NHS London, along with all other Strategic Health Authorities, was abolished as part of the reform of the NHS that the Health and Social Care Act introduced on 1st April 2013. The Greater London Authority is the only body now capable of providing a strategic overveiw of NHS services in London. Items of London-wide interest will be posted in this section of the website.
Robert Craig, chief operating officer at Royal Brompton & Harefield NHS Foundation Trust, said:
“We find NHS England’s stated intention extraordinary. We are, however, reassured to see that the idea of removing congenital heart disease services from Royal Brompton is ‘subject to consultation with relevant Trusts and, if appropriate, the wider public’. We fail to see how any logical review of the facts will come to the same conclusion as this panel.
“While we understand the motivation of commissioners to show progress is being made with congenital heart disease services, threatening to withdraw services from one of the largest and most successful centres in the country seems an absurd approach.
“Teams at Royal Brompton Hospital carried out more congenital heart disease (CHD) procedures last year than any other centre in the country. For the past ten years, our experts have undertaken over 500 congenital surgical operations each year (paediatric and adult) and during this time our results have met or exceeded all the standards defined by the regulators. Since 2009 we have consistently been one of the five best-performing centres in terms of mortality rates.
“We are very concerned about where alternative capacity in other hospitals could be found if this ill-conceived proposal were to proceed and are surprised that this information has not been made available already
According to the national NICOR database:
“Royal Brompton Hospital meets all current standards, with well-developed plans in place to meet the new standards introduced this year. Indeed, in the announcement of the panel’s intentions, the description of a high-performing unit offered by Clare Marx, president of the Royal College of Surgeons, describes Royal Brompton well:
“Units need to be the right size to enable surgical teams to be familiar and skilled in all conditions, treating these patients on a regular basis to maintain their experience and expertise. It’s absolutely critical that teams are sufficiently staffed to provide secure on-call rotas, disseminate new techniques and train the next generation of specialists.”
“We are rightfully proud of the ground-breaking work of our congenital heart disease teams; many of our experts have achieved international recognition for their contribution to the field and are responsible for training large numbers of clinical staff, in the UK and abroad. Many thousands of patients have benefited from their innovative treatment and research and we have a duty to ensure they continue to experience ‘a lifetime of specialist care’.
“The process by which this decision has been made and announced has been deeply disappointing. In February the Trust submitted a self-assessment report on its CHD services and added supplementary information at NHSE’s request in April. Having had no feedback from NHSE commissioners since then, our chief executive received a phone call on 30th June, followed up by a letter which stated that commissioners were ‘minded’ to stop commissioning specialist congenital heart disease services from the Trust. The letter requested additional evidence to support our position which we were given three working days to supply.
“After submitting detailed information late on 5th July, we were astonished to learn at lunchtime on 6th July that the final decision was being ‘communicated out to trusts’ that same day, giving little or no time for the panel to have reviewed the supplementary details. We were not surprised therefore to learn at 7.23pm that evening that there had been no change to the original decision.
“The consequences of this decision, should it be implemented, would be far-reaching and would affect not only congenital heart disease services for adults and children but also paediatric intensive care: if paediatric cardiac services were moved from Royal Brompton, our paediatric intensive care unit would no longer be viable because of the drop in volume of patients needing such expertise.
In turn this would adversely affect our specialist respiratory services, many of which cannot be delivered without the back-up of a specialist intensive care service. Some adult services such as the nationally-designated pulmonary hypertension service would also be adversely affected because of their inextricable links with congenital heart disease services.
“It is a source of deep regret that once again, our patients and staff are faced with a period of uncertainty and anxiety. Of one thing they can be sure, we will be working closely with NHS England to ensure that full and frank discussions take place to determine what is behind this irrational and reckless announcement and to achieve our shared objective of high-quality services for patients with congenital heart disease.”
The guest speaker at the June 2016 meeting of The Community Voice was Dr Onkar Sahota, London Assembly Member for Ealing and Hillingdon, and Chairman of the Assembly’s Health Committee. He is a part-time GP in Southall. The main points of his address were:-
- The London Assembly covers 32 Boroughs.
- A 2015 report on Tuberculosis (TB) states that London is the “capital of TB” because of the high incidence of the disease – 7 cases diagnosed per day.
- The risk factors for TB are associated with people who are in poor health and whose immune system is compromised, often living in overcrowded conditions, such as the elderly, those suffering with HIV and the prison population.
- TB cannot be spread by day to day activities of work and travel.
