North West London Healthcare Commission – Call for Evidence

From Michael Mansfield QC 

In 2012 the government consulted on proposals to make significant changes to the healthcare economy of North-West London, set out under the heading “Shaping a Healthier Future”. This involved the downgrading of several hospitals across North- West London to “local” hospitals without A&E provision, closure of acute provision and reduction or downgrading of specific services. It also promised commitments to investment in capacity of out-of-hospital and community services in order to offset reductions in acute provision.

Two years into implementation of “Shaping a Healthier Future”, Brent, Ealing, Hammersmith & Fulham and Hounslow Councils are keen to review its implementation; in particular, the impact of reductions to acute provision on the North West London population, the extent of progress with investment in capacity and capability of community and out-of-hospital services to meet local needs, and the extent to which demand for acute services has changed as a result of those investments.

The North West London Healthcare Commission was launched on 1 December 2014 by the four councils to review the impact of the changes to the North West London health economy, arising from the implementation of “Shaping a Healthier Future”, and to assess the likely impact of planned future changes. I have been appointed to chair the Commission and my fellow Commissioners are Dr John Lister and Dr Stephen Hirst.

In order to assist us in the task of reviewing the implemented and planned changes, I invite you to submit written evidence that may assist the Commission in its consideration of the impact of these changes on patient care in the area. Any such written evidence should be submitted by Monday 2 February 2015 to Peter Smith, Clerk to the Commission, at Hammersmith & Fulham Council. Submissions should be addressed to him at Room 39, Hammersmith Town Hall, London W6 9JU or sent by email to peter.smith@lbhf.gov.uk. Later submissions will be forwarded to the Commission but may not be given the same attention as those received by the deadline.

I look forward to reading any submission you may wish to make. Yours faithfully

Michael Mansfield QC
, Chair, North West London Healthcare Commission

Scrutiny Committe unconvinced by assurances on Northwick Park A&E

Yesterday the BBC reported that ambulance crews would have to call ahead to the control room before taking patients to A&E at Northwick Park Hospital because of the pressures on the hospital. Local GPs are being asked to refer patients to other hospitals. It also reported that in September 179 patients had to wait for more than 30 minutes for an ambulance and 30 patients have to wait for more than an hour.

Yesterday at Scrutiny Committee councillors put the NW London NHS Trust under pressure regarding these issues.  In often emollient replies to tough questioning councillors were assured that there was no danger to patients.

Problems were ascribed to an increase in acuity of patients arriving at the hospital with a sustained rise in medical emergency admissions. In other words more Brent people are becoming sicker.

Although the planned increased bed capacity at Northwick Park would not take place until Autumn 2015 the Trust were taking steps to increase 'in year' capacity at Northwick Park by 32 beds and 20 at Ealing Hospital. Ealing had not shown a marked rise in admissions but there had been an increased length of stay for patients.

Measures to cope with the problem included quicker discharge and less DTOC (delayed termination of care).

In a rather chilling statement an NHS officer said that there was no evidence  that the problems were having an  impact on mortality rates. 'Yet...' was what I said to myself.

Summing up the Committee's view, last night's Chair, Cllr Reg Colwill,  said they were concerned about the timescale of the implementation of improvements to Northwick Park and the danger this posed to Brent residents.

The discussion of the repercussions of the closure of Ealing Hospital Maternity ward also centred on capacity.

Councillors were told that the facility was no longer viable and an earlier closure than the two years initially planned was necessary to maintain safe services. Northwick Park and Imperial had the capacity to expand maternity provision without infrastructure work and a maternity booking service would be introduced.  41% of Brent mothers already attend Imperial which includes Queen Charlotte's in Hammersmith. Ealing staff would be transferred to other facilities over a transitional period.

Officers said that current activity in the hospitals was less than the previous maximum and the expected rise in numbers would be within that maximum. there was an expectation that 95% of women would get their first choice of maternity care. The only cap was at Queen Charlotte's Hospital.

