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Mansfield calls for scrapping/suspension of Shaping A Healthier Future

The Mansfield Commission's Interim Report into the Shaping A Healthier Future consultation states of the programme that would rsult in the closure of four of the nine acute hospital sites in the North West London area and the loss of Central Middlesex A&E:  

The SaHF programme in our view was a preconceived solution that was imposed on the North West London health system without there being any clear problem that it was designed to solve. 

In particular there was no proper assessment of the needs of the whole area to which the health and social care system would respond.

 The following recommendations are made:

1.     We recommend that the SaHF programme is abolished / suspended, thereby saving a considerable sum at one fell swoop. 


2.     We recommend that an independent review of the North West London health system is undertaken under the auspices of a joint health and local authority initiative that builds its case on a thorough assessment of the needs for health and social care of local populations, at local levels. 


3.     There must be no presumption that so-called ‘reconfiguration’ of acute services is the solution to what may not be a problem at all. 


4.     In addition there must be no presumption that the solution will involve a top-down approach across the whole area as SaHF assumed; there should be an openness to consideration of local solutions possibly at the borough level where these can be shown to work. 


5.     The NHS and local authorities must agree to work together to achieve a joint aim to provide good accessible health and social care to all local populations within a sustainable financial model. 


6.     We recommend that the attempt to close Ealing and Charing Cross hospitals is immediately stopped; that a guarantee is given to sustain acute health services on these sites – with no more double talk from NHS leaders – until the above review is complete and any associated business cases are taken through to Full Business Case level, which is likely to be at least five years. 


7.     We recommend that in the light of current failures in the system in North West London there is an independent review of the emergency system under the auspices of the above joint health and local authority initiative; and that this as a matter of urgency examines the closure of Hammersmith and Central Middlesex A&E departments with a view to opening these, if that is what the review suggests is needed, and what local people want. Local people must be given honest and genuine choices; the opportunity cost of retaining these sites as A&Es must be made apparent. 


8.     We recommend that there is a review of primary care services in the region, and that following this review, immediate steps are taken to rectify any issues. However any investment must be based on a clear business case that relates costs and benefits to changes across the whole system. 


9.     Likewise we recommend that there is a review of OOH services in the region, to establish a clear case if it exists for OOH acting as a way of reducing demand for acute services, and also as a way of reducing total system costs. Following this review, any investment in OOH services must be based on a clear business case that relates costs and benefits to changes across the whole system. 


10.  In the case of changes that take place in primary care and OOH services as a result of the reviews outlined above, there must be a clear business case presented that makes a clear case for system- wide improvement arising out of these changes, and this should be consulted on with the relevant local populations; there should be no assumption that this is the population of the whole of North West London. 

The full report can be read here: 

The commission's final public session will be held at the Brent Civic Centre on Saturday 9 May 9am-5pm. Brent Trades Council and Brent Fightback are among those who have submitted evidence. It would be good to have as many health campaigners as possible at this session. More evidence will be heard

Brent Council Budget protest Monday 6.30pm Civic Centre

Brent fighting back against the cuts

Claim Back Our Cash - Reclaim Our Services

Challenge the cuts at Cabinet on Monday February 23rd

Monday's Cabinet will be approving the budget to go to the Full Council on March 2nd amidst press coverage of the row over the leadership refusing to take account of the vote of the Labour Group in favour of a Council Tax rise.

Meanwhile residents, and particularly the young and parents, have got togather to challenge some of those cuts.

The Cabinet will be receiving an unusually high number of petitions, accompanied by speeches from the petition organisers, which indicates the strength of feeling in the borough.

I am sure they will welcome support from the public at the meeting which starts at 7pm in the Civic Centre.

These are the petitions:

Cabinet – 23 February 2015

Petitions have been received in the following terms in response to the budget proposals:

1) Keep Stonebridge Adventure Playground Open “We the undersigned insist that the redevelopment of

Stonebridge School and the new housing, includes keeping the Stonebridge Adventure Playground open.”

From:         Brent Play Association

2) Keep Welsh Harp Environmental Study Centre open This petition comprises numerous letters from individual children at Chalkhill Primary School.

From:         Chalkhill Primary School

3) Save our youth service (paper and e petition)

“Youth services are vital for young people as well as the community and we

believe there will be an adverse effect if the service no longer exists. This will

put added pressure on statutory services such as the Youth Offending

Service, the police and social care. We call on Brent Council to consult with young people effectively before making any cuts to any youth provision in the borough.