- The belief that TB is brought into the country by immigration is false, but it may be that immigrants have been living in the cramped conditions which manifest the disease.
- TB is a bacterial infection which affects the lungs, gut and bones.
- Symptoms of the disease are tiredness, weight loss and blood in the sputum.
- The disease can be latent – those having been infected in the past with no symptoms can become active if their auto immunity is compromised - this applies to 10-30% of cases.
- Treatment is prolonged – 28 tablets daily for 6 months with various side effects, which must be completed for the full benefit of the drugs.
- Patients not only suffer from the disease, but also from the effects of the drugs and isolation from friends and family. TB is still globally shunned.
- Prevention is important :-
b. Good housing conditions, fresh air, good diet and good general fitness all help to aid prevention.
c. WHO is researching a long term vaccine.
d. A scheme by University College Hospital goes out to help the homeless and treats those found to be infected. This needs to be implemented across London.
e. Hackney Borough in London has a TB Centre where patients are monitored while taking their medication.
f. London is looking at screening prisoners on admission and carrying out treatment where necessary.
g. Unfortunately each Borough works independently and the London Assembly has no power to make them conform.
As part of the 100,000 Genomes Project, the partnership will recruit patients with a range of rare diseases and some common cancers. Patients’ genomes will be analysed for trends, in order to make a genetic diagnosis. The aim is to create a new genomic medicine service for patients, transforming the way people are cared for. The tests will be done through blood samples.
Britain will have the biggest Genomes Centre in the world; a big undertaking with a specially constructed building in Cambridge. he funding comes from the Government; David Cameron agreed 3 years ago to give a huge sum towards it.
It will be a big step forward to more personalised treatment, helping to avoid patients being undiagnosed for long periods of time and/or being treated with a variety of non-successful drugs
The report below provides only items of particular interest, not a summary of the meeting.
2. NW London Clinical Commissioning Groups expand adult mental health crisis teams: It was announced today that these CCGs are investing £1.9m a year to expand these teams. The Trust will use the investment for new Home Treatment Rapid Response Teams which will deliver a 24 hour, 7 day a week rapid response function in the NW London boroughs, including Harrow and Hillingdon, for urgent and emergency referrals into adult secondary care mental health services. The new teams are planned to start in November.
3. Northwick Park Hospital’s Mental Health Assessment Lounge: Brent and Harrow CCGs have confirmed continued investment in this lounge, which started as a pilot project. Both patients and local GPs rate it as successful in providing a secure environment for mental health patients to be assessed away from the main Accident & Emergency environment.
4. Medium and low security beds: Lack of such beds is problematic across London and the country. Last week there were no such vacant beds in either the NHS or private sector in England. Prisoners could not be moved out of prisons into more appropriate care.
5. Stopping patients smoking: There is no smoking in any CNWL wards but in some places patients have been able to smoke in the grounds. Making CNWL premises totally smoking free has proved very difficult and has led to problems in restraining patients, particularly prisoners. It was agreed at today’s meeting that more restraint training is required.
6. Finance: At the six month point in the NHS year a number of London NHS Trusts are reporting huge deficits. Stringent national guidance is expected to tackle this serious problem. However, this Trust expects to achieve its end of year financial target, aided by its planned disposal of property.
7. Forward planning in Harrow and Hillingdon: The possibility of a new sustainable strategy is being explored with the aim of providing a five year plan for mental health services, which would avoid the current postcode lottery. Such a plan must be affordable. It is envisaged as improving self help, richer community provision and demedicalisation of some conditions.
8. Foreign nationals in CNWL beds: There are usually around 22 such patients but the week before the Board Meeting there were 30, which was challenging.
9. Asylum seeking children in Hillingdon: Some of these children have been trafficked, suffering trauma of many kinds in addition to language problems. Their needs are complex. Staffing shortages have been experienced in all three of the Trust’s teams for Looked After Children (LAC). The teams are working to tackle child sexual exploitation, teenage pregnancy, substance use problems and lack of emotional well being. CNWL won the contract for LAC in Harrow at the end of 2014/15.
b. London Ambulance Service: Paramedic levels are understaffed. This and slow hospital handover times contributes to the failure of LAS to reach callers within target times.
c. NHS 111 ‘phone service: Call back problems have caused concern. A recruitment programme is in place to recruit more clinicians to the service.
d. North West London’s “Shaping a Healthier Future”: Ealing Clinical Commissioning Group has not yet agreed a date for transfer of maternity, paediatrics and gynaecology services from Ealing Hospital to other local hospitals, but Ealing Hospital’s Maternity Unit is still expected to close this summer.
