Redbridge CCG reply to Questions

Thank you to Redbridge Clinical Commissioning Group for providing the below

Oral questions from Cllr Andy Walker


Q: The CCG will be asked to seek an explanation from BHRUT as to why bed occupancy at Queens is 94% and 79% at KGH as CQC recommend a safe level of 85%.
A: In terms of high bed occupancy at Queen's, it's simple - too many people are being admitted to the hospital and those that are in there stay too long.
We launched two new services to Redbridge in November that are already having an impact on this - the Community Treatment Team and Intensive Rehab service - which help prevent admissions and also help get people home sooner. At the moment the CTT team at the hospital is able to treat and prevent around 60 people a week from being admitted. CTT teams in the community are currently treating and preventing more than 130 people a week from ending up in hospital. We've also reduced the time it takes to move people from a hospital to a community bed from 5 to 2 days.
The CCG and our health and social care partners are working in partnership to improve the integration of care so that people spend less time in hospital. The Trust is starting seven day working and a new joint discharge team will launch soon. Our draft 5 year strategic plan, which goes to NHSE in April, includes an objective to reduce avoidable time in hospital through integrating care by 13%.

The work we are doing on this with our health and social care partners has seen a reduction in admissions of 15% in the past 12 months and a reduction in A&E attendances of 5.67%.

Q: BHRUT is unable to provide waiting list figures for technical reasons and the CCG will be asked about this too.

A: This is caused by problems associated with the Trust's change of IT patient administration
system which means the Trust doesn't have access to accurate data and therefore isn't able to report waiting times at the moment.

This is a serious issue and the trust is working with the Trust Development Authority and our CCGs to help establish an interim solution while the IT issues are resolved.



Q: Cllr Walker will also call on the CCG to 'scrap the plan to close A&E at KGH in 2015'.

A: The plans to reconfigure services were signed off by the secretary of state for health in 2011, following a lengthy public consultation and an independent review by a panel of experts. Our job is to work with the hospitals Trust and other partners to implement those proposals safely and improve health outcomes for local people.

Centralising A&E services on one site will enable BHRUT to provide a safe, high quality A&E service. At the moment the service is stretched across two sites and the CQC identified that at times it may be unsafe because of this (e.g. staffing issues). We can't leave things as they are - it's not an option.

That's why we are looking at improving the entire urgent care pathway so that patients can be seen in the right place, more quickly, by the right teams with the right expertise and leading to better outcomes and shorter waiting times. Most people who go to KGH A&E now will still be seen there by an improved 24/7 Urgent Care Centre.

Last year we centralised maternity services and it has given us a safer, higher quality service for Redbridge women. That's what we plan for A&E.



Oral question from Cllr McGeary


Q: The improvements required by the Health for NEL proposals to A & E are likely to cost £50 million through the PFI route and are, as the trust says, unaffordable. How can the BHRUT say that they will still close King George A & E by December 2015 and still comply with the Secretary of State's statement that the reconfiguration changes will not happen until the health for NEL improvements have been made.

A: We've been very clear all along that changes to A&E services - just like maternity last year - cannot happen until it is safe to do so. That won't change. One result of the Trust being placed in special measures is that the new leadership is producing an Improvement Plan that will not only demonstrate how they will make the very necessary improvements to safety and quality of services, but will also show how they align this with the reconfiguration proposals.

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Photo from today outside Redbridge Clinical Commissioning Group

 

 

 

 

 

 

 

Thanks to Bob Archer for photo

 

 

Thanks to Councillors Fairley-Churchill and McGeary and Redbridge residents for attending.

 

The GPs made everyone welcome who wanted to speak, going out of their way to accommodate people by changing the agenda to let the public speak first to allow people to go after asking their questions rather than wait to the end of the meeting.

 

Valarie, a Redbridge resident made a passionate speech about how important King George Hospital is, her oratory drew a round of applause.

 

While no ground given by GPs on KGH A&E closure issue, GPs did appear to be concerned by the high bed occupancy rate at Queens hospital. This is an issue that needs to be kept under scrutiny as the CQC mentions a safe level of 85% and Queens was at 94% on March 16th.

 

GPs also appear concerned by BHRUT inability to provide waiting list figures. The responses to questions were detailed and I hope to be able to produce a note from the CCG of what was said in due course.

