Dawn Butler launches campaign against the overnight closure of Central Middlesex Hospital Urgent Care Centre

Wembley Matters reported on July 2nd that Brent Clinical Commissioing Group was proposing to Close the Central Middlesex Urgent Care Centre overnight (Midnight to 8am) citing lack of use. LINK

Dawn Butler  MP (Brent Central) has now launched a Central Middlesex Hospital Campaign with a petition aimed at preventing the overnight closure LINK

Butler writes

News has broken in recent weeks that Brent Clinical Commissioning Group (CCG) are now intending to cut the hours of operation for the Urgent Care Centre at Central Middlesex Hospital entirely from midnight to 8am, making potential savings in the region of £450,000 per annum.

I have used the Urgent Care Centre late at night and know first-hand that there is an absolute need for this 24 hour service in Brent. I am entirely opposed to cutting the hours of operation and call on the CCG to think again and to put any future proposals to a full public consultation.

If the Urgent Care Centre were to close at night local residents without access to a car will have to travel for anywhere between 45 minutes and 1 hour 20 minutes on public transport in the dead of night.

I therefore call on you to join me in condemning the proposed closure by signing my petition below. I will also continue to keep you updated on the petition and my campaign to put a stop to this proposed closure.

The above link takes you to the petition.

 

Proposal to reduce hours at Central Middlesex Urgent Care Centre by closing it overnight

Brent NHS Clinical Commissioning Group  is proposing to close the Central Middlesex Hospital Urgent Care Centre, presently available 24/7, from midnight to 8am, saving £450,000 annually in what they admit are financially challenging circumstances.

The service is currently provided by Greenbrooks and the CCG says the provider agrees with the proposal. The CCG health, rather than financial case, is based on low usage and availability of alternative provision:

The data analysis based on “reasons for attendance” showed that from the average of ten (10) patients attending per night, the following would be the appropriate course of action if CMH UCC were to close overnight: 


o Less than 1 per night would continue to require ED either urgent treatment or referral to specialty review

o One(1)per night would need to attend an alternative UCC such as Charing Cross, St Mary’s, Ealing or Northwick Park

o Four (4) per night could access an alternative night service such as GP out of hours

o Four (4) per night could access alternative provision, including their own GP, the next day

The UCC was set up in 2014 when the Accident and Emergency service was closed at  Central Middlesex Hospital, despite widespread opposition, which included rather belated opposition from Brent Council.  The overnight closure of the UCC represents a further deterioration of the service currently offered to residents in Harlesden, Park Royal and Stonebridge.

Transport difficulties to alternative A&Es was always a factor in the original campaign against the A&E closure was a major factor so the CCG puts forward the transport timings for residents seeking overnight treatment:

The CCG argue that the change would mean a 'safer urgent and emergency offer by reducing entry points to out of hours services':

The alternative offering being implemented by the CCG will aim to drive down [] inappropriate attendances, helping to provide choice and direction to those seeking advice and care. The majority of attendees overnight are between 20 and 44, the age group most likely to have internet access at home, or own a smartphone, and therefore be best place to benefit from digital signposting.

People arriving out of hours at Central Middlesex will be advised to dial 111.

The report will be considered by Scrutiny Committee at its meeting on July 9th. The full document is HERE

 

Butt poses key questions on future of NHS provision in Brent for Executive endorsement

The Brent Executive will be asked to retrospectively endorse a personal submission made by Council Leader Muhammed Butt to the Independent Reconfiguration Panel. The IRP was gathering evidence on the Shaping a Healthier Future plans for health services in North West London which include the closure of Central Middlesex A &E  and submissions closed  yesterday.

Th IRP will report to the Secretary of State on September 13th and his decision will be made in October 2013.

Muhammed Butt's Submission

I am writing to you to express my views on the Shaping a Healthier Future programme (SAHF). It is accepted that the NHS needs to change and services have to evolve but I have some serious concerns with the proposals as they stand, and whether they can really deliver improvements to health care in North West London within the planned timetable for implementation. I support the referral that Ealing Council has made to the Secretary of State for Health that will see the Shaping a Healthier Future proposals reviewed by the Independent Reconfiguration Panel. It is important that the plans are subject to robust and independent scrutiny and that the modelling and assumptions built into the proposals are properly tested.

Out of Hospital Care

SAHF makes it clear that changes to out of hospital care are essential if it is to deliver the planned changes to acute care. The general princip le of transferring services from acute to community locations with investment in primary and community care, where appropriate, is welcomed. People should not have to travel to hospitals for routine care or to manage a long term condition.

