Judicial Review of Harrow Social Service Changes

Last summer Harrow Council's proposed reducing its care service support to cater only for people with 'critical' needs instead of 'critical and substantial'. This was to save money, as the Council has a large deficit. The proposal was challenged by charitable groups in Harrow, who requested a judicial review.

The result of this review was announced on 20 December, when the judge ruled that the Council had acted illegally, as its proposal broke laws forbidding discrimination against the disabled. Interestingly, the judge expressed surprise that the Council had not been given advice that their action would be illegal. The Council now have to reconsider what is to be done.

The big problem, of course, will be that extending the range of the support services will mean that something else has to be cut as no additional money has been made available.

James Kincaid and Paul Samet

North West London Hospitals Trust Board 29 Nov 2007

Principal points of interest only.

As so often before, I was 'the public'.

1. Special awards Two were reported. The Radiology Department was awarded the ‘London Region Team of the Year’ by the Society of Radiographers. Secondly, the Wolfson Unit at St Mark’s Hospital has been recognised as a centre of Excellence by the World Organisation of Digestive Endoscopy, one of 14 hospitals world-wide to be recognised in this way.

2. Hospital Acquired Infections There is a mysterious outbreak of acinetobacter at Central Middlesex, with 57 cases. This is an infection that is endemic in the community. There seems to be no obvious cause for this outbreak. It has been reported to the SHA who confirm that the hospital has taken all the steps expected to eradicate this. The number of MRSA and C. Dificile cases is reducing but still above target. I was able to ask about Pseudomonas, which has received some national publicity recently but was assured that there are no cases at NPH or CMH.

3. Data Protection The recent publicity given to breaches of confidential information has led to higher alertness to these potential problems. Nothing untoward has happened in this trust.

4. Finance There was a long presentation and discussion of how to achieve savings in ‘overachieving’ departments. There is a slight overspend currently but the Finance Director is fairly confident of achieving in-year balance but rather less than originally planned. This will probably lead to an assessment of ‘weak’ for the use of resources.

5. NWL Strategic Governance Arrangements and General Update This is the same paper that Joan has referred to for meetings in Hillingdon. It explains the way PCTs will cooperate. There is no indication of the source of the document, its authors or where to contact someone for further information. I also noted that the chairmen of all the sub-committees involved are from inner London PCTs.

There were several more items but all were fairly standard.


Paul Samet
6 December 2007

Major NHS decisions in Hertfordshire!

Public consultation went on for months. Yesterday was decision day. The four NHS organisations involved held simultaneous Board Meetings in Hatfield then reached collective decisions:

1. Lister Hospital, in Stevenage, will provide major acute services for East Herts.
2. Welwyn Garden City and Hemel Hempstead will become local general hospitals
3. Eight urgent care centres will be set up across Herts
4. West Herts children's emergency and planned care will be at Watford General Hospital
5. St Albans City Hospital will be the long-term location for an NHS-run Surgi-centre

The Chief Executive of the two Herts Primary Care Trusts, Anne Walker, promised that facilities will be available in the community before major changes take place in hospital services such as A&E.

These decisions will now be considered by Hertfordshire Count Council's health scrutiny committee at meetings planned for January 2008.

A time-table for the changes has yet to be finalised. Some will take place in 2008-09 but others will take much longer.

Previous consultation had already located West Herts acute hospital services in Watford General Hospital, so those services took no part in this consultation.

The future of the regional specialist cancer treatment service currently at Mount Vernon Cancer Centre will be the subject of a separate future review led by the primary care trusts.

Joan

NHS London Update

Finances: The SHA expects London NHS bodies to produce a total surplus of £300m at year end in March 2008, just over 2% of its income. Better than being in debt – but better still is to have it spent and spent usefully

Healthcare for London: Public consultation runs until 7th March 2008. The public consultation document can be obtained from Free-phone: 0808 238 5430. Also see the website: www.healthcareforlondon.nhs.uk for details. the document considers general principles but does not identify specific proposals for change. It has lots of tick boxes so it is easy to indicate personal views, but letters are welcome too.

Proposals for various forms of polyclinic are outlined, ranging from single site models, through hospital based models, to models based on links between scattered GP practices. Questions focus on whether or not almost all London GP practices should be part of a polyclinic.

Other questions concern proposals to centralise hospital services for strokes, major accidents and complex emergency surgery. If this happens, other hospitals will then provide fewer services.

Six NHS London projects are already underway, to develop:
· A major trauma pathway
· A stroke pathway
· The polyclinics model / identifying potential sites
· Local hospital feasibility
· Unscheduled care
· New model of care for diabetes

Infections in hospitals: There has been some reduction in hospital infections. The SHA has allocated £10m to hospital trusts to help them pay for deep cleaning their facilities. Progress will be monitored.

