Dire impact of A&E closures in North West London exposed

Closing A&E departments has led to a deterioration in the performance of those that remain in North West London. An anaylsis by Dr Gurjinder Singh Sandhu for the Centre for Health and the Public Interest warns of the risk to patients if further A&Es are closed. 

Across England NHS Sustainability and Transformation Plans (STPs) are proposing the closure or ‘downgrade’ of up to 24 emergency departments.

This analysis shows how A&E performance has suffered across North West London following the closure of two emergency departments in 2014.

Performance against the 95% 4-hour wait target dropped to as low as 60% shortly after the closures, meaning that up to 40% of patients requiring serious treatment had to wait over 4 hours to be assessed and admitted to an appropriate bed. Since then the performance of North West London hospitals has been some of the worst in the country, sometimes managing to treat fewer than half of the patients within four hours. For time-sensitive conditions such as sepsis or respiratory failure such delays are life-threatening.

In addition, since the A&E closures in 2014 the bed occupancy rate in all hospital trusts in North West London has been above 85%, compromising clinical safety through overcrowding.

This paper also points out that the closures aggravate health inequalities, hitting the most deprived boroughs in the region. (See image below)

The full paper by Dr Gurjinder Singh Sandhu can be found here LINK

Hospital Merger Plans Challenged

36 people turned up at the Sattavis Patidar Centre, Forty Avenue last night to discuss the proposed merger of Ealing and North West London Hospitals Trust (covering Central Middlesex, Northwick Park and St Mark's hospitals). This compared with 100 at the recent Ealing meeting and a 'client' base of 800,000 people.


Professor Rory Shaw, Medical Director, made the case for the merger. The organisational merger would enable the joint Trust to have larger specialist teams which would be more viable than the present small teams, enable shift-work to take place and would attract high calibre staff Economies of scale would mean the Trust could keep pace with developments by buying up to date equipment and make resources, including scanners and operating theatres 'work harder' and the buildings 'earn their keep'. 

He said that Northwick Park's  stroke care unit was a good example of the merits of large, centralised teams and had led to better survival rates and fewer cases of paralysis.


Although the Chair of Brent LINk (Local Involvement Network) had stipulated that the meeting was not to discuss services, Shaw said that the merger was being proposed against the consultation on the commissioning of services that would take place in Summer 2012.  The focus would be on prevention and long-term conditions and more care and treatment in the community. He claimed that the latter was bothe cheaper and more effective.


He said that the move was taking place as a time when there was a general recognition that bigger was better. Other speeches from the six suited males on the platform extolled the merits of 'an army of generic workers', with an implication that these might be volunteers, who could help patients at home with hospital-home transition. We were treated to the management  mantra 'Localise where possible, centralise where necessary'.


Challenged that the presentation had not mentioned the financial plight of the NWLH Trust and that the merger proposal was a cover for cuts, the platform said that there was a financial saving involved of £7m and that this was specified in the Business Plan. Savings would be made in management and through reduction in 'back office' costs. Asked if  'developing the estate' meant selling off prime sites, especially in the light of the apparent running down of the Ealing and Central Middlesex hospitals, they said that sell-offs were not in the Business Plan but 'there may be scope for that in the future'.

Carers criticised the emphasis on volunteers and a speaker from the Sickle Society was concerned about the speed of the changes and poor consultation with users. He said that there had not been sufficient consideration of the needs of people with Sickle Cell and Central Middlesex Hospital's historic role in providing specialist care.

The platform was challenged on the implications of patients having to travel further for treatment and concern that the disadvantaged population of South Brent would be further disadvantaged if Central Middlesex was run down. Health inequalities would increase. A speaker from the floor made a strong demand for a Equality Impact Assessment. Despite repeated requests the platform were un able to advise which bus patients should get from Harlesden to Northwick Park Hospital.

Behind it all was the implication that larger teams would mean each site would have different specialisms which would not be offered at other hospitals in the Trust. The platform argued that routine care would still be provided at each hospital. A question asking if the new arrangements would be able to cope with a 'major incident' in South Brent with its many railways, the North Circular, waste sites and commercial premises; was not answered.


Brent LINk will be putting together its response and you can contribute: brentlink@hestia.org Tel: 020 8965 0309. Brent LINk Unit 56, The Designworks, Park Parade, Harlesden, London, NW10 4HT

Harrow LINk will hold its own consultation:
HARROW LINk: Thursday 12 January 2012. Registration and refreshments from 5.30pm. Event starts at 5.50pm and will close at 8pm. Premier House Banqueting, Canning Road, Harrow, HA3 7TS. Places are limited. If you like to attend please contact Harrow LINk at info@harrowlink.org.uk
or call 020 8863 3355.


TIMETABLE
November 2011 Outline Business Case for merger signed off by NHS London
March/April 2012 Full Business Case approved by the Trust Boards and NHS London
May 2012 Submission for approval by Department of Health Transaction Board
July 2012 Merger takes places
Autumn 2012 Commissioning of Services

Shahrar Ali's report on the meeting is HERE