"I passionately feel that the average person should have a voice in the healthcare service"

 

Dr Onkar Sahota is the London Assembly member for Ealing and Hillingdon. He has also been a practising GP for more than 20 years, making him uniquely placed to comment on the effects of coalition policy on the health service. He says that he went into politics because his time spent ‘on the front line’ showed him how important the running of the NHS is to people’s lives.

Left Foot Forward writer Ruby Stockham met Onkar at his City Hall office to talk about London’s growing population, the NHS, and Boris’ lack of action.

On GP waiting times

RS: Why does it take so long to get a GP appointment at the moment?

OS: GP access is very difficult for two reasons. One is that we have a growing population, particularly in London, and secondly we have a shortage of GPs. Work is being shifted out of hospitals into the community without investment in the infrastructure and increase in clinical staff. The system is overheating.

There is also an element whereby people think that they should see their GP for all their ailments. We talk about an extended primary care team being, for example seeing the pharmacist for advice, but the public perceives them as provider of medicines and not as providers of clinical care. My experience is that people do not go to the pharmacist even for minor illnesses and prefer to see the GP. The pharmacist are also reluctant to take responsibility for diagnosing conditions.

RS: Labour changed the GP contract when it was in government. Does that have anything to do with it?

OS: Absolutely not. And that’s not just my opinion – this is the opinion of independent assessors. Let’s not forget that the changes to the GP contract were in 2008, and the crisis we’re seeing in GP access is since 2012. It is also worth remembering that the very GPs who are working in their practises are the ones who are working in the Out of Hour GP Services, Urgent Care Centres and at weekends. We limit the number of hours a coach driver can drive for, or a pilot can fly; it makes sense that our GPs are not expected to work all hours.

On the Health and Social Care Act

RS: What is the main way that you see the Health and Social Care Act affecting your job on a daily basis?

OS: One word that comes to my mind is fragmentation. I saw a patient on Monday who had had a knee procedure…this procedure was done in hospital and the care package should conclude with physiotherapy. So the consultant did a referral to the physiotherapy department, but a month later the patient had no appointment from the hospital, and she found out the referral had not been received by them.

So she came to see me..and my problem is that I can’t make a referral from the community into the hospital physiotherapy service. Hospital physiotherapy is available only through the hospital consultants. I cannot make the referral to the community physiotherapy service as that care package for this patient should have been provided by the hospital (as they will have been paid for it). This patient’s care has been fragmented by contract boundaries, as far as the patient is concerned she needs the treatment and she has paid her taxes for the NHS. I can understand why patients are frustrated.

RS: But how do we move forward now? Would reversing the Act not amount to another restructuring?

OS: If you’re doing a bad job should you carry on doing it? The answer is no. I think we should stop and think about how we can repair the system without totally dismantling it.

I, and most doctors, went into medicine to care for patients and make them better. GPs have had Commissioning thrust upon them and they are not the experts in this area. GPs didn’t go into a career in medicine to sit across tables and negotiate commissioning contracts.

On hospital closures

RS: What problems will we be facing if the government’s planned hospital closures go through?

OS: Let us take the example of north-west London where I practice. There are nine A&E departments and the Government wants to close four of them: Ealing, Northwick Park, Hammersmith and Charing Cross. This is an experiment too far, an experiment with human lives. Experiment is maybe the wrong word, because this government doesn’t want to know what the results are – it is driven by ideology. [North-west London] is an area with a growing population, and we are reducing capacity!

On TfL’s role

OS: They want to close Ealing Maternity Unit, I think around June this year. Here is a borough that has an increasing birthrate, and patients are more happy with Ealing than they are with Northwick Park (which is performing worse than Ealing) and yet they want to put even more pressure on Northwick Park.

This will put a journey of one hour and forty minutes on expectant mothers. The other thing I realised is that when they’re looking at travel plans, no one talks to TfL about them. I heard whilst sitting on the Transport Committee, that TfL was not consulted on the travel times quoted in consultations for A&E Closures. Where do they did their travel times from ? Did they just pull them out of the air ?

On competition

OS: We need to protect the NHS from competition. In Britain we have taken the view, quite rightly, that looking after the health of one’s citizens is responsibility of the government.