Tackling health inequalities: Nationally there are 70 areas with very low life expectancy and bad infant mortality rates. 11 are in London. The Mayor is being tasked to develop a strategy to tackle inequalities by addressing the wider determinants of health through political, social, and community action – this covers health protection measures, such as reducing poverty, pollution, crime, drug taking etc, improving sports facilities, better nutrition and so on – all things which affect health but over which the NHS has no control.

Joan

Hillingdon Primary Care Trust News

Financial issues: This PCT seems to be winning its fight to break even financially by March 2008, but that would still leave a historic deficit of £42.5m to be paid later. NHS London expects it to pay back £7.7m of this debt in each of the next three years. It seems unfair that local people should face this huge burden, year after year, for years ahead – they should not be made the scapegoat for past PCT failings! We will continue to press for this debt to be time limited - and then written off.

Money for repairing local hospitals, clinics etc: There is some good news here! For the first time in three years the PCT is investing in maintenance and repairs and will spend £1.1m this year. But that will still leave a backlog £2.3m, so many necessary repairs will still not be done, which we think is deplorable.

More treatment outside hospital: A new Referral Management Centre is opening in Hillingdon in January so that only necessary referrals are made to hospitals. Some patients will be referred to local GPs with special interests or to the new Community Assessment and Treatment Service, which will avoid hospital visits.

National targets: These are keeping everyone on their toes. Some patients are being referred to the private sector to avoid over-long delays in treatment or scans!

Northwood and Pinner Community Unit at Mount Vernon Hospital: This 22-bedded unit is recognised as far from ideal, particularly its lack of isolation facilities, but some improvements are in progress – more hand wash basins are to be installed early in the New Year.

“Healthcare for London” public consultation : Hillingdon PCT is to hold a public road show on Saturday 2nd February at the Civic Centre from 1pm to 7pm to explain the issues. The public can drop in to hear about the consultation and feed in personal views.

Joan

Harrow PCT Meeting 4 December

Report on Harrow PCT Meeting, 4 December 2007

Principal points of interest, not a complete report.

This was the first meeting in the PCT’s new offices.

The new regime invites the public to raise questions and comments at the beginning of the meeting, with responses at the appropriate places in the meeting. There were 3 such contributions, from John Hunter, James and Paul, as follows:
John: The nature of the suggested ‘provider services’;
James: The total absence of matters relating to the consultation on the Darzi Report;
Paul: The unsatisfactory wheelchair provision service (a follow-on from the last meeting).

1. Wheelchair service Andrew Bland told us that the general hope is that chairs can be delivered within 8 weeks but the process could be much longer, especially if the chair has to specially fitted to the patient’s body shape. There are nearly 4000 wheelchair users supported by the PCT, of whom about 2000 are ‘elderly’. One of the Board members asked how many chairs were returned in a year but Andrew had not anticipated that question and so was unable to answer.

2. Performance Report This was mostly about meeting the Healthcare Commission’s criticisms in their latest report. Some of the items had been criticised for being sent without having been passed by the Board, so it was reporting procedures that had been at fault, not necessarily that actions had been faulty.
On current objectives the PCT had received a grade of ’amber’, one of 6 such grades in London, with everyone else in London getting ‘red’. The chairman remarked that there was quite a lot of envy at Harrow’s grade!

3. ‘18 Week Referral’ This is to be introduced in March 2008. Work is well advanced, with an 18 Week Board, composed of representatives from Brent and Harrow PCTs and NWL Hospitals Trust. There are some problems, largely concerned with the accuracy of referrals data. This is not just a local problem. Robust data of waiting times and capacity is essential for commissioning of services. An interesting question from a Board member was how much leeway there is in the system to transfer a patient from one waiting list to another if a delay is likely to occur.

4. Provider Services This deals with community services and ‘payment by results’, as there are fixed tariffs for activities. This is a problem for many PCTs. Here, too, there are problems with accurate recording of what is being done by PCT staff, with many activities being unrecorded. So there is a false impression of what staff actually do. Must be improved, but how?

5. Brent Birthing Centre The Board agreed to support the NWLH proposal to close the centre and transfer activities to Northwick Park. There has been very little use of the Centre.

6. Healthcare for London Consultation This came up as a side issue in the CEO’s report (itself an ‘Information Only’ item not requiring discussion), which just mentioned this had started on 30th November, without giving any details. We were then told that some events have been planned and that the consultation document will be available. Details available on a website. There was a heartfelt plea from a Board member about not putting too much emphasis on websites, not everyone has easy access to them.

James Kincaid and Paul Samet
9 December 2007

77,781 Petition signatures reached Whitehall!

Yesterday, our petition “Save Cancer Services at Mount Vernon Hospital” reached the Ministry of Health in Whitehall – and what a team we had!

Three MPs came with us to give cross party political support - Nick Hurd MP (Ruislip / Northwood), Gareth Thomas MP (West Harrow) and John McDonnell MP (Hayes and Harlington). We thank them all for this assistance – also John Randall MP (Uxbridge)who supported our cause but could not be present.