 

It is welcome that GPs are willing to have a dialogue with the public about the proposed closure of KGH A&E.

 

 

 

 

 

 

 

 

 

 



Photoshoot 12:30 Thursday 27th March Becketts House

There will be a photoshoot at 12:30pm outside Becketts House on Ilford Hill on Thursday 27 March before the Redbridge Clinical Commissioning Group meets.

The purpose is to call on the CCG to scrap the plan to close KGH A&E in 2015.

The CCG will be asked to seek an explanation from BHRUT as to why bed occupancy at Queens is 94% and 79% at KGH.

The CQC recommend a safe level of 85%.

BHRUT is unable to provide waiting list figures for technical reasons and the CCG will be asked about this too.

A Recorder photographer has been booked.

As the Chair of BHRUT resigns, there are As the Chair of BHRUT resigns, there are strong parallels with Mid-Staffs as the public, experts and local politicians are ignored by NHS authorities

Neil Zammett writes

 

The news last Friday 21^st February that Sir Peter Dixon has resigned as Chair of BHRUT the trust that runs Queen’s and King George is a body blow to local services and management alike.

As a former Chair of the Housing Corporation, University College Hospital and Enfield and Haringey Health Authority Sir Peter is a highly regarded and experienced public servant whose presence at BHRUT gave a calibre of leadership which it would be hard to match.

He of course follows a similarly distinguished Chair, Sir David Varney, who left the Trust after only six months in June 2010, and joins the current medical director, finance director and chief executive in departing.

Only very recently Sir Peter was heard to say at a Scrutiny meeting that he was in it “for the long term” so something significant has happened to prompt his departure.

The answer to this lies in the complex relationship between the Care Quality Commission (CQC), NHS England and a shadowy body called the National Trust Development Agency (NTDA).

The CQC ‘s last report on BHRUT made it clear that they had ran out of patience with the Trust’s inability to solve the local crisis in A&E; a crisis that had lasted for three years, not just days or months.

The NTDA, who effectively act for the Department of Health, were faced with a recommendation from CQC to put the Trust into “special measures”; they had to comply and this started the current sequence of events.

Reading between the lines it is clear that no one had worked out what “special measures” actually meant in this case. It was so unclear that the NTDA despatched an NHS grandee, Sir Ian Carruthers to the Trust to assess the situation after they had made the announcement.

But before special measures Sir Peter had already presented his assessment independently to the NTDA backed up by management consultant’s report. Again we do not know the detail but an important part of this assessment must have been a need for resources and capacity.

We can imagine that the report would have said something along the lines that: “Without the ability to source adequate capacity to support both management and clinical staff, these hospitals will continue to fail.”

Obviously Sir Peter’s arguments fell on deaf ears.

The Future

Whatever else this sad turn of events has meant it is clear that the Health4NEL plan to close A&E at King George has now run its course. There is no doubt that the management of BHRUT have done their best but the colossal projected overspend for 2013-14, the continuing dreadful performance of A&E and the departure of all the key staff all point to the same conclusion-it is simply not possible.

Even Professor Sir Mike Richards the head of the CQC has gone on record about the huge challenge facing BHRUT which he later described as “A task like Everest”.

The recently appointed turnaround director and the interim finance director are both veterans of the South London Trust and the administration regime while the new “interim” Chair Dr Maureen Dalziel has only been given a three month contract. This would run out at the end of May, around the time of the local elections.

All of this suggests that Queen’s and King George are being lined up for administration by the NTDA and local CCGs, the GP organisations that now commission hospital services. The timing of the new Chair’s contract suggests that a formal announcement will be delayed until a politically less sensitive time.

Administration carries substantial extra risks. There are already indications that the recruitment of clinical staff is being adversely affected by the “special measures” and managers are obviously not going to be rushing to join the Trust. Morale at all levels must be at an all time low. Administration would accelerate this process and could lead to “recruitment blight” as has happened at Mid-Staffs.

More serious is the fundamental difference of view between a very senior and experienced public servant like Sir Peter and the NTDA. This cannot be dismissed as a simple personality clash given the history outlined above and goes to the heart of the continuing problems at BHRUT:

· On the one hand, the NTDA, the CCGs and the Urgent Care Board (UCB) are still backing the Health4NEL plan

· On the other Sir Peter, Redbridge Council and this Blog see the need for more capacity and resources.

