The Government’s new Health and Social Care Act has significant implications for the way healthcare in Hillingdon will be administered. To help you gain a better understanding of what to expect over the next few years, the Gazette is putting a series of questions to key NHS players in the borough. To begin, JAMES CRACKNELL talks to Graham Hawkes, chief officer of health scrutiny body Hillingdon Local Involvement Network (Link).
How will the changes to the NHS in the Health and Social Care Act impact on Hillingdon Link?
Hillingdon Link will cease to exist on March 31, 2013 and a new patient champion called Local Healthwatch will start on April 1. This will be supported by Healthwatch England, which is due to be in place in October 2012.
The expectation is that Link will transition into Local Healthwatch, but this is not guaranteed. The full implications will not be apparent until guidance is produced and regulations published. The final decision will not be taken until after a full consultation.
Although this will be our final year as Hillingdon Link, it is not a time for reflection but a time to remain focused on the task ahead.
Do you welcome the changes to the NHS the act makes?
Whether the Governments restructuring plans within the Act are the best way to do it is debatable. The simple solution would have been to put GPs on the primary care trust (PCT) boards and rationalise the PCTs. As it has turned out, this is not far from what has occurred since the bill for the legislation was published.
The PCT has cut staff by two-thirds and GPs will not be fully in charge of commissioning, and are not likely to be. NHS North West London, in the guise of the Commissioning Support Organisation, will be very influential until at least 2016.
The local GPs have their patients needs at heart, but they are being set up to fail. They will not have the commissioning power the bill suggested and will be dictated to by the National Commissioning Board.
Hillingdon PCT is in deficit and is looking to make huge efficiency gains in 2012-13 of about s18million to balance the books. It is likely GPs will inherit a deficit.
This will probably impact on mental health services in particular. Hillingdon already funds mental health at one of the lowest levels in the country.
In 2011-12, Central North West London (CNWL) NHS Foundation Trust was commissioned by Hillingdon PCT to provide mental health services on one of the lowest budgets in north-west London.
In 2012-13, Hillingdon PCT is looking to possibly reduce the budget by nine per cent. Efficiency savings will be another five per cent reduction.
Services are already being affected. The Improving Access to Psychological Therapies (IAPT) service only exists in a fledgling form because it is being subsidised by CNWL and supported by the London Health Programmes. The memory clinic at CNWLs Woodland Centre in Hillingdon has severe budget pressures. This is not good for patients. They are told they may have dementia and then wait 10 months to find out if they have.
North West London NHS and the local Clinical Commissioning Groups (CCGs) are together planning an enormous consultation in June 2012 which will outline plans to possibly transfer hospital services into the community and move, or even close, hospital departments.
Hillingdon Hospital will not be unaffected by these proposed changes and, although we expect the accident and emergency (A&E) department to remain open, it will be the new investment in the urgent care centre at the hospital that should enable them to cope should a neighbouring hospitals A&E close.
Power over the budget in Hillingdon is already being taken away. From April 1, 2012, Hillingdon CCG will join with CCGs from Ealing, Brent and Harrow and form a governing body. The joint meetings of governance boards would be held mostly outside the borough, leading to loss of local accountability.
On a positive note, we welcome the emphasis on the public health agenda and the initiatives for care to be integrated across health and social care. These, if implemented and funded correctly, can only impact positively on peoples health.
How will the Act change the relationship you currently have with patients?
If there is any change in the relationship we have with the patients, we can only really see it as being enhanced under Healthwatch.
The possible additional functions to be carried out and the intention to give Healthwatch a national identity should ensure there is a greater involvement with patients who will require our services.
How do you think the emphasis on competition and choice, and the introduction of GP Commissioning Boards, affect health services in Hillingdon?
Most people do not want a choice, they want their GP to take control and tell them what is needed to make them better. Choice is just frightening.
That does not mean that some people do not want choice and will look to receive the best care from others experiences of organisations. That happens today without the Act.
Choice is more prevalent for those with long term conditions, who have learnt about their illness and have experienced the care.
Whether choice will be as expansive as the Act suggests I doubt, because the budget will not be there. The issue with choice of course is that people choose with their feet. If a service is poor people will choose to not use it.
Although this highlights poor practice it actually affects the old, infirm and impoverished. A poor GP is left with a few highly dependant patients without the funds needed.
Competition can also affect the service provided. Take a service provided by a private company in the community which traditionally is provided by a hospital. The GPs send their patients to the private company because they are cheaper than the hospital. The hospital cannot compete on price because of its setting.
The patients complain that the service of the private provider is not as good as they got at the hospital, but due to cost the GP insists they continue to use the private provider.
Eventually even though is it proved that the hospital service is better, the department has to cut back on staff and is threatened with closure. If this happens to enough departments the fabric of the hospital becomes threatened.
Under competition, more services which are provided in the hospital setting are being tendered for, locally the Ophthalmology Service and the Urgent Care Centre are going out to tender at Hillingdon Hospital.
If this continues, because of over competitive pricing, there is a severe danger the hospital will not be viable.
Why do you think the changes have been implemented now, is this the right time to be restructuring the NHS?
Technically the changes are being implemented now because of the change in government, but the underlying issue for the restructure is that there is not enough money to pay for the NHS in its current form.
It is in fact a victim of its own success. People are living longer, more are being diagnosed with conditions not recognised in previous generations, diagnostic and treatment technology is getting better and new successful, but expensive drugs, are being manufactured.
The current spend is not sustainable.
Your views welcome, as always, at www.uxbridgegazette.co.uk/tellus.