Alternative uses proposed for Central Middlesex Hospital after A&E closure

The Central Middlesex Accident and Emergency facility is still set to close despite extensive local opposition.  However the hospital is still being paid for through a Private Finance Initiative scheme so North West London NHS has to find ways of using the building to the maximum once the A&E is closed. It is claimed that just having an elective hospital there would result in an £11m recurring deficit.

At a Shaping a Healthier Future (SaHF) meeting on Thursday the initial plans were unveiled.  SaHF said that they want to make changes as 'soon as practicably possible' but also need to consider whether neighbouring A&Es are ready for transition and whether Central Middlesex and Hammersmith Urgent Care Centres are operating according to North West London wide specifications.

Options of using Central Middlesex as just an Elective Hospital (pre-arranged treatment) and the closure of the site were rejected. Instead SaHF opted for an option in which a 'Bundle of Services from multiple providers' would operate on the Central Middlesex site. After reducing an initial 'long list'  of possibilities their 'optimised proposal' is:

HUB PLUS FOR BRENT - A major hub for primary care and community services including additional out-patient clinics and relocation and expansion of community rehabilitation beds from Willesden Community Hospital.

ELECTIVE ORTHOPAEDIC CENTRE - A joint venture for local providers delivering modern elective orthopaedic services.

BRENT'S MENTAL HEALTH SERVICES - Transferred from Park Royal Centre for Mental Health.

REGIONAL GENETICS SERVICE - Relocated from Northwick Park Hospital.

These are in addition to a 24/7 Urgent Care Centre at Central Middlesex. The changes would necessitate considerable investment in the site.
 
In answer to my question SAHF  said Sickle Cell services would continue from Central Middlesex. They argued that the Hub Plus option would mean more primary care and community services available on site, direct access to diagnostic services, more out-patient clinics and that co-location would support integration.  Provision of community rehabilitation beds would have repercussions for the Willesden Community Hospital site with a possibility of other services moving there.including another GP service, or that some of it may be sold off.

SaHR said that dedicated planned/elective care would give the advantage of reduced length of stay and low infection and complication rates. It would be based on a 'proven model of care receiving high patient satisfaction' as provided by  the South West London Elective Orthopaedic Centre. It would be a joint venture between Northwick Park, Ealing, St Mary's and Charing Cross (Imperial) hospitals.

They claim that the transfer of Mental Health Services would mean better standards and a reduction in risk and the optimisation of care. Patients would benefit from a rebuilt mother and baby unit and moder pharmacy services that could also be used to support other services on the site.

The Regional Genetics Services provides outreach services across North West London and surrounding counties. It has two laboratories at Northwick Park which are independent of the general labs which are provided by a private provider. SaHF claim that moving it to Central Middlesex would 'allow profitable service lines to be developed' at Northwick Park.

It is proposed to hold an 'Options evaluation workshop with wide stakeholder audience' on the proposals on January 14th 2014.

Unfortunately the audience on Thursday was made up of people who were expert in the area, understood the jargon, and were on first name terms with the organisers. SAHF asked for ideas on how to engage more people, and apart from reducing the jargon, an idea that I put forward was for a special meeting about the proposals for the lead first aiders/welfare assistants of Brent schools  so that they can be briefed about the upcoming changes and can pass that knowledge on to parents of children who use those services.

Central Middlesex A&E closure announcement makes People's Inquiry even more important

Jeremy Hunt's announcement today that Central Middlesex Accident and Emergency ward is to be closed will come as a bitter disappointment to Brent health campaigners, particularly after the euphoria which greeted the Lewisham Hospital campaign's court victory yesterday.

Hunt's decision shows that that the Tories have absolutely no understanding of the needs of an area such as Harlesden/Stonebridge and the social and health inequalities that make an easily accessible local facility so important.

Campaigners will be considering next steps along with those fighting for Hammermith hospital but meanwhile after the announcement  it is even more  important that as many people as possible submit evidence to the People's Inquiry into the London Health Service. Details LINK and attend the local meeting of the Inquiry which will be held. Send your views using this LINK

• Friday Nov 8: 2pm-7pm, Ealing Town Hall, New Broadway, Ealing, W5 2BY. View map:

This is the trenchant evidence to the Inquiry submitted by Harlesden resident Sarah Cox:

I am a 76 year-old retired early years teacher. I worked for more than 30 years in Brent schools and have lived for more than 40 years in Harlesden. I am also an outpatient at Central Middlesex Hospital.

As such, I was extremely concerned about the likely effect of the changes enshrined in the Shaping a Healthier Future consultation and also about the consultation itself.

I followed the consultation carefully, read the documents and attended meetings called by NHS NW London and public meetings organised by local health campaigns. Overall, the consultation was more like a public relations exercise. Its questionnaire was designed to reach a desired conclusion rather than to look at the real health needs of the vast area it covers.

