Tuesday, 14 September 2010

Public representations for the Council’s September 16th Health Housing and Adult Services Overview and Scrutiny Committee NHS

1. It is to be hoped that substantial progress will be reported on the end state of Hounslow and Richmond Community Healthcare under agenda item 9.

NHS London will however be concluding its review of HRCH by this September. In the event of the SHA vetoing its continuation as a ‘standalone’ agency, will the Committee please confirm that full and formal consultations will be held - either on the PCT’s initiative or at the Committee’s request - on the range of alternative options? These should include the social enterprise model adopted by Kingston.

2. It is good to see, agenda item 11, the importance Whitehall and the NHS pays to individual PCTs and their corresponding Overview and Scrutiny Committees, by ‘pre-consulting’ the latter on changes in Children’s Heart Surgery Services. For these particular services a regional or London-wide scrutiny arrangement might seem appropriate, but for maternity services, now being considered by SW London NHS, does not the Committee agree that scrutiny should be undertaken by each of the six OSCs in the sector, even if their responses are routed through a Joint SWL OSC?

2.1 According to DH policy guidance of 2003 the duty of SHAs and PCTs to consult patients and the public is not confined to occasions when a ‘substantial variation’ of services are proposed (see top of page 55). The duty also applies in ‘developing and considering proposals for changes in the way those services are provided.’ Does this policy guidance still hold good?
3. In its comprehensive annual report, agenda item 10, the Safeguarding Adults Partnership Board identifies priorities for 2010-11. ‘Embedding the performance framework and ‘good practice’ is included in the second of these priorities, but the sixth draws attention to a major concern, the need ‘to respond to high levels of staff and role change.’ If staff turnover is considered by the Partnership Board to be a priority concern, why does its Report make no mention of a much more serious concern, the high level of vacancy rates for social workers in Richmond - at 35.6%, the second highest in the country and more than double the average for London, as reported last month in ‘Community Care’ and the local press? If the Partnership Board is reluctant to draw attention to this lamentable state of affairs, the Council’s Committee, overviewing and scrutinising adult services, can not afford to do likewise. Can an explanation please be provided for the present situation and how it will be remedied?




Francis King

Monday, 2 August 2010

Public questions for the July 27th PCT Board

Dear Chairman
Public questions for the July 27th PCT Board

1. The agenda for the July 27th Board of NHS Richmond includes its ‘Integrated Governance Annual Report 2009/10’, dated July 16th, i.e. after the White Paper. The Report’s chapter on ‘Practice-based Commissioning Prescribing’ (top of page 31) carries a remarkable and most welcome statement that “this will now mature as NHS Richmond begins to establish itself as a World Class Commissioner.” And so say all of us! NHS Richmond, it's PCT – and its team from the Board down – is one of Richmond’s success stories. Now is not the time to give such a long-experienced team the go-by.

1.1 Contrary to this week’s Richmond & Twickenham Times – with its inaccurate reports on “hospitals moving out of the NHS” and on the “PCT, NHS Richmond, ceasing to exist by April 2013” (wrongly ‘confirmed’ by the PCT’s spokesman) – the White Paper says something very different. It only “expects PCTs will cease to exist from 2013” and then only when “GPs have been successfully established.”

1.2 Moreover, the Coalition Government is adamant that “Implementation will happen from bottom up.” If Richmond has better ideas on how the NHS might develop, then so be it!

1.3 Does the PCT Board – and its partners – not agree that the basic question it faces is this? How should NHS Richmond evolve from its present PCT status to achieve the principal objectives of the White Paper? Evolution, not abolition has to be the order of the day for the restructuring process now underway. Increasingly NHS Richmond should regard itself as an embryonic GP consortium in the making.

1.4 Putting GPs in the driving seat has to be commended. No clinician (or statutory officer) has a more direct, wider and more balanced understanding of the health needs of patients. Many will be reluctant but there are enough GPs in Richmond’s 31 practices able and willing to undertake and develop this role. GPs are well aware that the PCT has all the budget-balancing and other decision-taking skills that their consortium will need.
1.5 The Government’s ‘deficit and mounting debt’ has to be the main problem and doubts clearly exist within Whitehall that PCTs, including NHS Richmond, are too closely associated with the profligate bureaucracy of recent years to be entrusted with the “45% saving of managerial costs required in the next 4 years.” It would be up to NHS Richmond, old and new, to prove the doubters wrong, or does its top team, with its record of success in assiduously following Whitehall dictates, want to end their days on a note of failure and resignation?

2. The “End State Process and Timelines” of Hounslow and Richmond Healthcare, HRHC, is featured in Agenda L. Despite misgivings, it is to be hoped that HRHC is “given the go-ahead to pursue the standalone option”, para 3.3.

2..1 If, however, the review does not support this option, then formal consultations will be necessary that include consideration of the social enterprise model adopted by Kingston. Would the Board please confirm that in the event of a standalone veto from the SHA, it would be its intention to hold such consultations? A repetition of the NHS inadequacies on consultation, covered in the May 25th minutes, is in nobody’s interest.
3. It is of note and concern that, to date, the PCT’s governance department has been unable to confirm the correct date when the Board decided to ‘delegate’ its key strategic functions to the Joint PCT of SW London.

