Posts Tagged ‘London’

Leadership vacuum threatens care in London

By Mike Broad - 28th December 2011 9:59 am

Health services in London will be operating in a leadership vacuum following the abolition of strategic health authorities by April 2013, a report claims.

Successive reviews of healthcare in London have highlighted the poor health of the population in some areas, variations in the quality of primary care, and inappropriate configuration of hospital services.

The King’s Fund study said the most recent by Lord Ara Darzi started the process of restructuring London’s services only for the coalition government to halt the reforms.

Many of the historical problems remain and report questions who will take a lead in improving health and health care in London with the dismantling of SHAs.

There needs to be much greater clarity of roles and responsibilities within the reformed NHS structure within London to avoid ambiguity and confusion, it says.

The report suggests the particular challenges for London include a worsening in the capital’s financial situation with both providers and commissioners forecasting deficits greater than those in other parts of the country.

Furthermore, very few of the trusts that should be aiming to achieve foundation status by 2014 are likely to be financially viable by that date.

Variations in the quality of both primary and secondary care persist, it says: patients report poor quality care in general practice; health inequalities need to be addressed; reconfiguration of hospital services is needed to save lives.

In the absence of a strategic health authority, there is considerable uncertainty about who will make the difficult decisions about issues that affect the whole of London.

Improving health and health care in London presents an overview of the current financial position and the distribution of activity and resources around the various sectors of London. It assesses the likely impact of the new government’s NHS reforms and concludes with some suggestions of ways to facilitate appropriate service change, improve the quality of care, and improve the health and health outcomes of Londoners.

The report recommends that hospital services are reorganised, with emergency care concentrated in fewer hospitals.

Chris Ham, chief executive of The King’s Fund, said: “London’s NHS is in urgent need of change, but the risk is no-one will be in the driving seat to push through the changes needed to improve patient care. New pan-London health organisations are emerging, but none has a clear mandate to take the lead. Strategic leadership is important across the NHS, but in London it is particularly important as the challenges are more acute and urgent.”

A combination of perspectives is needed to drive forward the required changes, which brings together the NHS Commissioning Board, clinical commissioning groups, health and wellbeing boards and health care providers. But the report warns that this will fail unless it is clear who is responsible for overall pan-London leadership and co-ordination.

Read the report.

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“Support extended consultant delivered services”

By Mike Broad - 21st September 2011 1:58 pm

A leaked NHS London report suggests that over 500 deaths a year in London could be prevented if consultant cover was increased at weekends.

Sir Richard Thompson, president of the Royal College of Physicians, commented on the report in a letter published in The Independent.

Here is that letter in full:

Dear Sir,

Your article ‘Hospital staff shortages cause 500 deaths a year’ shows too few junior doctors are caring for too many patients over night and at the weekend. Patients who are admitted to hospital in the evening and at the weekend risk receiving sub-standard care.

Despite the best efforts of consultants who work above their contracted hours, patients are not getting sufficient input to their care from senior doctors during these periods. The supervision and training of junior doctors is also adversely affected by a lack of senior input during these periods. More doctors are required to provide this high level service.

The Royal College of Physicians believes that there is an urgent need to review workforce patterns in hospitals to ensure that medical in-patients receive direct input from consultant physicians on a seven day a week basis.

We previously issued guidance for physicians caring for very sick patients. Hospitals admitting acutely ill medical patients should have a consultant physician on-site for at least 12 hours per day, seven days per week, at times related to peak admissions. Consultants should have no other duties during this period.

We can begin now by reconfiguring acute services. Concentrating specialist services in centres of excellence will improve standards and help to provide a consultant delivered service.

Furthermore, junior doctors’ contract, the New Deal, and the European Working Time Directive must be renegotiated to provide more local flexibility when designing staff rotas in hospitals.

The RCP calls on the government to take urgent action to ensure that extended consultant delivered services - providing safer care for patients and the opportunity for excellent training of the next generation of doctors - can be achieved.

Yours faithfully

Sir Richard Thompson

President

Royal College of Physicians

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More weekend consultant cover could prevent deaths

BMJ - 9:31 am

Increasing cover by consultants in acute medical and surgical units at weekends could prevent more than 500 deaths a year in London, early findings from a review of acute medicine and emergency general surgery services in the capital have shown.