I am very concerned about accountability. NHS NW London made the decision to go ahead with the changes, but went out of existence before the process of introducing them had even begun. Who will be accountable if they turn out, as many of us believe they will, to result in damaging cuts to our health services, rather than improvements?

Although I will concentrate on the likely effects of changes to the area in which I live, I believe that all the changes will have knock-on effects on neighbouring areas and I am strongly opposed to the whole package. My husband was referred from Central Middlesex Hospital where he was diagnosed with laryngeal cancer, to Charing X where he was expertly treated. The co operation between the two hospitals was exemplary. Cuts to any of the hospitals will increase the strain on the others and on the ambulance service.

I believe that the case for fewer specialist hospitals further apart has been made for stroke, heart attacks and some serious injuries and services have been developed in line with that. Ambulance crews know the best place to take such patients and expert paramedics are able to stabilise them before transporting them to the best hospital. However, I do not believe that the extrapolation to other conditions such as serious asthma attacks, is justified. The surgeons want a concentration of expensive high-tech facilities in fewer, larger hospitals. What they ignore is the vital importance to patients' recovery of being in a setting that is accessible to friends and relatives. There has been a great deal of publicity recently about poor standards of care on understaffed wards. The best insurance against inadequate care is the vigilance of patients' families.

In fact, although we are told that the plans are based on clinical evidence, they are really based on a desire to cut costs. It the plans go through, nearly 1,000 beds and 3,994 clinical jobs will go from hospitals in NW London, saving £1billion over three years. The remaining hospitals will not be able to cope, the ambulance service will not be able to cope, the 111 service is already inadequate and yet we are told that it is crucial to the success of providing alternative services in the community. 

One of the declared aims of the Shaping a Healthier Future strategy was to reduce health inequalities, but moving health provision away from the areas of greatest deprivation and lowest life expectancy, will in fact increase health inequalities.

As a resident of Harlesden Ward and having worked on the Stonebridge Estate, I am most concerned with the loss of services at Central Middlesex Hospital and the impact on the people of Harlesden, Stonebridge and the surrounding area. The Brent Joint Strategic Needs Assessment and in particular the Harlesden Locality Profile (accessible through the Brent Council website www.brent.gov.uk) shows that Harlesden and Stonebridge wards are among the 10% of most deprived wards in the country. They have high levels of unemployment and of long term disease and disability. They also have a higher than average birth rate, and a larger than average percentage of young children and large families and higher rates of teenage pregnancy. Yet the maternity and paediatric services have been taken away.

Areas of poverty and poor housing like these have, it is widely recognised, higher levels of respiratory disease and mental health problems among other health problems. The government welfare cuts will increase these problems.

If health inequalities are to be overcome, health services should be provided where the need is greatest. If access to health services is difficult, people living in poverty and facing many other problems are less likely to seek help and relatively minor problems can become more serious.

Some of the reasons why it is wrong to close A & E departments at CMH and Ealing (these arguments apply to other hospitals in areas of deprivation):

·        A & E services are the first port of call for patients with mental illnesses and they are likely to find it harder to travel further for help.

·        When patients attend A & E, other problems e.g. cancer are often detected and can be treated before they become more serious.

·       There is no simple public transport link from the Harlesden or Stonebridge areas nor from Central Middlesex Hospital to Northwick Park and cabs are far too expensive for people dependent on benefits, so people who are taken ill or have an accident themselves or whose children are taken ill or have an accident will be forced to call an ambulance adding to the pressure on the ambulance service.

·       Transport difficulties not only affect patients, they make it hard for family and friends to visit patients. Support and care from family and friends are important for helping patients to recover. Negotiations with TfL even on the simple extension of the 18 bus route to Northwick Park Hospital have been unsuccessful, so patients and their families and friends from the area around CMH will continue to find access to Northwick Park extremely difficult.

Northwick Park is already struggling to meet targets and ambulances are being diverted back to CMH from there and from St Mary's. If all the proposed closures go through, how will Northwick Park cope with the added burden on A & E maternity, paediatric services, surgery and intensive care?

How will the ambulance service cope with the extra demand? It’s struggling already.

Has there been consultation with the Fire Service about the effect of the proposed changes? 

Schools were not consulted by the Shaping a Healthier Future team, yet during the school day, thousands of children become their responsibility and if any are taken seriously ill or have accidents, school staff will have to go with them to an A & E department further away.  