We call on Brent Council to scrutinise existing provision to ensure that these

resources are appropriate and effective. The young people of Brent are willing and able to assist Brent Council with this important task. We call upon Brent Council to consider the voice ofyoung people in the light of these savings!”

E-petition: started by Roisin Healy (Brent Youth Parliament)

4) Save School Crossings Patrols

“Brent Council is under a legal duty to promote road safety and to promote sustainable transport, such as walking and cycling.  Road traffic accidents are the biggest killer of children in the UK (they peak when children start primary school and secondary school). 2011-2020 is the United Nations Decade of Action for Road Safety. School Patrol Officers are an integral partof the community, ensuring the safety of our children and they encourage children to have independence. Many schools in Brent are on busy roads (e.g. Salusbury Primary School and Islamia on Salusbury Road in NW6) which are only going to get busier with new housing developments with a new influx of cars and residents. Our roads should become safer places for our children, not more dangerous. And children should be encouraged to walk and cycle to school rather than be driven.”

E petition started by: Michelle Goldsmith on behalf of local residents .

5) Leopold Primary School - save our School Patrol

Officer

“Brent Council is considering removing our Lollipop crossing patrol at Hawkshead Road. The School is surrounded by several busy roads. We believe this is unacceptable and will directly put our children in danger of a road traffic accident.”

From:         the Parent, Teachers and Friends Association of Leopold Primary

                   School

6) Keep Bridge Park Community Leisure Centre Open

“The centre provides a venue for many members of our  local community and plays a vital part in our leisure time. Many of us use the facility on a weekly basis to play football, use the gym, relax in the steam and sauna and meet friends. The centre hosts children education, courses and activities th at are beneficial to their development. The centre serves as a venue where rooms can be hired to many different groups who hold meetings, training and celebrations. Closing Bridge Park would affect all of us in different ways. We need this Centre to remain open so that our young people have a place to meet and do sports in a safe environment.

Stonebridge is a deprived area and we feel that crime and unsocial behaviour will increase if the centre is closed. Unlike a few years ago the centre now is used by men and women of all ages and faith. People come to Bridge Park to get fit and improve their health. Although we understand that the council funds are limited, the cost of dealing with health and antisocial behaviour will far outweigh the cost of operating our leisure centre. We have signed below to show our opposition to the closure.”

From:         Mr Adam, Tordjok, local resident.

Extra time to write to the Independent Healthcare Commission about health cuts

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
 

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.

Brent Fights Back - Claim Back Our Cash!

Brent Council's latest savage cuts are intolerable - time to make a stand

Brent Council has now published its draft proposals for cuts in services that will be considered by the Cabinet on Monday December 15th.  The document is available HERE 

Readers are advised to read the whole document as it is impossible to prove the full detail here. Please post comments drawing attention to anything I have over-looked or to outline its impact on staff or service users.

The cuts are divided up into four categories:

• Stopping Services Completely
• Leverage in Resources and Income
• Building Independence and Community Resilience
• Driving Organisational Efficiency

The document needs careful study and I will update this posting throughout the day as I go through it but the headlines are:

• Cessation of all Youth Services in the borough
• Close 10 of the 17 Children's Centres
• Close Welsh Harp Education Centre
• Cease all School Crossing Patrols
• Close Energy Solutions
• Cease funding for Stonebridge Adventure Playground
• Cease grant to Energy Solutions
• Close one Leisure Centre
• Gradually reduce grant to Tricycle Theatre to zero
• Reduce respite care by £450,000
• Reduce Day Care by up to 40%
• Reduce Connexions to the minimum
• End rough sleepers service
• No litter clearing in residential roads, no pavement mechanical sweepers, no weekend litter service in parks
• Reduce face to face customers service at Civic Centre to 2 days a week by appointment

One of the problems in reading this report is the avoidance of the word cuts and the selling of them in some cases as advantageous for service users. It would be much better to admit that they are severe cuts and are going to seriously affect service users. The pretence feeds into the Coalition's justification for cuts and claims of local government profligacy.

How many different ways can you avoid saying cuts?

Under the 'Organisational Efficiency' heading there are are a number strategies that could worsen services or undermine the working conditions of employees.

