Like Oliver Twist Redbridge should ask for more

Neil Zammett writes 

Just recently the Public Health budgets for the next two years have been published by the DOH in a complicated format which shows the enormous differences in spend across London.  Apart from Bexley Redbridge has the lowest current and planned spend per head, now and in two years time.

                                                      Baseline 2013-14         Grant 2014-15  

                                                              £Per head                      £ per head

Tower Hamlets                                          113                                         116

Hackney                                                        112                                         117

Newham                                                       68                                           81

Barking and Dagenham                            60                                           71

Waltham Forest                                         38                                           45

Havering                                                       33                                           39

Redbridge                                                    32                                           38

Even though we have shared public health challenges with Inner London around Diabetes and Tuberculosis there is an enormous disparity in investment in these vital preventive services.   The supposed “equalisation” exercise has in fact seen the gap between Redbridge and most other boroughs actually increase.

It is not just Public Health where Redbridge is the poor relation; investment in family doctor service has been cut as well.  As part of the closure of A&E, Redbridge was supposed to be getting four more polyclinics now that is down to one in vacant accommodation at King George.  The bulk of new investment in primary care will be going into other boroughs.

There are also warnings that the overall allocation for next year, used to buy all of our hospital and other health services is short by well over £10 and possibly up to £20 million.  I have also heard that there are plans to reduce community beds at places such as Wanstead hospital.

Looking around; Havering has Queen’s, Whipps has a new A&E, Barking and Dagenham a new birthing unit, Newham a new A&E and maternity extension, the Homerton a maternity extension  and Tower Hamlets a billion pound new PFI hospital. 

Redbridge has nothing.

In all of this Tower Hamlets and Inner London more generally are the big winners but Redbridge stands alone as the Borough which loses most and on all fronts. Isn’t it time for us to start asking for a bit more and not to be bashful about it?  If Oliver had the courage do it so can we and it’s time for our CCG and other representatives to start making some noise.

Public representation and CCGs

How the public are going to be represented in the new style NHS is like so much else these days-a complicated arrangement.  The former LINKs (local involvement networks) are being transformed into Healthwatch with a brief to represent the public as an independent body.  For those who remember the CHCs (community health councils) they are going to be much the same although in Redbridge complaints will be dealt with by a body covering several boroughs. They become operational on 1^st April this year at the same time as our CCG (clinical commissioning group) goes live.

The CCG itself will have two lay members one for governance, mainly financial issues, and the other to represent the views of the public.  How they are going to do this is not entirely clear given the size and complexity of the population here in Redbridge.

To add to the mix there is a CCG Engagement Forum made up of representatives of the PPGs (patients’ participation group) at individual GPs practices across the Borough.  They also have a role in informing GPs about public opinion.

It also now looks as if the local authority Health Scrutiny Committee will continue and we can add to this the Joint Health Overview and Scrutiny Committee and I personally welcome this. Confused? Well who wouldn’t be.  Here in Redbridge we have additional problems because of the history of public opinion being so strongly opposed to the closure of A&E and Maternity at King George, baggage which the CCG has inherited.

To build confidence they need to ensure that they have representation which is truly independent and have a demonstrable commitment to linking with existing community networks and organisations.

The DOH are worried about this as well and have commissioned an external report on embedding patient and public engagement in CCGs.  To quote from a statement in the Health Service Journal taken from the study

”Some are concerned that CCGs may pick lay members who act as champions for them rather than challenging decisions.”

The test we should be applying is one of credibility looking at the track record of representatives in terms of their connections with local networks and speaking out on issues such as closures and also their association with the NHS. 

We need to recognise that any representative will have to deal with the baggage the CCG has inherited particularly as the most senior staff are so closely associated with the previous PCT’s history of poor quality consultation.

They deserve our support.

Let’s have clear financial accounting

If all of this wasn’t enough we also have a simmering problem with the way in which the finances of trusts and PCTs/CCGs are reported.  Regular readers of this Blog will know that I have been pointing up the amount of non-recurrent reserves and other special funds which have been propping up the spending position in NE London for a while now.

This means that a quick look at financial reports and year end accounts does not show the underlying position, although I have calculated that there is some £120 million of non-recurrent funding of various types supporting Barts Health and BHRUT alone.  How much of this is going to be “bridged” for future years is not clear to me. NHS London due to close this March is forecasting a surplus overall  for 2012-13 of £150 million including the use of reserves but understandably they have not produced draft balance sheets and I &E (income and expenditure) statements for 2013-14.

My concerns are that we are being lulled into a false sense of security which could affect key decisions. Barts Health is slipping badly on its savings target which is ironic because the savings were one of the main reasons for creating the giant trust in the first place.  Similarly with BHRUT I am not clear how their savings plan reports compare with the baseline they set at the start of the year or whether the additional money they have received for over performance (treating more patients than planned) is artificially generous.

I would like to see a separate section of financial reports and accounts introduced as an accounting standard which required trusts and PCT/CCGs to show the true underlying financial position more clearly.