Out of hospital care

Of course it is always best to keep people out of hospital if appropriate alternative care and treatment can be provided in the community and of course we need more preventive services. We are promised all sorts of out of hospital care to take the place of the lost hospital services, but will the resources really be there? There is already a shortage of trained, skilled community health workers, health visitors, midwives and specialist nurses as well as GPs. Will the CCGs really be able to train and pay for those we need when they are facing constant budget cuts? Successful treatment and care for patients out of hospital demands integration with decent social care services, but the swingeing cuts to Local Authority budgets mean that social care services are at best barely adequate and unlikely to aid recovery and recuperation for patients who have been treated out of hospital or discharged early from hospital.

Getting information about the CCG’s commissioning decisions before they are made is extremely difficult. There are massive documents with quantities of acronymic alphabet soup and a hierarchy of meetings, some useful, most completely opaque to the interested patient or campaigner and suddenly, before you know it, another service has been outsourced and privatised.

However often we are assured that the changes to the NHS are clinically driven, it seems clear that the real drivers are financial the transformation of the NHS into a cash cow for the private sector so that even if it remains free at the point of use for patients, it will be run for profit.

Sarah Cox

Brent Council decisions made this week

Brent Council Executive among other decisions on Monday approved Muhammed Butt's statement on 'Shaping a Healthier Future' and this now represents the Council's stance. The application for an ECO grant to reduce energy use and bills was approved as were changes in SEN provision and procurement for public health contracts.

The Planning Committee approved the Electric House, Willesden Green, application subject to conditions and the 575 North End Road, Wembly private student housing development was approved but will be referred to the Mayor of London.

Butt poses key questions on future of NHS provision in Brent for Executive endorsement

The Brent Executive will be asked to retrospectively endorse a personal submission made by Council Leader Muhammed Butt to the Independent Reconfiguration Panel. The IRP was gathering evidence on the Shaping a Healthier Future plans for health services in North West London which include the closure of Central Middlesex A &E  and submissions closed  yesterday.

Th IRP will report to the Secretary of State on September 13th and his decision will be made in October 2013.

Muhammed Butt's Submission

I am writing to you to express my views on the Shaping a Healthier Future programme (SAHF). It is accepted that the NHS needs to change and services have to evolve but I have some serious concerns with the proposals as they stand, and whether they can really deliver improvements to health care in North West London within the planned timetable for implementation. I support the referral that Ealing Council has made to the Secretary of State for Health that will see the Shaping a Healthier Future proposals reviewed by the Independent Reconfiguration Panel. It is important that the plans are subject to robust and independent scrutiny and that the modelling and assumptions built into the proposals are properly tested.

Out of Hospital Care

SAHF makes it clear that changes to out of hospital care are essential if it is to deliver the planned changes to acute care. The general princip le of transferring services from acute to community locations with investment in primary and community care, where appropriate, is welcomed. People should not have to travel to hospitals for routine care or to manage a long term condition.

That said, I am concerned about whether the proposed changes can really be delivered, and even if they are, will they deliver the reduction in demand for acute services that SAHF claims?

I have seen no guarantees that out of hospital care will get the investment in the near future that is needed to ensure that SAHF can deliver improvements. The business case outlines the level of out of hospital care investment required, but in times of financial pressure and constantly shifting priorities, I need cast iron assurances from all of the CCGs in North West London that this money will be allocated to out of hospital services that underpin SAHF no matter what other challenges are faced in the coming years. 
 

The Decision Making Business Case (DMBC) is clear that commissioners and providers should not undertake reconfiguration of hospital services until out of hospital care is shown to be working and have sufficiently reduced demand on acute services. But I need clarity on exactly what the thresholds are for the reduction in demand that will need to be met before the reconfiguration of acute services is allowed to begin, particularly on critical services such as A&E.

I also need to be convinced that delivering more and more services out of hospital will be cheaper for the NHS. There is an assumption that this is the case, but I have seen no evidence to support it. One of the benefits of providing services in a hospital setting is the critical mass that can be achieved by locating services in one place. For some services, such as maternity, we will see a reduction in the number of places services can be offered.

For other services, we will see an increase in settings as services are delivered away from hospitals. The CCGs need to demonstrate more clearly how out of hospital services will be cheaper.

While there appears to be a general consensus of support across CCGs in North West London for the provision of out of hospital care, the provision of this falls to individual CCGs and individual Out of Hospital Care Strategies. A failure to deliver an Out of Hospital Care Strategy in any one CCG areas could have a knock oneffect on neighbouring CCGs, particularly if it affects demand on shared acute care services. For example (and this is hypothetical), if Harrow CCG fails to reduce demand for acute services, how will this affect Brent residents using Northwick Park Hospital where services could be under extreme pressure? Similarly, in these times of stark finances and shifting priorities, if one CCG decided to reduce its commitment to out of hospital care, it is not clear what the effect would be on neighbouring boroughs and shared acute service provision.

