Coventry and Warwickshire STP is morphing into an ‘Integrated Care System’ (ICS)

Dear SWKONP Supporters,

Below is an update from the ‘Coventry and Warwickshire Place Forum’, the name adopted for the joint body comprising the Health and Wellbeing Boards of Coventry City Council and Warwickshire County Council. It appears to be no more than a mouthpiece for the CCGs and STP (now re-branded Better Health, Better Care, Better Value).

The update provides confirmation that Coventry and Warwickshire STP is morphing into an ‘Integrated Care System’ (ICS).

This is happening across England and is a fundamental change to the 2012 Health and Social Care Act. Two judicial reviews opposed the introduction of ICSs (see below on why KONP opposes them). One JR focused on there being no primary legislation or Parliamentary scrutiny of this major change to running the NHS. The JRs failed, but have forced the government into a public consultation.*

Note – the Coventry and Warwickshire ICS is being brought in before the national consultation on introducing the new contracts (Integrated Care Contracts) has finished on October 28th 2018. This is happening all over the country.

Integrated Care Systems and Accountable Care Organisations need to be opposed for the following reasons:

• They are being introduced without adequate public involvement or meaningful consultation, and without full Parliamentary scrutiny;

• They are being imposed in a context where NHS and social care services are seriously underfunded;

• They are being implemented beyond any legal framework, creating problems of governance and accountability;

• They are being introduced at pace, with no robust evidence base to support their use in the UK context;

• They increase the potential scope of NHS privatisation. For example, with ACOs, multiple procurements will be replaced by a single, major, long-term contract to provide health and social care services for an entire area. The draft model contract for ACOs published by NHSE allows for, and may well attract, bids from multinational corporations.

• ACOs will help strip NHS assets, such as land and buildings, so ending the social ownership of much of the NHS estate while allowing private companies to profiteer from it.

• They will enforce the unprecedented real terms freeze in spending (while costs continue to rise by an estimated £22 billion by 2020, compared with 2015 levels) and transfer the NHS’s funding shortfall to new local, self-contained areas.

• Through introducing different payments systems, they incentivise rationing of services and denial of care, and so are fundamentally at odds with social solidarity and the values of equity and universalism that underpin the NHS;

• They rely on unrealistic expectations, for example about collaboration and the sharing of risk and gain between private and NHS service providers.

• They entail ‘transforming’ the NHS workforce; replacing experienced clinicians such as doctors and nurses with digital technologies and new, less skilled roles, such as physician and nurse associates. ACOs are likely to under-deliver required skill levels and undermine NHS terms and conditions of employment.

No one can deny that acute, primary care and community NHS services and social care need to be better coordinated in order to improve patient care. However, this does not require commercial contracts and the involvement of corporations.  

Read the full KONP Briefing on ACOs/ICS.

*n.b. We are waiting for guidance from KONP as to how to answer the questions on the consultation

September 2018

The Place Forum is how the Health and Wellbeing Boards of Warwickshire and Coventry work together to integrate health and wellbeing at the heart of their communities.

Integrated Care System Update

Coventry and Warwickshire is aiming to form an Integrated Care System (ICS) to enable closer collaboration on health improvement work.

A structure of how this could work was agreed at the Place Forum, shown here, with 4 population-based primary care network of populations between 30,000 and 50,000.

The 12-week development programme offered to all localities across the West Midlands by NHS England has recently concluded. This is aimed at supporting the senior leaders and their teams to further develop capability in the following areas:

  • Building a whole system strategy and plan
  • System level financial planning
  • Integrated governance
  • Execution and implementation

A draft plan that starts to identify what actions will be required to allow the Coventry and Warwickshire STP to reach Shadow ICS status was presented to NHS England on 24th August. Formal feedback is awaited. This plan will continue to be developed and once it has been signed off by all the respective organisations it will be circulated.

Year of Wellbeing

Preparations for the Year of Wellbeing are going well:

  • Three early examples for the Year have been agreed: Daily Mile (promoting exercise), Workplace Wellbeing, and Start a Conversation
  • A Daily Mile steering group meeting took place on 5 September, including Sports Leads
  • CWPT has allocated a communications officer to develop the YoWB campaign – Ian.Andrew@covwarkpt.nhs.uk
  • A communications strategy is being drafted ready for September
  • A logo and brand for YoWB have been developed
  • Pledges of support are being collated from Place Forum partners
  • An Elected Member pledge programme is being developed to improve awareness of prevention and wellbeing
  • Health and social care system model and narrative about prevention have been agreed by the Health & Wellbeing Boards for sharing across organisations and applying locally
  • Ideas to launch the YoWB are being explored, eg a sculpture trail along the lines of Birmingham’s ‘The Big Hoot’. We are looking into how WMCA set this up
  • Storytelling training delivered to cohort 1 and more planned for Sept-Nov. Please contact janecoates@warwickshire.gov.ukwith nominees for training. We are keen to get diverse champions across ages and ethnic backgrounds
  • If anyone has pictures to share to support YoWB publicity and represent sport and culture, please let Jane or Ian Andrew know

Health & Wellbeing Concordat

Partners across Coventry and Warwickshire have renewed their strong commitment to working together by signing an updated health and wellbeing concordat. The concordat is a partnership agreement which underpins commitment to a programme of work around wellbeing, including the Year of Wellbeing. You can read the concordat here.