The electronic survey of the 31 hospital emergency units in London, conducted in March by the strategic health authority NHS London and London Health Programmes, an NHS unit that aims to improve the delivery of healthcare in the capital, found that on-call consultant presence on site is significantly less overnight and at weekends than on weekdays.

Only half of patients admitted as medical emergencies at the weekend were “always” seen by a consultant within 12 hours, compared with three quarters on weekdays.

The draft report Acute Medicine and Emergency General Surgery: Case for Change also shows that in 2009-10 the hospital mortality rate in London was 0.32% higher for patients admitted at the weekend than among patients admitted during the week.

Read more at the BMJ.

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NHS London chief exec resigns over reorganisation

The Guardian - 28th May 2010 9:20 am

The head of the NHS in London, the biggest authority in the health service, has resigned over the government’s decision to halt a wave of hospital reorganisations, becoming the first major casualty in the life of the new coalition administration.

Sir Richard Sykes, chairman of NHS London since 2008, is said to be furious at the scrapping by the health secretary, Andrew Lansley, of the review of healthcare in the capital. The review included possible A&E closures and the possible closure of some maternity units.

In a letter to Lansley, Sykes said it made “no sense” for him to continue, because “our visions of healthcare delivery bear so little in common”. He revealed that other NHS London board members were also “considering their positions”.

Lansley replied saying he was sorry Sykes was leaving, but “neither the government nor NHS London should dictate the decisions made”.

The new secretary of state had made it clear during the election campaign that he regarded Labour’s attempt to reorganise the NHS to cut costs as a flawed exercise. Opponents criticised him for promising in some cases to reverse decisions to shut down services - even when doctors had backed them.

NHS London, which employs 200,000 people, was at the forefront of producing a radical plan aimed at heading off a £5bn deficit in the capital’s health budget. It said London had a higher number of hospital beds than the national average and warned: “The current configuration of hospital services is not making best use of taxpayers’ money.”

Read more at The Guardian.

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London hospitals facing crisis, report says

By Mike Broad - 20th January 2010 4:57 pm

Hospital services in London could close or be down graded as healthcare in the capital heads towards ‘a major financial and organisational crisis’, a report claims.

The BMA-commissioned report, London’s NHS on the brink, predicts real term cuts of £5bn by 2017 in the capital.

London faces unique challenges, the report claims. It has 14.8% of the English population but could suffer a much higher share of the expected cutbacks.

There are more mental health patients per head of population in London than other regions, the capital has rising patient activity and it has more PFI hospital schemes. The repayments for London’s 20 PFI hospital projects will have a lifetime cost of around £16.7bn - more than six times the basic cost of the buildings.

The report highlights proposals NHS London has made public, including reducing the number of people visiting A&E by 60% and hospital outpatients by 55%. Polyclinics, as proposed by Lord Darzi, will fill the gap.

The hospital network will be slimmed down, with the reduction of many district general hospitals to smaller hospitals, leaving a lower number of major acute hospitals. The report also highlights plans to reduce staffing in non-acute services by two thirds, shorten GP appointments and cut payment by results tariffs.

The study also criticises NHS London’s refusal to release a confidential report drawn up by management consultants McKinsey’s on the way a head.

Some reports have however indicated that London PCTs will face a funding gap in the region of £5bn by 2017. The health budget for London in 2009/2010 was £13 billion.

Dr Kevin O’Kane, chairman of the BMA’s London Regional Council, said: “We are calling for full disclosure of the proposals so that there can be a public debate. This is vital so that Londoners can have their say about local cuts and take a wider view of what is happening to the NHS.

“The truth is that most Londoners have no idea of what is happening to their health service. If people realised that we are heading towards financial meltdown involving cuts in bed numbers and hospitals closing or being down-graded, they would demand the opportunity to make their voices heard about these plans.”

A spokesman for NHS London said change was being driven by population growth and health inflation, with the downturn making it more urgent.

He said: “Healthcare for London will deliver an even better quality NHS for less money. Patients told us they wanted a more convenient and accessible health service. This meant localising services where possible and centralising where necessary.

“We already have the first of more than a hundred polyclinics open longer hours than traditional GP surgeries, providing care normally only available in hospital. We are also creating new world class specialist centres for stroke and major trauma which will save 500 lives a year. No change will lead to the death of the NHS in London by a thousand cuts.”

Read the full report.

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