That said, I am concerned about whether the proposed changes can really be delivered, and even if they are, will they deliver the reduction in demand for acute services that SAHF claims?

I have seen no guarantees that out of hospital care will get the investment in the near future that is needed to ensure that SAHF can deliver improvements. The business case outlines the level of out of hospital care investment required, but in times of financial pressure and constantly shifting priorities, I need cast iron assurances from all of the CCGs in North West London that this money will be allocated to out of hospital services that underpin SAHF no matter what other challenges are faced in the coming years. 
 

The Decision Making Business Case (DMBC) is clear that commissioners and providers should not undertake reconfiguration of hospital services until out of hospital care is shown to be working and have sufficiently reduced demand on acute services. But I need clarity on exactly what the thresholds are for the reduction in demand that will need to be met before the reconfiguration of acute services is allowed to begin, particularly on critical services such as A&E.

I also need to be convinced that delivering more and more services out of hospital will be cheaper for the NHS. There is an assumption that this is the case, but I have seen no evidence to support it. One of the benefits of providing services in a hospital setting is the critical mass that can be achieved by locating services in one place. For some services, such as maternity, we will see a reduction in the number of places services can be offered.

For other services, we will see an increase in settings as services are delivered away from hospitals. The CCGs need to demonstrate more clearly how out of hospital services will be cheaper.

While there appears to be a general consensus of support across CCGs in North West London for the provision of out of hospital care, the provision of this falls to individual CCGs and individual Out of Hospital Care Strategies. A failure to deliver an Out of Hospital Care Strategy in any one CCG areas could have a knock oneffect on neighbouring CCGs, particularly if it affects demand on shared acute care services. For example (and this is hypothetical), if Harrow CCG fails to reduce demand for acute services, how will this affect Brent residents using Northwick Park Hospital where services could be under extreme pressure? Similarly, in these times of stark finances and shifting priorities, if one CCG decided to reduce its commitment to out of hospital care, it is not clear what the effect would be on neighbouring boroughs and shared acute service provision.

GP Support and “Hubs”

The Out of Hospital Strategy underpinning SAHF cannot succeed without GP support and I note that one of the key issues listed in the panel’s terms of reference is the consideration of GP’s views. I have seen no evidence of grass-rootsGP support for the changes, particularly in relation to out of hospital care (I refer to GPs themselves rather than the CCG). Although GP events took place, the DMBC gives limited reference to them, despite the report’s acknowledgement that Health Scrutiny Committees in North West London had made it clear that they expected to see evidence of GP support.

It seems to be a general assumption throughout the decision making process that the support of CCGs should be taken as implicit supportof GPs. This is an erroneous and dangerous assumption. Shaping a Healthier Future relies heavily on additional out of hospital services and without the full buy-in and cooperation of GPs SAHF will face serious, if not insurmountable, challenges. I ask that the IRP challenge the CCGs to provide the full details and results of the GP engagement activities that were undertaken to demonstrate that there is GP support for their proposals

Besides the lack of evidence of general support fro m GPs, we have seen little evidence that GPs will be prepared to make changes to the way they work or provide additional services/support that is required. SAHF and the CCGs needs to satisfy the panel that the GP elements of the Out of Hours services can be delivered, and what the back-up alternatives are in cases where it proves they cannot.

One of the key elements of the Out of Hospital Strategy is the provision of additional local medical centres (“hubs”). Yet purpose built centres that already exist in Brent have not fulfilled their potential. Monks Park Medical Centre for example remains under-occupied and consequently underused. Similarly, I understand that the NHS Brent has failed in the past to encourage a GP practice (the Willesden Medical Centre) to relocate into the Willesden Centre for Health and Care (one of the designated hubs) despite considerable efforts. I urge the panel to fully investigate SAHF's claims that the proposed centres will really be able to deliver on their promises across NW London and particularly in Brent.

Evidence from Brent to date suggests that efforts to move GP practices into purpose build medical centres have not succeeded and that they remain committed to working from their existing premises. Why should SAHF change this?

Given that “hub” medical centres are a central component of the Out of Hospital strategy underpinning SAHF, I need to see more clarity on exactly what services are planned for each hub. In particular there needs to be clarity on exactly what services will be provided at Willesden Centre for Health and Care and for Wembley Centre for Health and Care, which are already large medical centres in Brent and two of the designated hubs. I also want to see assurances that no existing services at these sites are going to be removed.