NHS Correction on major incident

I have asked to put the below at the request of the NHS

 A spokesperson for NHS North East London and the City said: “Barking, Havering and Redbridge University Hospitals NHS Trust experienced a major surge in demand for its accident and emergency service in early January. This was incorrectly reported as a “major incident” in a paper to the NHS North East London and the City Board last month. “The Trust reported the surge to NHS North East London and the City (primary care trust) and it was agreed that staffing in the Emergency Department would be increased and 16 beds would be opened to deal with the increase in patients. It is usual when there is a surge in demand for the service for this to be reported to the primary care trust so the hospital and PCT can work together to ensure services are available for patients. “We apologise for any misunderstanding as a result of using the phrase major incident.”

Press from Saturday photo shoot

Wanstead and Woodford Guardian on Saturday photo shoot here http://www.guardian-series.co.uk/news/rbnews/10237268.Hospital_campaigners_join_London_wide_A_E_protests/

Picture from Saturday, great to have six cllrs turn up.

Photo Shoot Sat 16th Feb 1pm outside KGH

The purpose of this photo shoot is link up with other events taking place in London this week.

Thanks to Bob Archer for pointing for sending me the stuff below from Save our Hospitals.

W&W photographer needs to be in Walthamstow for 1.30 so a prompt arrival for 1pm would be very welcome. Press release is below

Subject: Press release from Save Our Hospitals for Press Conference 11.2.13

Dear All Mark has asked me to forward this to you - it went out today. He has contacted as many media outlets as he knows but asked that you send it on to any local media you have contacts with yourself. Kind Regards Anne D

08.02.13 – This is to alert you to the launch of a new London-wide coalition of doctors, patients and health workers opposed to the downgrading of A&Es and other vital hospital services in the capital.

Angered by the ‘divide-and-rule’ policies of NHS bureaucrats and politicians that set one hospital against another, Defend London’s NHS is calling for a London residents to come together and defend all their services.

The campaign kicks off on Monday, 11 February, with a press conference at the House of Commons bringing together representatives of the Lewisham, Ealing, Hammersmith & Fulham, Kingston and Islington hospitals campaigns.

This will be followed by a Week of Action involving meetings, protests and vigils outside London hospitals faced with imminent threats to their A&E and maternity units. Details are constantly being up-dated but at present the actions include:

· a public meeting on 12 February in defence of Whittingdon hospital.

· a rally on 15 February in Lewisham in protest at the recent decision by the Secretary of State for Health to downgrade the hospital’s A&E and maternity services.

· the presentation on 14 February of ‘We Love Our NHS’ Valentine’s cards at the Department of Health.

· simultaneous rallies in Hammersmith and Ealing on 16 February in protest at NHS North West London’s plans to downgrade A&E, maternity and other services at Charing Cross, Hammersmith and Ealing hospitals.

· a demonstration on 16 February in Kingston in protests at NHS South West London’s plans to close two out of five of he A&Es and maternity units serving the area.

For further details please send a representative to the press conference on 11th February 2013 in the Jubilee Room, House of Commons, 10-11.45am.

Speakers include Dr Louise Irvine of Save Lewisham Hospital: Dr Onkar Sahota, London Assembly Member for Ealing and Hillingdon and Save Our Hospitals Ealing; Julie Reay, Kingston Hospital UNISON; Shirley Franklin, Defend the Whittington Hospital Coalition; John Lister, from London Health Emergency; and Andy Slaughter MP for Hammersmith (Labour) and secretary of Save Hammersmith & Fulham Hospitals.