These include in Adult and Social Care The report's terminology):

• Negotiate with Residential and Nursing Care providers to ensure value for money
• Reduce service user and carer engagement to a minimum
• Close New Millennium and Kingsbury Resource Day Centres
• Change Tudor Garden Residential Home to Supported Living accommodation
• Increasing the number of Direct Payment personal care assistants
• 'Transforming' the Mental Health Social Care model to save £750k
• Reduce social work staff in Adult Social Care by 20% over two years
• Reduce Learning and Development to statutory minimum

In Children and Young People

• Early Years - review future resource requirements in general workforce budgets
• Reduce support and delivery costs of the Youth Offending Team
• Reduce cost of Special Educational Needs assessments by restructuring staff
• Integrate Children's Information Service with other customer services - reduction of 50%
• Children's placements - includes some Looked After children currently in residential placement moved to independent foster agencies
• Children with disabilities -end summer playscheme, more direct payments, reduce overall level of support
• Reduce managerial posts in Children's Social Care

Environment and Neighbourhood Services

• Transfer management of libraries to an established library trust resulting in business rates savings
• Reduce library book stock to CIPFA bench-marked average
• Delete Environment Projects and Policy Team
• Stop nearly all Sports Development work including school holiday programmes
• Brent Transport Services - end the employment of in-house drivers and attendants
• Reduce the Emergency Planning Team by one post - will require arrangement with another borough to maintain 24/7 coverage 
• Review regulatory services  and consider shared services with another borough

Regeneration and Growth

•  Reduce the number of Housing Options Officer posts by 4, over a two year period from 2016/17
•  Proposals will be developed for increased income from the Civic Centre. The additional income assumed from 16/17 onwards assumes that an additional floor being made available and a tenant found to occupy the space on a commercial basis from 2016.

Human Resources

• It is proposed  to carry out a major reconfiguration of the HR service in 2015/16 saving £1.4m by 2016/17. This will result in the merging of some areas in order to reduce the number of managers required in the new structure.  It is the intention to devolve responsibility for some existing activities undertaken by the Learning and Development team to HR Managers.  Other activities will be accommodated by a new performance team with a broader remit which will include resourcing, workforce development, policy and projects.
•  In addition it is proposed to cap the existing trade union facilities time allocation awarded to GMB and Unison to a maximum of 1 x PO1 post per trade union, to move the occupational health service inhouse saving £60k and reduce the learning and development budget by £67k. In year 2016/17 further reductions in staffing can be potentially achieved through shared service arrangements within payroll, pensions, HR management information and recruitment.

New Borough Plan will decide our services to be cut over the next 4 years

Christine Gilbert, Interim Chief Executive of Brent Council, has been kept on to work on the new Borough Plan, according to Muhammed Butt, Labour leader of Brent Council,

Although the Borough Plan sounds innocuous and not a little boring, it would be wise to look a little more closely. It is really the Council's attempt at embedding future cuts into a long-term plan. Cuts that many see as meaning the end of local government as we know it.

The Borough Plan will earmark services to be cut as well as to be preserved. As such is is more important that the annual budget making as the budget making will be informed by its priorities.

It basically signals that the Council will acquiece in the cuts rather than challenging them and leading the community in campaigning against them.

We are being asked to tell the Council which of our limbs we want to cut off first.

The Council makes no secret of this but local residents may have missed the introduction on its website.

Here it is:

The Brent Borough Plan 2015/19 Consultation

Brent residents are being asked for their views on how local public services should evolve and what they can do to improve the borough given the continuing squeeze on budgets.

The borough plan consultation opens today (September 16) and invites residents to help shape the future of the borough in the context of significantly reduced budgets for local public services.

Over the next four years services in Brent face the most challenging financial cuts ever. The council’s budget alone is expected to be halved by 2018.

Have your say now

Brent also has increasing demands on public services with a growing population, more babies being born, more people moving into the borough and more people living longer. To meet these challenges some services will need to be delivered in different ways and some stopped altogether. Residents are being asked what their priorities are through a series of surveys and public meetings throughout September and October.

Residents are being asked how they could play a vital role in their local community as well as how services should be designed in the future. In some cases, prioritising one area will mean that something else has to be cut back, or stopped altogether.

Leader of the Council, Councillor Muhammed Butt, says: “Brent has been through tough financial times – which are sadly not yet over.