A new model of health and care services for Coventry and Warwickshire is also being developed to transform the way that services for our local communities are designed, delivered and used. You can find the System Design here.

Better Health, Better Care, Better Value

We are currently holding engagement sessions with midwives from our three local Trusts, led by the respective Head of Midwifery, about continuity of carer.

This is to help achieve the national ‘Better Births’ expectation that 20% of all women should have a small team of four to six midwives caring for them during pregnancy, labour and postnatally.

Staff feedback will help to develop the Coventry and Warwickshire Local Maternity System’s (LMS) plans to transform and sustain improvements in maternity and neonatal services.

The LMS is part of the Maternity and Paediatrics workstream of the Better Health, Better Care, Better Value programme.

New Mental Health Service in South Warwickshire

Patients in Stratford-upon-Avon who are experiencing mild to moderate mental health problems are to benefit from an innovative mental health service thanks to a special grant from Stratford Town Trust. The grant will be used to offer an additional service for the adult population, over and above statutory mental health provision in the area, and will provide an essential evidence base to evaluate the scalability of the service across south Warwickshire in the future.

The service, called Active Monitoring, will be delivered by Springfield Mind, a local mental health charity based in Stratford-upon-Avon with over 30 years’ experience working with those living with low mental wellbeing and mental ill health across Warwickshire and Worcestershire. Active Monitoring is a needs based, early intervention programme developed and co-designed by the national charity Mind and GPs to provide support to people in Stratford-upon-Avon who visit their GP with symptoms of common mental health needs including stress, anxiety, depression and low self-esteem. Click here to find out more.

What’s next?

  • We are working on an Outcomes Framework for the next Place Forum on Wednesday 7 November.
  • Updates on Integrated Care Systems and the Better Health, Better Care, Better Value programme will be provided at the next Place Forum.
  • ‘Locality’ have been appointed to carry out an evaluation of community capacity pilots in Coventry alongside other Better Care Fund prevention projects, this will include developing an evaluation methodology to help assess asset-based ways of working.

……………………………………

Our current ongoing local challenges:

1) Mental Health Services in South Warwickshire

Interesting to read of the above plans.

We are fighting the sale of of four vital mental health outpatients’ buildings in Leamington, Warwick and Whitnash.

How do these plans, and those for Stratford -upon-Avon add up? Does any of this make sense as far as improving mental health care across South Warwickshire?

2) Planned closure of acute stroke wards at Warwick Hospital and George Eliot Hospital, and centralisation of all acute stroke care at University Hospital Coventry and Warwickshire.

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South Warwickshire Foundation Trust and its wholly owned subsidiary, SWFT Clinical Services.

Here is some background about SWFT and its private company, SWFT Clinical Services. SWFT was one of the first Foundation Trusts in the country to set up a limited company as a subsidiary (sub-co). Since then, many other Foundation Trusts have set up similar Pharmacy businesses, and the model is now well established. Issues of concern: transparency, public accountability, staff terms and conditions.

South Warwickshire NHS Foundation Trust https://www.bloomberg.com/research/stocks/private/snapshot.asp?privcapId=31271224:

South Warwickshire NHS Foundation Trust operates hospitals. It provides adult in-hospital, adult out-of-hospital, children, and young people and family services. The company, through its subsidiary, provides outpatient pharmacy services; operates a private consulting and day surgery clinic; and provides online service that offers health information and recommended products to treat various common conditions. South Warwickshire NHS Foundation Trust was founded in 2010 and is based in Warwick, United Kingdom. It also has hospitals in Warwick, Stratford, and Shipston-on-Stour, United Kingdom.

