Brent Community and Wellbeing Scrutiny Committee tonight asked Brent Clinical Commissioning Group (CCG) to use its statutory right to ask North West London NHS to reconsider the abolition of overnight hours at Central Middlesex Hospital Urgent Care Centre and to put the issue out to public consultation.
The decision was one of several made after an exhaustive discussion of the North West London NHS Recovery Plan and the proposal to merge the various CCGs in North West London into one 'Super CCG'.
Dawn Butler MP was unable to attend the Committee due to pressing duties in the House of Commons but her speech was read out for her by Cllr Colacicco. Butler said that the Recovery Plan was coded language for cuts in NHS services. She said that the cuts fell disproportionately on the south of Brent affecting the poorest areas in Stonebridge and Harlesden where life expectancy was 13 years lower than in the north of the borough.
When the A& E at Central Middlesex was closed it was on the basis that the Urgent Care Centre at the hospital would be provided on a 24 hour basis. It had now been shut at night with no public consultation. She said that a whistle blower had informed her that this was a 'closure by design' and was part of a plan that could lead to eventual closure of the hospital.
I understand that Dawn Butler and Barry Gardiner MP will meet the CCG tomorrow to discuss their concerns.
Addressing the Committee Cllr Mary Daly refuted claims that the Recovery Plan did not relate to patient care. It aimed to cut referrals to consultants by GPs - 'there was not enough money to treat Brent patients' - by scaring them. GPs would not be allowed to refer patients more than once and if a consultant decided a patient needed to be referred to a consultant in a different discipline the request would first have to go back to the GP. Emergency A&E patients would not be admitted to hospital and patients would have to pay for over the counter medicines themselves.
Cllr Nerva introduced himself as a former non-Executive Director in the NHS and said that as things had developed there was now a lack of democratic accountability in the NHS. The proposal that patients should choose hospitals within The NW London NHS Trust, in order for it to enjoy the 30% in-house cost reduction, would provide an incentive to limit choice. These were toxic cuts and there should have been officer input to the Committee for members to consider.
Cllr Colacicco and Cllr Ann Clarke (Labour, Barnet, Childs Hill ward) both concentrated on the proposed closure of the walk-in Cricklewood Health Centre. Colacicco criticised the consultation for not enabling people to state that they wanted the Centre kept open. Clarke said the Centre had been under threat before, in 2014, and had been saved then. New developments, including that at Brent Cross, meant there would be many new homes in the area in the future and the Centre would be needed. She was also concerned with the suggestion that extended GP hours would increase local capacity when the Centre closed.
Cllr Thomas Stephens proved to be the most incisive and persistent member of the Committee when cross examining NHS and CCG officers. Most questions were fielded by Mark Easton, Accountable Officer for the NHS North West London Collaboration of Clinical Commissioning Groups (the shadow Super CCG), He attributed the financial crisis to population increase, an ageing population, cost increases caused by new treatments with costs going up 18% and population 5%. Units costs were increasing faster than numbers treated. Regulators recognised that the planned deficit could not be wiped out in one year so a three year programme had been introduced.
He said patients would be allowed to go into hospital but that some GPs were not aware of community services that would keep patients out of hospital. The CCG were visiting GPs who may have referred more than 3 times as many patients as other GPs to make them aware of community services.
He said that hospitals inside the NW London NHS area were as good as those outside and had the advantage of being 30% cheaper, although patients could still choose to go outside.
Patients paying for over the counter medicines rather than through prescriptions was already policy and it was just a matter of ensuring compliance by GPs. Eligibility criteria were based on evidence from NICE.
Adherence to the NHS Constitution would ensure that the changes would not affect the quality and safety of health services.
Scrutiny adopted a number of recommendations including that the NHS should ensure that local services were sufficient for the needs of local residents, there should be a full Equality Impact Assessment of proposed changes in referral behaviour, review the impact on Primary Care which is already low quality in comparison with the rest of London, review the impact of changes after the Winter.
Regarding the merger of local CCGs into one NW London body Scrutiny recommended that the CCG guarantee that the new structure will include local government representatives and lay people, before a final decision is made on the super CCG that they should come back to Scrutiny with the full financial implications and assessment of the shadow structure currently in operation, if a single CCG is formed it should more adequately integrate medical and social care.