“Local public services face the same challenges, those of reducing income and increasing costs, which many of our residents are facing.

“For example, by 2018 Brent Council's funding from central government will have been cut in half. To put this in context, we would need to more than double council tax next year to start plugging the gap in the council’s budget and this would still not address the shortfalls in other local service budgets such as the Police and Fire Brigade.

“This harsh reality means we will inevitably face tough choices in the coming months and years and this is why the borough plan consultation is so important in informing the future of Brent.

“All of the organisations involved in the consultation want to work with local people to make sure that our plans are the right way forward given the limits we are all working with.

“This is your Brent, your community and your services so please get involved as we are listening.”
You can get involved by responding to the call for evidence before 28 November 2014.

Read more about the call for evidence and the challenges Brent faces

Have your say now

Protest Against closure of A&E at Central Middlesex September 10th 10am

Latest Actions from Brent Fightback

ACTIONS ARISING FROM BRENT FIGHTBACK MEETING OF DECEMBER 4^TH

Stop TfL Cuts After hearing from Leon of the RMT about fare rises, safety dangers arising from staff cuts and ticket office closures, it was agreed to support the campaign. Actions:

1. Carol will write to local papers about the issue.

2. Sarah will inform Mencap and Ann MIND about impact on people with disabilities

3. Martin and Sarah will contact NUT re impact on teachers taking classes ontube.

4. Sarah will try and contact the Harrow-on-the-Hill lift campaigners.

5.. Pete will contact Cllr Jim Moher (lead member for transport) and Navin Shah, Michael will contact Sadiq Khan, Martin Green AMs.

6. Consider sending questions for Mayor to Navin Shah and participate in Mayor Question Times.

7. Distribute own or RMT leaflets on Met Line and hold impromptu public meeting on the train as appropriate.

8. Think about more imaginative ideas to get the message over to build a broad-based campaign to stop the cuts.

Contact: thefuturewebuild@gmail.com

Copland campaign against forced academy status Teachers had been on strike again on Tuesday against forced takeover by Ark Academy. Action:

1. Support picket lines at Copland on December 17^th if planned strike goes ahead.

NHS Campaign continues on several fronts with moves to set up a Brent and Harrow Keep Our NHS and pressure on SERTIC to organise a London-wide demonstration late-Spring/early-Summer 2014.  Actions:

1. Meeting on Future of Central Middlesex Hospital organised by CCG. Thursday December 12th 6 - 8 pm at the Sattavis Patidar Centre in Forty Avenue Wembley. We need as many people as possible to attend to find out what is proposed and perhaps help shape what is being planned for our hospital.
2. London Save Our NHS are organising a workshop based event in early February, date to be confirmed, including sessions on workplace organising an campaigns, what kind of NHS do we want etc.

Council Consultations Following the confusion about what exactly council reports were proposing on council rents and council tax support, Sujata will look at how such reports could be made more readily accessible and understandable.

Copland teachers on strike again on Tuesday

Staff at Copland Community School in Wembley will hold their third day of strike action  tomorrow Tuesday December 3rd against an attempt by Michael Gove and an imposed Interim Executive Board (IEB) to force the school to become an academy. Despite Cllr Michael Pavey, Lead member for Education in Brent, saying 'it is not a done deal' so far there had been no other option but ARK. Whatever happened to Gove's 'increasing choice' agenda?

Staff will hold a rally outside The Torch pub in Bridge Rd, Wembley against ARK forcibly taking over their school at 10am.

Hank Roberts, ATL Secretary and Immediate Past President said, “Stanley Fink, a leading ARK trustee, is the National Treasurer of the Conservative party and a friend of Michael Gove. He supports Gove's and the Conservatives policy, as revealed in the Independent, of handing over state schools to be run for profit. They're not in it for charitable giving. If they want to give Copland money we'd welcome it. Long term they're for taking money out of the system to add to the many millions they already have”.

Tom Stone, NASUWT Acting Secretary said, “If Brent would only go and get the money the ex headteacher spirited away, the whole scenario of becoming an academy would disappear and Copland school would be a flourishing and effective school.”

Lesley Gouldbourne, Joint NUT Secretary said, “A recent leadership review of Copland carried out in October 2013 showed many improvements in teaching and learning and more robust financial management. Give the school time to continue this good work.”

