Tuesday, 9 October 2012

A&E closure will affect schools' capacity to deal with child illness and accidents

The UCC can deal with broken arms but not broken legs

My submission to the Shaping A Healthier Future had a particular focus on the impact of the Central Middlesex A&E closure on children and schools, as well as the role schools could play in preventative medicine.

This is an extract:

  1. Dr Mark Spencer, leading on the Shaping a Healthier Future consultation, told a TV news programme before the consultation had begun that A&Es would close. This suggests that the consultation is a sham as decisions had been prior to the public having a say.
  2. Despite claiming that ‘nothing had been decided’ the continuation of Central Middlesex A&E was not included as an option in the proposals. The statement is thus untrue and misleads the public.
  3. No risk assessment was carried out on the proposals prior to the consultation so the public have had insufficient evidence on which to base their responses.
  4. Throughout the consultation meetings it has been claimed that the proposals are not ‘cuts’. However flat funding at a time of population increase and increased demand does amount to a cut in real terms even before we take into account the financial plight of the Trust and the subsequent need to make ‘savings’. This again amounts to misleading the public.
  5. Headteachers and school governing bodies, responsible for the health, safety and well-being of children in their care, were not consulted about Sustaining a Healthier Future.. Key stakeholders have thus had no say about the impact of the closures on a particularly vulnerable section of the community.


  1. The department has been run down over several years, including overnight closure, pre-empting the closure proposals.
  2. The department serves two of the most deprived wards in the capital (Stonebridge and Harlesden) with low life expectancy and high incidence of illness including a specialism in sickle cell anaemia affecting the African Caribbean population.
  3. Car ownership at only 22% is low and public transport links poor making the journey to Northwick Park A&E difficult with potential dangers to patients of long and delayed journeys in emergencies.
  4. The area has a significant number of sites where major incidents could occur which necessitate an easily accessible fully functioning A&E in the vicinity:
    1. Railway lines including Euston-Birmingham mainline, Chiltern line, London Overground, Bakerloo, Jubilee, Metropolitan and in the future possibly HS2
    2. The North Circular Road, Harrow Road, Edgware Road.
    3. The industrial area around Wembley Stadium and Neasden, and the Park Royal Industrial estate (one of the largest in Europe)
    4. Major venues including Wembley Stadium, Wembley Arena and Fountain Studios
  5. The area has a rapidly growing child population so has increasing demand for A&E services associated with  childhood illnesses such as meningitis, asthma, allergic reactions and the increasing incidence of TB; as well as the usual head injuries and fractures associated with childhood accidents.
  6. Many recent immigrants in the area are not registered with GPs which leads to increased use of A&E by their parents for childhood illnesses.
  7. The assumption is that Urgent Care Centres and A&Es are complementary provision, operating on the same site. This will not be the case if Central Middlesex A&E is closed and instead cases that cannot be treated by the UGC will have to be transferred to Northwick Park A&E. This will necessitate an additional journey by ambulance, private transport, cab or public transport increasing the risk to the patient.
  8. Concerns about first aiders in schools and work places having to make decisions about whether to send patients to the UGC or Northwick Park A&E were not answered convincingly during the consultation. We were told that they would soon get to know which was appropriate or could ring a new telephone service for advice. I remain concerned that this could put patients in danger and puts far too much responsibility on the first aiders concerned.
  9. School first-aiders and support staff taking children to Northwick Park A&E act in locus parentis until parents get to the hospital. The distance and transport issues mean that parents will take longer to get to Northwick Park hospital with resultant distress for children, and school staff will have to stay at the hospital for longer periods.
  10. Similar arguments can be made for other A&E facilities threatened with closure in the NW London NHS area.


  1. The demarcation lines between UCCs and A&E are unclear and without an A&E at Central Middlesex could cause dangerous delays to treatment.
  2. The UGC is privatised and therefore less accountable to the local community and susceptible to market pressures.
  3. The Central Middlesex UCC, run by Care UK.  having lost 6,000 x-rays does not have the confidence of the local community.


  1. Schools and Children’s Centres have not been included in the section about care outside hospitals and preventative care in these settings could be of vital importance.
  2. As mentioned above newly arrived families are often not registered with GPs and schools could play a role in campaigns over registration, immunisation and be a site for health checks on new arrivals.
  3. The health service could also deliver support to groups of  parents in school on health, sexual health and other related issues in an environment in which they already feel at ease.
  4. As well as health screening for new arrivals dental, eyesight, allergy and weight checks for all pupils could be reintroduced as a form of preventative care.


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