IN October 2012 Enfield Council engaged the services of Hygeian Consulting, a specialist healthcare consultancy, to support its scrutiny of the implementation of the BEH (Barnet, Enfield and Haringey) Strategy.
Central to it was the shutting down of major services currently provided at Chase Farm Hospital and their replacement with increased primary care.
The main focus of the ‘strategy’ was on accident & emergency and maternity services and the development of services in primary care.
The Hygeian report notes a lack of information about this replacement.
It says ‘A full description of healthcare provision in 2007/08 when the BEH Strategy was ratified has been constrained by the lack of data on activity in A&E, maternity and primary care.
‘24 hour A&E services were provided at each of the three hospitals – Barnet, Chase Farm and NMUH’ (North Middlesex University Hospital).’
The report noted the huge demand for these services.
‘All three hospitals provided antenatal, postnatal and in-patient consultant-led maternity services, with midwifery-led units at Chase Farm Hospital and Edgware Hospital.
‘Primary care in Enfield was served by a total of 62 GP practices with (on average) a higher than recommended list size per professional.
‘A high proportion of practices operated from premises which required up-dating (66% according to Enfield Council).
‘The average list size per Primary Care Practitioner (GPs and nurses with extended skills) was 1,923, higher than the 1,800 recommended by the RCGP (Royal College of General Practitioners) .
‘A target GP list size of 1,500 was set out in Enfield PCT’s “Care Closer to Home Investment Plan 2008 to 2013” published in June 2007.
‘The forecast growth in Enfield’s population at the time of the BEH Strategy was 1% for the ten years from 283,000 in 2005/06 to 286,000 by 2015/16.
‘This forecast was soon overturned by actual growth to an estimated 296,000 in 2011, with a revised forecast by the NHS of 303,000 by 2021. Recent figures from the Office for National Statistics (ONS) (including Census figures) highlight an even higher baseline population of 313,935 for 2011 and a significant growth over the next ten years to 365,589 by 2021.
‘We are also advised that changes in the qualification for housing benefits will continue to drive a population shift from inner to outer London, bringing a younger, mobile population to Enfield.’
The patient demand is set to enormously increase at a time when facilities are to be closed.
The report assessed the ‘progress’ made in carrying out the ‘improvements’ – ie the replacement of the closed A&E, Maternity and Paediatric facilities.
It found: ‘The NHS remains aligned to or has completed work on 11 of the IRP’s (Independent Reconfiguration Panel) 16 conclusions and recommendations.
‘Work on the remaining 5 is underway, and is largely expected to be completed in line with the timetable for service changes in November 2013. (when the A&E and Maternity are to be shut. News Line)
‘The areas for most concern are the improvements in primary care (IRP recommendation 9) and transport (IRP recommendation 12).
‘With regard to the changes in hospital services, the evidence available demonstrates that progress has been made to prepare for the implementation of the strategy, with all of the capital developments expected to be completed on schedule.
‘Measures implemented since 2008 designed to stem the flow of patients to the A&E departments include increasing capacity in general practice, improved utilisation of available capacity in general practice and demand management.
‘Total attendances have grown by less than 2% overall, with a small reduction in attendances at Chase Farm balanced by small increases at Barnet and North Middlesex. [Source: NCL provided data November 2012].
‘However, with regard to maternity services, the NHS has yet to confirm that the planned capacity at Barnet and North Middlesex is for 13,000 births and that this will be sufficient for the needs of the significantly increased population.
‘Although there has been positive progress in respect of hospital services, and the planned developments in urgent care services have largely already been delivered, further work is required to deliver the planned improvements in primary care where progress is patchy and there are “on-going issues arising from previous failed primary care premises strategies”. [Source: “Transforming the primary care landscape in North Central London, July 2012].
‘Progress on the four new primary care centres has been slower than originally anticipated, and the contract for the Ordnance Road development had not been signed at the time of the review.
‘Many of the smaller GP practices remain in sub-standard premises, and consequently the primary care scene in Enfield as described by NCL “seems to be the most underdeveloped in North Central London”. . . .