SWFT Clinical Services Ltd

General background on NHS Sub-Co’s: (https://nhsprivate.wordpress.com/executive-summary/private-patient-services/commercial-companies/

‘One common scheme is to create a company to provide outpatient pharmacy services to exploit a VAT loophole (for example South Warwickshire, University Hospitals Birmingham, Birmingham Children’s Hospital). However, such companies are a potential vehicle for trusts to develop more commercial services, and possibly private patient services. For example South Warwickshire has a company called SWFT Clinical Services Ltd and in the trust’s Forward Plan [2] it says that the trust intends to “develop this model further”

SWFT CLINICAL SERVICES LTD. was set up in 2010 and incorporated at company house in 2011. (https://beta.companieshouse.gov.uk/company/07542436)

History

Formed in March 2010 SWFT Clinical Services Ltd. (SWFT–CS) is a wholly owned subsidiary of South Warwickshire NHS Foundation Trust. When South Warwickshire Trust was awarded Foundation Trust status in 2010, it was one of the first in the country to set up a limited company as a subsidiary. Since then, many other Foundation Trusts have set up similar Pharmacy businesses, and the model is now well established.

Business purpose

The company’s primary purpose is to develop income for the Trust through commercial activities. All profits made by the company’s trading activities are either reinvested in the business or returned to the Trust for reinvestment in health care services. In 2013 it was decided to formally register the company as a Social Enterprise. In January 2014 SWFT-CS received the Social Enterprise Mark. The mark is awarded to companies that are trading for the purposes of community and public benefit, and who commit to at least 50% of their profits being utilised for public benefits allied to the organisations purpose, or for reinvestment in growth of the organisation.

Businesses:

Outpatient pharmacy
SWFT Clinical Services operates the Outpatient Pharmacy for the Trust based at Warwick and Stratford Hospitals. The pharmacy deals primarily with outpatient and A&E prescriptions as well as oral chemotherapy. Additionally the Outpatient Pharmacy also provides a continence service; providing an ordering and delivery service for continence products for both patients and care homes. To find out more about the services available at the Outpatient pharmacy click here (link to new pharmacy page).

The Beauchamp Suite at Warwick Hospital
The Beauchamp Suite offers NHS patients undergoing orthopaedic surgery the opportunity to pre-book a guaranteed individual en-suite room ahead of planned treatment.

The Stratford Clinic
The Stratford Clinic is a unique private consulting and day surgery clinic located in the heart of Stratford-upon Avon. Our experienced specialist Consultant Surgeons provide consultation, treatment and surgery for a range of conditions and are supported by our dedicated specialist nurse team.

  • cosmetic surgery
  • dermatology
  • eye surgery
  • hand and wrist surgery
  • varicose veins

For more information about The Stratford Clinic or to book a consultation visit
www.thestratfordclinic.co.uk

Stratford Hospital – New Wing

Stratford Hospital comprises two buildings, the original building, now called ‘Building Two’, which is public NHS, and the new wing, Building One, which is owned by SWFT wholly owned sub-contract company, SWFT Clinical Services.

Building One is a new development which opened fully in August 2017. The building comprises of three floors;

The ground floor includes:

  • Café Lomas, a health and wellbeing hub. Café Lomas provides information and advice on a range of health and wellbeing services in Stratford upon Avon and the surrounding areas
  • Outpatient Pharmacy
  • Some diagnostic services will be introduced

The first floor is an Ophthalmology Unit and includes:

  • Eight outpatient consulting rooms
  • Three treatment rooms with associated investigation rooms
  • State of the art operating theatre

The Rigby Unit, known as the Rigby Cancer Unit, on the second and includes:

  • 12 chemotherapy treatment chairs
  • Macmillan Information and Support Centre
  • A range of facilities to support patients such as a complimentary therapy room

It is owned by SWFT Clinical Services, a wholly owned subsidiary of SWFT.

SWFT clinical services:

http://south-warwickshire.frank-digital.co.uk/about-us/swft-clinical-services

From above website:

‘SWFT Clinical Services Ltd. is a wholly owned subsidiary of South Warwickshire NHS Foundation Trust.

When South Warwickshire Trust was awarded Foundation Trust status in 2010, it was one of the first in the country to set up a limited company as a subsidiary. Since then, many other Foundation Trusts have set up similar Pharmacy businesses, and the model is now well established. The company commenced operating in March 2011. The company operates the outpatient pharmacy for the Trust based at Warwick Hospital, a private patient day surgery clinic in Stratford-upon-Avon (www.thestratfordclinic.co.uk), and most recently has developed a facilities and estates management service, under which it manages the Stratford-upon-Avon hospital on behalf of South Warwickshire NHS Foundation Trust.

The company’s primary purpose is to develop income for the Trust through commercial activities. All profits made by the company’s trading activities are either reinvested in the business or returned to the Trust for reinvestment in health care services’.

www.thestratfordclinic.co.uk/

www.swft.nhs.uk/about-us/swft-clinical-services

The new wing’s services are not on the main Stratford Hospital website via SWFT:

https://www.nhs.uk/Services/hospitals/Services/DefaultView.aspx?id=1566

History of the New Wing.