Cllr Mary Daly challenged this in the light of the area's rising birthrate. In summing up Cllr Colwill said that the Committee was not convinced that the rise in birthrate had been sufficiently taken into account and remained  concerned about whether alternative provision would be in place in time.

The main discussion on the future use of the Central Middlesex Hospital site following the closure of the A&E, was the transfer of rehabilitation beds from the Willesden Centre to Central Middlesex.  This raises the question of the future use of the vacated space at Willesden.

The plans for moving Park Royal mental health facilities to Central Middlesex are not going ahead. This was because the costs arising from the 'enhancements for mental health service would not be economically appropriate'.

Brent hospital proposals must come under intense scrutiny on Thursday

Days after NHS England announced an inquiry into why waiting times at Ealing Hospital and Northwick Park A&Es have the longest waiting times in the country, LINK, Brent's Scrutiny Committee on Thursday will be examining several important aspects of local health care.

Representatives of the North west London NHS Hospital Trust will be questioned about progress on the recommendations of the Care Quality Commission's (CQC) critical  report on Northwick Park Hospital.

The report LINK sets out the issues to be examined clearly:

CQC made specific recommendations for improvement at Northwick Park Hospital concerning A&E and related services. These are set out below:-

• Ensure that there are appropriate numbers of staff to meet the needs of patients in the A&E department, surgical areas and critical care.

• Ensure that there are systems in place to assess and monitor the quality of services provided in A&E, critical care, surgery and maternity to ensure that services are safe and benchmarked against national standards.

•Review the coping strategies within A&E during periods of excessive demand for services.

•Empower senior staff to make changes to ensure that patients are safe in A&E in maternity.

•Review discharge arrangements in A&E and critical care to avoid re-admission to these areas.

Given the significant number of areas requiring improvement in the current A&E provision at Northwick Park Hospital reassurance is sought from the senior management concerning implementation of actions and the safety of the A&E services available to Brent residents.

Another area to be examined is the proposals from Shaping a Healthier Future and Brent NHS to close maternity and other associated services at Ealing Hospital. 

The committee is recommended to question representatives of the Brent Clinical Commissioning Group on:-

•the robustness of their modelling assumptions and assurance plan;

•the timescale for their implementation; and

•what contingency plans are in place in case any of the proposals turn out not to be possible or feasible

A puzzling aspect of the report LINK is the timing. This meeting is on November 26th and it looks as if key decisions on this issue are actually to be made by the CCGs on the same day:

The next stage of reconfiguration is the changes to maternity services and the inter dependent services at Ealing Hospital. Brent Clinical Commissioning Group is due to make a decision on delegating the decision on timing to Ealing Clinical Commissioning Group, along with the other CCGs across North West London, on 26thNovember 2014. Ealing Clinical Commissioning Group is due to make a decision on the timings of changes to maternity services, and the interdependent services at Ealing Hospital on 26^th November 2014.

One can only wonder if what the Scrutiny Committee thinks will have any impact given this timetable.

The report's authors reach a soothing conclusion:

The impact on Brent residents and NHS services of changes to maternity and inter-dependent services at Ealing Hospital is not expected to be significant. Local services have the capacity to receive additional activity from Ealing without causing a negative impact on accessibility for Brent residents

The final health report to be considered is on the future use of the Central Middlesex Hospital site LINK. Current proposals are:

•An elective orthopaedic centre.

•Mental Health inpatient facility relocated from the site at Park Royal.

•A GP and primary care ‘hub’.

•A Genetics laboratory relocated from Northwick Park Hospital.

•Relocation of rehabilitation beds currently at Willesden.

This is a crowded agenda with lots of 'suits' from Brent NHS Health, the Clinical Commissioning Group abd Shaping a Healthier Future attending.  At previous meetings the chair has seemed irritated by the searching questions posed by Cllr Mary Daly and tried to hurry through proceedings with so many of the scrutinised wanting to speak.

