Friday 9 December 2016

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 1st 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

See 'I, Daniel Blake' free at Tricycle Kilburn tomorrow morning


There are still some free tickets available for tomorrow's  Sufra screening of Ken Loach's  I, Daniel Blake, at the Tricycle Cinema, Kilburn High Road, 10.30am.

In order for the organisers to monitor numbers please register HERE using the promotional code 'FRIENDS TICKET'.

New Wembley Park development comes with built in flood risk

Brent Planning Committee on Wednesday 14th will consider a planning application for the vacated Amex site in North End Road, Wembley. LINK

The officer's report has the familiar mantra for the Quintain area which considers that the height of the building, though not meeting planning guidelines, can be approved because of its good design and the height of other buildings such as Victoria House, in the near vicinity; and the proportion of affordable housing at 22.6% not meeting the 50% target is approved as a result of the financial viability assessment carried out by advisers.


The buildings front on to North End Road and follow the loop of the Wealdstone Brook at the back. The aim is to partially naturalise the Wealdstone Brook which is currently in a concrete culvert although lined by mature trees.  Naturalisation was a long term aim of the Wembley Plan to improve the environment but it is unclear from the application whether there will be public access.  I am awaiting  response from the Planning Officer to my query.


The development is next to Danes Court and Empire Court which are four storeys high and set in gardens. The Courts will now have tall buildings at each end of North End Road. In the original Wembley Plan there was a proposal to re-build the North End Road junction with Bridge Road where the Michaela Free School now stands. I have asked Planning about the current status of this plan.



One of the difficulties of the site is that it is surrounded on what could be seen as three sides by the Wealdstone Brook and this is a flood risk area. See the line of the brook below:




In a period of extreme weather caused by climate change there is obviously a need to build mitigation into the development. The Planning Report sets out the risk and actions taken to mitigate the risk. I publish it below for the record. In the event of  extreme flooding the site has the potential to become a temporary island.
The Wealdstone Brook is a 2m wide culverted watercourse, the base level of which is some 2.5m 
below adjacent ground level. The canalised brook is a tributary of River Brent and passes through the area within the engineered structure, and only becomes ‘naturalised’ where it emerges further south.
112.    The application site lies within Flood Zone 3a, defined by the NPPF as having a high probability of flooding. Development classified as ‘more vulnerable’ is only appropriate in these areas following application of the Flood Risk Sequential Test and where the Exception Test has been applied in full and has been passed. The revised FRA submitted has now used updated and revised climate change allowances to assess flood risk on site using the modelling already carried out and approved in support of application at Wembley Point for the Wealdstone Brook. The Environment Agency (EA) accept the design flood level detailed in the submitted FRA.
113.    The NPPF requires the Exception Test to be applied in the circumstances shown in Table 3 of the ‘Planning Practice Guidance: Flood Risk and Coastal Change’. Paragraph 102 of the NPPF makes clear that all elements of the test must be passed for development to be permitted. Part 2 of the test requires the applicant to demonstrate that the development will be safe for its lifetime taking account of the vulnerability of its users, without increasing flood risk elsewhere, and, where possible will reduce flood risk overall.
114.    The flood modelling prepared by the applicant shows that North End Road would be inundated in both the 1 in 100 35% climate change event and the 1 in 100 70% climate change event, which appears to be the only access/egress route. This means that safe refuge within the development is required for future occupants as safe access and egress cannot be achieved.
115.    The finished floor levels of the development have been raised above the 1 in 100 chance in any year, including an allowance for climate change flood extent. This means that floodwater is unlikely to enter the property during a 1 in 100 chance in any year plus climate change flood extent.
116.    The applicant has overcome the EA’s previous objection by submitting an acceptable emergency flood plan framework to the local planning authority that deals with matters of evacuation and refuge to demonstrate that people will not be exposed to flood hazards.
117.    The full detailed flood plan for the site will be secured by condition prior to the occupation of the development hereby approved.
118.    To summarise, the applicant has demonstrated that the site has satisfactorily addressed the EA’s previous objection, demonstrating that people will not be exposed to flood hazards and therefore the application is acceptable in flood risk terms.
North End Road is currently a 'dead end' street and the planning officers, despite the new development being designated 'car free' as it is so close the Wembley Park station and bus routes, take into account potential parking problems:

The applicant therefore proposes to designate the development as ‘car-free’ and the good access to public transport and other services would support this. There is however some concern that this development, with parking provision for just 8% of units, would generate an excessive volume of parked cars in the adjoining streets that cannot be regulated at the present time and that the proposal could potentially result in parking conditions detrimental to the free and safe flow of traffic in the area.

In order to avoid this in the event that the development is approved, it is essential that the right of future residents and businesses to on-street parking permits (both for the existing Stadium event day CPZ and for any future year-round CPZ that is introduced in the area in future) be withdrawn through a Section 106 Agreement.

A significant contribution (£100,000) via a S106 Agreement should also be provided towards subsidising the cost of on-street parking permits for existing residents in the area, so that if a CPZ is introduced to control overspill parking from this development, they are not unduly inconvenienced by it. This figure has been calculated using the Council's standard rationale for CPZ contributions.

There is another broader issue about the development around the stadium which is the gradual removal of small businesses as they are replaced by housing, hotels and student accommodation. This impacts on longer term employment opportunities in the area.




Thursday 8 December 2016

Extraordinary Brent CCG meeting on Wednesday to further controversial health plans

There is an Extraordinary Meeting of the Governing Body of the Brent Clinical Commissioning Group at noon-1.30pm on Wednesday 14th December at the Boardroom Wembley Centre for  Health and Care.  The meeting is open to the public and 30 minutes has been allocated to questions from the public.

The meeting is about the business case for Shaping a Healthier Future and the CCG consider this essential for delivering  the controversial NW London Sustainability and Transformation Plan. Cllr Krupesh Hirani confirmed in the Brent and Kilburn Times today that Brent Council intends to sign the STP despite the fact that neighbouring Ealing and Hammersmith and Fulham councils have refused to do so.

As usual the documents are massive, jargon ridden and with enough acronyms to fill Wembley Stadium.

Anyone who manages to plough through them AND understand them deserves an honorary degree.

Those who think that the STP, though argued on the  basis of benefits to patients, is really a cover for cuts may be interested in the Strategic Outline Case for investment to eventually save money: 
For trusts under the ‘comparator’ scenario, where no commissioner QIPP is assumed to be delivered and with business-as-usual CIP delivery, all our provider trusts will be in financial deficit, with a combined deficit of £114m at 2024/25. However, if commissioner QIPP were delivered, trustsI&E would improve to a combined deficit of £18m as additional CIPs can be achieved (termed the ‘SaHF scenario before reconfiguration). The CCG QIPP delivery is dependent in part on the building of the hubs, which is why it is not included in the ‘comparator’. If we receive the capital funding we are requesting, the trusts’ financial projections demonstrate that all trusts will have a sustainable I&E surplus position of £27.6m at 2024/25, with the reconfiguration contributing a c£50m benefit (termed the ‘SaHF scenario after reconfiguration’). 

Currently the trusts are running in-year deficits which would require an estimated cash support of £1.1bn over the next 10 years (and continue thereafter), which would reduce to £0.5bn under the ‘SaHF scenario before reconfiguration’ (where additional CIPs are delivered, partly due to hub investment to enable QIPP delivery). Under the SOC part 1 option (‘SaHF scenario after reconfiguration’), the cash deficit support in the 10-year period would reduce further to £0.4bn and are eliminated post reconfiguration. 

If the capital investment were funded by loans, two of the trusts would have a below target Financial Sustainability Risk Rating (FSRR) and be unable to meet the loan repayments. As the loan funding scenario is unaffordable from a liquidity perspective, we have explored two further scenarios and have concluded that our preferred option is for Public Dividend Capital (PDC) funding, and an accelerated timeline. 