SWFT borrowed £23 million from the Foundation Trust Finance Facility (https://www.gov.uk/government/groups/independent-trust-financing-facility, https://www.gov.uk/government/publications/guidance-on-financing-available-to-nhs-trusts-and-foundation-trusts) to build the new wing.

It then ‘lent’ this to SWFT Clinical Services to build the new wing. This financing avoided VAT, with a £3 million saving. The transaction and financing had to take place before the new wing opened in August 2017 for the VAT advantages to apply.

The new wing belongs to SWFT Clinical Services, and maintenance and new acquisitions also avoid VAT, so saving SWFT money. This is the same VAT model as PFI maintenance, except in this case the ‘lender’ is a sub wholly owned by SWFT.

In addition, charities contributed to the new wing for cancer chairs etc. https://www.swft.nhs.uk/news/stratfords-one-million-hospital.

KONP CONCERNS:

Transparency

  1. Stratford Hospital website must be updated to make clear this ownership structure.
  2. Can FOI’s be put to wholly owned sub?

Other Risks of the wholly owned subsidiary model

  • The wing could be sold off. But under the Health and Social Care Act 2012, this would be considered a ‘significant transaction’ and because it is a sub of SWFT would have to be approved by the SWFT Council of Governors.
  • Staff at the new wing do not have to be employed under NHS terms and conditions, including NHS pay scales (http://www.nhsemployers.org/your-workforce/pay-and-reward/agenda-for-change/pay-scales/annual). However, UNISON at SWFT is well organized, and I understand that NHS terms and conditions have been negotiated for the staff at Stratford Hospital. However, there is no guarantee that this could not be changed.
  • There is a general public accountability deficit problem with the new wing as a wholly owned SWFT subsidiary. There are fuzzy edges around finance. How does the sub relate to the main hospital, which is public NHS? It now appears that SWFT Clinical Services runs all estates and facilities management for Stratford Hospital.

 

 

 

Stroke Mortality Figures are worse at University Hospital Coventry and Warwickshire than Warwick Hospital and George Eliot Hospital

As part of Coventry and Warwickshire STP (re-branded ‘Better Health, Better Care, Better Value’), all acute stroke beds are to be centralised at UHCW. The acute stroke care beds at Warwick Hospital and George Eliot Hospital are due to close. 

We have been campaigning against this policy ever since the STP announced it in a so-called  ‘engagement’ last summer. Since then, we have sent a series of  questions about safety checks for this policy, none of which have been answered. See more on our campaign, and the evidence against centralising acute stroke care to one hyper-acute stroke unit in a large county, such as Warwickshire on our blog. 

Since then, more evidence is gathering on the dangers and folly of this policy.

This is based on the Sentinel Stroke National Audit Programme) for 2016/17 – the latest available and is on Stroke Units (with a routinely admitting team – main stroke centre) and their Standardised Mortality Ratio (SMR). 

There is a map of stroke units (with a routinely admitting team – main stroke centre) and their Standardised Mortality Ratio (SMR). This ratio should be 1.0 when the number of stroke deaths in the unit matches the expected number of deaths based on the mix of case profiles admitted to the unit. The official explanation of the model: 

“Unlike the Dr Foster data, we have adjusted for case mix including stroke severity. The model used for this has been published in Stroke, and the published paper shows that the model is very reliable when externally validated. Briefly, the model takes account of the age of the patient, whether they are in atrial fibrillation (AF) before stroke, stroke type (haemorrhage or infarction), and the NIHSS score at arrival (where this is not available, the level of consciousness at arrival).” 

On the map, units with SMRs of 1.0 and below are marked green, from 1.0-1.25 are yellow, and above 1.25 red. Ratios above 1.0 imply more people have died than would have been expected by the model. Click on the ‘Map of Hospital’ tab to see the map.  

The data comes from SSNAP (Sentinel Stroke National Audit Programme) for 2016/17 – the latest available.

Both Warwick (0.92) and George Eliot (0.95) score better than the expected 1.0 on the Standardised Mortality Ratio and are marked as green. UHCW does worse – 1.2 – and is marked as yellow on the map. Yet the STP want to close the acute stroke wards at Warwick and George Eliot hospitals and move everything to UHCW, which shows more people dying than would be expected from the model!!

The reasons must be complex, but the point is, the STP must be told to stop this untested policy.

The evidence against the consensus on benefits of centralisation of stroke care.