In fact Daly's interventions seemed based on the fact that, unusually, she is a councillor who has done her homework as well as being someone passionately committed to the health of local residents.

I hope that at this meeting, however inconvenient, she gets a fair hearing. I also hope, for the sake of the public, microphones are installed to get over the acoustic problem in the committee rooms as well as the suits' mumbling.

If all that Health material is not another there is a major and very interesting report  LINK by a Task Group on the Agenda.The Task Group, chaired by Cllr Neil Nerva, looked at promoting electoral engagement following the introduction of Individual Electoral Registration and is packed with information and ideas. The most innovative of which is the involvement of the campaign group Hope Not Hate.

Once again such a crowded and complex agenda raises the issue of the wisdom of reducing Brent Council's scrutiny committee to just one. This was a hasty decision made at the beginning of the administration with no prior consultation which took many Labour councillors by surprise.

These are decisions about vital issues, at the extreme perhaps a matter of life or death, and must have proper scrutiny.

GP says NW London hospitals under 'unbearable pressure' as A&E waiting times are longest in the country

 

Campaigning Against the Closures

 The BBC are reporting the longest A&E waits are in North West London. Brent Fightback and Save Our NHS, along with Ealing and Hammersmith hospital campaigners warned against the closure of Accident and emergency wards, including Central Middlesex.  LINK

Our concerns have been vindicated.

Patients requiring emergency treatment in north-west London had the longest waits in the country.

London North West Hospital Trust failed to see 32.2% of its patients within four hours during the week ending 19 October, and 26.7% the following week.

Labour London Assembly member Dr Onkar Sahota said the two "dangerous" results could be connected to the closure of two local A&E departments.

The Trust said it understood "where change is required".

The figures obtained by the Labour Party show the trust performing below the national average, which stood at 11.2% and 9.4% respectively during the two weeks highlighted. 

They revealed 827 and 628 patients had to wait more than four hours for emergency treatment.
In a statement the trust said: "We are working with our healthcare partners... to address specific issues relating to capacity, attendances and delays in discharging patients from hospital.

"Agreed actions are in place to improve performance which includes plans for 70 additional beds at Northwick Park Hospital."

Dr Sahota, a practising GP, said the closure of Central Middlesex and Hammersmith A&E departments in September had put west London hospitals under "unbearable pressure".

The GP said: "Despite consistent warnings, the mayor and government have refused to recognise the dangerous impact these closures have had.

"We can only hope that with the message now devastatingly clear, they will take urgent action to help get A&E services in North West London back on track."

In August the health watchdog the Care Quality Commission said staff across the trust "were found to be caring and compassionate" but that some patients at Northwick Park Hospital were being discharged too early because of the patient flow through its A&E department.

Central Middlesex closes its doors for the last time and the community loses yet another amenity

It was significant that last night on Twitter someone reacted with shock to the news that Central Middlesex A&E will be closed today saying 'but that's my local hospital. I've it used since I was a kid!'

The remark indicates both our failure to get the message out in time to more people and thus moblise them, and also the sense of ownership that local people have for what many call 'Park Royal'.

Photo Sarah Cox

Symbolic protests took place this morning at  Hammersmith and Cen tral Middlesex A&Es to mark their closure.

On Monday the Council called for the closure to be delayed until Northwick Park A&E was in a fit state to take over Central Middlesex's role.

Yesterday evening at the Brent Council Scrutiny Committee, Cllr Mary Daly tore into the 'men in suits' behind the closure accusing them of failing in their 'duty of candour'.

Today the Central Middlesex A&E is closed.

In truth Brent Council was very slow to recognise the negative impact of the closure and while Ealing Councl was leafleting residents and advertising on buses, it was left to Brent Fightback and other campaigners to get the word out in Brent  with street leafleting and public meetings.