Proposed Brent Budget cuts for 2014-15

The Brent Council Meeting on November 18th will be given a financial report for the 1st Reading of the 2014-15 Budget.

Below you will find the proposed savings/cuts for each Service Area:

Bonfire of Austerity - Nov 5th Actions

The People's Assembly is calling protests across the country to mark the 'Bonfire of Austerity' tomorrow, November 5th.

There will be a demonstration outside Willesden Magistrates Court at 9am tomorrow to protest at Labour controlled Brent Council's decisions to issue courts summonses to some 12,000 people who have not paid their Council Tax. These are often people already on low incomes who have had to pay a portion of their Council Tax for the first time this year due to changes in the Council Tax benefit system which is now administered by local councils.

Cllr Muhammed Butt was on the London section of Sunday Politics yesterday defending the Council's decision. He said that Council officers will be present at court to help those who have been summoned.

His appearance can be seen here at 53mins LINK

The Campaign for Renationalisation of the railways will be leafleting at Ealing Broadway station from 5.30pm until 7pm.

The London focus in the evening includes Anonymous in Trafalgar Square and Block the Bridge at Westminster Bridge:

Block Westminster Bridge – Assemble at Jubilee Gardens at 6pm, contact office@thepeoplesassemblyorg.uk/ Facebook

Bring your energy bills: we will be burning our energy bills on the bridge to highlight the massive rise in energy prices which have left people choosing between heating and eating.

NHS Brent Clinical Commissioning Intentions 2014/15 (Draft)

People'sInquiry into NHS even more important after Central Middlesex announcement

Brent Fightback on NHS March

Jeremy Hunt's announcement today that Central Middlesex Accident and Emergency ward is to be closed will come as a bitter disappointment to Brent health campaigners, particularly after the euphoria which greeted the Lewisham Hospital campaign's court victory yesterday.

Hunt's decision shows that that the Tories have absolutely no understanding of the needs of an area such as Harlesden/Stonebridge and the social and health inequalities that make an easily accessible local facility so important.

Campaigners will be considering next steps along with those fighting for Hammermith hospital but meanwhile after the announcement  it is even more  important that as many people as possible submit evidence to the People's Inquiry into the London Health Service. Details LINK and attend the local meeting of the Inquiry which will be held. Send your views using this LINK

• Friday Nov 8: 2pm-7pm, Ealing Town Hall, New Broadway, Ealing, W5 2BY. View map:

This is the trenchant evidence to the Inquiry submitted by Harlesden resident Sarah Cox:

I am a 76 year-old retired early years teacher. I worked for more than 30 years in Brent schools and have lived for more than 40 years in Harlesden. I am also an outpatient at Central Middlesex Hospital.

As such, I was extremely concerned about the likely effect of the changes enshrined in the Shaping a Healthier Future consultation and also about the consultation itself.

I followed the consultation carefully, read the documents and attended meetings called by NHS NW London and public meetings organised by local health campaigns. Overall, the consultation was more like a public relations exercise. Its questionnaire was designed to reach a desired conclusion rather than to look at the real health needs of the vast area it covers.

I am very concerned about accountability. NHS NW London made the decision to go ahead with the changes, but went out of existence before the process of introducing them had even begun. Who will be accountable if they turn out, as many of us believe they will, to result in damaging cuts to our health services, rather than improvements?

Although I will concentrate on the likely effects of changes to the area in which I live, I believe that all the changes will have knock-on effects on neighbouring areas and I am strongly opposed to the whole package. My husband was referred from Central Middlesex Hospital where he was diagnosed with laryngeal cancer, to Charing X where he was expertly treated. The co operation between the two hospitals was exemplary. Cuts to any of the hospitals will increase the strain on the others and on the ambulance service.

I believe that the case for fewer specialist hospitals further apart has been made for stroke, heart attacks and some serious injuries and services have been developed in line with that. Ambulance crews know the best place to take such patients and expert paramedics are able to stabilise them before transporting them to the best hospital. However, I do not believe that the extrapolation to other conditions such as serious asthma attacks, is justified. The surgeons want a concentration of expensive high-tech facilities in fewer, larger hospitals. What they ignore is the vital importance to patients' recovery of being in a setting that is accessible to friends and relatives. There has been a great deal of publicity recently about poor standards of care on understaffed wards. The best insurance against inadequate care is the vigilance of patients' families.