GP Support and “Hubs”

The Out of Hospital Strategy underpinning SAHF cannot succeed without GP support and I note that one of the key issues listed in the panel’s terms of reference is the consideration of GP’s views. I have seen no evidence of grass-rootsGP support for the changes, particularly in relation to out of hospital care (I refer to GPs themselves rather than the CCG). Although GP events took place, the DMBC gives limited reference to them, despite the report’s acknowledgement that Health Scrutiny Committees in North West London had made it clear that they expected to see evidence of GP support.

It seems to be a general assumption throughout the decision making process that the support of CCGs should be taken as implicit supportof GPs. This is an erroneous and dangerous assumption. Shaping a Healthier Future relies heavily on additional out of hospital services and without the full buy-in and cooperation of GPs SAHF will face serious, if not insurmountable, challenges. I ask that the IRP challenge the CCGs to provide the full details and results of the GP engagement activities that were undertaken to demonstrate that there is GP support for their proposals

Besides the lack of evidence of general support fro m GPs, we have seen little evidence that GPs will be prepared to make changes to the way they work or provide additional services/support that is required. SAHF and the CCGs needs to satisfy the panel that the GP elements of the Out of Hours services can be delivered, and what the back-up alternatives are in cases where it proves they cannot.

One of the key elements of the Out of Hospital Strategy is the provision of additional local medical centres (“hubs”). Yet purpose built centres that already exist in Brent have not fulfilled their potential. Monks Park Medical Centre for example remains under-occupied and consequently underused. Similarly, I understand that the NHS Brent has failed in the past to encourage a GP practice (the Willesden Medical Centre) to relocate into the Willesden Centre for Health and Care (one of the designated hubs) despite considerable efforts. I urge the panel to fully investigate SAHF's claims that the proposed centres will really be able to deliver on their promises across NW London and particularly in Brent.

Evidence from Brent to date suggests that efforts to move GP practices into purpose build medical centres have not succeeded and that they remain committed to working from their existing premises. Why should SAHF change this?

Given that “hub” medical centres are a central component of the Out of Hospital strategy underpinning SAHF, I need to see more clarity on exactly what services are planned for each hub. In particular there needs to be clarity on exactly what services will be provided at Willesden Centre for Health and Care and for Wembley Centre for Health and Care, which are already large medical centres in Brent and two of the designated hubs. I also want to see assurances that no existing services at these sites are going to be removed.

GP access is already a serious issue in Brent, particularly in the south of the borough, and previous attempts by the PCT to address this have had little success. Since SAHF is dependent on increasing GP access I urge the panel to establish with the CCGs (particularly Brent CCG) what evidence they have that that their new attempts to increase GP access will succeed where previous attempts have failed. Without this A&E attendances and acute demand will continue to rise.

Changes to acute care

I have seen little tangible evidence to support the models for individual services leading to reduction in demand on acute services. I acknowledge that there will be an element of risk in the modelling of any service reconfiguration, but the scale of change is huge and the impact of the Out of Hospital services not producing the required reduction in acute demand could be catastrophic. To this end I urge the IRP to establish what mitigation plans there are if the model fails, either for individual parts of the reconfiguration or for more fundamental modelling of the reconfiguration as a whole.

An example of a proposed service change that causes me concern is the provision of maternity beds at Northwick Park. Under the proposals there will be an increase from 69 to 70 beds by 2015/16, but a 20% increase in births atthe site. This appears to be based on the questionable assumption that a 15% reduction in average length of stay can be achieved by 2015/16. I ask the panel to establish what provision has been made if North West London Hospitals fails to deliver the numbers proposed?

Previous attempts to reduce acute demand through faster discharge have been unsuccessful and I would be interested to hear why SAHF believes it will succeed where previous attempts have failed.

I am particularly concerned about the deliverability of the proposals - maternity is one example. Changes on the scale proposed by Shaping a Healthier Future would ideally be carried out in a stable and highly functioning health system. But, we know that the NHS is in crisis, and North West London is not immune to this

.

Central Middlesex Hospital

It will come as no surprise to you that I am concerned about the future plans for Central Middlesex Hospital. Central Middlesex serves the south of Brent, which contains areas of significant deprivation and poverty. Has there been any research done on the evening closure of A&E at Central Middlesex that is already in place, and its effect on Northwick Park, St Mary's and other neighbouring hospitals? Northwick Park’s A&E Department is already failing to perform adequately or safely. Unless out of hospital services deliver a marked reduction in the use of Northwick Park’s A&E, the removal of A&E services at Central Middlesex could cause Northwick Park hospital to reach breaking point.