In countries where there are number of health providers, like America, use of competition to drive up quality is understandable. The patients will then choose from which provider to purchase their healthcare from. In the UK, there is only one provider, the NHS. We need to drive quality of healthcare through benchmarking and regulating for good practice. Competition is not the appropriate tool to use in this country. I want every GP Practice, every Hospital Trust and every Community Trust to be giving the best care as there is only one choice for the patients.

On Boris Johnson

RS: What do you think the biggest challenge facing the next London mayor will be?

OS: The biggest challenge will be housing. If we don’t start doing something about it now, we’ll have a whole generation lost without housing. Most of the houses that have been built by this mayor have been built for the overseas investors. The second is the growing population – we need to make sure our health and transport systems can cope. We need to create jobs and a City that fulfils the aspirations of its citizens.

RS: Will Boris leave any positive legacy?

OS: Well the question is, what has he started? What has he done? Everything that has happened was started by previous Mayors: the Olympic Games, Crossrail, the Bike Hire scheme. The only thing he’s done was put up a cable car ride! So I am at a loss [as to what] his legacy will be.

On GP salaries

OS: On one hand, the GP Principal is an independent contractor – acting as a small shopkeeper. Not being on a fixed salary needs to maximise on the profits from the practice. One the other hand, people are expecting GPs to deliver additional services and increase services which they feel are not adequately funded. There is an unhealthy tension in the system. The obvious thing is to develop a Salaried GP career service in the NHS.

When I started practising in 1989 about 10 per cent of doctors were salaried. Now in London it’s 55 per cent. Increasingly doctors don’t want the responsibility of becoming partners in a practice, they just want to look after the patients. Providing NHS GP Services through a salaried GP career pathway, would be good for the patients, good for the NHS and good for the profession, who are already increasingly choosing to be salaried.

Ruby Stockham is a staff writer at Left Foot Forward. Follow her on Twitter

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North West London NHS Healthcare responds to Dr Onkar Sahota 02/03/2015:

I was concerned to read the Left Foot Forward interview with Dr Onkar Sahota which contained a number of inaccuracies about the future of healthcare services in North West London.

Doctors and healthcare professionals have come together with patient groups and community representatives to develop an integrated approach to improving healthcare for the two million people who live in North West London. Through the ‘Shaping a Healthier Future’ (SaHF) programme, healthcare services in this part of London will become more localised, with more consultant-led care that will help address a number of demographic pressures, such as our growing and ageing population.

It is important that people are not misled about the changes to healthcare services in North West London, and the benefits it will bring. As such, I felt compelled to respond to some of the most concerning and inaccurate statements made by Dr Sahota.

Dr Sahota said:

• “There are nine A&E departments (in North West London) and the Government wants to close four of them: Ealing, Northwick Park, Hammersmith and Charing Cross.”

Some services in some hospitals are changing but no hospital sites are closing. In fact, not only will A&E departments remain at both Charing Cross and Ealing but both sites are being rebuilt with modern, new £80m premises.

He said:

• “This is an experiment too far, an experiment with human lives. Experiment is maybe the wrong word, because this government doesn’t want to know what the results are – it is driven by ideology. [North-west London] is an area with a growing population, and we are reducing capacity!”

The SaHF programme has been developed by clinicians, with the involvement of patient groups and community representatives, on the back of clear evidence-based, tried-and-tested changes and improvements. The programme will lead to more consultant-led care and other improvements such as better midwife-to-birth ratios.

Regarding maternity plans, Dr Sahota said:

• “This will put a journey of one hour and forty minutes on expectant mothers. The other thing I realised is that when they’re looking at travel plans, no one talks to TfL about them. I heard whilst sitting on the Transport Committee, that TfL was not consulted on the travel times quoted in consultations for A&E Closures. Where do they get their travel times from? Did they just pull them out of the air?”