The British Medical Journal (2014): 349; g 4757:

The Department of Health’s National Stroke Strategy for England recommended major change in the system for stroke, identifying that care in a stroke unit was the single biggest factor that can improve outcomes after stroke. In several countries acute stroke services are being centralised as a means of improving access to organised inpatient stroke unit care. Hospitals of differing capability work together to create a centralised system of stroke care in which patients are taken to central specialist units rather than the nearest hospital. Research in the United States, Canada, the Netherlands, Denmark, and Australia suggests this approach can improve provision of evidence based care processes for patients with stroke—for example, by increasing access to specialist care and thrombolysis. Other evidence suggests this approach is highly cost effective’

BUT – AND HERE IS THE BUT:

While the improved clinical outcomes associated with organised inpatient stroke care are well documented, it is unknown if centralising acute stroke care to a small number of high volume specialist centres produces better clinical outcomes. In addition, the wisdom of focusing on hyper-acute stroke care has been questioned.

SO, ORGANISED STROKE CARE IS GOOD, BUT THIS IS NOT NECESSARILY THE SAME AS CENTRALISED STROKE CARE.

The BMJ research finds that there is already an improvement in stroke outcomes across England. Research on two metropolitan areas studied (London and Manchester) where centralisation to fewer hyper-acute units took place, there was a ‘1.1% reduction in mortality at 90 days following the reorganisation of stroke services in London. The reorganisation of services in Greater Manchester showed no reduction in mortality at 90 days, but a slight reduction in hospital stay of 2 days’.

So no improvement in Manchester, but a small improvement in London. Is this sufficient evidence on which to base the widespread closure of local units across England?

Furthermore, the whole centralisation policy is based on the use of fibrinolysis, a special form of thrombolysis (clot busting procedures).  But its risks are never addressed, nor does this treatment apply to all stroke patients. It was studied in a large clinical trial by the National Institute of Neurological Disorders in the USA, reported in the New England Journal of Medicine, (1995): 333; 1581-87. A discussion of the balance of risks and benefits of this treatment  by Dr Peter Trewby is available in the Doctors for the NHS Newsletter on page 9at https://www.doctorsforthenhs.org.uk/wp-content/uploads/2015/02/mar2014.pdf .  

Essentially, this treatment was appropriate for 15% of stroke patients. In the treated patients the chance of full recovery increased from 26% to 39%, but there was no survival benefit at one year. There was, however, a greater risk of suffering a cerebral haemorrhage within 36 hours of treatment. 20 die acutely for every 100 that make a full recovery and there is a 20-38% chance that the person who died would have made a full recovery if left untreated.

So as with all medical procedures there are pros and cons. These are never addressed. And according to this research, it is not appropriate for around 85% of stroke sufferers.

But there is a further factor: geography.

The BMJ 2014 study showed results after hospital admission and did not include travel time. It was conducted in two metropolitan areas – conurbations in which the difference in travel time between being admitted to a local or a central hyper-acute hospital was 2 minutes:

The hospital episode statistics database includes only patients admitted to hospital. It does not include any information about patients who died before they reached the hospital, nor does it include information on the time of stroke; hence our analyses of mortality were based on time from admission. If patients with stroke in London were more likely to die before reaching the hospital because of longer travel distances to hyperacute stroke units then the effects of the reconfigurations on mortality would be overestimated. Evidence suggests this is unlikely because ambulance journey times for patients with stroke did not increase appreciably after the reconfiguration in London , with mean times from scene to hospital of 14 minutes from January 2005 to March 2008 and 16 minutes from April 2011 to March 2012.

The greater travel times in rural areas make centralisation challenging and might necessitate other solutions, such as telemedicine, whereby consultation and triage can be conducted remotely by a stroke physician in a specialist stroke unit’.

Warwickshire is a huge county. Travel times have huge variations, and even Google map times are an under-estimate. The STP policy asserts that increased travel time is outweighed by the benefits of centralisation. There is no evidence for this. The STP policy also asserts that it is based on a reduction in strokes, because of improved prevention. There is no evidence for this.

This is a dangerous policy. We need further evidence on what types of care exist in current acute wards, and types of stroke patients for whom these forms of treatment are most suitable. We are never told. Far more discussion is needed before the CCGs rush headlong into this policy.

There needs to be evidence of the policy’s safety and proper risk assessment. So far there is no evidence of this. 

 

 

A PICTURE OF HEALTH – A new report edited by Jonathan Ashworth MP explores a comprehensive agenda for the future of the NHS looking at how it is funded, organised and reformed.

A PICTURE OF HEALTH

A new report edited by Jonathan Ashworth MP explores a comprehensive agenda for the future of the NHS looking at how it is funded, organised and reformed.

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The NHS needs a major funding increase, structural re-organisation and new priorities according to a Fabian Society report edited by the Shadow Health Secretary. A comprehensive agenda for the future of the NHS is presented in a series of chapters commissioned and edited by Jonathan Ashworth MP. A Picture of Health: the NHS at 70 and its future brings together analysis and policy recommendations from 12 leading experts on the NHS hand-picked by Ashworth, from both left-wing and non-party perspectives.