LAS is facing an outflow of paramedics eg to the 111 telephone service. Chief Executive Ann Radmore said ”Every year demand increases and now, in addition to this, there is a shortage of paramedics in the UK, which is making it difficult for us to recruit”.
LAS is leading a campaign to get 1,000 extra defibrillators in London. Where there is a defibrillator in a public place and someone trained to use it, the chance of survival can increase from 28% to 80%.
- a. London’s response to failed targets: London’s NHS Chief Executives and CCG Chief Officers met in October to discuss common challenges. London as a whole has recently failed to meet some NHS targets for the first time since before 2007-08.
- b. London Ambulance Service fails to meet its targets: The LAS again missed the target of 75% of top priority calls arriving within 8 minutes, with 72.9% for Cat A Red 1 and 69.1% for Cat A Red 2..
At the October 2014 meeting of The Community Voice, of which we are a member, the guest-speakers came from NHS England London Region - Julie Sands, Deputy Head of Primary Care Commissioning, Kelly Nizzer, Deputy Regional Lead for Dentistry, and Alice Benton Head of Dentistry for London. Their main points are summarised below:
Kelly Nizzer spoke first, about dentistry: She used slides to provide an overview of North West London’s 1.9m population. The budget to cover all dental services in the eight boroughs is £94m including prison and domiciliary contracts, services in acute hospitals, and out of hours services.
Out of hours assessments are made over the phone from 6pm - 10pm weekdays and 9am - 10pm at weekends. Telephone 0203 402 1312 , or 111. Patients may be booked into a local practice on the following day, with normal NHS charges, or emergencies are dealt with at Charing Cross, University College London, Guys or Kings hospitals..
Orthodontic services across NWL are available under the NHS if patients meet the criteria required.
Children should be given guidance on dental health at an early age. There are to be more specialist practices for children, and leaflets about dentistry for children in public places.
The audience questioned the rising cost of NHS dental services over the years, but the speaker claimed dentistry costs had not increased significantly over the last few years. She noted that there should be posters in surgeries explaining what each of the three bands of treatment entail and cost. The contracts and costs for dentists are different from those for GPs. Dentists are often sited in main shopping areas for accessibility, so reimbursement in a similar form to GPs is not appropriate..
The audience also expressed concerns about difficulty in finding NHS dentists in some areas, concerns about poor child services, and concerns about dental services not being included within the umbrella of general NHS care. Other concerns noted that some dentists refer patients to hygienists or to outside practices for difficult treatments. The speaker noted that some advanced treatments are beyond the remit of most dentists. Her team monitors how each practice performs..
Julie Sands then spoke about primary services: She heads the Local Area Team dealing with the eight Clinical Commissioning Groups and 401 GP practices in NW London whose contracts provide the core primary care services for minor ailments, the chronically sick, terminally ill patients and services such as cervical screening, minor surgery, immunisation programmes and baby clinics.
From 2014-2015 nationally agreed services will include more minor surgery, vaccinations, immunisations, carers’ support, dementia support, and proactive care for vulnerable people to avoid unnecessary admissions to hospital. GP practices will extend their opening hours and set up Patient Participation Groups to look at their services. NHS England's role is to oversee the required changes and to monitor contract performance. It also has a joint role with the CCGs to improve the quality of care and to engage with stakeholders and patients when new developments are proposed.
To ensure improved choice, patients will be able to join GP practices outside their own residential area and be assured of seeing a GP on the same day if necessary, which should improve services for vulnerable groups such as the homeless and drug users. A named accountable GP will be provided for those over 75 years, although the patient may not see that particular GP on every visit. GPs will be contractually required to offer on-line appointments and ordering of prescriptions service and to allow access to the patient's own medical records. In 2015/2016 there will also be a named accountable GP for all patients including children, and practices will be required to publish the net earnings in 2014/15 of all salaried or contractual doctors within the practice.
Members asked about the difference in the responsibilities of NHS England and local Clinical Commissioning Groups within Primary Care. NHS England is responsible for GP services. The CCGs are responsible for specialist primary care services, such as district nurses.
Members also voiced their concerns, noting that not all patients have internet available, and that some GPs do not have the necessary training to identify and to care for dementia patients. They were told that GPs are encouraged to refer such patients to those GPs with that expertise.
NHS England can be telephoned on 0300 3112233.
The speakers were thanked for their interesting presentation and for answering questions, which was endorsed by applause as they left the hall.