No. We worked very closely with Transport for London (TfL) and the Transport Advisory Group (TAG) throughout the development of the SaHF programme, which includes plans to consolidate maternity services on six sites in North West London and cease maternity deliveries at Ealing Hospital. These plans were subject to public consultation and a review by the Independent Reconfiguration Panel (IRP), who supported the proposals. The proposed changes to maternity services will lead to a number of benefits, including:

• The six sites will all have upgraded facilities and a choice of midwife-led or consultant-led deliveries.
• Antenatal and postnatal care will continue to be delivered locally (including at Ealing Hospital).
• The new model will deliver more consultant-led care overall.
• It will help improve the midwife to birth ratio.
• It will involve an increased investment in the home birth team and more community midwives
• And neonatal services will expand on all six sites.

I hope this helps set the record straight.

Dr Mark Spencer

Deputy regional medical director, NHS England (London)

Clinical Lead, Shaping a Healthier Future

GP at Hillcrest Surgery, W3

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A local campaigner responds to the above 06/03/2015

To paraphrase Dr Spencer, I was concerned to read his response, which contained a number of inaccuracies about the future of healthcare services in North West London.

Dr Spencer was perhaps misquoted as replying:

‘Dr Sahota said:

• “There are nine A&E departments (in North West London) and the Government wants to close four of them: Ealing, Northwick Park, Hammersmith and Charing Cross.”

Some services in some hospitals are changing but no hospital sites are closing. In fact, not only will A&E departments remain at both Charing Cross and Ealing but both sites are being rebuilt with modern, new £80m premises.’

Dr Sahota did not say that any hospital sites were closing;  that would have been untrue.  He said that 4 A&Es were closing;  that is true.

Restructured A&E departments at Charing Cross and Ealing will not be A&E departments in the sense that any sane person would recognise – Dr Spencer himself called them ’emergency centres’ with no Consultants and no blue lights.  (Evening Standard, 24 November 2014: ‘A&E departments at Charing Cross and Ealing are to be replaced with “emergency centres” run by GPs and specialist nurses.  These will not have surgeons or intensive care units and will be unable to receive “blue light” – full emergency – ambulances.’)

Dr Spencer did not even know in November which bits of Charing Cross would be sold off as flats for foreign investors.  The £80 million is, as usual, just a fantasy figure (or the £160 million – it makes no difference).

Of course, the ‘new’ Charing Cross has had a range of price tags fixed to it – £90 million, £60 to £90 million (FoI response), £150 million – and as late as last October Dr Spicer, CCG Chair at Hammersmith and Fulham, said: ‘We have to wait for NHS medical director Sir Bruce Keogh to publish his report which will tell us what a local hospital A&E will entail because it doesn’t fit into any definition we have at the moment’.  But before that, Charing Cross was touted, by Dr Spicer again, as a ‘Health and Social Care Hospital’, with no definition.  (H&F Clinical Commissioning Group, February 2013)

Spencer’s response on the travelling times for expectant mothers is laughable – he simply ignores Dr Sahota’s valid point that they will have to travel further and for longer.  We know they will not be accepted at Hillingdon because they do not have enough midwives (even if the CQC had not damned that Hospital in its latest report), so they will mostly have to flog down to West Mid, which will not be able to cope just as Northwick Park is currently unable to cope with displaced A&E demand after the closures of Hammersmith and Charing Cross A&Es.

Spencer says: ‘Through the ‘Shaping a Healthier Future’ (SaHF) programme, healthcare services in this part of London will become more localised.’  It is hard, no, it is impossible to square that with the need for every expectant mother in Ealing to have to travel to another Borough for specialist Obstetrics or for a routine hospital delivery.  And home birth is not the full answer, despite the misleading claim by the Shaping a ‘Healthier’ Future team that it is ‘safe and recommended’ – it is safe where it is safe, but even second-time mothers with a planned and ‘low-risk’ home birth will have a 12% chance of ending up in Obstetrics;  at that point, distance is crucial.  For first-time mothers with a low-risk home birth plan, the transfer to Obstetrics figure rises to 45%.  (the Birthplace in England national prospective cohort study, BMJ 2011;343:d7400, Table 2)

As usual, Dr Spencer does not let the facts get in the way of a useful fantasy.

I hope this helps set the record straight.

Colin Standfield runs the Save Ealing Hospital Campaign

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