Our NHS in Crisis

Issue: 98

17 May 2020

The UK Now Has the 4th Highest Covid-19 Death Rate in the World

Deaths/Million of Population

UK: 495

Some countries which are much more densely populated than the UK have much lower Covid-19 deaths/million rates. These include Bangladesh (2), South Korea (5), India (2) and Israel (31). (Source Worldometer, 14 May 2020).

Why has this happened? Who is responsible? Is new leadership now required in the UK?

Covid-19 Care Commissioning/Purchasing/Supply Chaos

Clinical Commissioning Groups, NHS Trusts, NHS England, Local Authorities, care homes and now DHSC/eBay are all purchasing Covid-19 supplies including PPE.

Where is the control? Where is the order? Where is the leadership?

On 1 May 2020, somewhat belatedly, The Department of Health and Social Care (DHSC) apparently wrote to all NHS Trusts stopping them from purchasing supplies. This includes PPE. I’m sure NHS Trusts are not intentionally stupid. They have been buying PPE themselves because the DHSC/NHS England/CCGs were not commissioning/purchasing/supplying PPE!

The latest supply channel is a joint venture between DHSC and the shopping and auction site eBay. The venture is very new and according to ’Health Service Journal – on 6 May 2020 had supplied just 400,000 PPE items to only 1,400 of the 58,000 UK care service suppliers.

Ealing Council Leader Julian Bell is alleged to have announced in a Unite Zoom meeting on 12 May 2020 that Ealing Council had been successful in purchasing PPE for four West London Councils’ ‘local care services’. Following recognition of this, Councillor Bell said the Council would soon be the purchaser of all PPE for all London Councils’ local care services. All this seems quite odd when one considers that the vast proportion of care/nursing homes are privately owned. Shouldn’t the owners of the homes be expected to provide PPE for their staff? Surely the same logic applies to the vast proportion of domiciliary care staff who are employed by private companies – their employers should surely provide them with PPE, not Local Authorities.

On 15 May 2020 ‘The Guardian’ reported on the shambles at the Government’s outsourced PPE depot run by Movianto. Apparently PPE equipment was being stored in a smoke damaged Merseyside warehouse found to contain asbestos. In late March 2020 the Government ordered Movianto to begin distribution of the £500 million PPE stock. However, because of poor management and staff sickness progress was slow, errors were made and as demand grew apparently it became chaotic. The army was called in to sort it out. It didn’t help that during this period the American parent company sold Movianto to a French company. Questions are being asked as to why DHL lost the contract in 2018 and why Movianto, a loss making company for every year since 2010, had managed to win the £10.5 million/year contract.

Local Resilience Forums (LRFs) Claim Government’s Approach to Them for Covid-19 Has Been ‘Top-down, Uncommunicative and Controlling’

There are apparently 42 LRF’s in England and Wales. They have been tasked by Government to respond to Covid-19. A review by Whitehall, revealed in ‘Municipal Journal’, is very critical of the Government. The leaked report cited withholding vital data and intelligence on the progress of Covid-19. Research was carried out by Nottingham Trent University for the C-19 Foresight Working Group – a cross-party Government committee.

Local Resilience Forums – which most people have probably never heard of – were introduced in 2004 in the Civil Contingency Act to provide the means to those involved in preparedness to collaborate at a local level. There is just one LRF in London (serving 9 million residents!) and it’s based at the London Fire Brigade, London SE1.

Will the Government Mishandle Covid-19 Local Testing/Contact Tracing/Isolation/Quarantining?

Sadly this is likely.

Public Health Professor Allyson Pollock at Newcastle University and a member of the King Independent SAGE team has on numerous occasions emphasised that the Covid-19 national epidemic is not homogeneous. It is in fact hundreds or thousands of local Covid-19 outbreaks that are active in this country – all at different stages of ‘diffusion’.

The key to contact-tracing is local knowledge and meticulous research on the ground. This suggests using Local Authority resources, GPs and the myriad of volunteer groups which already exist in all towns and villages throughout England.

Allegedly Government outsourcer Serco has assembled/is assembling 15,000 tracers (Call Centre staff?) and 3,000 clinical support staff (recent NHS retirees?). ‘Health Service Journal’ reported on 13 May 2020 that much of the national test centre data/results were not being shared with GPs and Local Authorities. Will Deloitte who run these national test centres hand this test data to Serco?

Yet another ex-McKinsey & Co employee is joining the fray and in a top position too. Baroness Dido Harding has been appointed leader of the Government’s Covid-19 Test and Trace Taskforce.  Her stint at McKinseys was in the 1980s. However she became notorious for her performance when CEO of TalkTalk for seven years. Her handling of a cyber attack resulted in losses of £60 million, four million customer accounts allegedly hacked, and a loss of 95,000 customers.  Baroness Harding also seems to have kept her role as Chair of NHS Improvement. Maybe with the merger of NHS England and NHS Improvement (NHSI), the NHSI Chair’s role is effectively redundant.

The Government’s (as yet unnamed) contact-tracing App is still on trial on the Isle of Wight. If it ‘fails’ – on ethical or technical grounds – the Apple/Google App, being used in Europe, is waiting in the wings. And, according to ‘The Times’ of 14 May 2020, there are 43 Covid-19 contact tracing Apps in use worldwide.

National Audit Office (NAO) Describes £8.1 Billion NHS IT/Digital Transition Spending as Inadequate and Confused

  • 54% of NHS Trusts reported that their staff could not rely on digital records.

  • NAO recommends spending 5% of the total annual NHS budget on IT/digital transformation. NHS is spending 2%.

  • Interoperability between new and legacy systems, especially with repeated changes in national strategies has created a fragmented environment.

  • NHS management of digital transformation at a national level is confused.