Without a consensus on how to move the Trust forward local people face a long period of uncertainty with failing services and an emerging crisis of confidence and leadership.

It’s just like Mid-Staffs

When things go wrong in the NHS it is difficult to find out who is responsible. At Mid-Staffs two enquiries and two massive reports gave us some clues and some recommendations about stopping this happening again. There are close parallels between Mid-Staffs and BHRUT.

In both cases, a major problem was the single minded pursuit of management objectives at the expense of patient care. At Mid-Staffs it was foundation trust status; at BHRUT it is the closure of A&E at King George.

At Mid-Staffs expert opinion from Professor Brian Jarman was disregarded; at BHRUT it is Sir Peter’s and Sir David’s from a management perspective and the evidence from this Blog from an analytical one.

Finally there are the views of the public and local politicians; again comprehensively ignored, just like Mid -Staffs. I am not suggesting the consequences are on a comparable scale but local people have had to endure a dreadful A&E service and Redbridge women have been forced against their wishes to use a sub-standard maternity service at Whipps Cross.

Who is responsible?

Although the NHS reorganisation means that many of the decision making bodies have gone, the NTDA as the controlling successor body is primarily responsible.

But the CCGs and the Urgent Care Board (UCB) although they are in a less controlling role still bear a heavy responsibility for what is happening. Without their support the NTDA could not continue with the closure plan. Surrey Downs CCG in South London has done just that; pulling out of the equivalent plan to downgrade Epsom and St Helier Hospitals.

Finally the CQC, while precipitating the current management crisis, has very little authority to influence plans as such, illustrating the weakness of accountability and regulation in market economies.

What needs to happen?

At the heart of this is the need to scrap the Health4NEL plan. It clearly has not worked, there is overwhelming evidence now that the assumptions underlying it were deeply flawed and continued efforts to implement it have created the present crisis.

Making this decision is primarily the responsibility of the NTDA. Redbridge CCG could take the lead on this, however by following the example of Surrey Downs and withdrawing from the plan. It’s up to them.

Local people need to be involved not pushed to the margins. They are supposed to be at the centre of what the NHS does, but locally their voice has been systematically ignored. The same is true for local politicians. The CCGs and the UCB need to open up and start listening to their views.

In particular there needs to be a critical review of the schemes the UCB has funded this winter and their impact on A&E performance. A central question is why the UCB has not opened up more beds to ease the pressure on A&E. This is what has precipitated the crisis.

Finally there is the issue of ignoring expert advice. There is a sense in some quarters that the NTDA and others are knowingly pushing BHRUT over the edge for whatever reasons. This is a potential charge they should be given an opportunity to answer in a way which makes them publicly accountable.

The news on Friday 21^st February that Sir Peter Dixon has resigned as Chair of BHRUT the trust that runs Queen’s and King George is a body blow to local services and management alike.

As a former Chair of the Housing Corporation, University College Hospital and Enfield and Haringey Health Authority Sir Peter is a highly regarded and experienced public servant whose presence at BHRUT gave a calibre of leadership which it would be hard to match.

He of course follows a similarly distinguished Chair, Sir David Varney, who left the Trust after only six months in June 2010, and joins the current medical director, finance director and chief executive in departing.

Only very recently Sir Peter was heard to say at a Scrutiny meeting that he was in it “for the long term” so something significant has happened to prompt his departure.

The answer to this lies in the complex relationship between the Care Quality Commission (CQC), NHS England and a shadowy body called the National Trust Development Agency (NTDA).

The CQC ‘s last report on BHRUT made it clear that they had ran out of patience with the Trust’s inability to solve the local crisis in A&E; a crisis that had lasted for three years, not just days or months.

The NTDA, who effectively act for the Department of Health, were faced with a recommendation from CQC to put the Trust into “special measures”; they had to comply and this started the current sequence of events.

Reading between the lines it is clear that no one had worked out what “special measures” actually meant in this case. It was so unclear that the NTDA despatched an NHS grandee, Sir Ian Carruthers to the Trust to assess the situation after they had made the announcement.

But before special measures Sir Peter had already presented his assessment independently to the NTDA backed up by management consultant’s report. Again we do not know the detail but an important part of this assessment must have been a need for resources and capacity.

We can imagine that the report would have said something along the lines that: “Without the ability to source adequate capacity to support both management and clinical staff, these hospitals will continue to fail.”

