Councillor Barrie Taylor has set out Labour’s prescription for the NHS in Westminster North:
“Westminster North is unlike other parts of the NHS in England & Wales. It is an Inner City area with a set of unique demands – which can be summarised as a need for immediate actions to improve acute hospital services (i.e. St Mary’s A&E) as well as needing significant improvements to the infrastructure for integrated social & and healthcare services.
St Mary’s A&E services – our diagnosis
Much of the current state of our local NHS stems from the ‘Shaping a Healthier Future’ plan – as approved by the Secretary of State and covering eight other local authority areas in North West London. Westminster was told this would lead to serious improvements and the saving of lives. But we were misled by NHS England on the question of its implementation. In particular, the rationalisation/closures of other urgent/emergency facilities at Hammersmith, Central Middlesex and the downgrading of facilities at Charing Cross required capital investment to boost the physical infrastructure – especially at St Mary’s.
However, the way NHS England has approved these changes fits the public’s perception of UK government – top down/inadequate and short term – more an afterthought than a progressive move. Capital investment needed at St Mary’s should have been made before the closures took place – rather than waiting until other parts of the NHS estate are sold off sometime in the future.
St Mary’s Hospital figures to meet the 95% 4 hour A&E waiting target are abysmal – for the past couple of months it has been 76.1%. This level of performance was so bad that Hospital Inspectors issued an ‘inadequate’ warning notice at Christmas.
Other (current) weekly figures show:
• 2056 patients attending A&E (up by 25);
• 690 Emergency Admissions (up by 8);
• 414 patients waiting over 4 hours (England average 217);
• No ambulances queuing outside A&E;
• 105 planned operations (England average 10.9);
• 77 beds blocked (up by 19 – England average 150.7)
Labour Councillors argued their case at a recent Council meeting and their performance has since been raised to 83%. But their performance has still not even matched its neighbouring hospitals. Chelsea and Westminster, UCH and Guys hospitals have all achieved performance ratings of over 93%. Although this week’s figure is 79.9% it is not solely the fault of St Mary’s.
The closure / rationalisation of A&Es at Hammersmith, Charing Cross and Central Middlesex was imposed upon them by NHS England and the Secretary of State. The physical infrastructure was not modified before closure took place and we are where we are.
To ameliorate the impact of high levels of A&E attendances, the government introduced a ‘Better Care Fund’ Locally, a plan was approved by NHS England in November 2014 – supported by the Health & Well Being Board proposals to improve Out of Hospital’ care.
Social Workers now attend weekly GP meetings to discuss the avoidance of hospital admission. The local acute hospitals are looking at using intravenous medication in the community – all of which they anticipate will reduce admissions and attendances at A & E departments.
Funding of these schemes amounts to £1.5m in 2015/16. In January Westminster Council also received grant funding from the Department of Health to help reduce pressures on local acute hospitals because of delayed discharges to social care. The money must be used on social care issues to reduce Delayed Transfers of Care (DTOC) from an acute hospital to their own home, or an alternative residential setting.
A prescription for St Mary’s A&E
We are told that the NHS is unable to provide information on the likely value of the former Samaritan Hospital building.
What we know is that the Samaritan Hospital closed in the 1990s and has been in a derelict state for 20-30 years.
What we urgently need now is action to address both the immediate problems associated with A&E attendances and the intermediate infrastructure needs at St Mary’s Hospital.
Labour councillors in Westminster, on behalf of local people, have publicly called for NHS England to make available anticipated capital receipts of its future sale immediately – so that imperial Trust can get on with introducing the necessary physical changes.
Crisis in GP services – our diagnosis
Our GPs are struggling against the odds. In Westminster North our GP services are faced with a dual crisis. It cannot be dealt with locally – as the government decided to abolish health authorities in favour of GPs merely commissioning health services – which does not include planning for the replacement/training of new GPs and their practices.
1. North Westminster is crammed full of smaller, single handed GP practices – many of whom are on the cusp of retirement. And as GPs are small independent businesses the question of land prices also affects their business.
• Prices and land values in Westminster push landlords to obtain much higher rents from GPs.
• GPs nearing retirement are also forced to make a judgement about the massive increase in the value of their property and its implications for their pension / retirement.
We have already lost one practice due to land values and another landlord is seeking to raise the rental value so high that we may yet see another practice being forced to leave.
2. Secondly, all major political parties accept the need to integrate health with social care services. Labour has even made it a plank of its general election promises. Not only is there an urgent need to do so, but an opportunity exists to develop / invest at this time to help integrate the estate for health & social care services.
3. Neither are we convinced by the argument that our GP practices should be dragooned into opening their practice premises for 7 days a weeks. It does not improve the quality of their professional decision making and has not even been shown to be cost effective.
4. Unlike many more rural areas, North Westminster has already developed ‘Walk In’ and ‘Urgent Care Centres’ (such as St Charles) which offer a distinct and complementary 7 day service to those of A&E departments and ambulances (which are obliged to provide 7 x 24hr cover). This attitude/approach towards our GPs could even result in the loss of doctors who didn’t join the service to operate like a supermarket, but to be able to have a family life as well.
5. Existing NHS and social care services are housed in properties that will not be considered fit for purpose for the provision of integrated care in the future.
GPs and integrated services – our prescription
Our duty at this time is to show vision and leadership in tackling the crisis – not by knee jerk reactions, but by using all of the powers at our disposal to propose progressive solutions.
In the absence of a local health authority we need to press NHS England to devise solutions that will attract/replace retiring doctors. We deserve to attract the best of GPs to work in our locality. For instance, women doctors – many of whom have families/children and do not want to become a business partner in a 7 day a week GP practice, but may prefer to work more flexible hours.
Westminster Council already has powers and opportunities to help make this a reality:
• More and more planning applications in WCC are for high quality residential properties – which brings with it the opportunity to use section 106 and Community Infrastructure Levy powers to develop the community infrastructure
• The price of property and land in Westminster has never been so inflated by overseas buyers
• The announcement by the NHS of their 5 year plan used as its vision for the future the Ludwig Guttmann Health And Wellbeing Centre near the Olympic village site in East London
• We should set as our target the development of at least two Health & Wellbeing Centres in Westminster – not only for integrated health and social care services, but a wider brief that accommodates healthier lifestyle activities – including sports and leisure facilities
• We could put to good use of the value of our current public assets owned by health and social care. Not by making one off sales (as with police stations) to reduce ‘deficits’.
• We could also invite developers to help build the necessary infrastructure (with guaranteed rental income) – which has already taken place in other parts of London
To prime this vision for the future health and social care in Westminster, Labour Councillors have already tabled a motion for the City Council to take the lead – inviting NHS England to form a partnership with WCC – with an initial target of setting up a £20m capital fund from joint resources (including s106 & CIL monies) to kick start these critical developments.