We have also demonstrated that the case is affordable under a range of scenarios by conducting sensitivity analyses.
This is the Brent Cabinet decision as recorded in the minutes of the October 24th Cabinet meeting:


1.     Cabinet noted the STP submission for North West London. 

2.     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. 

3.     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 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. 


Buy ethical Traidcraft presents for your children this Christmas

Wembley Matters does not carry advertising but I have made an exception in this case. You can make a difference to the lives of some of the poorest people on the planet by making ethical consumer choices.

Show You Care - Nepal: The Stonebreakers (Subtitled) from Traidcraft on Vimeo.

Toy adverts are dominating TV screens and parents are crumbling to the pressure of pester power, but most children are bored with their Christmas presents by the end of the festive season, according to a new study. A national survey by Traidcraft, the UK’s leading fair trade organisation, found that 67% of parents expect their children to tire of their new toys by the end of the holiday season, while almost 3 in 10 parents expect their children to be bored with their gifts on the big day itself.

This lack of interest comes despite the majority of parents surveyed (60%) estimating they spend more than £100 per child on Christmas presents. The survey also found that around nine in 10 people receive at least one unwanted Christmas gift every year. The survey was commissioned by Traidcraft in support of its Show You Care campaign, which calls on UK consumers to shop with thought and buy meaningful fair trade gifts in the run up to the Christmas period. The survey results, which shed light on the nation’s Christmas gift giving, come as a stark contrast with the lives of some of the children and families that the organisation works with in developing countries overseas.

 In Kenya, where Traidcraft works with farmers struggling with the effects of climate change, children surveyed by Traidcraft were excited by the prospect of receiving fizzy drinks for Christmas, while in Nepal Traidcraft’s partner organisation Get Paper Industry provides education for children of desperately poor rural families. Nepal’s ‘Stonebreakers’ are some of the poorest people in the world, whole families including the children make their living collecting, breaking down by hand and selling stones from the riverbed. The average income for Stonebreakers is just 75 rupees, or 50p per day, which must support an entire family.

Stonebreaker Suvash Parijar, who is father to five year old Sudip, is forced to beg and borrow to keep his children clothed and fed. Suvash said: “As I have a family I have responsibilities. I have to make sure they are looked after and have enough to eat. There is no other way to look after my children unless I work. It is all my responsibility. “Sometimes there is no money at all, so if my children demand something that I cannot provide I have to find a way of explaining to them. But we usually beg and borrow to get them what they need. It is very difficult.”

Buying from Traidcraft helps our partners such as Get Paper Industry transform lives, allowing them to run life changing products around the world.

 Roderick Stuart, Traidcraft’s Head of Communications, said:
Of course we want families to enjoy a fantastic Christmas and receive the gifts they want and will enjoy, but we’ve all probably experienced a time when we feel under stress or pressure to buy Christmas gifts that are maybe beyond our means and it feels like we’re in danger of forgetting the true meaning of Christmas.

Meanwhile there are whole families in developing countries living on the equivalent of just 50p a day. Many people think that fair trade simply equates to a fair wage and while ensuring a fair wage for producers is a hugely important part of what we do, the benefits of buying fair trade reach so much further.

In the case of the Stonebreakers in Nepal, our work with fair trade producers means that the children of these desperately poor families have access to a free education, which can eventually help lift the whole family of poverty changing lives for the better forever.