‘No evidence has been provided to demonstrate an increase in the number of GPs and PCPs (Primary Care Practioners), a reduction in average list sizes or an increase in the number of appointment slots in primary care.’
In addition to current plans, several other risks that must be considered are:
‘Given that the service transfers will take place a few weeks ahead of seasonal winter pressures, the preparedness and resilience of primary care, urgent and emergency care and the London Ambulance Service must be tested to identify risks, associated mitigation and develop business continuity plans.
‘Due to recent material changes at Board level in both Trusts and the wider organisational changes within the NHS on 1st April 2013, working relationships between the Council and the NHS could be impacted and “corporate memory” within the NHS could be reduced even further.
‘The potential impact in terms of possible further service changes arising from the proposed merger of BCFHT with the Royal Free NHS Foundation Trust.
The report continues: ‘The developments in both primary and secondary care that need to be in place before the changes to service provision take place at Chase Farm are embedded in the BEH Strategy Integrated Implementation Plan (November 2012) and can be summarised as:
‘Completion of capital developments at Barnet Hospital, Chase Farm Hospital and NMUH.
‘Implementation of process improvements planned for the urgent care centres at Chase Farm Hospital and NMUH to underpin the move from a triage based service to “see and treat”.
‘Full implementation of the Transport Working Group’s work programme including processes and systems for joint working and communication between Barnet, Chase Farm and North Middlesex hospitals to ensure people are able to access the right service, first time.
‘Continued work with the London Ambulance Service to design and implement safe and efficient transfer protocols and service developments that support primary care services to manage more patients within community and primary care settings.
‘The community midwifery and primary care services models need to be settled by early spring to ensure women are clear about their choices and where they can choose to deliver in advance of the service changes in November 2013.
‘Mental health pathways need to be reviewed to assure safe services once the Chase Farm 24-hour A&E is removed and with it a formal “place of safety” regularly used by people with mental health conditions who can’t access immediate support from the mental health services located on the Chase Farm site.
‘Further premises development and improvement plans are to be implemented – with four new premises being available during 2014/15: Southgate, Ordnance Road, Moorfields Road and Highmead.
‘Full realisation of additional primary care appointment slots has still to be achieved, to provide additional capacity.
‘Delivery of the full impact of the four new GP posts is to be achieved to demonstrate a reduction in list sizes.
‘The latest information available confirms 85% extended hours coverage across Enfield.
‘Although no target was given, the Abridged Pre-consultation Business Case infers 100%.’
The report concludes: ‘The NHS remains aligned to or has completed work on 11 of the recommendations made by the IRP in 2008. However, the NHS has failed to provide evidence to confirm the extent of progress made in two key aspects of primary care: the number of GPs and PCPs, and the number of available appointments.
‘Further progress is required before the proposed service changes can be made.
‘The NHS needs to provide the appropriate empirical data to reassure the Council and public that the pre-requisite underpinning investments in primary care in particular have been made and are proving effective.’
The report quotes Hygeian researchers saying that NHS North Central London ‘stated in a clarifiation letter dated 21 January 2013 that “there are no assumptions from the implementation of the acute changes in the BEH clinical strategy that there will be an activity shift from acute to primary care”.’
The report states: ‘This is a clear change in the assumptions in the original plans.’
The cat has been let out of the bag. The A&E and Maternity Departments are to be closed with no primary care ‘replacements’, however inadequate, at all!
Already the demand for healthcare is far outstripping supply.
The closure of the A&E and the Maternity departments at Chase Farm will create a massive health care disaster.
The North East London Council of Action is 100 per cent correct in insisting that Chase Farm Hospital must be kept open through occupation backed by strike action to remove the government, and bring in a workers government.
The Council of Action has called for a massive demonstration to the hospital on October 26, a week before the proposed closure. There is now massive support in the area for this march.
This is the only way to defend the lives and health of millions of working class and middle class families throughout the UK, where at least 60 District General Hospital closures are planned.
