London Eye: Inequity in the capital

Maybe the lobbying worked and there really will be a bit more revenue funding for services this year.

It will be pretty grim without it – The London Ambulance Service saying it will have to delay recruitment of call handlers and paramedics until April because of budget pressure (ideally you would have these people in place for winter).

Meanwhile acute trusts board urgent and emergency care patients (using the space between beds for more beds) to reduce crowding in accident and emergency departments. People have also died from fatal falls in the actual emergency departments.

Barking, Havering and Redbridge University Hospitals boss Matthew Trainer will lead the “learning and improvement network” in the capital on urgent and emergency care. BHR’s recent move out of the bottom decile on A&E makes him the logical choice.

Chelsea and Westminster Foundation Trust’s Lesley Watts for electives also makes sense. London Eye has written before about the North West London Acute Collaborative starting the (sometimes painful) job of standardising practice of 14 specialties across four trusts on the patch. This can sometimes involve confronting rivalries and enmities between clinical teams at different institutions going back years.

These are more common than you think but do sometimes fade out naturally when one generation of clinicians retires. South West London (which also has a good record on networking elective services – Stella Vig works at Croydon when she’s not in her national role) is bringing together two renal services that were only a few miles apart.

North West London also came up in a recent roundtable discussion of NHS finances (TL:DR trusts knowingly agree to ludicrous savings plans. Also, NHS England can’t/won’t let ICBs know how deficit-y the whole system is)

London North West University Healthcare Trust chief executive Pippa Nightingale said NWL boss Matthew Swindells was insisting on breakeven plans from all providers, including Hillingdon Hospitals, which just can’t do it.

Ms Nightingale also brought up that in an hour-long meeting with Amanda Pritchard she hadn’t once been asked about quality, only the finances.

Say what you like about money, it’s very quantifiable. Unlike care quality and (until the clinical negligence lawyers’ letters arrive) patient harm. Ms Pritchard’s pre-NHSE experience was mainly at Guy’s and St Thomas’sand Chelsea and Westminster Hospitals foundation trusts – institutions that (until recently) glided fairly serenely above the properly-staffed-wards/balanced financial plan dilemma faced by trusts outside zone one.

Equity

Talking of money, the Institute of Health Equity’s report this week had some interesting insights, even if they were mainly tangential to the health service itself.

Professor Sir Michael Marmot’s talk at Imperial’s Institute of Global Health Innovation last month majored heavily on inequality and its correlation with health. By one measure London has twice the income inequality as the rest of England.

The IHE report – Structural Racism, Ethnicity and Health Inequalities – said that as of August, 77 per cent of the capital’s NHS trusts are Living Wage accredited. Sadly no one seems to want to show their working on this measure.

HSJ asked the Living Wage Foundation in April which trusts were paying this and were told that information was a secret. There are trusts in London that used to make the uplifts to keep pace with inflation for their lowest paid staff but now cannot.

This is going to feel pretty egregious to the local cleaners, porters, security guards and other low paid staff (who died at disproportionately higher rates from covid) while the clinicians get uplifts.

At the other end of the pay-scale, London Ambulance Service is considering plans to make any interviewing panel at the trust that does not appoint a minority-ethnic candidate to a band seven or higher role write to the chief executive to explain why.

In terms of the varying clinical outcomes for different ethnic groups, the report highlights the well-known and egregious differences in maternity and mental health.

The latter has been known about for a long time and seems to have resisted attempts to control it. Issues in maternity services only became well-known more recently.

The report highlighted a “caseload midwifery” scheme in Lambeth which had reduced pre-term births by half by offering “individualised care pathways enabl[ing] frequent and longer visits as required. Two midwives are involved from booking to postnatal care for each patient. Teams are on call for labour.”

Sadly, this is exactly the kind of scheme trusts are having to cut.