A Picture of Health: the NHS at 70 and its future looks backwards at the history and achievements of the NHS over the last 70 years. And it looks to the future, in the context of acute financial pressures and growing healthcare needs . The report argues that now is the time for the left to develop a new agenda for how the service is organised, funded and reformed.

As well as Jonathan Ashworth MP, the report’s authors include Luciana Berger MP, Paul Williams MP, Lord Kerslake, Sara Gorton (head of health at UNISON), Tara Donnelly (chief executive at the Health Innovation Network), and Andrew Harrop (Fabian Society).

Recommendations by the report’s authors include:

  • Annual funding increases for the NHS in England substantially in excess of Conservative plans
  • Restructuring the NHS to unpick the market reforms of Andrew Lansley
  • Prioritising child health, mental health and action on health inequalities
  • Strategically shifting away from reactive acute hospital services towards proactive community-based care
  • Systematically implementing digital solutions with the strongest evidence base.

You can read the report in full here.

Planned Mental Health Services Building Sell-Off Leamington and Warwick

SWKONP Press release 22nd  August 2018

Coventry and Warwickshire NHS Partnership Trust (CWPT), which runs mental health services in Coventry and Warwickshire, plans to sell off the only NHS mental health outpatients’ premises in Leamington and Warwick and move all staff and patients to Stratford-upon-Avon.

CWPT is getting rid of:

·     St. Mary’s Lodge – adult mental health outpatients’ psychiatry and psychotherapy.

·     Whitnash Lodge – learning disability.

·     Warwick Resource Centre – run by community mental health teams and specialising in psychosis.

·     Ashton House – early intervention and psychosis, run by community mental health         teams. This is currently rented, but CWPT is not renewing the lease.

So far, there has been no consultation with staff, patients or the public about these sale plans, and SWKONP fears that any future ‘public consultation’ will be no more than a sham rubber-stamping exercise.

To give some idea of the scale of the planned loss of outpatient and community mental health care to Warwick and Leamington, St. Mary’s Lodge alone runs at least 100 psychiatry appointments per week, with over 120 other appointments for psychology, care-coordinators, and social workers. These numbers are a conservative estimate, and we have no figures yet of patients seen at the other premises earmarked to go. How can the premises in Stratford possibly accommodate all these patients? And how can vulnerable patients, most of whom are reliant on public transport, make their way on at least an hour’s journey to a town they do not know?

One member of the CWPT says:

For many of our patients, having links in the community, albeit professional ones, are extremely important, as many people live a life of isolated misery. The support workers in the team are often called upon to support people in meeting the basic tasks of life, like going to the local shops, attending appointments or engaging in social activities. If we are not based in the community, where our patients live, how can we say that we are a community based service and how can we possibly be receptive to the very complex needs of our patients? There are not enough rooms in Stratford for us to offer even a fraction of the care that we offer now. I anticipate that many staff will leave, as they will be unable or unwilling to make the trip to Stratford, which will be costly in both time and money. There will inevitably be redundancies.

Anna Pollert, Chair of SWKONP, says:

Mental health facilities are not just chunks of real estate. They cannot be sold off without major repercussions for the most vulnerable people. Mental health funding has already been cut to the bone. How can our communities be further starved of scare resources? Please join our campaign to stop this short-sighted policy. To get involved, please contact us on: Facebook: https://www.facebook.com/KeepOurNHSPublicWarwickEmail: southwarwickshirekonp@gmail.com

Chief Executive, Simon Gilby’s, statement on the matter:

Simon Gilby, Chief Executive from Coventry and Warwickshire Partnership NHS Trust, said: “We are continuing to review our use of  buildings to ensure we continue to provide services to our patients in suitable premises whilst improving service efficiency.   We can confirm there are no plans to cease the provision of any services or clinics in Leamington and Warwick.  Changes to the locations of any clinics would, of course, involve engagement with our patients and the public to ensure that the venues continue to be accessible.”

We are not saying that provision will cease. The issue is whether it will remain in the current Leamington, Warwick and Whitnash premises (i.e. the local community), or move elsewhere (i.e. Stratford).

NHS England – Babylon combine to undermine London’s GP practices

KONP   

We have pleasure in reproducing this press statement from Save Our Hospitals – Charing Cross & Hammersmith (SOH), who organised a protest on 24 July 2018 outside the HQ of GP at hand, supported by London KONP groups:

Starts: Tuesday’s protest about the online private/public enterprise GP at hand was well supported by campaigners, patients and GPs from across London. They leafleted passers by in North End Rd Fulham then rallied near GP at hand HQ. The business has hoovered up thousands of patients from existing general practices – destabilising their finances and risking increasing health inequality.

