the plan to turn GPs from being a “cottage industry” to the brave new world of “Accountable Care Partnerships”.

Dr Simon told us she was not a medical doctor but had been a philosopher before moving into the healthcare world. For several years up to last September she was a senior leader at NHS England, working on primary care and commissioning issues. She had left to be able to break out of some of the constraints that being at NHSE imposed, not least in relation to the speed at which the STPs were being imposed across the country and the realism of some of the claimed financial figures.

Striding around the room like a university lecturer, Dr Simon captivated her audience with the clarity and honesty of her presentation. She said that in the 90s the idea of a market had been introduced into the NHS to drive up standards. This involved creating a division between “commissioners”, who worked out what was needed and paid for it, and “providers” such as hospitals and GPs who delivered it. The trouble was that under the NHS healthcare was not a market because it could not be allowed to fail.

In 2012 Parliament enacted the Health and Social Care Act, the brainchild of Andrew Lansley, whose wife was a GP. This put local GPs into 209 local Clinical Commissioning Groups to be in charge of designing and paying for about two-thirds of the health care provided by hospitals and in the community. The downside was enormous fragmentation because NHSE became commissioners for specialist services and local authorities for public health. In addition local authorities remained responsible for adult social care, which was means-tested, whereas healthcare was free at the point of delivery.

This was the context into which the new chief of NHSE, Simon Stevens, launched his plan for the future in 2014, the “Five Year Forward View”. As well as accepting that the NHS could make £22billion “efficiency savings” by 2021, this plan called for integration between GPs, hospitals and adult social care. All parties, medical bodies and commentators signed up to it without apparent reservation.

Then in December 2015 the annual Planning Guidance from NHSE to the CCGs and hospital trusts announced that implementation of the Forward View was much too slow and current trust deficits were “unsustainable”. The CCGs and trusts were grouped into 44 areas (Footprints) across England and required, working with local authorities, to produce STPs by 30 June 2016 to eliminate deficits and implement “transformation” over a 5 year period.

Meanwhile various experiments in new forms of integrating services locally had been launched under the brand of “Vanguards”. As Dr Simon explained these are still in progress and there are no evaluations. “The jury is out on the Vanguards”, she said.

The Vanguards include integrated primary and acute care systems, as well as multi-speciality community providers. The first of these embraces Accountable Care Partnerships (ACPs). Dr Simon spelled out some of the features of ACPs. These envisage a fixed budget for each patient (capitated budget), an emphasis on self-care and prevention leading to fewer hospital admissions and merging the boundaries between commissioners and providers. New legislation might be needed and there were some perverse incentives in the present system.

To conclude Julia Simon said that, while she was convinced that new approaches to organising the NHS and delivering care were needed the STPs had been produced in semi-secrecy and much too fast. Moreover the savings being suggested were not really credible. She likened the situation to George Orwell’s “1984” where officials state in public numbers that in private they admit are impossible. However she saw some signs that the top of the NHS would soon announce a delay enabling more serious public consultation.

Julia was congratulated by an audience member on delivering the most informative address he had ever heard from an NHS person. There was general support for this sentiment.

Her presentation was followed up by some 40 minutes of questioning and passionate statements of concern, especially at the unacceptability of the STP for NW London. Noting that Ealing and Hammersmith and Fulham Councils had refused to sign up to the Plan, audience members wanted to know what more could be done to persuade elected councillors in Brent and other boroughs not to endorse it.

Robin Sharp

Chair Brent Patient Voice

Ealing and Hammersmith & Fulham Councils show Brent how to campaign on the STP

 It is just not possible for me to go to every vital meeting that I advertise on Wembley Matters so I am posting this account from the Hammersmith and Fulham website of their public meeting on the NW London Sustainability and Transformation Plan.

How about a similar meeting in Brent, Brent Council?


The decision by Hammersmith & Fulham and Ealing councils to refuse ‘secretive’ hospital closure plans was backed by hundreds at a packed town hall meeting this week.