In fact, although we are told that the plans are based on clinical evidence, they are really based on a desire to cut costs. It the plans go through, nearly 1,000 beds and 3,994 clinical jobs will go from hospitals in NW London, saving £1billion over three years. The remaining hospitals will not be able to cope, the ambulance service will not be able to cope, the 111 service is already inadequate and yet we are told that it is crucial to the success of providing alternative services in the community. 

One of the declared aims of the Shaping a Healthier Future strategy was to reduce health inequalities, but moving health provision away from the areas of greatest deprivation and lowest life expectancy, will in fact increase health inequalities.

As a resident of Harlesden Ward and having worked on the Stonebridge Estate, I am most concerned with the loss of services at Central Middlesex Hospital and the impact on the people of Harlesden, Stonebridge and the surrounding area. The Brent Joint Strategic Needs Assessment and in particular the Harlesden Locality Profile (accessible through the Brent Council website www.brent.gov.uk) shows that Harlesden and Stonebridge wards are among the 10% of most deprived wards in the country. They have high levels of unemployment and of long term disease and disability. They also have a higher than average birth rate, and a larger than average percentage of young children and large families and higher rates of teenage pregnancy. Yet the maternity and paediatric services have been taken away.

Areas of poverty and poor housing like these have, it is widely recognised, higher levels of respiratory disease and mental health problems among other health problems. The government welfare cuts will increase these problems.

If health inequalities are to be overcome, health services should be provided where the need is greatest. If access to health services is difficult, people living in poverty and facing many other problems are less likely to seek help and relatively minor problems can become more serious.

Some of the reasons why it is wrong to close A & E departments at CMH and Ealing (these arguments apply to other hospitals in areas of deprivation):

·        A & E services are the first port of call for patients with mental illnesses and they are likely to find it harder to travel further for help.

·        When patients attend A & E, other problems e.g. cancer are often detected and can be treated before they become more serious.

·       There is no simple public transport link from the Harlesden or Stonebridge areas nor from Central Middlesex Hospital to Northwick Park and cabs are far too expensive for people dependent on benefits, so people who are taken ill or have an accident themselves or whose children are taken ill or have an accident will be forced to call an ambulance adding to the pressure on the ambulance service.

·       Transport difficulties not only affect patients, they make it hard for family and friends to visit patients. Support and care from family and friends are important for helping patients to recover. Negotiations with TfL even on the simple extension of the 18 bus route to Northwick Park Hospital have been unsuccessful, so patients and their families and friends from the area around CMH will continue to find access to Northwick Park extremely difficult.

Northwick Park is already struggling to meet targets and ambulances are being diverted back to CMH from there and from St Mary's. If all the proposed closures go through, how will Northwick Park cope with the added burden on A & E maternity, paediatric services, surgery and intensive care?

How will the ambulance service cope with the extra demand? It’s struggling already.

Has there been consultation with the Fire Service about the effect of the proposed changes? 

Schools were not consulted by the Shaping a Healthier Future team, yet during the school day, thousands of children become their responsibility and if any are taken seriously ill or have accidents, school staff will have to go with them to an A & E department further away.  

Out of hospital care

Of course it is always best to keep people out of hospital if appropriate alternative care and treatment can be provided in the community and of course we need more preventive services. We are promised all sorts of out of hospital care to take the place of the lost hospital services, but will the resources really be there? There is already a shortage of trained, skilled community health workers, health visitors, midwives and specialist nurses as well as GPs. Will the CCGs really be able to train and pay for those we need when they are facing constant budget cuts? Successful treatment and care for patients out of hospital demands integration with decent social care services, but the swingeing cuts to Local Authority budgets mean that social care services are at best barely adequate and unlikely to aid recovery and recuperation for patients who have been treated out of hospital or discharged early from hospital.

Getting information about the CCG’s commissioning decisions before they are made is extremely difficult. There are massive documents with quantities of acronymic alphabet soup and a hierarchy of meetings, some useful, most completely opaque to the interested patient or campaigner and suddenly, before you know it, another service has been outsourced and privatised.

However often we are assured that the changes to the NHS are clinically driven, it seems clear that the real drivers are financial the transformation of the NHS into a cash cow for the private sector so that even if it remains free at the point of use for patients, it will be run for profit.

Sarah Cox