GP access is already a serious issue in Brent, particularly in the south of the borough, and previous attempts by the PCT to address this have had little success. Since SAHF is dependent on increasing GP access I urge the panel to establish with the CCGs (particularly Brent CCG) what evidence they have that that their new attempts to increase GP access will succeed where previous attempts have failed. Without this A&E attendances and acute demand will continue to rise.

Changes to acute care

I have seen little tangible evidence to support the models for individual services leading to reduction in demand on acute services. I acknowledge that there will be an element of risk in the modelling of any service reconfiguration, but the scale of change is huge and the impact of the Out of Hospital services not producing the required reduction in acute demand could be catastrophic. To this end I urge the IRP to establish what mitigation plans there are if the model fails, either for individual parts of the reconfiguration or for more fundamental modelling of the reconfiguration as a whole.

An example of a proposed service change that causes me concern is the provision of maternity beds at Northwick Park. Under the proposals there will be an increase from 69 to 70 beds by 2015/16, but a 20% increase in births atthe site. This appears to be based on the questionable assumption that a 15% reduction in average length of stay can be achieved by 2015/16. I ask the panel to establish what provision has been made if North West London Hospitals fails to deliver the numbers proposed?

Previous attempts to reduce acute demand through faster discharge have been unsuccessful and I would be interested to hear why SAHF believes it will succeed where previous attempts have failed.

I am particularly concerned about the deliverability of the proposals - maternity is one example. Changes on the scale proposed by Shaping a Healthier Future would ideally be carried out in a stable and highly functioning health system. But, we know that the NHS is in crisis, and North West London is not immune to this

.

Central Middlesex Hospital

It will come as no surprise to you that I am concerned about the future plans for Central Middlesex Hospital. Central Middlesex serves the south of Brent, which contains areas of significant deprivation and poverty. Has there been any research done on the evening closure of A&E at Central Middlesex that is already in place, and its effect on Northwick Park, St Mary's and other neighbouring hospitals? Northwick Park’s A&E Department is already failing to perform adequately or safely. Unless out of hospital services deliver a marked reduction in the use of Northwick Park’s A&E, the removal of A&E services at Central Middlesex could cause Northwick Park hospital to reach breaking point.

I note that North West London Hospitals and Brent CCG both support the plans for the closure of A&E at Central Middlesex but that does not alter the fact that there is a genuine, strongly felt public opposition to this plan which cannot be ignored and I urge the panel to give this strong consideration when they consider the proposals.

It is proposed that Central Middlesex be an elective hospital with an Urgent Care Centre. However, there is a complete lack of information on precisely what elective services will be delivered at the site, and what catchment area they will serve. It is also unclear what the UCC will provide despite plans for a standard UCC offer to be developed across London. A working group set up to develop plans for UCCs has,to the best of my knowledge, not published any proposals. I need to see clarification from Brent CCG on its plans for services at Central Middlesex Hospital and assurances on its long term viability as an NHS hospital before I can support the proposed changes.

Northwick Park Hospital

Northwick Park has struggled for some time to deliver an adequate or safe A&E and has one of, if not the worst, “four hour waiting time” performance in the country. It has recently had a crisis summit focussing on A&E leading to the imposition of an “Implementation Plan” to address the issues. Is it really prudent to give extra A&E responsibilities to a hospital that has shown itself incapable of delivering adequate A&E services to date and what is being put in place to manage these increased risks? The recent risk summit at the Trust highlighted the depth of the problems that currently exist and I have serious concerns about how you can transform a system which is already in crisis.

In addition, the response to the current A&E crisis at Northwick Park has been to utilise facilities at Central Middlesex. What back-up options will there be in the future once Central Middlesex’s emergency facilities have been removed?

Equalities and Population

Many residents of the south of Brent suffer deprivation and hardship. It is an area with a high proportion of BME residents and residents with English as a second language. We have sought assurances from SAHF that these communities will not be unduly disadvantaged by the reconfigurations and particularly the closure of Central Middlesex A&E.

In particular we have sought clarity on the travel implications for both patients and residents. To date we remain dissatisfied that sufficient consideration has been given to this. Clinical priorities are cited as being more important, but we should not ignore the fact that the mental health and recovery of patients can be dependent on regular visits and support from family and friends and I urge the panel to push for clarity on the effect that the changes would have on low cost transport options for patients and visitors, particularly in this deprived area. We would similarly seek assurances from Brent CCG that it will take seriously the public transport implications to the medical centre "hubs", which besides being an equalities issue, could reduce the numbers of patients using these services.