Mark Honigsbaum

http://www.markhonigsbaum.co.uk/

http://www.saveourhospitals.net/

Mike Gapes Speech on KGH

It is a pleasure to follow the hon. Member for Enfield North (Nick de Bois). He and I have something in common. He said that he had been let down by the Secretary of State after 2010. Sadly, I have to say that my constituents and I, and my neighbour, the hon. Member for Ilford North (Mr Scott)—unfortunately, he cannot be here today, but he asked me to mention the fact that he has been in Committee—also felt let down because of a decision that was taken. Eight Members of Parliament from north-east London campaigned together on a cross-party basis to save the A and E at King George hospital, yet in 2011 the Government announced that, after the previous decision, they were going to go ahead with a recommendation to close the A and E and the maternity unit at King George hospital in Ilford. There will be no more births there at the end of March. We will no longer have children born in Ilford, unless they are born in the back of taxis or cars that are trying to get through traffic jams to take them to Queen’s hospital Romford.
However, I want to concentrate on the A and E. This afternoon, a risk summit is being held between Barking, Havering and Redbridge University Hospitals NHS Trust and the commissioners to consider the implications of the absolutely damning Care Quality Commission inspection, one of a series of inspections of Queen’s hospital, which was published on 30 January, which is last Wednesday. Among other things, the report stated: “The accident and emergency department…has not met most of the national quality indicators as a result of extensive delays in the care of patients. Five percent of patients who need to be admitted to the hospital are waiting for more than 11 hours in the department. The Trust should be aiming to transfer 95% of patients who are being admitted to wards within four hours of their arrival.” Many patients are waiting much longer than four hours, and 5% are waiting for more than 11 hours. That was from an inspection in December. The report also says that there is “poor care for patients in the ‘Majors’ area” and that the “environment is unsuitable for patients to be nursed in for long periods of time,” because of a “lack of privacy/dignity, no washing facilities, no storage space for personal belongings and no bedside tables.” I could go on—there are complaints about other A and E services and facilities at Queen’s hospital.
  Queen’s is a new, PFI-built hospital that was designed for 90,000 admissions. Last year it had 132,000, as my right hon. Friend the Member for Barking (Margaret Hodge) mentioned in an intervention. It is in a joint trust with the King George hospital in Ilford, which has fewer admissions, but there was a proposal—the then Secretary of State and his Health Minister said this was the intention—to close the A and E at King George hospital in about two years from October 2011. Patients would then have had to go to the A and E at the already over-pressed and stressed Queen’s hospital. Frankly, that policy was always insane and foolish. We fought against the first such proposals in 2006—the misnamed “Fit for the Future” proposals—right the way through, in cross-party unity with neighbouring MPs, under the last Government. We managed to get implementation halted for reconsideration and review, but sadly this Government have given the go-ahead to closure of the King George A and E unit. Nick de Bois: I hope the hon. Gentleman will benefit from the time he gains by giving way to me. He is right about the documents—as he will recall, we had “Healthy hospitals”, which was the last thing being sought.
Let me remind him that we have another thing in common: the merry-go-round of chief executives, from my former chief executive to his hospital’s chief executive. It worries me that the administrators are in control, not the people or the politicians. Mike Gapes: I do not personally blame Averil Dongworth, the new chief executive at Barking, Havering and Redbridge University Hospitals NHS Trust, for the current situation. She has not been there long enough. There are a number of predecessors who were party to the proposal. I also blame Ruth Carnall and the people in NHS London who were behind the original proposals. They and Heather Mullin, along with others in the NHS in London, have been determined for six or seven years to close the A and E unit at King George regardless of the petitions, the protests or the fact that the public overwhelmingly rejected their proposal, even in their rigged consultation. Jim Dowd: On the malign influence of NHS London, let me tell my hon. Friend that its policy director—one Hannah Farrar—was appointed as number two and chief assistant to the special administrator of South London Healthcare NHS Trust, precisely to achieve what had always been wanted: the closures at Lewisham. Mike Gapes: Where are we now? Last year saw a 22% increase from 2011, with 26,859 additional attendances in the A and E unit at Queen’s hospital. In addition, there were 73 patients a day more than in the previous year, with 23 days on which there were more than 470 compared with only three days in the previous year.
The pressure on Queen’s hospital today is getting bigger and bigger, yet the plan is still to close the A and E unit at King George hospital. Where are all the patients supposed to go? Presumably not to Queen’s hospital, because it cannot cope. What is already happening? Although the figures are not being made public, I am told that on a number of occasions over recent weeks, in December and January, ambulances have been diverted to other hospitals from Queen’s hospital, including Whipps Cross hospital, which is part of the Barts Health NHS Trust—and it has its own problems. We are facing a real crisis.
  I also understand that performance at Queen’s hospital has fallen off drastically. Only 65% of patients have been seen within four hours since the end of last year. The figure at King George hospital was much better, yet it is King George—the better-performing hospital in this trust—that is supposed to be run down. I spoke to the Care Quality Commission this afternoon, which is now proposing a potential cap on the numbers of patients in the “majors” area at Queen’s, because of the problems and lack of safety that will arise. This is not just a question of resources. It is also, of course, a question of management, but ultimately it is not possible to get a gallon into a quart pot, which is what we face in north-east London. The trust’s board meeting on 9 January looked at these issues in detail. It has already got McKinsey in and it already has the so-called reset programme running. It also says that it has been making improvements for the past few months. Well, it made big improvements on maternity, but it has failed on A and E.
There is a real problem as long as the proposal to close A and E at King George is on the agenda. There is a problem of morale, motivation and, potentially, recruitment. The CQC report is absolutely damning about the shortage of consultants, the reliance on temporary locum staff and many other issues that are part of a fundamental problem in the trust’s culture that has been going on for a long time. It is not very easy for my constituents to go to other hospitals. If the problems at Queen’s continue, it would be insane to go ahead with the proposals to close King George’s A and E. Last month I asked the new Secretary of State to reverse his predecessor’s decision; unfortunately he refused, but please will the Minister give me that commitment today?"
At the end of the debate Health Minister Anna Soubry failed to respond or even mention King George and Queens hospitals in her wind up speech. How much longer can this government put its head in the sand? The fight goes on.
7.2.13