Nearly 700 cheered and applauded the leaders of the councils as they explained why they have refused to sign up to the local NHS Sustainability and Transformation Plan (STP). Councils across the UK have been asked to endorse similar plans for each region of the NHS, before they are submitted to government for approval.

“The STP is a deeply cynical re-hash of the earlier flawed plans which now proposes to close Charing Cross Hospital in 2021,” said Cllr Stephen Cowan, Leader of Hammersmith & Fulham Council.

“There are no good arguments for demolishing Charing Cross or for selling off much of the land and replacing it with an urgent care clinic just 13 per cent the size of the hospital. That’s why this administration will continue its fierce defence of Charing Cross and the vital local NHS services people rely on.”

The meeting drew campaigners from across the region who have been fighting plans to close or downgrade services at five out of the nine hospitals in north west London.

Despite the published plans, an NHS spokesman has said: “We want to reassure our staff, patients, local residents and partners that Charing Cross is not closing and that there will be no reduction in the hospital’s A&E and wider services during the lifetime of the STP, which runs until April 2021.”
Anne Drinkell, of the Save our Hospitals campaign, said: “This is a cuts and closures programme. We’re not saying we want no change. But objectively there’s already not enough capacity in our local hospital so closing more services would be unsafe.”

Campaigners were united in condemning the tactics being used to force through drastic reductions in local health services secretively and without public consultation.

The NHS has pressured councils to approve STPs by linking it to the release of vital government cash needed to keep councils’ social care services from collapsing under ever-rising demand.

But Cllr Julian Bell, Leader of Ealing Council, said: “The NHS tried to bounce us into signing the STP. They tried to get us to agree to the STP on the basis of a two-page summary and they told us we didn’t need to see the full document. We insisted, but it didn’t arrive until they day before we were meant to sign it. And once we finally saw what was in it, we understood why. There was no way on earth I was going to sign up to those plans.”

Dr David Wingfield, chairman of the Hammersmith and Fulham GP Federation, suggested the STP was not equipped to tackle the health and social care problems facing the borough. He offered to form a ‘grand alliance’ between GPs, councillors and members of the community to confront local healthcare challenges.

 

Save Charing Cross Hospital meeting audience

 

Save Charing Cross Hospital campaigners

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.

How effective was Brent Scrutiny's consideration of the STP?

The Sustainability and Transformation Plans for the NHS have come in for severe criticism as a cover for cuts.  The Brent Community and Wellbeing Scrutiny Committee of September 20th discussed the plans.  This is the official minute of their discussion:

The committee considered the report from the Chief Executive of Brent Council and Chief Officer of Brent Clinical Commissioning Group on the Sustainability and Transformation Plan (STP). Rob Larkman (Chief Officer, Brent Harrow Hillingdon CCGs) advised that the requirement for the production of the STP was introduced by the NHS England in 2015. The purpose of the STP was to help local organisations plan how to deliver a better health service by addressing three key areas; improving health and wellbeing, improving quality of care and tackling the financial gap. The STP moved away from an organisation by organisation view to establish a broader strategic approach. Brent fell under the STP for North West London. It was acknowledged that work for this was taking place at several levels. At the North West London Level work was underway to draw together the place- based planning taking place in Brent and the seven other North West London Boroughs which were encompassed by the North West London STP. The STP was required to be submitted by the end of October 2016. It was emphasised that the timescales set out for the creation of the STP were extremely challenging. A draft NWL STP had been published and it was now necessary for all the statutory bodies affected by the STP to consider the details in line with their respective governance arrangements.

