NHS Estates siphoning of £2 million a year from Brent health and care budget

Willesden Centre for Health and Care

NHS England policy that health organisations should pay market rent for NHS Property means that Brent Clinical Commissioning Group is paying £2 million annually for spaces (voids) that are not being used, Cllr Nerva established at the Community and Wellbeing Scrutiny Committee on Wednesday.

The Willesden Centre, built under the Private Finance Initiative costs £6.5 million a year with a void of £1m and other property voids gives a total of £2m. PFI costs were higher with additional ad hoc charges.

Monks Park is a joint local authority - NHS PFI initiative and the rents have been too high for most user organisations.

It is of course banks and shadowy investment trusts that profit from PFIs. LINK 
 LINK   LINK

Source

Earlier this year, following the release of the Panama Papers it was revealed that Chris Hudson, a property developer and the owner of 100,000 British homes, helped finance the building of the Willesden Centre for Health and Care in a Public Private Partnership deal. He set up the Yarrow foundation in Panama, which records show transferred €85,000 into his personal account and made available €115,000 to buy a Boeing 747 jumbo jet.

The Brent Clinical Commissioning Group (CCG) has to pay the market rent for the spaces whether or not they are occupied.  This is money that could otherwise contribute to the health and care budget.  The CCG is attempting to gather all out of hospital services in one of three centres. Some hospital services were over crowded and could use any spaces released spaces on their sites.

Councillors were told that NHS Estate advisers were experts in their field:

Health estate is a market of its own own. Our advisers are expert at health provision. They may be more expensive than other properties and not economically viable for general office space, but there are benefits of proximity to other health users.

When a councillor asked why the CCG should pay for space it wasn't using Sarah Mansuralli, Chief Operating Officer of the CCG replied, 'You may well ask - but that is the policy.'

Cllr Lesley Jones asked if there was any discretion over voluntary organisations having to pay market rents, giving the example of Brent Carers forced out of the Wembley Centre by higher rents.
Mansuralli said she would like to support voluntary organisations but it was difficult to have space occupied by a voluntary organisation that even with a subsidy would not be able to afford the rent. The CCG could not subsidise fully and also close the financial void.  She was willing to look to see whether some space could be used on a sessional basis, when other users were not using it.

Mansuralli added that Brent CVS were working with voluntary organisations to help them develop the capacity to afford the rents.

The practical impact of this can be seen in the case of Brent Advocacy Concerns LINK who have sent me this email about their situation:

I attended the meeting with our NHS landlords last Tuesday and received a 'fair hearing' but they only told us what we already knew.  That at some point in the future we will be sent the rent and service charges that we will have to pay to stay in our office.  The manager present said that her 'pay scale' did not allow her to make the final decision on our situation.

I just had a phone conversation with a disabled lady from Brent.  She needed face to face advice to help her with filling out her PIP FORMS. She had tried the council first at the Civic Centre in Brent who could not help her and they sent her to Brent CAB, who after a whole morning could not help her either and they gave her our number.  I offered to help her if she could come to our office this afternoon but she wanted an appointment for next week which I could not offer her, as my own health issues might cause me to miss it.  I then told her to try Brent Age UK but she had already tried them without success.

So my question is, where in Brent can she get face to face advice, as she told me she has both physical and mental health issues?

It is clear that voluntary organisations provide an essential service, that in the long term saves the NHS money, but the operation of 'the market' means that they cannot be accommodated in NHS or local authority property due to the monetisation of these estates.

Given these examples the Scrutiny Committee's recommendation that the  'social value' of organisations should be taken into account when filling voids will appear to have little traction.

Cllr Rita Conneely  asked about joint working between the regeneration and planning teams and health.  She was told that the council's strategy and the local development framework explored section 106 opportunities regarding local health care.

Conneely said that some developments had been ear-marked for primary health use and then were not occupied by them. This had been a contractual agreement with developers and so we ended up losing valuable community space.  She was told that the CCG was aware that this had been the case in the past with the primary care estate. These had been small spaces but larger spaces were needed to deliver at scale and thus be sustainable.

Conneely pursued this issue stating that the NHS Estates document had not designated South Kilburn a growth area despite its regeneration. The original idea was that young families would move in but rents were so high that they were not available for starter families.  Sarah Mansuralli answered that plans were made around 'units' and health impact studies for each area using Wembley growth as a model.

The Committee recommended that the needs of South Kilburn as a growth area should be factored into plans.