Fair trade Christmas gifts really are a win-win way of spreading festive cheer and that’s why we’re calling on the people of the UK to ‘Show You Care’, buying ethical gifts with thought and love in the run up to Christmas.
 Traidcraft’s fair trade Christmas range is available to purchase at www.traidcraftshop.co.uk

Wednesday 7 December 2016

Tulip Siddiq makes a passionate plea for her EU residents


Cllr Carr raises key questions on Brent's Eastern Europeans report

Guest blog by Dr Helen Carr, Indepedent councillor in Brent, on the report about the Eastern European community in Brent. Publication does not mean that I agree with everything said in the article but I think Cllr Carr raises important issues. The original report is HERE

Summary

Feedback, comments, notes & queries re: ‘East European Communities Living in LB of Brent’

1.1.What do you mean by ‘socio economic barriers’? Barriers to what? Who and what is this report for? What is this report intended to do? To describe, compare and contrast who, what and why?
‘Does not include rough sleepers, overcrowding or anti-social behaviour’. Why not? Surely these are all ‘socio economic barriers’ 

1.2 ‘Eastern European’ – which countries exactly? This is a redundant Cold War term, similar to ‘Eastern Bloc’. Does this include the Central Europe (Mittle Europea) Balkans (not all in the E.U.), the Baltics, and South Eastern Europe (Romania and Bulgaria)?
3.1 Romania is in South Eastern Europe. Where is the evidence the Polish community is settled? 

 Which Poles? Why are ‘Poles’ settled and Romanians not? What do you mean by ‘settled’?

By Romanians, do you mean ‘Romanian speakers’, Roma(ny), Romanian speakers from Moldova? Cigany (Gypsy Roma) forms of speech can be heard in and around Mapesbury alone. Speakers can be divided into two groups: Beas (archaic Romanian, similar to Chaucer’s English), Csengo and Lovari (a Magyar Romanian mix found in Banat and Transylvania). How do you know what type of passports / ID people hold? Even if documents can be produced, the black market trade in ID passports, especially for non EU peoples not entitled to work in the UK is thriving. Not all peoples of Romania speak what the Romanian State understands as ‘modern Romanian’. Even in 2001, there was not an agreed official orthography.

Where is the evidence for any of this material? This is a public document. This might not be an academic paper, but this does not mean there should not be intellectual rigor. The majority? How many is the ‘majority’? How was the material collected and by whom? Over what time frame – did anyone attend any of the Romanian Churches/Church groups? In which case, it would be obvious that many women, who are not necessarily publicly and obviously visible (why would they be?), live and work in the hotel and catering industry, or as domestic workers (servants). 

'Men and women are ‘sex workers’. Are ‘East European’ female sex workers subject to ‘abuse and violence’ and ‘health inequalities’ more or less than other sex workers? What about the men? Or are all Eastern European women sex workers?

3.4 Where is the evidence for any of this material? There are sufficiently few numbers to be specific.

Homeless referrals (Start Plus): Not all peoples in Romania are considered ‘white’: is this description or ascription? Cigany/Romany peoples in Hungary especially are described as ‘our black problem’.  

4. Recommendations
4.1 The most obvious issue here is, what for? Is this report intended to ‘get a better understanding’ of...? What languages are required if ‘information and support’ are to be provided? What if the ‘clients’ are not literate in the mother tongue?
4.3 What do you mean by ‘personal and social skills’? Are all ‘East Europeans’ smokers who are anti-social, mentally ill, substance abusers and prostitutes?
4.6 ‘Ethnographic Research: to inform outreach.’  Conducted by whom? To what end? Shouldn’t this have been conducted before this report was produced?
5.0. Where is the money for this ‘research’ coming from? What for? This statement is meaningless. Who decides ‘need’?
6.0 I am afraid there may be legal implications from this report: is the report intended to demonstrate deprivation or discrimination? Of who? By who? Unfortunately, the authors do seem to have demonstrated their own prejudice and discrimination. This report is in the public domain. I refer the authors of this report to the recent publications of the Equalities Commission and Hate Crime.
7.0 As above.
8.0 As above. I am concerned a staff member of Brent with the job title ‘Head of Equality’ has produced this report. There is insufficient material related to the role of the ‘Partnerships and Engagement Manager’ to warrant inclusion.
Why are there no background papers?   