Addressing concerns regarding transparency and accountability, Carolyn Downs (Chief Executive of Brent Council) explained that the task of creating high quality plans to the level of detail required within the timescales set out had been extremely challenging. However, the NWL STP was recognised as one of the more detailed plans created and was the only one in the country for which joint governance processes had been supported to ensure political input from all affected local authorities. Reflecting this, five of the eight local authorities had jointly commissioned work to test the assumptions in the plan specifically related to the cost of additional out of hospital care to social care as a result of any proposed changes to acute services. The NWL STP was the only plan in the country to specifically address the social care funding gap. The NWL STP was also one of only two plans to have been published and a series of public engagement events would be held. Councillor Hirani (Cabinet member Community Wellbeing) added that events would be held out in the community in places such as supermarkets, stations and high streets to inform and engage residents.

Sarah Mansuralli (Chief Operating Officer, Brent Clinical Commissioning Group) outlined the work taking place at a local level. Members heard that a STP Brent- level working group had been established bringing together statutory partners including the Acute Trust, the Central and North West London Mental Health Trust and Brent Healthwatch, to break down organisational barriers. The working group had sought to identify the initiatives that would have the highest impact in Brent for addressing the three key issues at which the STP was targeted. Phil Porter (Strategic Director, Community and Wellbeing) detailed the five areas which had been identified as part of this work noting that this included prevention and self- care, renewing the ambition and focus in Brent’s Better Care Fund schemes, using the OnePublic estate model, ensuring mental health and wellbeing had equal focus with physical health and wellbeing and, underpinning all the rest, integrated workforce and organisational development.

At the invitation of the Chair, Simon Crawford (Director of Strategy, London North West Healthcare NHS Trust) emphasised that the STP provided a vehicle for collaborative working on the out of hospital agenda and integration and Brent was one of the most advanced in identifying what this meant locally. Julie Pal (Healthwatch Brent) expressed her confidence in the process being followed in Brent, having experience of delivering across a number of STP areas and noted that Brent residents’ voices were clearly contributing to the shaping of the transformation agenda.

Members questioned the extent to which Brent had been able to influence the setting of local priorities within the STP. A Member emphasised that housing was integral to the safety and security of those with Mental Health issues but that taking up employment could create a significant barrier for accessing appropriately supported housing. In view of this and with reference to plans to develop a multi- disciplinary team with a remit for mental health, employment and housing it was questioned what would be done to address this issue and ensure necessary support was provided. Further details were sought regarding the planned engagement activity and how this had been advertised. It was suggested that local pharmacists be approached within this engagement work in recognition of the level of contact that they had with people and similarly, that consideration be given to involving other local organisations and bodies including voluntary organisations and the patients forum. Questions were raised regarding extending access to GPs and investment in the Central Middlesex and Willesden sites. Addressing the tight timescales involved, the committee queried whether this posed any risks in terms of gaps in delivery.

Rob Larkman and Sarah Mansuralli confirmed that the borough had absolute discretion in determining the priorities for Brent. Local priorities had been established with reference to the Joint Strategic Needs Assessment and had then been consolidated at the NWL level. Similar processes had been followed by other NWL authorities. Phil Porter acknowledged the significant challenge posed by housing and employment issues for those with mental health needs and noted that a dedicated housing officer was now in place and work was underway to build a network of private sector landlords willing to offer secure tenancies. Carolyn Downs welcomed the insight provided by members into this area. It was suggested that the committee consider at a future meeting the West London Alliance Mental Health and Employment Integration National Trailblazer which aimed to bring together GPs and wider organisations to support people into employment.

Addressing queries regarding the community engagement activity, Councillor Hirani emphasised that public meetings would be held alongside a series of events at public locations. Members of the public would be invited to share their views in a variety of ways. Work was also currently being carried out to allow residents accessing acute and hospital services to feed their views into the process. Sarah Mansuralli welcomed members suggestions regarding approaching pharmacists and other groups including patients’ forums and confirmed that these would be taken forward. A Health Partner Forum was scheduled for 19 October at which the CCG commissioning intentions (based on the STP) would be discussed. Members were further advised that an online engagement tool had been launched for the whole of North West London and had been widely circulated.