I hope to be able to attend the meeting.
Yours sincerely



Francis King

Friday, 25 June 2010

Letter to the Health Overview and Scrutiny Committee

Dear Councillor Jones

1. Agenda Item 7 of your June 29th Health OSC claims that the “Cabinet and PCT Board have agreed the guiding principles for our joint work” on borough-based commissioning.
According, however, to the June 16th agenda papers of SW London’s Joint PCT, NHS Richmond has already “delegated” its key strategic functions to this body, which is claiming the specific authority to “approve strategic and operating plans for the sector, incorporating sector priorities including services, finance, workforce etc”.

It is too early to ask whether this Joint PCT has approved Richmond’s plans and principles, but why should it have to do so? Why can’t NHS Richmond speak for the NHS in our borough?

The reason seems to be an NHS directive issued in September ’09 called the Whole System Development Programme, ostensibly and publicly to review A&E services in the sector’s hospitals, but in fact to cover “all community and primary activity”, including “Polysystems Out of Hospital Care, Community Services, social care, Mental Health.”

A SW London sector approach to A&E services through its Acute Commissioning Unit is understandable, but it is inappropriate for community health and social care services, and adds to what the last administration called the “democratic deficit.” Your Health OSC is asked to make its position clear to NHS Richmond on this issue, as it did on its abortive meeting of June 14th.
2. Kingston is successfully progressing with its Social Enterprise for community health services with completion date expected in August. Can Richmond receive an NHS report on Kingston’s expectations with this initiative?

3. I was sorry to see, in this first meeting of the new Health OSC, there was no agenda item for public participation. I hope to be present.

Yours sincerely



Francis King

Friday, 4 June 2010

NHS London and Strategic Health Authority Resignation

The Editor, Richmond & Twickenham Times

You reported last week on the resignation of Sir Richard Sykes, Chairman of NHS London, its Strategic Health Authority, “following a change of Government policy” – and the effect this is likely to have on the clinical review now being undertaken on the A&E and maternity services at Kingston Hospital.

But this major change, announced by Health Secretary, Andrew Lansley in the May 21st Telegraph, applies to community health services just as much as it does to hospital services.

The Health Secretary has ordained a “halt on the current process” and “a complete change in the way we (the NHS) deal with these issues, (such as) closures and reconfigurations” – so as to allow, among other criteria “genuine engagement with the public, patients and local authorities”.

It therefore has to be considered that the “externalisation” of Hounslow and Richmond Community Healthcare, and its “alignment” with some remote hospital or mental health trust, is one of those current processes on which a halt has to be called – and that this will be made clear at the Stakeholder Event” NHS Richmond has planned for June 7th.

It is also to be hoped that Sir Richard’s will be the last of the NHS resignations arising from this change of Government policy and practice.

Yours sincerely

Francis King

Monday, 15 March 2010

Ongoing campaign for local hospitals

This letter appeared in Richmond and Twickenham Times on Frday, 12th March 2010.

Dear Sir,

The confusion created by your coverage last week on Kingston Hospital has made bad matters worse, and just at a time when greater clarification was expected and required from our PCT, NHS Richmond.

Requests under the Freedom of Information Act have been turned down on the pretext, you report, that they were “too wide in their scope”. But a simple question has also been lodged with NHS Richmond calling for the full brief to be made public, to which the ‘Clinical Strategy Group’ set up by the joint PCTs of SW London has been working. The continued refusal to answer this simple question - who has told the clinical group to do what, by when? - does NHS Richmond no credit, with its duty to share basic information “at an early stage in the policy development process”

The Clinical Strategy Group may have its importance but it can only make recommendations. In no way can it usurp the authority of the Joint PCTs to whom it reports. Nor, contrary to the statement of one of its three joint directors, Dr Freeman, can it “rule out” options, such as keeping all four hospitals, including Kingston, “open round the clock”. Nor will it be producing the final options for consultation with the public.

Further, Dr Freeman goes on to say that a major reason for changes is that the NHS in SW London is “tired and jaded”. Poppycock! If that is how the Board of NHS Richmond regards itself and sets out to win the essential support of its partners and patients, then I’m a double dutchman (if you’ll pardon my French).

The NHS should borrow a leaf from the military. Generals have good cause to query their lords and masters for being “disingenuous..... and not telling the truth”, and they do so publicly. They do not call their troops “tired and jaded”.

Of all the many problems, a major one concerns SW London’s Mental Health Trust, just as much as its four A and E hospitals. What changes can the five PCTs make in their commissioning systems that would enable these key health providers to plan with confidence their statutory duty to break even? Professor Darzi dodged this problem in his clinical report on ‘Healthcare for London’. If the NHS and its London Strategic Health Authority continue to dodge, then it’s up to SW London and its Joint PCTs, led by NHS Richmond, to come up with a solution.

