A new borough in East London?

Neil Zammett writes

The 2011 Census

Last week saw the publication of the “headline” results from the 2011 census, quite possibly the last we will have.   I have been looking at these for East London and not unexpectedly they show a lot of change.  Much more detail will be coming out in the coming months and years

In outer London both Redbridge and Waltham Forest have shown increases of around 40,000 total population placing them in the top twenty nationally of fastest growing local authorities.  Havering and Barking and Dagenham in contrast have shown more modest increases of 13,000 and 20,000 respectively.  Proportionally the Havering increase is very low because its starting population was bigger at around 225,000 in 2001; B&D was around 164,000.

In Inner London the increase were much greater across the board excluding the City which has a tiny population of about 7000.  Tower Hamlets are up by 60,000 Newham by a whopping 65,000 and Hackney by 40,000.  Hackney, Waltham Forest and Tower Hamlets are all around 250,000 now, Redbridge 280,000 and Newham has topped out at 308,000.

The reason for the headline is that the total increase in East London is just under 280,000 the equivalent of a fair sized borough.  This massive increase, a combination of migration and high birth rates has big implications for health and other public services.

Although the Office for National Statistics have yet to give us their forecast of growth for the next ten years until 2021 it will probably be around the same figure or slightly more, getting on for an extra 300,000 people, with just under half of this in the Queen’s catchment area.

I don’t think we have to look much further to find the origins of the Primary Care Trust's (PCT) woes with the Health4NEL strategy to close maternity and A&E at King George.  It was always based on1990’s thinking when the population was believed to be far more static and “getting something closed” made more sense.  What we are now witnessing is the impact of population growth in London more than “balancing out” gains in efficiency by improving work flow and shortening length of stay in hospital.

The closure plan just looked at two and five years ahead which is very inadequate for NHS planning where a ten year horizon makes much more sense.  Does anyone believe that Queens A&E will be able to cope without King George with another 150,000 population by 2021?  No; it’s time for the PCT to come up with a proper plan which includes long term population growth.

Again, if you look at the figures what is happening is that Redbridge with a “top twenty” population increase is having its services removed and boroughs like Havering and Barking and Dagenham with much lower growth figures are having them expanded.  It simply doesn’t make sense.

Mental health

I just want to pick up one item from the Joint Health Overview and Scrutiny Committee which covers Barking and Dagenham, Havering, Waltham Forest and Redbridge which was the announcement that Nasebury Court the acute unit in Waltham Forest will be closing and re-located to Goodmayes.

I was one of the original team which planned the shift away from large hospitals to community settings in East London some thirty years ago.  The presentation from North East London Foundation Trust was welcome news with more home treatment teams to see people in their homes.

Things have changed now with hospital admission reserved largely for those who are a potential risk to themselves or others. Because we were planning for Essex as well as East London the original plan had Runwell hospital, near Southend, as the final “asylum” or centre for institutional care primarily because of land values and the age of the existing buildings. 

I think Goodmayes is now a better site because of it is near an acute hospital which will help to remove stigma from mental health and open up possibilities for better integration of psychiatry with other medical disciplines.  It’s also a lot better for travelling.

There are a few worries however; caring for people leads to additional stress for family members and we need to be sure that this home treatment approach is a better experience across the board for families.  We also need to be sure that the same number of patients is treated, subject to need and that this is not a cost cutting measure.

This is particularly true because NELFT has a big savings target from the PCT.  Mental health should not in my view be used to bail out acute services and any efficiency gains should be ploughed back to improve services and to meet the needs of the growing population.

Management Changes at BHRUT

One of the elected members in Redbridge asked me the other day if we had any further news about the departure of the five executive directors from BHRUT the other day.  The answer is apart from the appointment of Mike Gill from Newham to replace Stephen Burgess as Medical Director-no.

Eerily the website still shows the same faces, apart from Mr Burgess, and I can’t help feeling that the lack of a clear statement is creating an unnecessarily ambiguous situation for all concerned.

But there are other unfortunate aspects to the situation as well.  If these “departures” were related to individual performance then it is unlikely that they would have been dealt with at the same time.  If they reflected corporate performance then the non-executive directors would be equally responsible. 

What is particularly worrying is the report in the Recorder newspaper saying that the departures were linked to the directors concerned asking the Chief Executive to make “...some difficult decisions.”

If this is true, and there has been no challenge from the Trust to the Recorder story, then it falls into the “whistle blowing” category and there is a responsibility on the part of the non-executive directors and the Chair in particular to ensure that the actions taken are consistent with the Nolan Committee standards for public life.

The problem is that without a clear statement from BHRUT we are all in the dark.  Openness is of course one of the Nolan standards and given the nature of the story there is legitimate public interest in knowing what “difficult decisions” the directors were asking the Chief Executive to make.  .

I wish all concerned well because BHRUT must be one of the biggest management challenges in the NHS. If it is any consolation I have just heard that John Goulston, who “departed” as Chief Executive from BHRUT about eighteen months ago, has just been made interim Chief Executive of Croydon hospitals, formerly known as Mayday Hospital.