Our own strong team demonstrated cross-borders solidarity too – James Kincaid from Harrow chairs the Pinner Association, Janet Baddeley from Hertfordshire is a Watford Councillor and Donald Edwards and Joan Davis come from Hillingdon, the latter is Vice Chairman of Ruislip Residents Association.

And what a surprise we had! We knew we would meet the Minster of Health for London, Ben Bradshaw, but he had summoned a big reception party too – David McVittie, Chief Executive the Hillingdon Hospital Trust; Nick Carver, Chief Executive, East & North Herts Hospitals Trust, Anne Walker, Chief Executive of both West Herts and East & North Herts Primary Care Trusts – as well as several Ministerial aides.



We presented our petition to the Minister amidst many photographic flashings - some from our own Publicity Officer, Donald Edwards, and some from the Harrow and Hillingdon Times, which sent photographers to Whitehall to record the event.

This was followed by frank and open discussion with the whole gathering. We explained our concerns and stressed three things:
1. Local people right around Mount Vernon want the Cancer Centre to stay on that site – providing local cancer services.
2. It is absurd for the Cancer Centre to be run from Stevenage – 30 miles away; we want it to be run locally, logically by Hillingdon Hospital, which already provides anaesthetic services and is its landlord. The Minister agreed that on the face of it the current position looked anomalous.
3. We welcome current exploration of collaboration between the Cancer Centre and the Marsden Hospital – prestigious friends in the NHS would be an asset!

We were assured that there are no current plans to move the Mount Vernon Cancer Centre. The forthcoming Herts. Cancer Services Review will consider cancer services strategically, including the future role of the MV Cancer Centre and we were promised our views will be taken into account. It was also stated that no funding is available to provide services on a Mount Vernon scale elsewhere in Herts., so any services thought to be required would be likely to be provided as an outreach from the Mount Vernon Centre.

Now we must await proposals in the Herts. Review, expected early 2008 and hope our petition -and representations! – will influence what is proposed. When ordinary people pull together, they can have impact on what actually happens!

Joan

The Petition is ready for delivery to the Minister

The Petition to “Save Cancer Services at Mount Vernon Hospital” was launched on the 16th March 2007. At the launch were Nick Hurd MP for Ruislip-Northwood, Gareth Thomas MP for Harrow West and John Randell MP for Uxbridge. Also present were about 25 Community Voice members. Today, nine months later, the total number of people who have signed the petition now stands at 77,780. The people who have signed came from places as far away as Southampton in the south and north of Stevenage and many places in between. It was a lot of fun, but also hard work, collecting signatures and there were many stories of the wonderful treatment loved ones, relatives and friends, received at The Mount Vernon Cancer Centre, regardless of the outcome. Many thanks to all who took part, but most of all to our Chairman Joan Davis who worked tirelessly. From all at The Community Voice, thank you Joan.

Foundation Trusts in our area

All Hospital Trusts are scrambling to get Foundation Trust status – unsurprising, as they face being disbanded or taken over by other Trusts if this coveted status is not achieved.

Hillingdon Hospital Trust
The Hospital’s CEO, David McVittie gave a presentation this week to Hillingdon PCT on his Trust’s FT plans - currently stalled until the PCT gives its backing. This led to very searching questioning by PCT Non-Execs. However, David McVittie claimed his Trust can flourish despite the Ara Darzi proposals and he defended his Trust’s application as robust and viable. Since rebuilding of Hillingdon Hospital and Mount Vernon elderly care facilities hang on this Trust achieving FT status, we hope the PCT now gives the application its blessing.

East & North Herts Hospitals Trust
Having put its finances in order, this Trust now forecasts a small end of year surplus, so it can turn its thoughts to applying for FT status. This is important for us because this Trust, based in Stevenage, controls the Mount Vernon Cancer Centre. In Board papers published this week the Trust proposes six public “constituencies” in it FT membership. One of these will be for the Mount Vernon Cancer Centre catchment area. If this is confirmed it will be vital for people to sign up for membership so that cancer centre issues are properly represented. We will monitor this closely.

North West London Hospitals Trust
Currently plans are still under wraps, but the Trust expects to apply in the last wave of applications.

West Herts Hospitals TrustFinancial recovery and combating poor Healthcare Commission ratings dominate this Trust, so an application for FT status is on the back burner of its concerns - but it is still hopeful of success in the last wave of applications.

Royal Brompton & Harefield Hospitals Trust
This Trust romped away long ago with its application for FT status, but this is currently stalled – as it is for all similar Trusts that depend on research income. Changes in funding procedures threaten these Trusts with uncertain future income and this undermines their FT applications.

Central North West London Foundation Trust
This mental health Trust has already arrived – the only Trust in our patch to do so! It is now flourishing as a Foundation Trust and reaping the rewards of greater freedom to govern its own policy and direction of travel.

Joan Davis