Campaigners attended consultations and  repeatedly pointed out the degree of deprivation of the population that used Central Middlesex; the health statistics for the area; low car ownership and poor transport links to Northwick Park; the presence of the large industrial estate at Park Royal with a high risk of industrial accidents; Wembley Stadium and major railway lines with the potential for major incidents (remember the Harrow train crash of1952 which killed 85 people?) and the strain on the ambulance service when, with only an Urgent Care Centre on the Central Middlesex site, needy patients will have to be transferred to Northwick Park.

After months of consultations and meetings none of these issues have been satisfactorily addressed and the Care Quality Commission's (CQC) report on Northwick Park and Centrasl Midddlesex Hospitals has added further doubt. Northwick Park was given a 'requires improvement rating' and Central Middlesex A&E a 'good'.

The 'men in suits' quickly moved into PR mode following that report, and before the closure, with a 'feel good' story about the new Northwick Park A&E, faithfully carried by the Kilburn Times LINK.

In fact the new unit will not be ready until November at the earliest and full operational changes until 2015.  There are concerns about the intervening period and Scrutiny called for further reports from the Hospital Trust.  Meanwhile some members of the Clinical Commissioning Group, with interests in  out-sourced services, are keen to bad mouth the hospitals and claim that they can offer something better.

Unfortunately the privatisation of health means that doctors and other staff often have private interests in health provision and there were calls from the public gallery last night for these interests to be declared at such meetings. 

I agree. 

Hospital Trust officials claimed at Scrutiny that the CQC's concerns were being addressed and that 20 new beds at Northwick Park would come into use today and help clear the backlog at Northwick Park A&E.  It would improve bed capacity by 20%.  They claimed that a new clinical and medical leadership team was now in place and would result in improvement.

In remarks that were not fully explored Scrutiny were told that the Trust would improve capacity at Northwick Park for the winter by looking for additional beds outside the hospital on other sites. This raises the prospects of the elderly being sent further afield during the peak illness periods which coincide with severe weather.

Will Brent Scrutiny Committee have sufficient time to consider far-reaching changes in health provision in the borough?

The Scrutiny Committee on Wednesday August 6th will discuss two key issues relating to health in the borough.

They will receive a report from the NHS Clinical Commissioning Group (CCG) on the closure of Central Middlesex Accident and Emergency. The report is available here: LINK

The committee is recommended to question representatives of the CCG on the robustness of their assurance plans and the timescale for their implementation, as well as on what contingency plans are in place in case any of the proposals turn out not to be possible or feasible.

The A&E Department is due to close on September 10th and David McVittie, Cheif Executive of NW London Hospitals NHS Trust this week admitted that there could be problems initially LINK    It is  hard to see what additional safeguards could be demanded by the Commitee if they are not satisfied, just 4 weeks before the closure.

The second report to be considered, also from the CCG,  outlines three 'transformational' strategies to reduce the costs of healthcare in the borough whilst at the same time improving outcomes. The full report is available HERE

The committee is recommended to question representatives on the viability of these transformation plans, the timescale for their implementation, as well as on what contingency plans are in place in case any of the proposals turn out not to be possible or feasible. In particular the committee is asked to consider the adequacy of proposals to expand capacity within primary care services.

These are clearly complex issues with huge implications for Brent residents.  It does raise the issue of whether the decision to have one Scrutiny Committee rather than several specialist ones was wise. There used to be a Health Overview and Scrutiny Committee, now this Committee will also be considering the 'Garden Tax' call-in, proposals for a Budget Scrutiny Commitee and the Committee's Forward Plan. LINK 

Will the crowded agenda allow for the full examination and  discussion required?

Have your say on Thursday about the future of local hospitals

Wembley residents will get the chance to air their views on proposed hospital reform in the borough which could see two hospital trusts in North West London merge.

The meeting, held by Brent Local Involvement Network (LINk) on Thursday December 12th  will discuss plans for a proposed merger between North West London Hospital Trust and Ealing Hospital Trust.

