Depth of North Mid A&E crisis revealed

How has this situation come about?

Different commentators have laid the blame at different people's doors.

MPs Joan Ryan and David Lammy have linked the crisis at the North Mid to the controversial closure of Chase Farm's A&E department in 2013. However, at the time compensatory changes to capacity were made at Barnet Hospital and the North Mid and the North Mid's A&E was performing adequately up until September 2015. In my view, the Chase Farm closure may have been a factor, but is unlikely to be the main cause.

The Care Quality Commission's press release (issued on 6 June) is phrased in such a way as to suggest that the blame lies with the North Mid's management and that they just need to bang a few heads together to fix the problems. There is no hint that there may have been any external factors outside the hospital's control that might have led to the crisis.

In his statement issued today, David Burrowes MP, while acknowledging that Enfield is not receiving a fair share of the London health budget, also seems to place some of the blame on the hospital's management. He says that the hospital is "failing in its duty of care towards [its doctors and nurses] and to the public" and says that the NHS has a "duty of care to my constituents".

Judging from the BBC's report on today's Prime Minister's Question Time, David Cameron seems positively relaxed about the situation and this afternoon boasted about what his governments have done to help the North Mid: "If we look at what has happened since 2010, there are 120 more doctors, there are 280 more nurses recruited by the trust. The health secretary will continue to monitor this closely."

In my view, all the above assessments fail to notice the elephant in the room: the chaotic situation caused by the coalition government's total and continuing re/dis-organisation of the NHS and the current government's failure to fund the health service adequately. These are the main reasons for the crisis, and they have been exacerbated by the movement of poorer people out of central London into Enfield and the huge increases in the cost of buying or renting a home in north London. Both of these latter problems are also consequences of government policy. To suggest that the hospital bears the main responsibilities for its problems is, in my opinion, a case of victim blaming. While I agree with David Burrowes that the NHS has a duty of care to his constituents, it can only exercise it if it has the resources to do so - I also believe that the government is failing in its duty of care to the NHS.

I am a volunteer at the NMUH and have been for about 15 years in was called the Patients Representative Forum, now called the Eye & Ears, unfortunately closing the Chase farm A&E has not helped and problem with Whipps Cross as well, Barnet has the same problem as NMUH, lack of Money is a big factor, unfortunately the A&E when built under the new PFI building was not built with any expansion capacity, and I don't care how many doctors or nurses you throw at it will continue to have problems, its called capacity, if any thing it will get worse, as this government has deemed we must build more houses in Enfield and Hornsey but no plans to add the facilities to cope with it, plus we have a migrant population the in their own country normally go to a hospital with medical problems not a local doctor, unfortunately the last bit of property at the NMUH site that would allow expansion the Trust board has because it is strapped for cash decided to sell to a firm that want to convert it into a school, so the CQC want to get its act together and help not hinder, our MPs are not a lot of help all wind and no blow.

The following statement has been published on the Enfield Council website:

Here is the text of a statement regarding North Middlesex Hospital that was endorsed by Enfield Council's Cabinet last night.

Statement to Cabinet from Cabinet Member for Health and Adult Social Care:
As Cabinet Member for Health and Adult Social Care I wish to comment on the recent worrying media coverage about ongoing concerns at North Middlesex Hospital.

Following the publication of the CQC warning notice, The Leader and I wrote to the Secretary of State for Health – Jeremy Hunt to express our very significant concerns regarding the challenges that North Middlesex University Hospital NHS Trust are facing and seek his personal intervention to ensure that all support and resources are made available to bring an immediate and sustainable solution to this situation.

The North Middlesex A&E is one of the busiest Emergency Departments in London and serves a very deprived area with significant health needs in the local population. The Trust has been under considerable strain not least as a result of a lack of emergency department Consultants, resulting in performance and quality issues. North Middlesex University NHS Trust has been given until 26 August 2016 by CQC to make the improvements.

The Council has continually engaged with North Middlesex University NHS Trust, NHS commissioners, regulators and neighbouring trusts to encourage a whole system response that ensures the support required to the Hospital is provided. A Programme Oversight Group has been established by the NHS to take forward the required support to the Trust at which the London Borough of Enfield will be represented.

I have no doubt the issues with North Middlesex University NHS Trust are compounded by the financial underfunding of Enfield CCG, which has to find an additional £7 million in savings on top of £14 million already planned this year, which is in addition to an underlying £49 million structural deficit. This must be an impediment to supporting North Middlesex University NHS Trust and I will continue to raise this issue with the NHS.

Finally, we must not forget that when Chase Farm Hospital lost it’s A&E, local people were repeatedly assured that there would be a safer and better service available to them, like me they will be gravely concerned to hear such worrying reports about the service on the North Middlesex site. On their behalf we will continue to do all we can to support the hard working front line staff at North Middlesex Hospital and to press the Secretary of State to ensure that he makes sure local NHS services have the resources and support they need to provide local people with safe, high quality services in the emergency department at North Middlesex Hospital and beyond.