Rob Larkman confirmed that extending access to GPs was a crucial element of the STP and now that co-commissioning arrangements were in place between NHSE and CCGs, greater influence could be exerted. Addressing queries about investment in the Central Middlesex Hospital and the Willesden Hospital sites, Sarah Mansuralli explained that the intention was to fully utilise each site for out of hospital provision. The demography of the area around the Central Middlesex Hospital was changing and consideration was being given to how best to organise service provision accordingly. Carolyn Downs emphasised that the work on the STP would remain an alliterative process and the flow of investment, savings made and outcomes achieved would need to be constantly reviewed.

RESOLVED:

.        (i)  that the officers and colleagues present be thanked for contributing to the detailed and open discussion held; 


.        (ii)  that the committee welcomed the work being undertaken to ensure that issues regarding transparency and accountability were highlighted as part of the process of creating the Sustainability and Transformation Plan; 


.        (iii)  that an update be provided to the committee on the OnePublic Estate, including an update on the Central Middlesex and Willesden Hubs; 


.        (iv)  that efforts be made to engage with Health Scrutiny across North West London with regard to the Sustainability and Transformation Plan; 


.        (v)  that consideration be given to collaborative work with Healthwatch groups to support engagement around the Sustainability and Transformation Plan 


.        (vi)  that a regular progress report on the Sustainability and Transformation Plan be provided to the committee, the first of these to be provided six months from the date of the current meeting. 


Camden Council leader condemns lack of political oversight and public engagement in STP

It is often instructive to look at what Councils in our neighbouring boroughs are doing and saying. This is a press release from Camden's Labour leader. Camden's STP is different from the NW London plan which includes Brent but the overall approach is the same.
 

The NHS in the north central London area – which represents Camden, Haringey, Islington, Barnet and Enfield – has submitted a draft Sustainability and Transformation Plan (STP) to NHS England.

This has been developed by a host of NHS organisations with the support of officials from the area’s local authorities to propose changes to the way services are delivered, to make them more effective and efficient.

Councillor Sarah Hayward, Leader of Camden Council, said:

There is a national crisis in both the health and social care systems - both need to change and we recognise that they could be more efficient. That said, I have serious reservations about the Sustainability and Transformation Plan process so far.

There has been no political oversight, and minimal public and patient engagement. At present, there is a lack of appropriate focus on adult social care. That lack of public, patient and political involvement is why I am publishing this document on our website. It is vital that there is full transparency in Camden as this work progresses.

The next stage is for the bodies involved to respond to this draft plan and we will be consulting residents and patients on our response over the coming weeks. Local Authorities see first-hand the impact of the profound health inequalities that exist in the north central London area. In the light of this, we’ll be using our role to influence the future quality of local social care and to improve the health and wellbeing of our residents.

As the provider and commissioner of social care services in Camden we want to be sure that future needs are reflected in this plan. We will be holding a number of public events to gather the views of residents before our response to the draft plan is considered in public by Camden’s cabinet.

Brent Cabinet decision on North West London STP published

This is the official decision notice about the NW London Sustainability and Transformation Plan following Monday's Cabinet discussion LINK:

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Cabinet noted the STP submission for North West London.

1.    Cabinet welcomed the principles adopted within the STP of prevention, out of hospital care, dealing with the social care funding gap and the need to work across the public sector to maximise benefits from changes to the NHS and other public sector estate.

2    Cabinet noted that the STP will need formal sign off by the end of December and that between October and December the following issues need to be clarified both within the submission and through other NHS processes, in order for the council to give full support for the plan:

a.    That the IMBC (Implementation Business Case) on which delivery area 5 is based is released, debated and understood;

b.    That the flow of monies from acute to out of hospital settings are clarified;

c.    That the specification for out of hospital settings, in particular social care, are clarified based on an agreed model of out of hospital care;

d.    That a full risk assessment for the plan and relevant mitigations are included.