Residents are invited to air their concerns and answer any questions from experts at both hospital trusts during the meeting in the Sattavis Patidar Centre in Forty Avenue.

Although there are no concrete plans for the merger a potential scenario could see Central Middlesex Hospital in Acton Lane, lose its Accident and Emergency Department.

Ealing Hospital Trust manages Ealing Hospital as well as community services across Brent, Harrow and Ealing while the North West London Hospital Trust manages Northwick Park Hospital and St Mark’s hospitals in Watford Road and Central Middlesex Hospital in Park Royal.

The hospital trusts are planning a merger after an independent report revealed that both trusts were among 20 trusts country wide that were not clinically or financially viable.

The evening begins at 7pm. For more information contact Carol Sealy on 0208 965 0309 or email: Carol.Sealy@hestia.org

At this stage, Brent LINk does not have an opinion regarding the merger.

Study confirms poorest hit hardest by A&E closures

An Equality Impacts report commissioned by NHS managers into the closure of four West London Accident and Emergency facilities LINK has confirmed the fears of many campaigners. The report by consultants Mott MacDonald into the closures of A&Es at Ealing, Charing Cross. Hammersmith and Central Middlesex and the reconfiguration programme under the Shaping a Healthier Future proposals concluded:

• 33% of 'blue light' ambulances across the area will take longer to reach hospital
• Among those picking up patients from poorer areas, 41% will take longer
• The four A&Es proposed for closure are all in deprived parts of London
• Elderly, poorer and disabled people who need non-urgent care will be 'disproportionately' affected
• Seven in ten people travelling by bus or tube will have journey times of 30 minutes or more
• Travel times are a key concern and warnings need to be raised about the prospect of longer and more complext journey times
• Closure could affect 'continuity of care' particularly for children
• Well-developed services at Ealing hospital to help Southall's large South Asian population, which suffers high levels of poor health, would also be lost.

The report's authors believe no ambulances will take more than an extra 10 minutes to reach an A&E  after the closures but of course that could be an extremely crucial 10 minutes.

Dr Onkar Sahota, chair of the London Assembly health committee,told the Daily Mail LINK  that he thought their calculations were wrong:  'There is clear evidence that when travel times are increased, mortality rates go up'.

NW London NHS: If it's not an accident or an emergency, where should I go?

Guest blog by a Brent (would be) NHS user

Recently I have begun to feel that I might resemble a cod fish which has evolved to become smaller than its ancestors, so that it could slip through the holes in trawlers’ nets in order to avoid being made into fish fingers. Inadvertently I seem to have evolved into a life form that slips through the mesh of the NHS in North West London in 2013, albeit with less positive consequences that is the case for the above mentioned fish.

One of the several ailments that afflict my legs causes them to swell, then, if the skin breaks, fluid can seep out. About a year ago I had an outbreak but this problem which was effectively treated by the nurse at my local GP practice. For a while this entailed wrapping the leg in several layers of bandages which had to be changed about every two days since the leakage soon soaked through the dressings. Gradually the leg healed up and the leaking ceased, I was then able to treat myself at home with creams and a stocking bandage.

This self-medication worked well until about a month ago, when the leaking started up again. I tried to apply layers of more absorbent bandage myself, but my efforts weren’t very effective and the leg seemed to leak more and more. 

I rang my GP surgery but they couldn’t make an appointment for me for a week, but my bandages were soon both falling off and soaking wet, so I sought treatment elsewhere. I went to an NHS “Walk-in” Centre, about five miles from my home. The nurses there did what they could, but said that the “Walk-in” Centre did not keep a sufficient stock of bandages to treat cases such as mine and advised that I should be seeing my GP.

The temporary bandaging just about held out for four days until I was able to see the GP nurse again. The sopping bandages were removed and replaced with more extensive bandaging, but this too was wet through within a day, to the extent that one of my shoes was filling up with fluid whilst the bandaging was slipping down my legs, but the next GP appointment that I could now get was in six days’ time, so I decided that fresh bandaging was needed.