Cllr Alev Cazimoglu
15 June 2016

A new report in the Guardian provides yet more alarming details of the crisis at the North Mid, based on a leaked internal NHS report:

North Middlesex A&E staff describe unit as unsafe and unsupported

By contrast, Healthwatch Enfield's website has this rather bland statement:

One hopeful development is that Barts Hospital is looking into the possibility of sharing A&E doctors with the North Mid. However, the Barts spokesman who mentioned this is also quoted as referring to "the national shortage of senior A&E doctors" - an indication that the crisis at the North Mid isn't simply caused by poor local management (which is what the Care Quality Commission has implied) so much as reflecting the dire situation in the NHS at national level. While it's true that there are allegations of a "bullying culture" in the way the hospital is managed, my guess is that this is because the hospital's managers are themselves being subjected to bullying, albeit of a more subtle nature, from above. This is what happens when unfair and unremitting pressure is applied from above and is passed down the management chain.

Writing in this week's Enfield Gazette, Bill Linton of Enfield Green Party alleges that as a consequence of government policy "breakdowns within the NHS are not only inevitable - they are intentional". His contention is that "the NHS has for years been starved of funds, partly because that's all part of austerity and partly so that in due course Mr Osborne (or his successor) can say, 'Oh look, it's not working - better privatise it". And he concludes that "It is North Mid's bad luck to be one of the first dominoes to fall".

Evidence that the situation at the North Mid is not an isolated case came this week in a statement by the Royal College of Nursing. Janet Davies, RCN chief executive and general secretary, said: “Having once been the preserve of the worst weeks of winter, overwhelming pressure and major incidents have sadly become the new normal in our hospitals."

Whether or not you buy into Mr Linton's argument that the NHS is being deliberately run down, it is certainly the case that the NHS was in a far healthier condition when Messrs Cameron and Osborne took over than it is now. Six years of budget cuts, continuous reorganisation and criticism of health service employees have taken their toll.

In my view, the fact that such an important hospital in one of the wealthiest cities anywhere in the world has reached such an existential crisis is a national scandal and the government needs to sort it out urgently. It makes me very angry, and scared too of the consequences of an accident or serious illness.

Excuses Excuses.

I lived in this area in the 1970's / 80's and no one wanted to go nowhere near the North Mid . The reputation was that you were lucky to come out alive. My father died there 8 years ago , before I could get him moved , and to this day I have no idea why he died. The wards were filthy and I had to clean up my fathers room which had blood all over the surfaces.
It seems to be the same story for all hospitals in Enfield and it is and always has been down to bad management.
So blame the migrants all you like but they were not an issue in the 80's and you still had a problem . Shame on you

The contribution from Peter Smith reads
the new PFI building was not built with any expansion capacity,

There seems to be some misunderstanding as that the A & E under the original PFI was intentionally built with "excess bed capacity"
so that the treatment area would not need to be "touched" at a later date. In the most recent works by the transfer of the A & E from Chase Farm it was only the additional beds that were to be added under what I will described as Phase 2. [For more information contact the project manager mailto:]

The Commissioner of services at NMUH is Haringey CCG under the guidance of commissioner Jill Shattock. Currently each week Jill Shattock (haringey CCG)., Aimee Fairburns (enfield CCG) under take a teleconference with stakeholders. It seems strange to me that it was only recently a root cause analysis identified that patients were being discharged "too late" in the day and that by transferring patients to a zero overnight stay ward beds would be released from the acute accommodation and from the A & E treatment area. By releassing patients by lunchtime there would be improved bed utilisation

Both Barnet, and Enfield JHOSC representatives claimed that Delayed Transfers of Care (DTOC) were not being caused by lack of their respective care package provision.

Those who wish to follow through, should be at the Annual Meeting of NMUH to be held at the hospital on 30th June 2016 from 11:45 to 14:00. It would be helpful if advance questions can be e-mailed to the Board Secretary Molly Clark, mailto:.

Those wishing any special buffet food (such as gluten free) should contact Diana Mohair

In the most recent NHS England statistics in the public domain the number of A & E attendances actually declined as performance worsened

Sorry Don we of the NMUH PRF were in from the beginning of the new build and live in the real world , we asked Kevin if the new build could expand if needed he said no, so we new what has happened now was coming, we hoped that the old trust building would remain so that could be used to build additional capacity but short sightedness has come into play, the firm that runs the hospital catering wanted to use the old trust building as a respite accommodation so patients waiting to be repatriated home could be accommodated freeing up bed space, but this has fallen on deaf ears, so Don what is the trust going to do about it?

Peter Smith

Today's Guardian reports that two hospitals in Lancashire are asking patients not to visit their A&Es unless absolutely necessary - "calling on the public to help us"

https://www.theguardian.com/society/2016/jul/04/patients-urged-stay-away-lancaster-and-furness-ae

The Department of Health has been trying to make out that the problems at the North Mid are caused by bad management/poor staff at the hospital. It looks to me though as if it's just the first sign of a national problem caused by underfunding, deliberate undermining of public confidence in NHS front-line workers and a never ending process of complete reorganisation.

