Brent Community Cardiology Service: not out of the wood

We need to alert Brent NHS patients and their doctors to the serious continuing defects in Brent Community Cardiology Service.

We have followed the start of this service as one of the first of the NHS Brent large ‘out-of -hospital’ services under the ‘Better Care: Closer to Home’ model proposed for both the NW London NHS ‘Shaping a Healthier Future’ project, and the new ‘Sustainability and Transformation Plan’.

Is this the future of the NHS? Some of what follows is very detailed but BPV tries to get beneath the NHS’s reassuring slogans to discover what is really going on. The devil really is in the detail.

This Brent NHS out of hospital adult out patient cardiology service at Willesden and Wembley Centres for Health and Care started in March 2015 provided by the Royal Free NHS Foundation Trust for Brent Clinical Commissioning Group. We have already reported on its continuing defects, especially the many months of default by the Royal Free in complying with the 14 day maximum patient waiting time from referral to being seen for cases assessed as urgent.

We have monitored the breach of contract defaults by the Royal Free with this service by Freedom of Information Act requests for the service activity data required by their contract.

In February 2016 the mean waiting time reported for stress echo-cardiogram was 9.2 weeks, and for diagnostic ECG recordings 7.1 weeks. The contract dated 18 December 2014 maximum waiting time to be seen for diagnostic investigations is 99% within 6 weeks. These reported waiting times are average times so some patients were clearly waiting much longer to be seen than the average. The total number of appointments cancelled by RFL was 12.4%. This overall average disguised disturbingly high numbers of Royal Free cancellations for some groups of patients: 25.9% for stress echo-cardiograms; 18.4% for rehabilitation exercises; and 12.9% for heart failure/valve disease. The contract requires less than 3% of appointments to be re-scheduled by the trust.

In March 2016 two thirds of all nurse led heart failure appointments were reported as cancelled by RFL (67% of new heart failure appointments, and 64% of follow up appointments). Under the contract no more than 3% of appointments may be re-scheduled by the provider. This appears to be a very serious breach of contract by RFL. In March 2016 RFL cancelled 56% of Stress Echo-Cardiogram appointments, 51% of Community Follow-Up Consultant Appointments, and 50 % of ’24 hour tape’ Consultant Requested ambulatory ECG appointments. The contract permits no more than 3% appointments to be re-scheduled by RFL. This appears to be a further breach of contract by RFL. The March 2016 activity figures reveal a 7.5 week mean waiting time for stress echocardiogram, and 6.4 weeks for 24 hour tapes requested by a consultant with 5.6 weeks wait for 24 hour tapes requested by a GP. RFL are in long continuing default and apparent breach of contract over patient waiting times for stress echocardiograms and diagnostic ambulatory ECG recordings (’24 hour tapes’).

On the April 2016 activity data now disclosed the main continuing cause for concern as to RFL breaches of contract is that 35% of all stress echocardiogram appointments were cancelled by RFL (as against a contract limit of up to 3%), and the average waiting time for patients to be seen was 9 weeks 2 days (as against a contract limit said to be 6 weeks).  Since the reported waiting time figure is an average clearly some patients are waiting a lot longer than 6 weeks.

There are 2 unexplained discrepancies over the April 2016 urgent case 14 days maximum waiting time figures. The chart in the e.mail refers to 82 cases: but the activity data attachment refers to 89 cases in this category. There is no explanation of what happened to the other 7 cases. This may affect the RFL claim to 100% compliance with the urgent case maximum waiting time limit. There are an additional 16 urgent referrals to the Diagnostics listed: but no report on how many were not seen within 14 days – only averages for all cases.

The contract requires RFL to report the service activity data by location but RFL in long continuing breach of contract have never reported the activity broken down as between Willesden and Wembley Centres for Health and Care.

In the Autumn of 2015 Brent Clinical Commissioning Group made vigorous efforts to require the Royal Free to comply with its contract obligations by operating the NHS ‘contract query’ procedure. They invited Brent Patient Voice representation on the Joint Contract Review Group. Despite the service shortcomings detailed here Brent CCG discontinued the contract query procedure and patient representation on this group as from March 2016 despite our protests.

In November 2015 Brent CCG confirmed to the joint contract review group that they would fill a gap in the service clinical specification to include diastolic heart failure cases. On 11 June 2016 Brent CCG confirmed to us that they will now proceed to do this, but have not said when they hope to implement it.

We have written on 10 and 31 May 2016 and on 10 June 2016 to Mr David Sloman, Chief Executive of the Royal Free detailing the Royal Free defaults and breaches of contact set out in this report inviting any comment or explanation before we publish it, and with a copy to their service lead Consultant Cardiologist Doctor Paramjit Singh Jeetley. To date there has been no reply from the Royal Free to the substance of these letters.

On 31 May and 10 June 2016 we wrote to Sarah Mansuralli, the Chief Operating Officer of Brent CCG, with a copy to their service Governing Body Clinical Director Doctor Shazia Siddiqi, protesting at the failure by Brent CCG to enforce full contract compliance by the Royal Free and accepting the Brent CCG offer to provide us with copies of the monthly service activity data and copies of the monthly joint contract review group minutes. To date Brent CCG have not provided us with any of these since this CCG offer. On 11 July 2016 we received a reply from Sarah Mansuralli assuring us that Brent CCG continues to monitor RFL compliance with their contract.

I am not qualified to comment on the clinical quality of this Brent Community Cardiology Service. This report is limited to the unchallenged breaches of contract clinical service defaults by the Royal Free London NHS Foundation Trust, and the failure by Brent Clinical

Commissioning Group to enforce full contract compliance by the Royal Free, and as yet to implement its promise to amend the contract to include diastolic heart failure cases.

Peter Latham, Vice Chair Brent Patient Voice;

Chairman Willesden Patient Participation Group.


11 June 2016

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