The ‘Situation of the Roma’, as it has become known, has been seen in terms of discrimination and deprivation. In November 1998, I contributed to a report commissioned by the United Nations Committee against Torture (CAT) in which I first voiced concerns about alleged abuses of Roma in Hungary.[1] In particular, “of cases concerning inhuman and degrading treatment.”[2] The situation of the Roma was and is understood in terms of relative deprivation, or ‘lack’: the lack of decent salary and income, good housing, satisfactory clothing and nutrition, healthy drinking water, education, and the ability to compete with non-Cigany (Kemeny 1992: 157). Public and state discourse has until recently perceived the cause of this ‘lack’ as the Cigany culture itself. Integration has always been seen as a solution (Stewart 1993: 187).

It seems from this report, that almost 20 years later, the same prejudices and discrimination are being applied by Brent Council to sections of its own population.

I am concerned about why people are leaving in huge swathes of Europe to seek a life in the UK. As EU citizens they are entitled to work, but not claim asylum (and all the rights and privileges this allows). Yet they too are fleeing poverty, distress, discrimination and deprivation, and also war: the war in the Crimea following Russia’s invasion of eastern Ukraine has inevitably sent populations fleeing westwards, as has the build-up of Nato troops along the Baltic borders with Russia. I represent all residents in my ward, and the Borough, not just the noisy, rich posh ones. I am particularly concerned those groups such as Roma who are an under/ unrepresented socio-economic demographic in the political process have a voice:  they tend to be excluded and avoid participation precisely because of the sort of discrimination and prejudice exhibited in this report.  

We need to demonstrate our commitment to human rights and protection of minority groups, especially important in the current toxic climate. Reports such as these are at the very least unhelpful. At worst, legitimise prejudice and discrimination because they emanate from the State - a Local Authority (and one with no ethnic majority at that). 

Public Space Protection Order

I wonder if this report is intended to legitimise the further extension of the Public Space Protection Order in Mapesbury? This is a tool originally intended to prevent large crowds gathering and ergo protect the public (and property) from injury and damage. It is not intended to protect house prices or enhance gentrification. I object again to the renewal of this Order in Mapesbury. 

We need to see the police records and statistics if we are to assess the usefulness of this Order: which crimes? How are they linked to the Order? Who commits these crimes and what category of crimes are they? If the police receive complaints about ‘migrant’ workers, from who? Where? What sort of complaints? How many, when, and how many are generated by the same people over what period of time?   

If we exchange the term ‘East European migrant worker’ with ‘Jew’ or ‘black’, would we be comfortable with this report?  

Cllr. Dr Helen Carr, Research Associate, University of Oxford, School of Anthropology and Museum Ethnography: Elected Fellow Royal Anthropological Institute; UK Delegate and Representative, Congress of the Council of Europe.




[1] United Nations Press Releases. Hungary Presents Report to Committee against Torture. HR/CAT/98/38. November 17, 1998.
[2] United Nations Committee Against Torture. Conclusions and Recommendations of the Committee Against Torture - Hungary. United Nations Publications. November 19, 1998.


We need to talk about SYRIA - come along on Monday


From Brent Stop the War

Speaker Dr Anne Alexander
Co-ordinator, Digital Humanities Network, Centre for Research in the Arts, Social Sciences and Humanities (CRASSH), University of Cambridge.

It is a hundred years since the Sykes-Picot agreement mapped out the extension of French and British control over areas of the Middle East which had, for hundreds of years, been part of the Ottoman Empire. The divisions that followed that agreement have influenced the subsequent history of the region culminating in the current complex situation of a war with multiple protagonists. Anne Alexander will give us an update on the tragic situation and its historical and political context.

Monday 12th December 7.30pm
BRENT TRADES HALL
375 High Rd, Willesden
NW10 2JR

Very close to Willesden Bus Garage, buses 6,52,98,226,260,266,302,460, and just five minutes’ walk from Dollis Hill Jubilee Line station

Details of a play about war and surveillance in the UK by one of our Brent Stop the War supporters: ISIS at Elmwood Theatre Club, Elmwood Lawn Terrace Club, Holland Road, NW10 5AJ : the Brent dates are 15-17 December 7.30pm DETAILS