Conclusion

I want Brent Council to work constructively to challenge our NHS colleagues. I am not opposed to change without good reason, but I remain concerned at the lack of clarity in key areas, including: 

 

• The ability to deliver better out of hospital services

• That Northwick Park Hospital will be able to provide additional acute services for an expanded population

• The future of Central Middlesex Hospital. Despite the Shaping a Healthier Future plans being published a year ago, I am no closer to understanding what will be delivered from the Central Middlesex Hospital once it becomes an elective centre.

NW London NHS: If it's not an accident or an emergency, where should I go?

Guest blog by a Brent (would be) NHS user

Recently I have begun to feel that I might resemble a cod fish which has evolved to become smaller than its ancestors, so that it could slip through the holes in trawlers’ nets in order to avoid being made into fish fingers. Inadvertently I seem to have evolved into a life form that slips through the mesh of the NHS in North West London in 2013, albeit with less positive consequences that is the case for the above mentioned fish.

One of the several ailments that afflict my legs causes them to swell, then, if the skin breaks, fluid can seep out. About a year ago I had an outbreak but this problem which was effectively treated by the nurse at my local GP practice. For a while this entailed wrapping the leg in several layers of bandages which had to be changed about every two days since the leakage soon soaked through the dressings. Gradually the leg healed up and the leaking ceased, I was then able to treat myself at home with creams and a stocking bandage.

This self-medication worked well until about a month ago, when the leaking started up again. I tried to apply layers of more absorbent bandage myself, but my efforts weren’t very effective and the leg seemed to leak more and more. 

I rang my GP surgery but they couldn’t make an appointment for me for a week, but my bandages were soon both falling off and soaking wet, so I sought treatment elsewhere. I went to an NHS “Walk-in” Centre, about five miles from my home. The nurses there did what they could, but said that the “Walk-in” Centre did not keep a sufficient stock of bandages to treat cases such as mine and advised that I should be seeing my GP.

The temporary bandaging just about held out for four days until I was able to see the GP nurse again. The sopping bandages were removed and replaced with more extensive bandaging, but this too was wet through within a day, to the extent that one of my shoes was filling up with fluid whilst the bandaging was slipping down my legs, but the next GP appointment that I could now get was in six days’ time, so I decided that fresh bandaging was needed.

I looked at a full page advert from the NHS in free magazine posted to me by my local council. It was headlined “If You Are Unwell, Choose The Right Place to Go” (NHS Brent Clinical Commissioning Group  p.8 Brent Magazine, June 2013).  This ad detailed the various NHS services provided locally, but also emphasised the message: “Choose Well: Only Use A&E in an Emergency”.

I had already been to the GP and the Walk-in Centre, so I tried ringing up the Urgent Care Centre at a local hospital, (Central Middlesex), which was mentioned in the NHS advert. When I described my problem, I was told that the Urgent Care Centre was not the appropriate place for me and that I should go to the A&E in another hospital (Northwick Park in Harrow) as the local A&E in Central Middlesex was now “appointments only”.

This contradictory arrangement which might seem to imply that a patient should be clairvoyant enough to know of an emergency before it happened to them, placed me in a quandary. Harrow A&E is a fairly difficult journey, I could, I suppose, have phoned for an ambulance, but I did not consider my condition, no matter how unpleasant it was, to be an emergency and I did not want to waste the time of ambulance crews and A&E staff in dealing with it. So I was effectively house bound for about three days until my GP appointment came up. Luckily, I had enough food at my home to last out, otherwise I might have gone to the A&E for lack of groceries, rather than for any medical reason.

The GP treatment, when I got it was adequate and I have l also now been referred for specialist treatment, so I make no blanket criticism of the NHS, but there do, locally, at least seem to be some gaping holes in its net.

Recently I have seen and heard, media coverage that suggests that A&E’s can no longer meet the demand placed on them by many people presenting with non-urgent conditions, and it could be that such pleading might cover for pressure caused by A&E closures, when no adequate service for non-emergency cases, such as mine, seems to be in place.

I know that there a places in the world where there have never been ANY health services and I know that currently, in other parts of the world (like Greece and parts of Spain), previously adequate health services are being systematically destroyed by mad neo-liberal austerity policies. So my whinges, as a relatively affluent, educated British urbanite, are minor; but someone more disabled, and/or less articulate, and/or with less access to transport, might find things far, far worse than I did. Public adverts advising people to use services that don’t really exist are annoying at the best and potentially dangerous at worst.