I note that North West London Hospitals and Brent CCG both support the plans for the closure of A&E at Central Middlesex but that does not alter the fact that there is a genuine, strongly felt public opposition to this plan which cannot be ignored and I urge the panel to give this strong consideration when they consider the proposals.

It is proposed that Central Middlesex be an elective hospital with an Urgent Care Centre. However, there is a complete lack of information on precisely what elective services will be delivered at the site, and what catchment area they will serve. It is also unclear what the UCC will provide despite plans for a standard UCC offer to be developed across London. A working group set up to develop plans for UCCs has,to the best of my knowledge, not published any proposals. I need to see clarification from Brent CCG on its plans for services at Central Middlesex Hospital and assurances on its long term viability as an NHS hospital before I can support the proposed changes.

Northwick Park Hospital

Northwick Park has struggled for some time to deliver an adequate or safe A&E and has one of, if not the worst, “four hour waiting time” performance in the country. It has recently had a crisis summit focussing on A&E leading to the imposition of an “Implementation Plan” to address the issues. Is it really prudent to give extra A&E responsibilities to a hospital that has shown itself incapable of delivering adequate A&E services to date and what is being put in place to manage these increased risks? The recent risk summit at the Trust highlighted the depth of the problems that currently exist and I have serious concerns about how you can transform a system which is already in crisis.

In addition, the response to the current A&E crisis at Northwick Park has been to utilise facilities at Central Middlesex. What back-up options will there be in the future once Central Middlesex’s emergency facilities have been removed?

Equalities and Population

Many residents of the south of Brent suffer deprivation and hardship. It is an area with a high proportion of BME residents and residents with English as a second language. We have sought assurances from SAHF that these communities will not be unduly disadvantaged by the reconfigurations and particularly the closure of Central Middlesex A&E.

In particular we have sought clarity on the travel implications for both patients and residents. To date we remain dissatisfied that sufficient consideration has been given to this. Clinical priorities are cited as being more important, but we should not ignore the fact that the mental health and recovery of patients can be dependent on regular visits and support from family and friends and I urge the panel to push for clarity on the effect that the changes would have on low cost transport options for patients and visitors, particularly in this deprived area. We would similarly seek assurances from Brent CCG that it will take seriously the public transport implications to the medical centre "hubs", which besides being an equalities issue, could reduce the numbers of patients using these services.

Conclusion

I want Brent Council to work constructively to challenge our NHS colleagues. I am not opposed to change without good reason, but I remain concerned at the lack of clarity in key areas, including: 

 

• The ability to deliver better out of hospital services

• That Northwick Park Hospital will be able to provide additional acute services for an expanded population

• The future of Central Middlesex Hospital. Despite the Shaping a Healthier Future plans being published a year ago, I am no closer to understanding what will be delivered from the Central Middlesex Hospital once it becomes an elective centre.

Brent Labour shrinks from supporting Ealing on hospital reorganisation

A motion referring the Shaping a Healthier Future proposals to the Secretary of State, moved by Cllr Claudia Hector, failed to find a seconder at tonight's Brent's Health Overview and Scrutiny Committee.  The proposals will mean the closure of Central Middlesex A&E.

At the Labour councillors' pre-meeting an alternative motion was amended so that it read that the Committee 'noted' Ealing Council's decision to refer the proposals in case it should appear that Brent Council supported their action. Instead the anodyne motion from Cllr Pat Harrison, seconded by Cllr Helga Gladbaum, said that 'it was right'  that the proposals should be 'thoroughly examined'  and sought assurances that services would not be  reduced or closed  unless changes in infrastructure had 'proved to deliver successful outcomes for residents'. This was passed with Lib Dem support from Cllr Ann Hunter.

The motion was in stark contrast to the earlier passionate call for arms from Sarah Cox of Brent Fightback and Brent SWP who told the Labour councillors that they were heirs to the creators of the National Health Service and, reflecting the commitment of the recently released Spirit of 45,  it was not too late for them to stand up for the NHS, and for the people of Harlesden and Stonebridge, and refer the  decision to the Secretary of State.

Her speech was loudly applauded by Lib Dem councillor Barry Cheese, who went on to make his own heart-felt intervention from first hand sources about the inadequacies of the ambulance service at Northwick Park. He had been told by ambulance workers that two stroke victims in separate ambulances had been delayed treatment because the vehicles had been behind 12 ambulances already on the hospital ramp. As presentations continued he repeatedly called out condemning privatisation. He seems to have moved to the left of the Labour group - which, let's face it, isn't hard.

There was a tedious presentation from NW London NHS on 'Improving Healthcare for people in Brent' that nearly had Cllr Gladbaum chewing the carpet in frustration.  However,  embedded in it was the tiniest hint that there may be slightest of chances that the Central Middlesex A&E decision may only be about 98% final.