Brent Patient Voice calls for no action on STP until public properly involved and consulted

Robin Sharp of Brent Patient Voice has submitted a critique to Carolyn Downs (Brent Council CEO) and others responsible for the NW London Sustainability and Transformation Plan (STP) which will have a major impact on health provision for years to come.

This is Robin's covering email:

Dear Colleagues

I am pleased to enclose for your consideration a critique by Brent Patient Voice of the draft NW London Sustainability and Transformation Plan of 30 June 2016, as placed on the NW London Collaboration website on 5 August.

You will see that this is a long document, though by no means as long as the draft STP.

Rather than simply complain about the proposed cuts in finance and services, as would be tempting, we have spent quite a lot of time examining the document in detail. This has been challenging because so much critical information has been withheld.

Nevertheless our conclusion is that at the level of detail the Plan, if it is a plan, does not withstand scrutiny and in that sense is not fit for purpose.

This is disappointing, though we do understand that the haste of preparation and the non-involvement of clinicians, councillors, CCG Governing Bodies and the public were ordained by NHS England.

We are asking you to advise NHS leaders to slow down this process dramatically and to open up the issues of radical change to primary care to doctors themselves and the public.  Surely it must be obvious even to the top of the NHS that this will not work without substantial consent?

We understand that you are ready to share with the public the next version of the STP shortly after 21st October. We urge the relevant bodies not to sign any agreement or contract by 23 December without fulfilling both the letter and the spirit of the law requiring the involvement of and consultation with the public in major changes to the provision of healthcare or without explaining how the bodies involved can lawfully commit to these plans. We also believe that the STP relies on a level and type of data sharing that has neither the consent of the public, nor the sanction of data protection law, and that the latest National Data Guardian review is unlikely to resolve this.
 

With best wishes

Robin Sharp
Chair Brent Patient Voice

Robin Sharp
Chair Brent Patient Voice

John Lister speaks about the NW LONDON STP here LINK

Cabinet to consider Brent's STP

The Brent Cabinet will be considering a report on the Brent and North West London Sustainability and Transformation Plans (STPs) on 0ctober 24th, three days after the draft NW London STP is due to be delivered to NHS England.

The Brent STP fits within the NW STP and is meant to consider Brent specific issues which are listed as:

The Brent specific health and well-being gaps have been identified as:

o   · Common mental health disorders (CMD): large numbers and projected to increase - in 2014, an estimated 33,959 people aged 18 to 64 years were thought to have a CMD

o   · Severe and enduring mental illness: affects 1.1% of the population

o   · Mental well-being: the percentage of people with depression, mental health issues or other nervous disorders in employment is 23% also lower than both the England rate (36%)

o   · Significant and growing challenges to provide housing which potentially further undermine mental wellbeing

o   · Childhood obesity: Brent is in the worst quartile nationally in terms of the % of children aged 10-11 classified as overweight or obese – 38%

o   · Diabetes: by 2030 it is predicted 15% of adults in Brent will have diabetes

o   · Long Term Conditions: 20% of people have a long term condition

o   · Dementia: prevalence of dementia in people aged 65 years and over is 2,225 2016) (and 80% of prevalence is diagnosed)

o   · STIs/HIV: 1,404 STIs per 100,000 population compared to 829 in England

o   · Health-related behaviour: physical inactivity: worst in West London; nutrition: 47% get 5 a day; tobacco use; alcohol; take up of immunisations

The Brent specific care and quality gaps have been identified as:

o   · Caring for an ageing population: 35% of all emergency admissions in Brent are for those aged 65 and over; once admitted this group stays in hospital longer, using 55% of all bed days.

o   · End of Life Care: Brent has one of the highest percentages of deaths taking place in hospital in the country

o   · Primary care: wide variation in clinical performance; Brent is in the worst quartile nationally for patient experience of GP services.

o   · Long Term Condition management: Brent is in the worst quartile nationally in terms of people with a long-term condition feeling supported to manage their condition.

o   · Cancer: Brent is in the second lowest quartile nationally in terms of GP referral to treatment for cancer and worst quartile in terms of cancer patient experience.

o   · Serious and long-term mental health needs: people with serious and long term mental health needs have a life expectancy 20 years less than the average.