Brent Council shrinks from outright opposition to Central Middlesex A&E closure

The Brent Health Partnerships Overview and Scrutiny Committee last night approved a response to 'Shaping a Healthier Future' which fell far short of outright opposition to the proposals which will mean the closure of Central Middlesex Accident and Emergency.

Although the response contains many reservations about Urgent Care Centres,  community care and transport issues the overall conclusions are anodyne:

Overall conclusions

5.1 The Brent Health Partnerships Overview and Scrutiny Committee believes a strong clinical case for change has been made by NHS North West London and that health services need to be reconfigured to secure better outcomes for patients. This will mean that difficult decisions will need to be taken, but to “do nothing” is not an option and it is in everyone’s interests to ensure that services in London have a sustainable future.

5.2 That said, we urge the Joint Committee of PCTs to consider the following points when making its decisions regarding Shaping a Healthier Future:

(i). Efforts need to be focused on successful implementation of the borough’s Out of Hospital Care Strategy and ensuring this is properly resourced before the reconfiguration of acute services.  Changes to the acute sector are dependent on this – cost shunting, or under resourcing out of hospital care would not be acceptable to the council and will lead to a worse service for patients escalating costs in the acute sector.

(ii). That services to be provided from Central Middlesex Hospital are confirmed as soon as possible. Work should begin with local communities to spell out what the future is for the site so they can be reassured their health and wellbeing won’t be adversely affected by the changes.

(iii). That Shaping a Healthier Future emphasises to TfL the conclusions relating to

transport set out in paragraph 4.11 above.

Earlier in the meeting committee members had subjected Care UK to a grilling regarding the loss of x-rays  and child protection procedures at the Central Middlesex UCC and the time they had taken to answer complaints.  Care UK told them that the problems had been caused by high staff turnover, a large number of interim staff and a failure to recognise the importance of the issues. Cllr Helga Gladbaum stressed the importance of safeguarding children in the brough with its history of cases such as Victoria Climbie, Care UK said that staffing was being stabilised, protocols were in place and there was robust auditing and monitoring. Cllr Sandra Kabir said it was astounding that Brent had not ended up with a terrible disaster on its hands. Dr Sarah Basham, representing the Brent Clinical Commissioning Group said that they had found Care UK willing to listen and learn from each other and they had been open and willing to meet. GPs ere aware of the situation and a feedback mechanism was in place.

There was a lively debate, mainly conducted at a comradely level between councillors apart from a tetchy spat between Cllr Gladbaum and deputy leader Cllr Ruth Moher, on public health. Local councils have now taken over public health functions from the NHS and a proposal had been made to appoint a Director of Health to be shared with the London Borough of Hounslow. The proposal goes before the Executive on Monday.

Phil Newby,  Director of Strategy, Partnerships and Improvement, moved a report advocating such an appointment in a long speech rich in rhetoric but short on substance. He wanted an evangelical leader to drive policy and change. Questioning revealed that the Director would have no budget and would not be part of the Corporate Management Team. Simon Bowen from Brent NHS addressing the committee said that such a 'part-time'  post-holder would be weak and marginalised and it would be hard to recruit to the post. The post was statutory and subject to guidelines. He said that Brent had been transformed in the last 5 years while Hounslow was 5 years behind it. Brent's gains would be put at risk by such an appointment.

Newby defended his report saying that the current Hounslow post-holder had just been given a new job in Croydon and that innovative strategies would be welcomed.

The Committee agreed to recommend to the executive that while they supported mainstreaming public health in the body of the Council that they had serious concerns over sharing a Director with another borough.

Poor turnout at NHS hospitals consultation

August is a curious month to have consultations, especially an exceptional August when the borough is hosting an Olympics. I was not expecting an enormous turnout at the 'Shaping a Healthier Future' road show on Tuesday but the 6-8 members of the public (some may have been from the PR company or local GPs) who had turned up by 2.45pm at the Patidar Centre was disappointing to say the least. Advertised variously as starting at 1pm or 2pm there were no NW London NHS people at the 2-4pm Q&A until one arrived at 2.45pm. Although a table had been set up for speakers at the back of the room the public chairs were arranged around the edge of the room like a school dance. There were half a dozen laptops on a table in the corner and some panel displays about the proposals. The room arrangement served to split people off from each other.