Campaigners  delivered a big bowl of cherries to GP at hand staff with the message: ‘Please stop “cherry picking” younger, relatively fit patients, you are damaging frontline GP medical practices’.

London GP Dr Kambiz Boomla raised concerns about the safety of the app used by GP at hand whilst his colleague Dr Jackie Applebee talked about the potential for the new online service to create further health inequality and an undermining of the  frontline GP services  that are the bedrock of the NHS.

Responding to questions from Save Our Hospitals (SOH), Hammersmith & Fulham CCG  revealed that whilst it is being compensated financially for the huge rise in costs triggered by GP at hand this year, there are no guarantees about future funding. SOH chairperson Anne Drinkell said:

If unchallenged this private-public consortium threatens to cream off trained GPs from face to face contact, cherry pick the easiest ( & cheapest) patients and leave us with 2 tier primary care services where those with greatest clinical need get the least access to timely care. New digital technology should be used to support not disrupt GP services.

Local MP Andy Slaughter raised the issue in parliament with new Health Secretary Matt (“There-is-no-greater-enthusiast-for-technology-than-me“) Hancock focusing on the threat of a two-tier system developing in primary care. The Conservative MP Dr Wollaston raised concerns about the safety of the app used by GP at hand (” which could be missing symptoms of meningitis and heart attack“.

Shadow Health Secretary Jonathan Ashworth also raised concerns about the safety of the Babylon-GP at handenterprise pointing out that Birmingham & Solihull CCG have refused to allow expansion into their area for this reason. (See Hansard[ends]

For more info contact Anne Drinkell (Chair Save Our Hospitals Charing Cross and Hammersmith scxandh@gmail.com)

 

Apps and Our NHS – A Question of Priorities

27th July 2018 KONP

From today, let this be clear: tech transformation is coming. The opportunities of new technology, done right across the whole of health and social care, are vast. Let’s work together to seize them.

Matt Hancock in his first speech as Health Secretary

Whilst at the very forefront of scientific advancement and research in many areas, our NHS admittedly lags behind in terms of how to embrace and utilise emerging technologies. Seemingly many of its problems could be solved by the introduction of new and exciting digital implementations, (specifically mobile software applications or ‘apps’) which would make day to day working more efficient and improve patient safety. This is the opinion of recently appointed health and social care secretary Matt Hancock, but is it the right one, and how suitable a candidate is he and his government to implement this digital revolution in the NHS?

Hancock previously held the office for Culture and Digital so, in line with his predecessor’s appetite for technology in the NHS, it seems a logical step for the Prime Minister to seek to transfer his enthusiasm for the subject over to another sphere. At a time of significant underfunding and hardship in our NHS it is also interesting to note that nearly £500m has been ‘found’ and set aside to make these changes.

The ‘Matt Hancock’ App

During his period in office Hancock launched the imaginatively entitled Matt Hancock app, the first of its kind where constituents could both keep in touch with the news of and message their local MP. However, the app has some large privacy flaws and when downloaded collects the personal information of its users. Privacy experts have questioned the apps data collection and privacy policy. In February Silkie Carlo, the director of civil liberties group Big Brother Watch said:

The Matt Hancock app is a fascinating comedy of errors. It is quite fitting, given this Government’s incompetence on digital privacy issues, that our Digital Minister’s app steals a bank of users’ personal photographs, even when permission to access them is denied.

This raises serious questions over Hancock’s capability to successfully deliver applications in an area where confidentiality is paramount. Indeed, the Conservatives general track record on cyber security is extremely concerning.

Babylon – the promised land?

In November 2017 GPatHand was launched. This mobile app, administered by private company Babylon, facilitates virtual consultations and diagnoses for patients, based on rigid algorithmic questions and answers, some of which are potentially dangerous. Errors have included failing to identify the symptoms of heart attack and meningitis. Meanwhile, accepting the app automatically deregisters the patient from their existing practice, meaning patients are without access to their regular GP practice setting – which loses income as a result.
The app though has the potential to be extremely profitable for its private provider, especially since it cherry-picks its patients with only those with straightforward or minor conditions permitted to register. It therefore sits well with the overall covert drive to erode public provision by this Conservative government.

Matt Hancock is eager to expand this application. His overall mission seems to be not to aid professional expertise but to replace it. At a recent meeting of the Health & Social Care Select Committee Hancock asserted of the Babylon app that he understood the flaws but that it was still preferable to doctors in some instances and that he would:

You have to take into account that humans aren’t perfect either and replacing ‘imperfect’ [clinicians] with ‘imperfect but better’ [eg Babylon’s app] is worth doing.