 Clearly these are extremely serious issues and the test is whether the STP, which many see as a cover for cuts, will address them. The full report going to Cabinet is below:

Are Brent residents adequately represented on STP proposals?

From 'Shaping a Healthier Future' to the 'North West London Sustainability and Transformation Plan' it is often hard to cut through the public relations and jargon to see precisely what is in store for the future of NHS services in our borough.

It is also hard to see who is representing our interests and how they are doing so.

Tomorrow morning the North West London Joint Health Overview and Scrutiny Committee LINK will be meeting at Ealing Town Hall. Our representatives are Cllr Ketan Sheth and Cllr Barbara Pitruzzella. Later tomorrow at 3pm Cllr Sheth is scheduled to have a scrutiny discussion with the the public at Costa in Central Square Wembley.  The Sustainability and Transformation Plan (STP) is not on the agenda of topics (see posting below).

Tomorrow's NW London Joint Health and Overview and Scrutiny Committee will be finalising the draft for the STP submission to NHS England a week later on October 21st.

Cllr Matt Kelcher, then our representative as Chair of the single Brent Scrutiny Committee,  sent his apologies to the last meeting in May, despite it being held at Brent Civic Centre.

The leaders of Ealing and Hammersmith and Fulham Councils have refused to  endorse the STP due to concerns over the future of Ealing and Charing Cross Hospitals. No reservations are recorded from Brent Council LINK


 
There are no elected Brent representatives on the Joint Health and Care Transformation Group. Dr Ethie Kong from the Brent Clinical Commissioning Group and Carolyn Downs, Brent Council CEO are members:

To its credit Brent Patient Voice  has raised issues about the STP and their concerns are clear in this August 2016 letter to the Guardian which unfortunately was not published:

We in Brent Patient Voice are pleased that the Guardian, 38 Degrees and the BBC have at last caught up with the huge threat to the NHS represented by the Sustainability and Transformation Plan (STP) process. In fact the NW London STP of 30 June has been in the public domain since 5 August and signposted on our website www.bpv.org.uk . We have been posting stories about this semi-secret initiative since the end of May, including an earlier version of the Plan submitted in April. Despite what spokespersons for the NHS are saying today, the NW London STP has not been prepared by clinicians or councillors, but by NHS and local government officials without any public debate. There are no clear proposals for consultation or public meetings arranged.
 
While today’s reports focus on the potential for hospital closures, these are essentially the highly controversial proposals issued in 2012 and misnamed Shaping a Healthier Future. So far these have been implemented by the closure of A&E Departments at Hammersmith and Central Middlesex Hospitals and the Ealing Maternity Department. As a result A&E waits at both St Mary’s Paddington and Northwick Park Hospitals are among the worst in the country and acute beds are under enormous pressure. This is the context for STP proposals to remove 592 acute beds which was mentioned in an early summary but has now been expurgated for fear of frightening the horses.

However what is new and barely understood at all by the public or even the GPs who will be at the heart of it is the “transformation” aspect of the STP. GPs are being paid to form themselves into legal companies called “federations” in order to be awarded (with other providers) single contracts to provide all primary services in, say, a borough. The jargon title for this concept, Accountable Care Providers, comes straight out of the American healthcare system textbook but it is completely untested at the scale envisaged in the STP. Ordinary GPs who can barely cope with patient demand for routine care have no idea what it is all about. Is not NHS chief Simon Stevens intelligent enough to see that such a major upheaval, even if justified (which we doubt), cannot be implemented safely and produce savings in the space of two years?

Robin Sharp CB, Chair Brent Patient Voice