Showing posts with label Independent Health Commission. Show all posts
Showing posts with label Independent Health Commission. Show all posts

Wednesday 23 December 2015

Brent Council may join Judicial Review bid on Shaping a Healthier Future

I thought this posting on the Brent Council website LINK by Cllr Kruoesh Hiran, Cabinet member for Adults, Health and Wellbeing,  deserved a wider audience. It sets out Brent Council's response to the Mansfield report.

Following a year long investigation into health service changes across five London boroughs the Independent Healthcare Commission for North West London reported its findings earlier this month.
The Commission, which was chaired by one of the UK’s leading lawyers Mr Michael Mansfield QC, was jointly commissioned by the boroughs of Brent, Ealing, Hammersmith & Fulham, Harrow and Hounslow. Naturally, as the democratically elected representatives of local people, we shared serious concerns about how A&E and other health services were changed across our boroughs.

However, it is important to also note that our concerns are not solely focused on A&E. One of the main issues here in Brent is the outdated population estimates underpinning the original plans. Yes A&E is a barometer of how the NHS is performing but it is clear that there is a wider system problem.

The Mansfield report highlights social care funding cuts and the significant cuts to local government. A good NHS needs a properly funded social care system. But the funding cuts to councils have reduced local authorities’ ability to provide more preventative services. It is the same problem emerging with Public Health funding.

Naturally when you are looking at a report, which affects two million people across North West London, there will be some issues more relevant than others to Brent’s 320,000 population.
First let’s turn to the main findings in the report:
  • there is still no completed, up to date business plan in place that sets out the case for delivering the Shaping a Healthier Future programme (SaHF), demonstrating that the programme is affordable and deliverable
  • there was limited and inadequate public consultation on the original SaHF proposals and those proposals themselves did not provide an accurate view of the final costs and risks to the people affected
  • the escalating costs of the programme do not represent value for money and is a waste of precious public resources
  • NHS facilities, delivering important public healthcare services, have been closed without adequate alternative provision being put in place
  • the original business case seriously underestimates the increasing size of the population in North West London and fails to address the increasing need for services.
The report also makes it clear that we are now looking at a £1.3 billion project while the original proposals were predicating a saving of over £200 million a year. A continued lack of investment in the out of hospitals strategy, while still implementing the A&E closures programme has led to unacceptable standards and low performance within A&E.

We are supportive of a good out of hospital strategy. It is in all our interests as it is generally better to have good health services closer to home. However, those services need to be in place before hospitals are reconfigured.

This is combined with a lack of bed capacity at Northwick Park and the delays in resolving this situation have been ongoing for the past year. Residents still consistently report problems with accessing GP appointments in a timely way and this inevitably leads to people presenting at A&E, while the use of urgent care centres is below capacity.

What was truly shocking to me in the report was the statistics on Northwick Park hospital where performance has been consistently poor since September 2014. A key graph in the report shows London Ambulance Service ‘black breaches’. These are where an ambulance has taken more than an hour to take a patient to A&E. In Northwick Park there were 633 such breaches compared to 106 at Hillingdon. Especially relevant is the fact that the London Ambulance Service has just been placed into special measures as, if you close A&Es, you are clearly more reliant on this service.

In summary, the SaHF plans really need to go back to the drawing board. We want greater local authority involvement in the actual decision making process and designing of services. While it is clear that mistakes have been made Brent Council wants to take this forward in a positive way.
Co-production is a good example where there is potential. There has been a recent decision to involve a Health and Wellbeing Board representative in local primary care. I am now Brent’s representative and although it has been a slow process to get here, I think we are now moving in the right direction.

In the meantime, we will thoroughly explore all of the recommendations in the Mansfield report
including the possibility of joining a Judicial Review after careful consideration and assessing the impact on Brent residents.

Finally, it does not give me any pleasure to write about the findings in this report but please do be reassured that Brent Council will continue to do our very best to help support our local NHS partners to learn the lessons from it and ultimately to deliver a good and more fully integrated NHS for all Brent residents.

Thursday 12 February 2015

THEIR CUTS-YOUR HEALTH Deadline for submissions to Independent Healthcare Commission extended to February 24th

From Brent Fightback

The Independent Healthcare Commission set up by four boroughs and chaired by Michael Mansfield QC to look into the effects so far of the implementation of the Shaping a Healthier Future proposals has extend the deadline for submitting evidence to February 24th. This is the evidence Brent fightback has submitted:

In addition to the points made in the BTUC submission which Brent Fightback endorses, we would like to add that effective out of hospital care, care in the community, cannot be provided if social care provided by the Council is slashed.

Brent Council's funding has been drastically cut and among their proposals to achieve a balanced budget are many cuts which will severely damage the quality of care available - in particular the reduction in time from 30 to 15 minutes for carers' visits which has been widely criticised by elderly peoples' charities as ineffective and dehumanising. Also the closure of the (ironically titled New Millenium Day Centre which caters for 80 plus people with complex mental and physical needs - the group SAHF proposals are supposed to focus on.

Also the withdrawal of any provision for rough sleepers who have a high level of unmet health needs and already a disproportionately high level of A&E attendances because they lack alternative means of care.

At the other end of their residents' lives, Brent Council proposes to close ten of its seventeen children's centres. As well as providing facilities for play and education, children's centres often host health services for under-fives including baby and child clinics and advice on health and diet for parents and their small children. Brent has a very poor record on child immunisation, dental health, child mental health and obesity. If these facilities are lost, the NHS primary care services will be put under even more strain.