Dr Murphy@DrMurphy11

Dear @CommonsHealth @sarahwollaston @theresa_may

How can staff have any faith in @MattHancock – when he openly supports unvalidated that compromises .

He appears to believe that the @babylonhealth is safer than current NHS services!

Days into his job, Hancock is putting more faith in largely untested technology than in NHS staff with years of practical training. It is a slight on the intelligent and hardworking clinicians who, it is safe to say, would never treat meningitis as a heat rash.

Dr Louise Irvine of Keep Our NHS Public and Chair of Health Campaigns Together says there are serious issues with reducing the practice of Medicine to a simple concept that every symptom has a pathological diagnosis.;

30% of symptoms don’t have a clear diagnosis and never will because not all symptoms denote underlying pathology, and in one in three GP consultations there is a significant mental health element, that often does not come out until the patient has presented their physical symptoms as a sort of “ticket of entry”. Symptom-based apps will miss all that and will also both miss diagnoses and over-diagnose.

The process of clinical assessment and diagnosis is not as simple as Babylon asserts and requires human thought processes, intuition and emotional empathy to comprehensively assess why someone is feeling ill and what treatments should be offered. Any new application should work alongside, and not seek to replace, the input of a skilled clinician.

Holding our NHS to Ransom

In May 2017 the NHS was hit by the biggest cyber security breach in its history. Nearly 7000 appointments were cancelled, ambulances diverted and non-critical care put on hold. It was only down to the ingenuity of staff that the ransomware attack wasn’t even more damaging. Interestingly these scenes were not replicated in Wales where firewalls had been kept up to date by a Labour government.

Money earmarked for IT upgrades is unsurprisingly sometimes diverted by NHS trusts. When there are so many other areas that require immediate funding, technology naturally becomes the poor relation. Attending to immediate patient need is the priority and technology becomes a ‘nice to have’ and not an essential criterion. Hancock’s policy of making the £20bn of funding dependent on this innovation smacks of either naivety or a deliberate plot to deprive the NHS of much needed funds directed to the most essential areas.

The fact that £500m has been earmarked to implement apps almost certainly run by private companies seems strange when in 2014 the government chose not to spend a measly £5.5m on security when it axed a deal with Microsoft. Had the virus protection been renewed and systems upgraded accordingly the whole cyber disaster may have been averted.

It is difficult to trust this government to implement brand new initiatives that deal in personal data and are largely untested. Apps used in our NHS should be subject to the same rigorous safety testing as any other medical device or treatment approach, when they have the same potential to inflict harm. Of all the sectors that could be a guinea pig for modern non-essential innovation, the NHS should not be at the front of the queue.

Throw out that pager?

Amongst the changes Matt Hancock is keen to implement is a smartphone app Medic Bleep to replace that NHS staple the pager (or ‘bleep’). Admittedly this technology is basic and out of date having been widely used by doctors in the NHS since the 1980’s and it is fair to say there is now little appetite for retaining it as a method of communication.

However, although attractive, it is also fair to say that in terms of spending priorities replacing pagers is not at the top of the list for clinicians and spending vast sums on creating a replacement in the current climate seems like folly especially when currently wi-fi blackspots in some hospitals could affect performance in critical situations. It is perhaps another example of the health secretary’s fixation on technology as ‘window dressing’ without fully considering the consequences and at the expense of more fundamental basics of NHS care.

‘Going off half-Hancocked’ – questions to answer

Like some of the initiatives of his predecessor, Hancock’s ideas seem inappropriately timed and ill thought through. Time will be the judge but the obsession with new technology when there are 100,000 staff vacancies and insufficient beds signals a flawed approach to leadership. It is an indicator of a more general failure to properly understand the complexities and requirements of our NHS that Hancock’s drive towards technological advances has been immediately set out, seemingly without prior or well considered reasoning. Our NHS can ill-afford a ministerial vanity project at a time of crisis.

App-based medicine while being presented as the latest advance may ironically be a step back to a two-tier system with a reduced quality of service for those who can’t afford the gold standard. In this brave new world, the rich will still insist on having personal doctors they see face to face. In future this may become a luxury we cannot all afford.

To many this preoccupation with new technology may seem like redecorating the house when the roof is leaking. Making the apparent £20bn funding announcement conditional on successful implementation of new technologies means the NHS is once again being held to ransom, but this time by a Conservative on an ego trip who is failing to grasp the blindingly obvious issues in the service. Namely that it is workforce planning and recruitment, better working conditions, increased resource and funding that will save our NHS, and not the headline-grabbing technology it now seeks to employ.

Samantha Wathen, Press and Media Officer