I looked at a full page advert from the NHS in free magazine posted to me by my local council. It was headlined “If You Are Unwell, Choose The Right Place to Go” (NHS Brent Clinical Commissioning Group  p.8 Brent Magazine, June 2013).  This ad detailed the various NHS services provided locally, but also emphasised the message: “Choose Well: Only Use A&E in an Emergency”.

I had already been to the GP and the Walk-in Centre, so I tried ringing up the Urgent Care Centre at a local hospital, (Central Middlesex), which was mentioned in the NHS advert. When I described my problem, I was told that the Urgent Care Centre was not the appropriate place for me and that I should go to the A&E in another hospital (Northwick Park in Harrow) as the local A&E in Central Middlesex was now “appointments only”.

This contradictory arrangement which might seem to imply that a patient should be clairvoyant enough to know of an emergency before it happened to them, placed me in a quandary. Harrow A&E is a fairly difficult journey, I could, I suppose, have phoned for an ambulance, but I did not consider my condition, no matter how unpleasant it was, to be an emergency and I did not want to waste the time of ambulance crews and A&E staff in dealing with it. So I was effectively house bound for about three days until my GP appointment came up. Luckily, I had enough food at my home to last out, otherwise I might have gone to the A&E for lack of groceries, rather than for any medical reason.

The GP treatment, when I got it was adequate and I have l also now been referred for specialist treatment, so I make no blanket criticism of the NHS, but there do, locally, at least seem to be some gaping holes in its net.

Recently I have seen and heard, media coverage that suggests that A&E’s can no longer meet the demand placed on them by many people presenting with non-urgent conditions, and it could be that such pleading might cover for pressure caused by A&E closures, when no adequate service for non-emergency cases, such as mine, seems to be in place.

I know that there a places in the world where there have never been ANY health services and I know that currently, in other parts of the world (like Greece and parts of Spain), previously adequate health services are being systematically destroyed by mad neo-liberal austerity policies. So my whinges, as a relatively affluent, educated British urbanite, are minor; but someone more disabled, and/or less articulate, and/or with less access to transport, might find things far, far worse than I did. Public adverts advising people to use services that don’t really exist are annoying at the best and potentially dangerous at worst.

Green MEP Jean Lambert calls for halt to London A&E closures on eve of NHS March

I hope to see London Greens out in force tomorrow at the Defend London's NHS protest  as well as some of the new Brent Council Executive A contingent from Brent Fightback will be there. They will be meeting on the Southbound platform of the Bakerloo line at Baker St at 1130 tomorrow to travel on together to the demonstration at Waterloo.

 

London  Green MEP Jean Lambert has called on the government to halt the closure of up to nine accident and emergency wards in hospitals across London.


The wards are scheduled for closure, as well as thousands of hospital beds, in what the Keep Our NHS Public coalition has described as ‘the biggest attack on our NHS in a generation’.


Lambert, who will join thousands of people from across the UK in a march to the Department of Health to protest against the closures – and the threat of hospital and community health services being taken over by private companies, said:

This Government promised to defend the NHS – but the reforms it has introduced have done exactly the opposite.

As well as privatising services – allowing Tory donors like Care UK to offer public health care - its cuts and austerity program has caused plans to close hospital wards across the capital.

Greens believe in an adequately-funded publicly-provided NHS, run in the interests of people – not profits – and I will be proud to march tomorrow alongside some of the millions of NHS workers and patients who agree.”

Butt vows to go full-out on Central Middlesex A&E campaign

Cllr Muhammed Butt, leader of Brent Council, has told Labour Group members that he is determined to get behind the campaign to Save Central Middlesex Accident and Emergency.

Butt and some of his colleagues took part in the Brent Fightback march against the closure but they cited lack of Liberal Democrat and Conservative support as the reason they could not take an official Brent Council stand on the issue. They claimed this  meant that they could not mount a campaign such as that by Ealing Council that mobilised thousands of the local population.