Obviously Sir Peter’s arguments fell on deaf ears.

The Future

Whatever else this sad turn of events has meant it is clear that the Health4NEL plan to close A&E at King George has now run its course. There is no doubt that the management of BHRUT have done their best but the colossal projected overspend for 2013-14, the continuing dreadful performance of A&E and the departure of all the key staff all point to the same conclusion-it is simply not possible.

Even Professor Sir Mike Richards the head of the CQC has gone on record about the huge challenge facing BHRUT which he later described as “A task like Everest”.

The recently appointed turnaround director and the interim finance director are both veterans of the South London Trust and the administration regime while the new “interim” Chair Dr Maureen Dalziel has only been given a three month contract. This would run out at the end of May, around the time of the local elections.

All of this suggests that Queen’s and King George are being lined up for administration by the NTDA and local CCGs, the GP organisations that now commission hospital services. The timing of the new Chair’s contract suggests that a formal announcement will be delayed until a politically less sensitive time.

Administration carries substantial extra risks. There are already indications that the recruitment of clinical staff is being adversely affected by the “special measures” and managers are obviously not going to be rushing to join the Trust. Morale at all levels must be at an all time low. Administration would accelerate this process and could lead to “recruitment blight” as has happened at Mid-Staffs.

More serious is the fundamental difference of view between a very senior and experienced public servant like Sir Peter and the NTDA. This cannot be dismissed as a simple personality clash given the history outlined above and goes to the heart of the continuing problems at BHRUT:

· On the one hand, the NTDA, the CCGs and the Urgent Care Board (UCB) are still backing the Health4NEL plan

· On the other Sir Peter, Redbridge Council and this Blog see the need for more capacity and resources.

Without a consensus on how to move the Trust forward local people face a long period of uncertainty with failing services and an emerging crisis of confidence and leadership.

It’s just like Mid-Staffs

When things go wrong in the NHS it is difficult to find out who is responsible. At Mid-Staffs two enquiries and two massive reports gave us some clues and some recommendations about stopping this happening again. There are close parallels between Mid-Staffs and BHRUT.

In both cases, a major problem was the single minded pursuit of management objectives at the expense of patient care. At Mid-Staffs it was foundation trust status; at BHRUT it is the closure of A&E at King George.

At Mid-Staffs expert opinion from Professor Brian Jarman was disregarded; at BHRUT it is Sir Peter’s and Sir David’s from a management perspective and the evidence from this Blog from an analytical one.

Finally there are the views of the public and local politicians; again comprehensively ignored, just like Mid -Staffs. I am not suggesting the consequences are on a comparable scale but local people have had to endure a dreadful A&E service and Redbridge women have been forced against their wishes to use a sub-standard maternity service at Whipps Cross.

Who is responsible?

Although the NHS reorganisation means that many of the decision making bodies have gone, the NTDA as the controlling successor body is primarily responsible.

But the CCGs and the Urgent Care Board (UCB) although they are in a less controlling role still bear a heavy responsibility for what is happening. Without their support the NTDA could not continue with the closure plan. Surrey Downs CCG in South London has done just that; pulling out of the equivalent plan to downgrade Epsom and St Helier Hospitals.

Finally the CQC, while precipitating the current management crisis, has very little authority to influence plans as such, illustrating the weakness of accountability and regulation in market economies.

What needs to happen?

At the heart of this is the need to scrap the Health4NEL plan. It clearly has not worked, there is overwhelming evidence now that the assumptions underlying it were deeply flawed and continued efforts to implement it have created the present crisis.

Making this decision is primarily the responsibility of the NTDA. Redbridge CCG could take the lead on this, however by following the example of Surrey Downs and withdrawing from the plan. It’s up to them.

Local people need to be involved not pushed to the margins. They are supposed to be at the centre of what the NHS does, but locally their voice has been systematically ignored. The same is true for local politicians. The CCGs and the UCB need to open up and start listening to their views.

In particular there needs to be a critical review of the schemes the UCB has funded this winter and their impact on A&E performance. A central question is why the UCB has not opened up more beds to ease the pressure on A&E. This is what has precipitated the crisis.

Finally there is the issue of ignoring expert advice. There is a sense in some quarters that the NTDA and others are knowingly pushing BHRUT over the edge for whatever reasons. This is a potential charge they should be given an opportunity to answer in a way which makes them publicly accountable.