Cllr Hector raised doubts about the population data that was being used which apparently showed a decline in the population of Willesden and appeared to neglect the fringes of the borough. She was told that GLA data was used but it did not cover everything. Cllr Conneely asked if the CCG was looking at concentrations of older people in particular parts of the borough.  he was told that this was not easy because there was a diversity of population and age groups within single area. There was an annual review of GP surgery provision in terms of population growth.

The Committee Chair, Councillor Ketan Sheth, asked why three hubs had been chosen.  He was told that this was based on existing estates that could be expanded. Sarah Mansurali had spoken with Carolyn Downs, Brent CEO, about why Brent had three when some other boroughs have one, and others have five. There would be a review to see if this was appropriate.

The Committee recommended that much clearer consultation procedures on the use of NHS Estates should be adopted.

Early warning: During the meeting Cllr Hirani, Cabinet lead member for Community Wellbeing, seemed quite happy at the prospect of building on the Vale Farm playing fields when discussing the One Estate (combination of Council and NHS estates) strategy. Watch out!

A 2013 Panorama on PFIs as a scam can be found HERE

Advice to GB Energy customers after company goes bust

IMPORTANT: GB energy has gone bust. Key info for its 160,000 customers. PLEASE SHARE URGENTLY pic.twitter.com/0EPnbMhqFV

— Martin Lewis (@MartinSLewis) November 26, 2016

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. 


Details of the vital services provided at the threatened Granville Centre

Wednesday's Scrutiny Committee will receive several reports when considering the Granville/Carlton call-in. One appendix describes the work of the various users of the centres. Following on from Zadie Smith's talk last night I thought it would be useful to publish it here in full so that readers are aware of what is currently provided.  

Background Information on Granville Plus Nursery School

Granville Plus Nursery School is a Nursery School, Nursery Schools have a different distinction from a nursery. The Maintained nursery schools: the state of play report (March 2015, Early Education: The British Association for Early Childhood Education) identifies that “maintained nursery schools are local authority funded schools, with a headteacher and qualified teachers leading a team of specialist early years practitioners”, they also identify that just over 400 remain in England. Within Brent only a few Nursery Schools remain.

The latest Ofstead inspection report for the Nursery School (they are inspected under two separate Ofsted frameworks, in the Nursery School (including Horizon, their Additionally Resourced Provision for children with autism), and in their Rainbow provision), both received a “Good” from Ofsted. The Maintained nursery schools: hubs for quality in the early years (Early Education: The British Association for Early Childhood Education) report states that “Nursery Schools are inspected under the Ofsted criteria used for primary schools, rather than those used for early years settings in the private and voluntary sector, with inspections lasting two days rather than half a day.”

Council Officers visited with the Nursery School Headteacher on the 8 September and were shown around the building which includes a recent extension. Key points highlighted included the importance of the outdoor space as an educational tool and for children who live in the surrounding area which is predominantly flat accommodation. The Nursery School has an identified offer for children with Special Education Needs and Disabilities. Below is information provided from the Headteacher in regards to the Nursery School.

Officers also met with the parents and with the Governors on two separate events. Information from these meetings are imbedded into this report. From all three meeting the clear message was that they wish to stay on their current site and would not wish to be part of a nursery attached to another school (this is driven partly by not wishing to lose the status of being a Nursery School).

Information provided by the Headteacher:

·      74% of the children are from NW6, with a further 14% from NW10 (Harlesden). 


·      94% are from ethnic minorities, and 86% have English as an Additional 
Language. 


·      17% of our children have significant Special Educational Needs and Disabilities 
(SEND), including 11 in our additionally resourced provision for children with autism, and a further 8 places for children with a range of significant needs including physical disabilities and medical needs. 


·      The children with SEND are fully integrated within our mainstream environment, and our SEND provision, including the autistic provision, was judged outstanding in our latest Ofsted. 


·      8% of places are for Children in Need (usually with social care needs, including child protection) 


·      All these specialist places are allocated by a borough-wide panel. 


·      We are open 8am to 6pm for 48 weeks of the year, with a flexible fees 
structure, to support parents back to work or college. 


·      51% of places are babies and 2-3 year olds, with nearly all the 2-3 year olds 
funded by the “vulnerable 2 year olds” NEG2 funding. 
  

·      We provide training placements for NVQ Level 3, and in
 partnership with the Institute of Education have trained staff to become qualified teachers. 