One slide read:

CENTRAL MIDDLESEX A&E

• The NWL Hospitals Trust has set up a project board to consider future  options for the A&E (includes senior representatives and clinicians from the trust and stakeholders)
• Commissioners expect to be fully involved in any decisions regarding the future of the A&E and would require reassurance regarding any future change in services around:

The reasons for any changes and the evidence behind this view
The likely impact on neighbouring services (eg Northwick park and Imperial)
The alternatives that had been considered
The monitoring that would be put in place
The involvement of stakeholders inc the OSC

The litmus test is whether a change of service would be safer that the current service

I read this as an opportunity for campaigners to continue to put on the pressure and make the case for the retention of the A&E. What we should also be saying though is that the 'current service' at Central Middlesex needs to be strengthened and its running down halted. This view is somewhat reinforced by news that the number of ambulances being directed to Central Middlesex had increased recently.

So let's not give up just yet - keep up the pressure.

Health and housing on the agenda tonight

Brent's Health Overview and Scrutiny Committee will be asked by local campaigners to refer the proposal to close Central Middlesex A&E to the Secretary of State at this evening's meeting. Ealing Council has already taken this step which has drawn an irritated response from NW London NHS:

Ealing Council has asked the Secretary of State for  Health to consider the programme. This is a shame, as  this process normally takes a few months and will d elay implementation of much needed improvements to local services which the majority of clinicians, local GP s and other local councils want to see go ahead.

Of course many residents think it is a 'shame' that we may lose out local A&E, especially when the alternative facility, Northwick Park, is already over-loaded.  A local resident has written to Brent Council leader Muhammed Butt putting her views:

Dear Cllr. Butt,

I am a resident of Brent and Brent should be fighting on behalf of their residents to keep all four Hospitals A&E departments open.  Urgent care centres are not acceptable they are not manned by many doctors or nurses, and are no alternative to an A&E unit.   How far will Brent residents have to go to the nearest A&E dept? will they be seen? How long will they have to wait?  This will put their lives at risk.  

 

St Marys Hospital Paddington, Northwick Park Middlesex A&E depts. are already full with the present numbers they deal with, how will closing four A&E's in North West London help the people of Brent?.

I have had two operations this year in Charring Cross Hospital, this hospital is to be sold off for real estate. Charring Cross Hospital services the people of Brent, I was sent there as St Marys Paddington do not have the facilities or the beds to cope.

The NHS was founded by the labour government in 1948, I expect a labour council to look after all its residents North and South of the borough and back Ealing borough council in fighting to keep all four A&E departments open. Emergency's, Maternity and the Ageing population are all at risk

Yours sincerely

Margaret von Stoll

Apart from the important issues of the future of Accident and Emergency services in the area and the Shaping the Healthier Future proposals, the Committee will also discuss and question NHS officers on failures in local pathology services:

A serious incident was logged in December 2012 after a concern was raised by a GP about the new system. It became clear that this was not an isolated case, and another GP complained of spurious results, missing results and samples not  processed. It was further identified that training for GPs had not taken place and that  alleged meetings with GPs had not in reality occurred. A number of issues have now been identified with different test results and these are listed in the report.

 As as health campaigners are attending the Committee, housing campaigners will be at Mencap in Willesden High Road for a meeting starting at 6.30pm to discuss strategies for dealing with the deepening housing crisis in the borough. Details were published earlier on this blog and can be found HERE

Action needed to save Central Middlesex A&E

It is sometimes thought that only the residents in the south of Brent and neighbouring areas of Ealing are concerned about the closure of Central Middlesex Hospital. However residents in the north of the borough, served by Northwick Park Hospital A&E are also affected as this Guest Blog shows:

I hear that Ealing Council's scrutiny panel has voted unanimously to refer a decision to downgrade A&E departments in north-west London to an independent panel and wonder what you think about the decision to close the A & E departments?

If Central Middlesex, Ealing, Charing Cross and Hammersmith A & E departments are to close what impact is this going to have on the whole of densely populated and hugely congested West London????

Ealing Council are campaigning hard against this decision and so far I can only see Navin Shah, London Assembly member for Brent and Harrow (see this LINK) campaigning against the closures I can’t understand why the local councillors and our MP Barry Gardiner* are not campaigning against the closures too?

Navin Shah's press release LINK said:

A&Es will be forced to cater for an extra 120,000 residents on average each. In 2010 there were 32 A&E departments in London, but only 24 would remain under these plans."

"The 32 A&E’s served a population of 8.17million Londoners, an average of 255,000 people each. Reducing to 24 A&Es will mean they have to cover 340,000 each, with London’s population due to rise to 9million by 2020. This will increase the number of people each A&E is due to cover to 375,000 residents - an increase of 120,000 for each A&E. This assumes that no further closures take place.