In addition Brent Council's Health and Overview Scrutiny Committee failed to take a strong stand in defence of the A&E, accepting many of the arguments for closure, and then defeated a motion to join Ealing Council to refer back the reorganisation.

Butt now wants to take a much stronger position and has challenged his colleagues to give him full backing.The issue has already been mentioned by several of the candidates for the Brent Central parliamentary candidate nomination.

The leadership of Brent Labour will again be up for challenge at the May Annual General Meeting. A challenge to Butt's leadership fizzled out in February when his opponents were unable to muster enough support to table a no confidence vote.

Northwick Park A&E falls well below national targets

The North West London Hospital Trust is failing to meet targets for A&E according to figures submitted to the Brent Health Partnership Overview and Scrutiny Committee LINK.  The national target is that patients should spend no more that four hours in the department from entry to exit. The annual average for Northwick Park (Type one) is 90.55% and in the week leading up to the report was only 73.71%. One quarter of patients were there for more than four hours.

Central Middlesex A&E figures, on a much lower total of patients, were 97.05% and 95.45% respectively.

Commenting on Northwick Park, Tina Benson, Deputy Director of Operations at the Trust, states:

"A farrago, a sham, an utterly dishonest exercise"

It reminded me of those Victorian pictures of the ragged, scrawny child, barefoot in the snow, with nose pressed against a restaurant window staring at the big-bellied rich tucking into their suppers in a warm glow of complacency.

We were in the opulent surroundings of a ballroom in the Hilton Metropole, Edgware Road trying to tell the smooth, expensively suited gentlemen from NW London NHS on the platform just what untold damage their 'Shaping A Healthier Future' (SAHF) proposals would do the people of Harlesden and Stonebridge, two of London's poorest wards. The whole consultation exercise to reach a foregone conclusion has cost £7,000,000

We were presented with a IPSO/MORI consultation report that ignored the thousands who had signed petitions against the proposals but instead went on to suggest that that the far fewer people who had submitted a response to Options A, B or C (all rejected by the petitioners) somehow represented some kind of democratic endorsement. 66,000 signatories on 18 petitions were apparently counted as 18 responses.

Andy Slaughter MP summed it up:

This is a complete farrago,  a complete sham, a completely and utterly dishonest exercise!

This was the beginning of many exchanges about the consultation which I felt rather let IPSO/MORI take the fire that should have been aimed at NW London NHS for the inadequacy and downright dangerousness and dishonesty of their proposals.

Ann Drinkell, put her finger on the dangers towards the end of the Q and A session. She claimed that SAHF had been dishonest about the ability of community care being suddenly able to pick up on the slack when fewer people were admitted to hospital or stayed for a shorter period.

Everyone know we aspire to good community care, good palliative care, but everyone also knows how difficult it is.  It is disingenuous to suddenly think it will be unproblematic. The impact of restructuring and budget cuts on community care and social care will be enormous. You are treating us like children.

Dr Mark Spencer then proceeded to do just that, treating us to a couple of anodyne PowerPoint slides on the 'Programme of Work' and 'Clinical Review of Responses' that would now begin. We were not allowed to ask questi9ons about this.

After a buffet supper (those ragamuffins in my head again) we went into 'Stakeholder Workshops'. These were introduced by Lucy Ivimy, Chair of the Joint Health Overview and Scrutiny Committee, a Conservative councillor in Hammersmith and Fulham.

She said that the initial impetus for the proposals had been the rationalisation of Accident and Emergency wards in the area and the fall out was a consequence of this, The virtual closure of two hospitals had been hidden deep in the plans, Given the wide geographical area and the propensity of people wanting to protect their own local facilities it had not been possible for the Committee to reach agreement.

