Causes for concern in Brent NHS provision

Peter Latham, Chair of Willesden Patient Participation Group and Member of the Steering Group of Brent Patient Voice, has given permission to Nan Tewari for this extract from his November 2015 Newletter to be published on Wembley Matters as a Guest Blog. It gives an interesting, and at times worrying, insight into current developments in local health provision.

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The national NHS news remains worrying.  Today we have news of junior doctors voting on a strike.  A new OECD report says that Britain now comes low in the international league tables for most categories of national healthcare.  Male expectation of life at birth comes 14^th out of 34, and 24^th for women.  Cancer 5 year survival rates are 21 out of 23 nations for cervical cancer, and 20 out of 23 for both breast and bowel cancer.  For surviving a heart attack we come 20^th out of 32 nations, and for surviving a stroke 19^th out of 31 nations. For unnecessary hospital admissions for asthma or lung disease due to poor care at home we are ranked 22 out of 34 nations.   The OECD estimate that to bring the NHS up to just OECD average performance would require an extra 26,500 doctors and 47,700 extra nurses at a cost of an extra £5 billion per year.  Britain currently spends £2,100 per person on healthcare, slightly below the OECD average.  Another report this week suggests that one quarter of all cancer diagnoses are made only when the patient goes to A&E already having symptoms so that their average survival time is poor. 

At our local Brent level there continues to be much paper activity at Brent CCG but not very much to report about actual changes put in place.

At the Brent CCG Governing Body meeting on 4 November 2015 the Deputy Chair Doctor Sarah Basham announced that the Brent CCG Chief Financial Officer Jonathan Wise is leaving.  She did not give any reason and did not announce a replacement.  This is unfortunate at a time when Brent CCG have moved from an annual financial surplus to Mr Wise’s report of an underlying financial deficit of about £1.3 million as at September 2015.  The CCG has filed a financial recovery plan as required by NHS England by 31 October 2015.  This needs to be set in the context of an annual budget of about £375 million.

Brent Community Cardiology Service & other Brent Planned Care projects.

The new Brent Community Cardiology Service provided by Royal Free London NHS Foundation Trust that started in March 2015 at the Willesden and Wembley Centres for Health and Care is improving on many of its early problems.  There are now clinics at both centres each weekday.  More specialist cardiologists have been appointed although not all have started yet.  There was a gap in the contract specification with no provision for diastolic heart failure.  The CCG has now decided to issue a contract variation to cover this when the projected volume of patients and their needs have been clarified.

I have been appointed as a patient representative on the monthly contract review group for this service.  The main continuing concern for patient safety is on the 14 day contract maximum waiting time for urgent cases from GP referral to first offered appointment.  Mr Robin Sharp Interim Chair of Brent Patient Voice has waived doctor/patient confidentiality in the public interest to reveal that when referred by his GP for atrial fibrillation in June 2015 his first offered appointment was with a 62 day wait.  No explanation has been given. At the monthly meeting on 4 November with an agenda item for waiting times as at 30 October no figures were published for current waiting times.  It was said by Brent CCG that the figures will only be published after they have been verified. So patients have no confirmation that all or any patients assessed as urgent are being offered a first appointment within 14 days.  I requested the figures ‘subject to verification’ but this was refused.  Brent Patient Voice will now report this problem to Healthwatch Brent with a view to notification to the Care Quality Commission.

At the Brent CCG Annual General Meetings on 2 September and re-run on 14 October in answers to my questions the chair Doctor Etheldreda Kong confirmed that the 2012 ‘Planned Care’ business case for transferring about 13 specialist adult out-patient services out of hospital in 5 ‘Waves’ into new community clinics under the slogan ‘Better Care Closer to Home’ has been discontinued after the introduction of just the Wave 1 new ophthalmology service provided by the commercial provider BMI (who run the commercial Clementine Churchill Hospital at Sudbury Hill), and the new Brent Community Cardiology Service provided by the Royal Free whose problems are reported above.  

This project has been currently replaced by much less ambitious schemes e.g. just for physiotherapy instead of the major Wave 2 new integrated multi-disciplinary, musculo-skeletal (MSK) service project for which the procurement was discontinued in March 2015 following which  Brent CCG estimated  £713,000 had been spent on it.

Brent CCG A&E Advertising Campaign: “A&E is for life-threatening emergencies only”.

This advertisement has cropped up at bus stops in the borough etc and also carried the Brent Council logo.  Brent Patient Voice has complained that it is false and misleading and made a complaint to the Advertising Standards Authority.  BPV has given examples of non life-threatening emergencies that justify admission to hospital through A&E e.g. a penetrating eye injury.  Brent CCG has not challenged this and it is notable now that the wording on the Brent CCG website headline slide show has now been altered to say ‘A&E is for emergencies only’.

Brent CCG Whole Systems Integrated Care (WSIC) Project with Brent Council

This imposing sounding project has run into difficulties from lack of funding.  It proposes an integrated care plan just for elderly people with one or more long term conditions such as heart failure or asthma. Part of the aim is to reduce the need and cost for unplanned hospital admissions.  A WSIC pilot in part of the borough was planned to make sure the systems would work.  This pilot has now been abandoned for lack of funds.  The current proposal is to start the scheme across the whole borough in April 2016 without this pilot testing.

Brent CCG Commissioning Intentions 2016/17.

At the Governing Body meeting on 4 November the ‘final’ draft Commissioning Intentions (local health services purchasing plan) 2016/17 was approved.  The plans can be found on the Brent CCG website and include feedback from the patient involvement and consultation events including the Health Partners Forum on 7 October 2015.  I have been unable to discover the closing date for the online patient survey.