·      We employ a number of local people, some of whom had their children here and whom we supported back into employment. 


·      Many families have a long association with the school, emphasising their sense of community, so that ex-pupils bring their children to us, and in some cases their grand-children, due to our early years education specialism and ethos. 


·      We equally welcome new arrivals, providing a place and an approach that connects them into a community network. 


·      The Nursery garden is an integral part of our early years curriculum, and an oasis within a highly urban environment for children that do not have gardens and who are reliant on public space. 


Background Information on Barnardos Children’s Centre

Barnardos received a contract in 2016 to deliver Children’s Centres for Brent Council. Barnardos are based within the Granville centre. They are commissioned to deliver 14 Children’s Centres in the borough for a 4 year period with an option for a fifth year.

During a meeting with officers from Barnardos they stated a preference that they wished to stay within the Granville Centre, as the families which they work with come from the local area. They also explained that children’s centres could not “just be closed down”.

Information provided by representative of Barnardo’s following the meeting

Granville Plus Children’s Centre, Granville Road, Kilburn
NW6 5RA
 Supporting all families in the local area with children aged 0-4. Services delivered By Barnardo’s on behalf of Brent Local Authority.

The purpose of our Children’s Centres is to support families of children from conception to 5 years to improve outcomes for the future by supporting the earliest years of a child’s life where there are opportunities to enhance their development. Centres promote outreach services to engage families in their communities rather than expect them to access buildings. Varied programmes and activities are offered that include working with partner agencies including Health Visiting, Midwifery, Citizen’s Advice Bureau Services and Speech and Language Therapists.

The vision for Barnardo’s Children’s Centres in Brent is to provide excellent support, guidance and services for all of our children and their families so they achieve their full potential. We want to ensure that their intervention has a positive and lasting impact on each and every family that they are in contact with, for better outcomes and to improve their life chances. 

 

Background information on the Granville Kitchen and Otherwise Club

The Granville Kitchen and Otherwise Club occupy space within the Granville Centre. During the meeting the following was discussed in regards to the range of activities carried out by the two functions:

Providing free meals to those in need – they receive food donations from local retailers including the newly opened Mark and Spencer’s Simply Food in South Kilburn. This can be up to 150 meals at a time.
Provide donated items for people to take freely such as clothes

Provide children’s activities
Provide fitness activities
Has a community garden where people can learn about food and where food used in the kitchen is grown
Provide meeting space
Provide access to computers

One of
was that the space that they operate from was welcoming and that people felt comfortable to come into the space to have a meal.

the key points raised in regards to the Granville Kitchen and the meals it provides

Information provided directly by representative following the meeting:

The Otherwise Club has 50-60 families a year who are members since we started at the Granville Plus Centre in February 1993. We also have at least 2 families each month who just visit.

That amounts to more than 250 individuals using our services a year; as a family is made of at least 2 people and often up to 6 or 7. One long term member family has 9 people in it.

We are mostly self-funded but also receive some small grant and volunteer run. We are a registered charity for over 15 years (Charity number 1071831)

Last year we had 8 young people taking 20 GCSEs between them, with 90% passing with B or above. We have done numerous trips within the UK including an annual trip for 30 people to a farm outside of Glastonbury.
We have taken groups of young people to Germany 4 times, Spain twice, France, 3 times, Italy 4 times and are planning a trip to Cuba in December 2016

We started Granville Community Kitchen over 2 years ago
It is now serving 120-150 meals at our weekly free community dinner.
We have regular film nights and dance nights with up to 30 people attending these evenings
We serve lunch on Thursdays in term time serving 30-50 meals each week.
The Kitchen ran a Summer Scheme in July -August 2016 with 85 children and young people attending mostly from the South Kilburn area
We collect surplus food from the local Marks and Spencers since the day it opened and from M&S Kilburn for nearly a year.
We also receive surplus food drops from food redistribution charity City Harvest London.

We are seeing our numbers increasing weekly, and expect these to rise further with the coming benefit cap. 

The Granville Kitchen and Otherwise Club would want to stay on site.

Zadie Smith speaks our for South Kilburn's Granville and Carlton Centres

Author Zadie Smith, whose novels White Teeth and NW show how well she knows the needs of the local community, spoke in support of the threatened South Kilburn's Granville and Carlton Centres last night.

Smith read extracts from an essay she has written about the defence of local services to an audience of more than 100 people.