Local MPs have arranged a public meeting about the North Mid crisis at 7pm on 26th July at the Green Towers Community Centre (round the back of the shopping mall at Edmonton Green - see https://www.eventbrite.co.uk/e/mps-public-meeting-north-middlesex-hospital-ae-crisis-tickets-26353023603?utm-medium=discovery&utm-campaign=social&utm-content=attendeeshare&aff=esfb&utm-source=fb&utm-term=listing

Others might be interested to know that a public meeting has been organised by two local MPs (Kate Osamor - Edmonton and Catherine West - Hornsey & Wood Green) to hear from residents who are concerned about the situation.

The meeting is on Monday 25th July, 7-8.30pm at Green Towers Community Centre, Plevna Road N9 0BT

It is a free event but people are asked to register via Eventbrite;
https://www.eventbrite.co.uk/e/mps-public-meeting-north-middlesex-hospital-ae-crisis-tickets-26353023603?aff=es2

A statement from the website of David Burrowes MP mentions that there will be a debate in parliament next Wednesday on the subject of NMUH A&E;

http://www.davidburrowes.com/content/north-middlesex-hospital-0

The public meeting at the Green Towers community centre is on Monday 25th July at 7pm, not on Tuesday 26th July as previously stated on this website and in this week's Weekly Newsletter.

Thanks to Donald Smith for the correction and apologies for any confusion caused.

Ahead of the public meeting about the crisis in the A&E department at the North Mid* it's worth reading in full the transcript of the Westminster Hall debate that took place on 12th July at the instigation of Joan Ryan, MP for Enfield North, and with the participation of the two other Enfield MPs (David Burrowes and Kate Osamor) and of David Lammy, MP for Tottenham, and Catherine West, MP for Hornsey & Wood Green, plus other MPs and a health minister.

www.theyworkforyou.com/whall/?id=2016-07-12a.59.0

I was intending to summarise some of the points made by the MPs, but found this too difficult. The participants had clearly done their homework ahead of the debate and all make some strong points with plenty of meat, making their speeches worth reading in full. One point that comes across is that MPs were apparently kept in the dark about the developing crisis. Predictably, Labour MPs saw the North Mid crisis as symptomatic of a wider malaise in the health service under the current and previous coalition governments. David Burrowes laid the blame mainly on the hospital's management, though he thought that the government should have "held their feet to the fire" five years ago and sacked some managers. To his credit, though, he did complain that the health service in Enfield is underfunded by comparison with other local authorities.(On the other hand, he failed to keep to his own resolution of "avoiding going down a political route" and started his speech by appearing to blame Tony Blair!)

[Edited on 22nd July to remove unsubstantiated comments about Healthwatch Enfield]

*(Monday 25th July at 7pm, not on Tuesday 26th July as previously stated on this website) it

The Healthwatch Enfield Annual Report was published on 1st July 2016 is available at
http://www.healthwatchenfield.co.uk/news/healthwatch-enfield-annual-report-2015-16-released

The Healthwatch Report strictly covers the period 1st April 2015 until 31st March 2016. In my opinion Basil Clarke makes unsubstantiated and unfair accusations of a cover up by Healthwatch. As someone who had regularly attended both the bi=monthly NM Hospital Trust Board meetings with Enfield Healthwatch and went on to attend the Hospital's Annual Meeting on 30th June 2016 I confirm the deafening silence offered to attendees at the NMUH Annual Meeting on 30th June 2016. It is only subsequent investigation by press reporters that I learnt of the appointment of Elizabeth (Libby) McManus as Interim Chief Executive and David Sloman as Interim Accountable Officer

The relevant CQC report was not published until 6th July 2016 .Any "cover up" was within the period of what is often called "Maxwellisation"

The Lead Commissioner for North Middlesex University Hospital and residents and interested parties are cordially invited to attend the HaringeyCCG Board meeting in Public on 28th July 2016 from 2pm at the Cypriot Centre, Earlham Grove N22

Donald is far more familiar with the workings of the local NHS than I am, so if he says that my accusations were unsubstantiated and unfair, then they were and the only honorable thing I can do is withdraw them. I shall remove the offending paragraph from my earlier post and apologise for any offence caused to Healthwatch Enfield people.

To get an idea of Donald's involvement in keeping tabs on the health service you just need to search for the minutes of meetings of for instance the managements of the North Middlesex University Hospital Trust or the Enfield CCG. You'll find questions and comments from Donald that go straight to the heart of the matter.

In fact, there was absolutely no reason to dream up conspiracy theories or drag Healthwatch into all this. They're clearly not responsible for the situation that has arisen at the North Mid. And, as Donald confirms, there was a "deafening silence" about the crisis when the hospital trust held its annual meeting only three weeks ago. Regardless of whether it was the hospital management who were hiding the true situation from the public or someone at a higher level, it's still scandalous and shocking that such a vital part of our health service (vital in both metaphorical and literal senses) should have been so close to collapse. In my view, the buck stops with the health secretary and the prime minister. The prime minister in question has gone (or should I say "scarpered", leaving behind utter chaos), but we still have the same health secretary.