A New Post Covid-19 Healthcare Plan Being Hatched for London

‘Urgent Action: System Plans for London’ is the title of a 29 April 2020 leaked memo to the five London Integrated Care System (ICS) Chairs and Senior Responsible Officers (SROs). The author is Sir David Sloman, NHS London Regional Director.

The memo asked all these bosses to rapidly review their ICS plans in terms of new Cocid-19 challenges and future care strategies. It also asks them to report against 12 expectations contained in a ‘Journey to a New NHS‘ paper along with a set of slides. They had to reply by 11 May 2020. Why the rush one wonders?

The backdrop to all this is multifarious. Firstly in terms of previous plans we have at least the October 2019 ‘London Vision’, the January 2019 national ‘Long Term Plan’, and the November 2017 ‘London Care Devolution’, and the five London regional October 2016 ‘Sustainability & Transformation’ Plans. In terms of statutory significance the ICSs have no legitimacy at all. In fact in at least one London region (NHS North West London) its ICS will not be formally born until 1 April 2021. (In NHS NWL for example, the only statutory legitimacy lies with the eight CCGs. Ealing’s CCG is strangely quiet at the moment. The last we heard from the Collaboration of the 8 CCGS was that all but Hillingdon CCG were ‘partnering’ with other CCGs. No doubt they are all trying to reduce their combined 2018/19 annual ‘employee benefits’ of some £10 million).

A bit more NHS NWL flavour here is also relevant. In May 2019 NHS NWL outlined there would be 8 ‘Place Teams’, 8 ‘Local Committees’ and 8 Integrated Care Parnerships (ICPs). One year on, one wonders what’s happened to plans for them? Or is planning and strategy a London-wide only approach now?

It really does seem an age away in 2013 when NHS bosses were preaching about local commissioning, by local GPs with local knowledge. Their bible then was the 2012 Health & Social Care Act – which ominously is the existing legislation that is being blatantly ignored in spirit and possibly in actuality.   

Now to the content of the memo. A quick glance at the 12 expectations:

  1. How are you going to deal with non-Covid-19 acute elective and non-elective work? In other words how are NHS Trusts going to carry out the jobs they are paid to do?
  2. A consolidation and strengthening of specialist services. Cancer, paediatrics, renal, cardiac and neurosurgery listed. Does this suggest mergers and closures?
  3. Increase web, telephone and video triage. Never mind the quality – it’s cheaper than actually having to travel from home and meet a patient in a clinical ’setting’.
  4. How will you separate emergency Covid-19 from emergency ‘other’. (Given that some emergency other patients are locked into the ‘stay at home’ paradigm and think NHS UCCs and A&E units are awash with the Covid-19 virus).
  5. Develop virtual by default Primary Care and Outpatients. See 3.
  6. Minimise inpatient length of stay and faster Delayed Transfer of Care. See NHS NWL ‘Shaping a Healthier Future’ case study – seven years and £1.3 billion spend made little progress on this minimalisation.
  7. Address health inequalities – see similar unmet aspirations like Climate Emergency and clean drinking water for all the 7.7 billion inhabitants in our world.
  8. Same expectation as in 2.
  9. Merge corporate support services and clinical support services. Cost savings here.
  10. A workforce plan. Good luck with that one. Too few doctors, nurses, consultants, mental health staff at all levels, and too few support staff. Too many commissioners.
  11. A plan to ‘join together’ NHS institutions and Local Authorities. With different business models, goals, budgets, culture, politics and a shared desire not to open up financial books to each other – little progress on this front visible over the last seven years. No mention of ‘Integrated Care Partnerships’.
  12. Public engagement including ‘deliberate’ forums (e.g. NHS NWL 4,000 EPIC hand-picked sounding board – which is an attempt at regularly polling a representative sample of the 2.4 million NWL patients).

Revenue and capital cost estimates were asked for. A three phase implementation over 18 months was proposed. But the NHS never meets its timescale projections. A new bit of jargon emerged – ‘London Vision the Touchstone’…….

The 32 London boroughs commission all London’s social care. However it’s clear from comments heard from the London Borough’s of Ealing and Hammersmith that they have not been asked to comment on these NHS ‘Systems Plans for London’. Yet another painful example of the long running disconnect between healthcare and social care.

A final postscript on NHS London supremo Sir David Sloman. Google can’t find anything about his life prior to 2009. In 2017 he was admonished by the Government’s data protection agency for illegally giving details on 1.6 million patients to Google Deep Mind.

Is the Care/Nursing Home Business Model Broken Beyond Repair?

Most care/nursing homes in England are privately owned. There are 17,000 nursing and residential care homes in England housing 400,000 people (NHS England, 2019). A lot of homes are part of care groups both small (e.g. Abbey Healthcare) and large (e.g. Four Seasons). Some are run by charities (e.g. St David’s, Castlebar Hill, W5). Care is commissioned by Local Authorities (LAs). The homes are regulated by the Care Quality Commission (CQC). Each home has a contract with a local GP practice. Many GP practices are commissioned by NHS England (NHSE). Some GP practices (e.g. the 75 in Ealing) are commissioned by the local Clinical Commissioning Group (CCG). Where local CCGs have been replaced by regional Integrated Care Systems (ICSs) could it be that the succeeding ICS is the commissioner? For over two years now the Department of Health has had social care responsibilities – so the DHSC has overall responsibilities for care/nursing homes. The care/nursing home acronym soup or tangled spaghetti looks like LAs, CQC, GPs, NHSE, CCG, ICS, DHSC.

‘Reuter’s’ data analysis up to 1 May 2020 shows at least 20,000 excess deaths in care homes in England and Wales during the pandemic. Is it any wonder then that when the Covid-19 history books are written one of the most painful chapters will be on unnecessary care/nursing home deaths.

Eric Leach

Silver Voices