As you know in recent years every single bit of space in Wembley has had flats built on it, bringing more and more residents to Wembley and more and more traffic congestion.  Add to this the new designer outlet and French school coming to Wembley Park - these will both bring more people and more traffic to the area.

What about Wembley Stadium with 90,000 capacity plus staff and Wembley Arena with 12,500 capacity plus staff, these bring another 102,500 plus people to the area when both venues are holding events - should there be a major incident when both venues are full to capacity how would Northwick Park A & E cope???  How would emergency vehicles cope with getting people through Wembley to Northwick Park or through to the other remaining A & E departments???  When the stadium was opened traffic schemes were put in place to get people away from the stadium to the North Circular to try and stop the congestion in Wembley so would it not make sense to keep Central Middlesex A & E open???? 

Also we hear that Central Middlesex A & E will close this June well before the new larger A & E is supposed to open at Northwick Park – how can this be allowed to happen when it clearly says that the A & E departments will close in the next 2-3 years after the new larger A & E departments are open???

My friend recently broke his toe and went to Northwick Park A & E at 10.00pm on a Monday night and was told he would have to wait 5-6 hours before he was seen – he decided not to wait and went back the next day and had to wait 4 hours to be seen.  How will Northwick Park A & E cope when everyone has to go there?  Will the hospitals be reducing parking charges for people that have to wait for hours and hours in the A & E departments to be seen??? Will there be improved public transport - if you have to go there in the middle of the night there will be no public transport available.

What impact will all the extra traffic have on the area with people having to travel further for treatment - not very good for the environment!

*Barry Gardiner says Central Middlesex A & E is not in his constituency but a lot of the people who will be affected by its closure are his constituents!!!

 Since this guess posting was sent to me Cllr Lincoln Beswick  (Labour, Harlesden) has written in the Brent and Kilburn Times regarding the closure of Central Middlesex A&E and other Coalition policies::

All these areas that this affects must stand up, be more forceful, challenge nationally elected members and jointly have a march for freedom from this atrocious, blatant, obvious and odious decision. Those elected and in opposition should not stay silent on these issues.

This requires joint action by all those who are affected - elected politicians, health service, trade unionists, general community and media services

A first practical action will be if Brent Council decides to refer back the decision to close Central Middlesex A&E at the meeting of the Health Partnerships Overview and Scrutiny Committee at its meeting on Tuesday March 19th 7pm Brent Town Hall. LINK

The public can request to speak at the meeting. The contact is: 

Lisa Weaver, Democratic Services Officer  (020) 8937 1358 Email: lisa.weaver@brent.gov.uk

NW London NHS vote to close Central Middlesex A&E with potentially life threatening consequences

Hospital campaigners from Brent, Ealing and Hammersmith and Fulham assembled at a chilly 8.30am today outside the Methodist Central Hall, Westminster in the shadow of Parliament's Victoria Tower. They were protesting against Shaping a Healthier Future plans to close A&Es at Hammersmith, Charing Cross, Ealing and Central Middlesex Hospitals.

Their pleas were ignored just as were their letters, petitions and marches and the Trust went ahead and voted for all four closures.

Campaigners warned that the decision will hit many of the area's most vulnerable residents and could result  in life threatening delays for urgent treatment.

The ITN report on the demonstration and decision can be found HERE

"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:

£7m spent on Shaping a Healthier Future consultation

The Daily Mail LINK has revealed that the NW London NHS Trust consultation cost £7,000,000. It seems that at national and local government level PR companies are one of the main beneficiaries  from austerity as those in power seek to dress up cuts decisions already made with spurious and meaningless 'consultation' exercises. In the case of Central Middlesex Hospital keeping the A&E open  was never an option the public were allowed to choose. Moreover with no risk assessment  in the public domain respondents had no way of assessing the true human cost of the changes. A shameful waste of public money. With so few turning up to consultation meetings it would be interesting to know the cost per attendee.

Meanwhile in Brent the PR bill for the Willesden Green Redevelopment project continues to mount as plans are tweaked but no ground given on the fundamentals.

When I worked for Erwin Wasey, Ruthrauff and Ryan Limited, an advertising agency, in the 1960s, I asked about a job in their Public Relations Department. In the interview I was naive enough (I was only 16) to say that I thought I was suited to work in PR because I got on with people. The director who interviewed me exploded and said, "Well you shouldn't work in PR then. You have to hate people and hold them in  contempt if you want to do well in this business."

David Cameron worked in PR for Carlton Television in order to have some experience outside politics. He got the job because his then girlfriend's mother, Lady Astor, had a word on his behalf with her friend, Michael Green, who was executive chairman of Carlton. He started on a salary of £90,000.

