I thought this posting on the Brent Council website LINK by Cllr Kruoesh Hiran, Cabinet member for Adults, Health and Wellbeing, deserved a wider audience. It sets out Brent Council's response to the Mansfield report.
Following a year long investigation into health service changes
across five London boroughs the Independent Healthcare Commission for
North West London reported its findings earlier this month.
The Commission, which was chaired by one of the UK’s leading lawyers
Mr Michael Mansfield QC, was jointly commissioned by the boroughs of
Brent, Ealing, Hammersmith & Fulham, Harrow and Hounslow. Naturally,
as the democratically elected representatives of local people, we
shared serious concerns about how A&E and other health services were
changed across our boroughs.
However, it is important to also note that our concerns are not
solely focused on A&E. One of the main issues here in Brent is the
outdated population estimates underpinning the original plans. Yes
A&E is a barometer of how the NHS is performing but it is clear that
there is a wider system problem.
The Mansfield report highlights social care funding cuts and the
significant cuts to local government. A good NHS needs a properly funded
social care system. But the funding cuts to councils have reduced local
authorities’ ability to provide more preventative services. It is the
same problem emerging with Public Health funding.
Naturally when you are looking at a report, which affects two million
people across North West London, there will be some issues more
relevant than others to Brent’s 320,000 population.
First let’s turn to the main findings in the report:
- there is still no completed, up to date business plan in place that
sets out the case for delivering the Shaping a Healthier Future
programme (SaHF), demonstrating that the programme is affordable and
deliverable
- there was limited and inadequate public consultation on the original
SaHF proposals and those proposals themselves did not provide an
accurate view of the final costs and risks to the people affected
- the escalating costs of the programme do not represent value for money and is a waste of precious public resources
- NHS facilities, delivering important public healthcare services,
have been closed without adequate alternative provision being put in
place
- the original business case seriously underestimates the increasing
size of the population in North West London and fails to address the
increasing need for services.
The report also makes it clear that we are now looking at a £1.3
billion project while the original proposals were predicating a saving
of over £200 million a year. A continued lack of investment in the out
of hospitals strategy, while still implementing the A&E closures
programme has led to unacceptable standards and low performance within
A&E.
We are supportive of a good out of hospital strategy. It is in all
our interests as it is generally better to have good health services
closer to home. However, those services need to be in place before
hospitals are reconfigured.
This is combined with a lack of bed capacity at Northwick Park and
the delays in resolving this situation have been ongoing for the past
year. Residents still consistently report problems with accessing GP
appointments in a timely way and this inevitably leads to people
presenting at A&E, while the use of urgent care centres is below
capacity.
What was truly shocking to me in the report was the statistics on
Northwick Park hospital where performance has been consistently poor
since September 2014. A key graph in the report shows London Ambulance
Service ‘black breaches’. These are where an ambulance has taken more
than an hour to take a patient to A&E. In Northwick Park there were
633 such breaches compared to 106 at Hillingdon. Especially relevant is
the fact that the London Ambulance Service has just been placed into
special measures as, if you close A&Es, you are clearly more reliant
on this service.
In summary, the SaHF plans really need to go back to the drawing
board. We want greater local authority involvement in the actual
decision making process and designing of services. While it is clear
that mistakes have been made Brent Council wants to take this forward in
a positive way.
Co-production is a good example where there is potential. There has
been a recent decision to involve a Health and Wellbeing Board
representative in local primary care. I am now Brent’s representative
and although it has been a slow process to get here, I think we are now
moving in the right direction.
In the meantime, we will thoroughly explore all of the
recommendations in the Mansfield report
including the possibility of
joining a Judicial Review after careful consideration and assessing the
impact on Brent residents.
Finally, it does not give me any pleasure to write about the findings
in this report but please do be reassured that Brent Council will
continue to do our very best to help support our local NHS partners to
learn the lessons from it and ultimately to deliver a good and more
fully integrated NHS for all Brent residents.