Because I had to catch a train from Wembley Central shortly after 3pm I button-holed the clinician with my questions. I first asked about the differencee between what the Urgent Care Centre offered and the service provided by A&E. I noted that the consultation document said that most UCCs were housed alongside A&E but that Central Middlesex would not have an A&E.

I was told that UCCs would deal with most cases - it could deal with broken arms but not broken legs! I was assured that cases that had gone to Central Middlesex UCC but could not be treated there would be transferred to Northwick Park by ambulance. Clearly this poses dangers for urgent cases.

I asked how school or work place first aiders would know whether cases should go to Central Middlesex UCC or Northwick Park A&E (would there be a 'menu'?) and was told that people would soon get used to the services offered by both as the changes would not be implemented for 3 or 4 years. Ambulance usage was only expected to rise by 5% (!) and NW London NHS supported the extension of the 18 bus route to Northwick Park to serve the people of Harlesden and Stonebridge.

When I reported the difficulties that a friend had with treatment at what appeared to be an overloaded A&E at Northwick Park I was told that £20m would be spent on expanding the ward, staff would be transferred from Central Middlesex A&E and additional doctors and nurses hired.

I would be interested to hear whether there was better attendance at the evening session and hear about any discussions that took place,

The roadshow is next in Brent on Saturday September 29th at Harlesden Methodist Church, 25 High Street, NW10 from 10am-4pm.

Care UK or DON'T Care UK?

Guest blog by Sarah Cox:

If the Accident and Emergency Department at Central Middlesex Hospital closes, as proposed in every option in the NHS NW London consultation document Shaping a Healthier Future, residents in Brent’s poorest wards with the greatest health needs will be at the mercy of private health care provider Care UK which runs the Urgent Care Centre at Central Middlesex.

Urgent Care Centres are designed to take the pressure off A & E departments by dealing with minor injuries and less serious illnesses. Fine, but one of the reasons people go to their doctors or to A & E when the doctor isn’t available, is that they are not medically qualified so don’t necessarily know how serious (or not) their condition is. One of the NW London NHS documents gives the example of a mother who takes her baby to A & E with a high temperature. She is told that the baby is just teething. One of the functions of qualified medical staff should be to reassure patients. What about the case where the baby’s high temperature is not caused by teething but is a symptom of meningitis? Meningitis is hard to diagnose, but if not treated very quickly, can be fatal. There have been reports of Urgent Care Centres failing to spot meningitis and sending a stroke victim home http://www.telegraph.co.uk/health/healthnews/5185165/Urgent-care-centres-putting-patients-lives-at-risk-doctors-warn.html

 

As a patient, Care UK’s record doesn’t fill me with confidence: 

X-rays: At the CMH Urgent Care Centre, Care UK failed to carry out the required checks on 6,000 x-rays, missing such details as broken bones http://www.channel4.com/news/flaw-leads-to-review-of-patient-x-ray%20records. All x-rays should be reviewed by a specialist to make sure that nothing has been missed, they should also be checked against the child protection register and GPs should be informed when their patients have attended the UCC. Care UK neglected to do this and took more than a year to find the flaw in their system and start to review the x-rays. Channel 4 reports, ‘Asked how it had happened, Care UK blamed it on "a couple of changes in the management structure of the team that ran the centre". They also failed to report it to the Care Quality Commission. Care UK said that although it was not legally obliged to do this, it "probably should have told CQC, but nobody picked up the phone".’ What a caring attitude!

The contract to run the CMH Urgent Care Centre was given to Care UK by the former Brent Primary Care Trust. All eight Brent NHS clinical directors wrote urging them not to sign the contract, but were told they were too late. Former members of that PCT are now non-executive directors of Care UK and NHS Brent is tied into a contract with Care UK that they cannot get out of.

Friends in high places: The wife of Care UK’s then chairman gave £21,000 to Andrew Lansley when he was shadow Health minister to help run his constituency office in the run up to the general election, an investment that has certainly paid off when you see how many contracts the firm has been awarded in the NHS and social care sectors. 

Tax avoidance  Care UK, which operates NHS treatment centres, walk-in centres and mental health services, has a reduced tax bill by taking out loans through the Channel Islands stock exchange and coming to an agreement with HMRC Guardian 17.3.12 Care UK join the likes of Vodaphone and Jimmy Carr in claiming that they’ve done nothing wrong.

There’s more about Care UK, but I’ll leave that for the next instalment. What’s your experience of Care UK or specifically of the Urgent Care Centre at Central Middlesex?