Brent Scrutiny Committee has called in the plans for examination at their meeting on Wednesday November 30th, 7pm at Brent Civic Centre. LINK

SUFRA offer free tickets to see 'I, Daniel Blake', at the Tricycle Cinema on December 10th

From Mohammed S Mamdani of Sufra NW London

If you haven’t had a chance to go to the cinema and watch the most coveted film of the year (give me credit, I’m trying to convince you), Sufra NW London invites you to an exclusive, private screening of “I, Daniel Blake” in the presence of the Mayor of Brent on Saturday 10th December at 10:30am at the Tricycle Theatre. Book your tickets here.

You regulularly hear my rantings about the welfare system and the reality of poverty in the UK. “I, David Blake” is a heart-wrenching drama about an elderly gentleman who suffers a heart attack and resorts to applying for government benefits.

The film follows his journey, attempting to navigate the red tape of the benefits system, alongside his new friend, a single-mother, who relies on a food bank to survive.

There’s also plenty of comedy – including Daniel’s attempt to use a computer for the first time to apply for Job Seekers Allowance. No offence to old people None taken - Martin), but trust me, it’s hilarious. And if you’re in any doubt about who is to blame for poverty in the UK or how difficult it is to survive on benefits, this film will convince you.

FREE tickets are available to all Friends of Sufra. If you’re a volunteer or a regular donor (that means you make a monthly donation of at least £5/month by standing order) you can come for free AND also invite an UNLIMITED number of guests at no cost! (We ask for a refundable deposit of £2, but that’s just to make sure you turn up. You won’t even see it appear on your debit/credit card bill). 

Book your tickets HERE using the promotional code "FRIENDS TICKET'.  We just want as many people as possible to gain an insight into how the current benefit system works.

Scrutiny to examine alleged flaws in South Kilburn Granville consultation

There is to be a Special Meeting of the Brent Council Resources and Public Realm Scrutiny Committee on Wednesday 30th November LINK to examine the situation around the proposals on the redevelopment of the Granville and Carlton Centres in South Kilburn. The issues has been covered extensively on Wembley Matters and the Cabinet discussion was reported HERE

The published reasons for the call-in are:

--> -->

·      That the process has been flawed with mistakes, warnings not heeded and lack of early consultation. 


·      That insufficient notice has been given to the views of the two Centres, local Councillors and other interested parties.

 
A member who has supported the call-in has provided further reasons for the call-in: 


·      The failure of the Cabinet to ensure that consultation took place with the users of the Granville Centre including the Granville Plus Nursery School.

·      The failure of the Cabinet to consider (ignored) warnings from a local councillor, that no consultation had taken place with the local community the Head of a popular local school and the parents who use it. Therefore putting valuable community assets under the unnecessary threat of closure and demolition.

·      The failure of the cabinet to adequately question the officer (consultant) who prepare the report on whether proper consultation had taken place, as it seem likely the consultant ever (sic) visited The Granville /Carlton centres or spoke to stakeholders.

·      The failure of the cabinet to engage with the South Kilburn Trust putting £2 Million at risk for a local employment Hub.

·      The failure of the Lead member for Regeneration to visit Kilburn or talk to stakeholders from May to the present day to re-assure local residents that there would be adequate consultation.

·      The failure of the Lead Member for regeneration to response to email requests for a meeting between Local councillors the Leader and CEO, between July and November.

Another blow to Brent and Kilburn Times

I wrote previously LINK about the decision of Archant, owners of the Brent and Kilburn Times, to make redundacies through doing away with News Editor posts on its papers, instead merging web and paper roles and centralising news gathering.

I now understand that the three sports writers on the newspaper are to be made redundant and a new post created which will essentially mean one person doing the job of three.  As the sports page, reporting on local fixtures, are probably one of the more popular features of the paper, this seems rather short-sighted.

It saddens me as someone who values the contribution of local newspapers to democratic accountability and building a sense of local community to see their gradual demise.

With few staff they are likely to rely on lightly edited press releases and shared copy rather than original stories.

At present local newspapers are helped to keep afloat by local government advertising in the form of statutory notices (see above). This ensures a steady income independent of the ups and downs of the local economy. However there have been reports that the government is thinking of removing the requirement for such advertising, allowing councils to put the information on-line only.  Given councils' budget constraints they are likely to go along with the proposal and withdraw such local newspaper advertising, dealing another, possibly fatal, blow to the local press.