This is the Submission made by Brent Trade Union Council
 
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Over many years the Brent Trade Union Council has campaigned with other concerned organisations and the local trade union movement about the cuts to the local health service.Our colleagues in the health service unions warned us that the removal of services from Central Middlesex Hospital (CMH) would lead to the eventual closure of A & E.

Central Middlesex Hospital was rebuilt and extensively modernised at a cost of more than £62 million, reopening fully in 2008. This modernisation was funded in large part by PFI and was specifically designed for emergency medicine.

In spite of this, over the intervening years, many services have been moved from CMH to Northwick Park Hospital in a far more prosperous area. Services were transferred without consultation, because there was no obligation to consult since the two hospitals were part of the same trust. Staff were often given only a few days' notice that they were required to transfer and eventually Central Middlesex was left without the back up services needed for its A & E to remain viable. So we have a situation where management moved the services, then used it as a justification for saying that A & E was no longer safe or effective as maintaining an A & E service is dependent on the full range of hospital services being available to patients. Yet, right up to the day of its closure the A & E department at CMH was still being sent patients from the overstretched departments at both Northwick Park and St Mary's.

Having moved so many services to Northwick Park and closed the A & E at Central Middlesex, the CCG is now responsible for a splendid modern building which they will have to pay for until the end of the PFI contract and the dilemma of how to make use of it.

Throughout these years, Primary care services have been severely overstretched and continue to be so despite the Shaping a Healthier Future organisation and the local CCG having a “vision” of improving those services by investing to prevent illness, lessen the need for hospital admissions and shorten the length of time patients need to spend in

hospital. Of course the BTUC supports improvements in primary care, but promises were made that these improvements would be in place before radical changes were made to hospital services. However, they remain, to quote the CCG's own documents, “visions” and “aspirations”.

There is a crisis in recruitment of GPs, community nurses, health visitors and other staff needed to transform these visions and aspirations into reality, just as there is a crisis of recruitment for hospital staff and an expensive and destabilising reliance on agency staff. BTUC believes that the government's refusal to pay NHS staff even the 1% advised by their own pay review body and the housing crisis which is extreme in Brent, contribute to the recruitment crisis in the NHS, while cuts to the Council's budget threaten the provision of adequate social care, essential if patients' needs are to be met in the community.

The two Brent wards closest to the hospital, Stonebridge and Harlesden, are some of the most deprived in the Borough. The Locality Profile for Harlesden makes for grim reading. Harlesden is ranked in 30s for deprivation for England.

Despite having a young population 32% below the age of 20 years, in Harlesden ward, life expectancy is 13.4 years for men and 9.6 years for women less than the highest expectancy rate in Dudden Hill ward. It can be described by a tube train journey. If you take the train from Harlesden station and travel a few station north you will gain a decade in life expectancy.

Chronic Illness is significantly higher when compared to London and England figures, the biggest killers are Cancer, Circulatory and Respiratory diseases.

Mental illness affects one in six residents, TB is the second highest in the Borough and HIV is “considered to be very high” (Locality Profile).

Too many Children are found to be obese in their reception year when starting school and teenage pregnancies are also high.

We have only outlined a few items from the Brent Locality Profile for Harlesden Ward but we want to emphasise how completely unacceptable it is to close the A&E and other services in the middle of a population that so desperately needs a proper A&E and the important the general health services that go with it.

To compound this misery the facilities at Northwick Park which is the A&E that is suppose to replace the CMH facility, cannot cope with the extra load from the CMH and was rated as the worst A&E in the country.

The near impossibility of using public transport to go to Northwick Park. The difficulty of taking a sick child in the middle of the night to the A&E does not bear thinking about. Again the Harlesden and Stonebridge wards have the lowest levels of car ownership and minicab costs are prohibitive for those on low incomes.

Brent Trades Council also want to support and be associated with the submission from The Hammersmith and Charing Cross Save Our Hospital Campaigns.

On behalf of the Brent Trades Union Council please place our submission before Mr Mansfield.


 Brent Fighback adds:



In addition to the points made in the BTUC submission which Brent Fightback endorses, we would like to add that effective out of hospital care, care in the community, cannot be provided if social care provided by the Council is slashed.


Brent Council's funding has been drastically cut and among their proposals to achieve a balanced budget are many cuts which will severely damage the quality of care available - in particular the reduction in time from 30 to 15 minutes for carers' visits which has been widely criticised by elderly peoples' charities as ineffective and dehumanising. Also the closure of the (ironically titled New Millenium Day Centre which caters for 80 plus people with complex mental and physical needs - the group SAHF proposals are supposed to focus on.


Also the withdrawal of any provision for rough sleepers who have a high level of unmet health needs and already a disproportionately high level of A&E attendances because they lack alternative means of care.


At the other end of their residents' lives, Brent Council proposes to close ten of its seventeen children's centres. As well as providing facilities for play and education, children's centres often host health services for under-fives including baby and child clinics and advice on health and diet for parents and their small children. Brent has a very poor record on child immunisation, dental health, child mental health and obesity. If these facilities are lost, the NHS primary care services will be put under even more strain.
 
Submissions should be made to: Peter Smith, Clerk to the Commission, at Hammersmith & Fulham Council. Submissions should be addressed to him at Room 39, Hammersmith Town Hall, London W6 9JU or sent by email to peter.smith@lbhf.gov.uk. Later submissions will be forwarded to the Commission but may not be given the same attention as those received by the deadline.