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Independent Healthcare Commission – a Brent view

By Cllr Krupesh Hirani, Cabinet Member for Adults, Health and Wellbeing

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is important to also note that our concerns are not solely focused on A&E. One of the main issues here in Brent is the outdated population estimates underpinning the original plans.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.

Written by Cllr Krupesh Hirani