Yours sincerely,


Francis King

Monday, 22 February 2010

The Debate on Kingston Hospital

Britain is skint! That was, recently, the forceful reminder of Marks and Sparks’ top performer, Sir Michael Rose! Ireland with a 12% budget deficit - the same as Britain’s - is cutting back public sector pay by 5% for the lowest paid, rising to 20% for the Prime Minister. That sets the scale of the problem. Repeating this year’s Government borrowing of £3,000 per head - for future generations to repay - does not! Nor can the NHS be excused from sharing in the need for more effective use of constrained resources.

While, therefore, every support has to be offered the “Big Health Debate” announced by NHS Richmond at its January Board, the future is not set fair. Too much is being reviewed too precipitately made worse by Whitehall calling this initiative “world-class commissioning.”

The news (R and T Feb 12) on Kingston Hospital and the possible closure of its accident and emergency (A&E) services and of its maternity services, shows NHS planning at its worst. Enormous resources have been concentrated on turning it into a Foundation Trust A&E Hospital only for the whole enterprise now to be questioned.

Leaked documents are no way to start the Big Health Debate, but they can be helpful. Too much consequence has and is being applied to the “clinical strategy group” that has no authority to “rule out” certain options unless it has been instructed to do so. Was it so instructed, and if so, by the SHA or by the joint PCTs of SW London? The full brief to which this group has been working can and must be made public.

Kingston is one of three hospitals in the SW London sector that provide a “midwife-led and a doctor-led unit on the same site”, the lead priority for mothers. Maternity services with a consultant present is no doubt desirable, but to plan for such care “around the clock” - or for 168 hours per week when current performance is less than 98 hours - is clearly not realistic, given the financial constraints.

As with maternity services, so elsewhere. All credit must be given the clinical group for starting off the process, but NHS Richmond’s full review of the options must be more cost-conscious, more patient-centred and with a more balanced perspective from its clinicians. Let Richmond get one polysystem up and running and see the saving effect this has on hospital costs before more extravagant measures are considered.

NHS Richmond has many strengths, not least its consistency in keeping within budget; but is not this strength, in its commissioning, only won at the expense of budget weakness amongst its NHS providers - a question that was glaringly omitted from Professor Darzi’s “Healthcare for London”. In its January agenda, the PCT divided its £210.8m budget into commissioning, £149.8m secondary and £40.9m primary, leaving £20m for what it calls “corporate”. Only a minor portion of this £20m is for front line services; the review needs to give it greater attention.

Another of Richmond’s strengths is its strength as a team led by chair Sian Bates, fully recognised in her role as chairwoman of NHS SW London. No one is more experienced in reconciling - with the support of her non-executive directors - health needs as perceived locally with strategic policies laid down by the Health Secretary.

Sadly, however this local perspective is not voiced strongly enough, aggravated by the Council finding it “inappropriate to question national considerations.’ If the statutory won’t, then the voluntary sector must, that all are agreed is an “essential component in a democratic society” (Compact). If NHS Richmond calls on numerous and costly management consultants to clarify its intentions then there is a strong case for its local partners to do likewise - by the CVS, for instance, commissioning Lord Crisp, the former Chief Executive of the NHS, to provide his far more pertinent advice at comparatively minimal cost.

Yours sincerely

Francis King

Monday, 15 February 2010

Letter to Richmond & Twickenham Times on Quality Care Commission

26 January 2010


Dear Sir

All Richmond’s social care and health providers, statutory as well as voluntary, have to be registered with the Care Quality Commission by April 2010 - under the Health and Social Care Act 2008. Now a draft statutory instrument is ‘going through Parliament’ - or so the Primary Care Trust informs us in its Jan 19th Board agenda over 500 pages long - setting out 23 regulations in 259 pages, sub-divided into more than 40 outcomes (with ‘personal care’ heading the list).

This is micro-management run mad. Worse it is a legal requirement to register - and presumably to comply with the standards laid down - and failure to do so can result in an ‘unlimited fine or 12 months of prison.’ What is wrong with treating these standards as a ‘highway code’ rather than as a legal obligation, a gift to ambulance-chasing lawyers?

All is not lost however. Any statutory instrument can be halted in its tracks by Parliament - by MPs in significant numbers formally registering their objection - when matters are postponed for a later debate.

Vincent Cable, Twickenham’s MP, has already been urged to lodge such an objection - and it may have to be by the deadline date of this Friday (according to the Commons Information Office). For all his many qualities Vince calls himself a ‘parliamentary eunuch.’ Now he has the chance to demonstrate another of his claims, that he is a champion of ‘localisation’ - to which might be added democracy!

But a further question needs to be raised. The PCT has been helpful but how does the Council and its majority political party raise major issues such as these through its two MPs? Does it ever, and if so when? A similar question can be posed with the opposition party: after all they are Richmond’s MPs, representing all of us. And what about the voluntary sector - the CVS, LINk and its Key Strategic Organisations (such as CORLD), Council-funded so that it can speak with a stronger voice? These are interesting times, an election is not far off.

Yours faithfully

Francis King

East Twickenham