Brent Council shrinks from outright opposition to Central Middlesex A&E closure

The Brent Health Partnerships Overview and Scrutiny Committee last night approved a response to 'Shaping a Healthier Future' which fell far short of outright opposition to the proposals which will mean the closure of Central Middlesex Accident and Emergency.

Although the response contains many reservations about Urgent Care Centres,  community care and transport issues the overall conclusions are anodyne:

Overall conclusions

5.1 The Brent Health Partnerships Overview and Scrutiny Committee believes a strong clinical case for change has been made by NHS North West London and that health services need to be reconfigured to secure better outcomes for patients. This will mean that difficult decisions will need to be taken, but to “do nothing” is not an option and it is in everyone’s interests to ensure that services in London have a sustainable future.

5.2 That said, we urge the Joint Committee of PCTs to consider the following points when making its decisions regarding Shaping a Healthier Future:

(i). Efforts need to be focused on successful implementation of the borough’s Out of Hospital Care Strategy and ensuring this is properly resourced before the reconfiguration of acute services.  Changes to the acute sector are dependent on this – cost shunting, or under resourcing out of hospital care would not be acceptable to the council and will lead to a worse service for patients escalating costs in the acute sector.

(ii). That services to be provided from Central Middlesex Hospital are confirmed as soon as possible. Work should begin with local communities to spell out what the future is for the site so they can be reassured their health and wellbeing won’t be adversely affected by the changes.

(iii). That Shaping a Healthier Future emphasises to TfL the conclusions relating to

transport set out in paragraph 4.11 above.

Earlier in the meeting committee members had subjected Care UK to a grilling regarding the loss of x-rays  and child protection procedures at the Central Middlesex UCC and the time they had taken to answer complaints.  Care UK told them that the problems had been caused by high staff turnover, a large number of interim staff and a failure to recognise the importance of the issues. Cllr Helga Gladbaum stressed the importance of safeguarding children in the brough with its history of cases such as Victoria Climbie, Care UK said that staffing was being stabilised, protocols were in place and there was robust auditing and monitoring. Cllr Sandra Kabir said it was astounding that Brent had not ended up with a terrible disaster on its hands. Dr Sarah Basham, representing the Brent Clinical Commissioning Group said that they had found Care UK willing to listen and learn from each other and they had been open and willing to meet. GPs ere aware of the situation and a feedback mechanism was in place.

There was a lively debate, mainly conducted at a comradely level between councillors apart from a tetchy spat between Cllr Gladbaum and deputy leader Cllr Ruth Moher, on public health. Local councils have now taken over public health functions from the NHS and a proposal had been made to appoint a Director of Health to be shared with the London Borough of Hounslow. The proposal goes before the Executive on Monday.

Phil Newby,  Director of Strategy, Partnerships and Improvement, moved a report advocating such an appointment in a long speech rich in rhetoric but short on substance. He wanted an evangelical leader to drive policy and change. Questioning revealed that the Director would have no budget and would not be part of the Corporate Management Team. Simon Bowen from Brent NHS addressing the committee said that such a 'part-time'  post-holder would be weak and marginalised and it would be hard to recruit to the post. The post was statutory and subject to guidelines. He said that Brent had been transformed in the last 5 years while Hounslow was 5 years behind it. Brent's gains would be put at risk by such an appointment.

Newby defended his report saying that the current Hounslow post-holder had just been given a new job in Croydon and that innovative strategies would be welcomed.

The Committee agreed to recommend to the executive that while they supported mainstreaming public health in the body of the Council that they had serious concerns over sharing a Director with another borough.

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:
   
PROCESS

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.

CENTRAL MIDDLESEX A&E

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.

URGENT CARE CENTRE

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.

SCHOOLS

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.

 

Come and present hospital petitions at 1pm today as consultation closes

 Brent hospital campaigners have collected more than 2,000 signatures on petitions opposing hospital closures in West London and the privatisation of the NHS.

They will join campaigners from Ealing and Hammersmith today at 1pm to present the petitions to the North West London NHS Trust at their offices at 15 Marylebone Road, NW1 (close to Regents Park).

Please join them if you can. Brent campaigners will meet at Baket Street Station at 12.45pm.

View Larger MapDriving Directions

The consultation on Shaping  Healthier Future closes  today at midnight.  The consultation document gives the NHS NW London address as Victoria Street SW1. In fact they have moved to Marylebone Road so I checked today that redirected postal responses would still be valid if they were received at Marylebone Road after today's deadline,. They confirmed that this would be the case.

E-mail responses should go to:  consultation@new.london.nhs.uk or online at www.healthiernorthwestlondon.nhs.uk  Many people have found the latter format restrictive as it does not allow them to support the continuation of Central Middlesex A&E.