She said that there were two main concerns:
1. SAHF was premised on success of the out of hospital strategy. This had been promoted for years but in real life admissions had continued to rise. We need more evidence on the strategy and a firm path to follow.
2. Transport was a big issue. Although there was a claim from the ambulance survey that there was little impact on the 'blue light' journeys the majority of journeys to hospital are by other means including public transport. There had been no analysis of these journeys.

A skirmish followed about whether this represented the committee and it emerged that an initial very critical report had been replaced by a much sifter version which was the 'official report'.

The workshops that followed were actually very interesting and dealt with issues that should have been discussed prior to the formulation of the plans. The public were feeding back on their real lived experiences - not going through a desk-top exercise. The world turned upside down.

In the workshop I attended I protested once again that schools as stakeholder had not been consulted at all and that children had been left out at a time when the child population is rising and they will be making demands on the health service. Gurjinder Sandhu, a specialist in infectious diseases, working at Ealing Hospital backed this up describing the importance being able to access hospitals and their presence aiding recovery, how A&E picked up child protection issues and that the difficulty schools would have in trying to deal with fragmenting services.  A&E had a role in detecting TB which was very high in Southall and Ealing - not to mention  HIV.

In the workshop on Urgent Care Centre a disagreement became apparent between practitioners about how reliable UCCs were with a suggestion that staffing levels and expertise were poor and that this represented a risk to patients. This was even more so when there was no A&E on the same site as will be the case with Central Middlesex Hospital.

The strong underlying thread was that health services and access to health services would worsen for the most vulnerable. The ragamuffin has been left out in the cold.

Consultation feedback below:

Brent, Hammersmith and Ealing march together to save hospitals

Refusing to be divided from one another with localist claims of one hospital against another, campaigners from Brent, Ealing and Hammersmith and Fulham marched to gather on Saturday calling for ALL the hospital A&E departments in the area to be saved, thus preventing the eventual running down of the main hospitals.

Speakers included the Leader of Ealing Council and a Conservative councillor from Hammersmith. Muhammed Butt, leader of Brent Council, joined the march briefly before going off  another official engagement.

However it was the speeches from hospital workers, patients, trade unionists (including Christine Blower, General Secretary of the NUT) and a mother of 5 children which really galvanised the crowd.  Pete Firmin, secretary of Brent Trade Union Council, was applauded when he emphasised the need for unity and outlined how the closures were an attack on the most vulnerable in Stonebridge and Harlesden.

The following comments from the public on the Hammersmith and Fulham Council website about Charing Cross A&E  echo many that have been made about Central Middlesex A&E:

Closing this A&E would mean over-burdening others in West London - the people of Hammersmith need this facility. NHS efficiency drives are to do with saving money, not with saving lives.
Jane Thurston-Hoskins
 
Has anyone tried getting to the Chelsea and Westminster hospital in a hurry, especially during a Chelsea football match?!!
S Jenner
 
What are planners thinking of!! Have they ever been to C&W Hospital from almost any direction and any time. Fulham Road is permanently gridlocked even for busses and there is no near by underground.I suppose it is a convenient way of having a quiet A&E. And where do patient go when they have to be admitted. ?To ChX. And why was ChX's A&E department been given an overhaul only recently. I do speak out of experience with both hospitals. ChX is by far the more caring hospital And what if there is an accident on the A4 The so called planners are an absolute disgrace. I could go on!!
Dina Harris
 
Keep Charing Cross Hospital with a full range of departments. I am disabled; it is my nearest hospital and the most accessible one. I have been well looked after in dealing with my cataracts, hammer toes and mastectomy. I remember it being built, serving a great need.
Patricia Owen
 
Absolutely agree. Charing Cross is a fantastic hospital with very high standard of care, at the forefront of medical technology and life saving equipment. My son was saved there at 3.5 years old after falling under a car. I have just had a laparoscopy on my gall bladder. I cannot believe what a high standard it is. It is clean, friendly and has super nursing and consultant staff.
Ewa Sylwestrowicz