Brent fighting back against the cuts

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.

Scandal: no risk assessment for NW London NHS proposals

The NW London NHS proposals for far reaching changes in health provision have not been subject to a risk assessment despite them involving the closure of four Accident and Emergency facilities, including that at Central Middlesex Hospital, and the down-grading of several hospitals in the area.  The proposals affect 700,000 people.

The revelation was made at the August 2nd meeting of the NW London NHS Joint Overview and Scrutiny Committee on which Cllr Sandra Kabir is Brent's representative. Risk registers are a standard method of assessing the risks on a High, Medium or Low traffic light system, establishing the nature of the risk and who is affected, and the strategies for reducing that risk.  Brent Council has such a scheme in its Corporate Risk Register LINK

Instead the authors of the Shaping a Healthier Future proposals proposed that the risk assessment would only be made AFTER the consultation and when the proposals have been approved. This means that councillors and the general public will have no way of assessing the severity of the risk posed to residents,  which clearly could  be a matter of life or death, during the consultation period. In effect they will be making a response without knowledge of the potential impact of the proposals on people's health and well-being.

The committee was clearly concerned and agreed to 'revisit' the issue at a later meeting.Cllr Lucy Ivimy (Conservative, Hammersmith and Fulham) wrote to a concerned member of the public who attended the meeting:

I agree with you about the lack of a risk register and as you say, for the NHS to produce one only after the decision has been taken is extraordinary. The committee will be looking further into various aspects of risk. I am personally concerned that the full impact of the proposed changes has not been made clear in this consultation process.

A further critical issue was the consultation document's claim that the proposed changes were based on 'tried or tested ways of delivering healthcare' that it claims already work in many parts of NW London and the rest of the county (p20). The two expert witnesses heard by the committee were less sure. Asked about whether the structure worked in other parts of Europe Professor Welbourn admitted, 'there is no evidence the  system will work'. Asked whether it would be possible to deliver the necessary community services involved in the changes, Dr Honeyman said, 'no one knows, no one has ever been here before'.

These revelations show that we are being sold a pig in a poke and it is imperative that the proposals are subject to robust scrutiny at the appropriate committees at the  NW London NHS and local council level. They confirm the need for a broad-based campaign against the changes..