The decision was one of several made after an exhaustive discussion of the North West London NHS Recovery Plan and the proposal to merge the various CCGs in North West London into one 'Super CCG'.
Dawn Butler MP was unable to attend the Committee due to pressing duties in the House of Commons but her speech was read out for her by Cllr Colacicco. Butler said that the Recovery Plan was coded language for cuts in NHS services. She said that the cuts fell disproportionately on the south of Brent affecting the poorest areas in Stonebridge and Harlesden where life expectancy was 13 years lower than in the north of the borough.
When the A& E at Central Middlesex was closed it was on the basis that the Urgent Care Centre at the hospital would be provided on a 24 hour basis. It had now been shut at night with no public consultation. She said that a whistle blower had informed her that this was a 'closure by design' and was part of a plan that could lead to eventual closure of the hospital.
I understand that Dawn Butler and Barry Gardiner MP will meet the CCG tomorrow to discuss their concerns.
Addressing the Committee Cllr Mary Daly refuted claims that the Recovery Plan did not relate to patient care. It aimed to cut referrals to consultants by GPs - 'there was not enough money to treat Brent patients' - by scaring them. GPs would not be allowed to refer patients more than once and if a consultant decided a patient needed to be referred to a consultant in a different discipline the request would first have to go back to the GP. Emergency A&E patients would not be admitted to hospital and patients would have to pay for over the counter medicines themselves.
Cllr Nerva introduced himself as a former non-Executive Director in the NHS and said that as things had developed there was now a lack of democratic accountability in the NHS. The proposal that patients should choose hospitals within The NW London NHS Trust, in order for it to enjoy the 30% in-house cost reduction, would provide an incentive to limit choice. These were toxic cuts and there should have been officer input to the Committee for members to consider.
Cllr Colacicco and Cllr Ann Clarke (Labour, Barnet, Childs Hill ward) both concentrated on the proposed closure of the walk-in Cricklewood Health Centre. Colacicco criticised the consultation for not enabling people to state that they wanted the Centre kept open. Clarke said the Centre had been under threat before, in 2014, and had been saved then. New developments, including that at Brent Cross, meant there would be many new homes in the area in the future and the Centre would be needed. She was also concerned with the suggestion that extended GP hours would increase local capacity when the Centre closed.
Cllr Thomas Stephens proved to be the most incisive and persistent member of the Committee when cross examining NHS and CCG officers. Most questions were fielded by Mark Easton, Accountable Officer for the NHS North West London Collaboration of Clinical Commissioning Groups (the shadow Super CCG), He attributed the financial crisis to population increase, an ageing population, cost increases caused by new treatments with costs going up 18% and population 5%. Units costs were increasing faster than numbers treated. Regulators recognised that the planned deficit could not be wiped out in one year so a three year programme had been introduced.
He said patients would be allowed to go into hospital but that some GPs were not aware of community services that would keep patients out of hospital. The CCG were visiting GPs who may have referred more than 3 times as many patients as other GPs to make them aware of community services.
He said that hospitals inside the NW London NHS area were as good as those outside and had the advantage of being 30% cheaper, although patients could still choose to go outside.
Patients paying for over the counter medicines rather than through prescriptions was already policy and it was just a matter of ensuring compliance by GPs. Eligibility criteria were based on evidence from NICE.
Adherence to the NHS Constitution would ensure that the changes would not affect the quality and safety of health services.
Scrutiny adopted a number of recommendations including that the NHS should ensure that local services were sufficient for the needs of local residents, there should be a full Equality Impact Assessment of proposed changes in referral behaviour, review the impact on Primary Care which is already low quality in comparison with the rest of London, review the impact of changes after the Winter.
Regarding the merger of local CCGs into one NW London body Scrutiny recommended that the CCG guarantee that the new structure will include local government representatives and lay people, before a final decision is made on the super CCG that they should come back to Scrutiny with the full financial implications and assessment of the shadow structure currently in operation, if a single CCG is formed it should more adequately integrate medical and social care.