Proposal to reduce hours at Central Middlesex Urgent Care Centre by closing it overnight

Brent NHS Clinical Commissioning Group  is proposing to close the Central Middlesex Hospital Urgent Care Centre, presently available 24/7, from midnight to 8am, saving £450,000 annually in what they admit are financially challenging circumstances.

The service is currently provided by Greenbrooks and the CCG says the provider agrees with the proposal. The CCG health, rather than financial case, is based on low usage and availability of alternative provision:

The data analysis based on “reasons for attendance” showed that from the average of ten (10) patients attending per night, the following would be the appropriate course of action if CMH UCC were to close overnight: 


o Less than 1 per night would continue to require ED either urgent treatment or referral to specialty review

o One(1)per night would need to attend an alternative UCC such as Charing Cross, St Mary’s, Ealing or Northwick Park

o Four (4) per night could access an alternative night service such as GP out of hours

o Four (4) per night could access alternative provision, including their own GP, the next day

The UCC was set up in 2014 when the Accident and Emergency service was closed at  Central Middlesex Hospital, despite widespread opposition, which included rather belated opposition from Brent Council.  The overnight closure of the UCC represents a further deterioration of the service currently offered to residents in Harlesden, Park Royal and Stonebridge.

Transport difficulties to alternative A&Es was always a factor in the original campaign against the A&E closure was a major factor so the CCG puts forward the transport timings for residents seeking overnight treatment:

The CCG argue that the change would mean a 'safer urgent and emergency offer by reducing entry points to out of hours services':

The alternative offering being implemented by the CCG will aim to drive down [] inappropriate attendances, helping to provide choice and direction to those seeking advice and care. The majority of attendees overnight are between 20 and 44, the age group most likely to have internet access at home, or own a smartphone, and therefore be best place to benefit from digital signposting.

People arriving out of hours at Central Middlesex will be advised to dial 111.

The report will be considered by Scrutiny Committee at its meeting on July 9th. The full document is HERE

 

Care UK or DON'T Care UK?

Guest blog by Sarah Cox:

If the Accident and Emergency Department at Central Middlesex Hospital closes, as proposed in every option in the NHS NW London consultation document Shaping a Healthier Future, residents in Brent’s poorest wards with the greatest health needs will be at the mercy of private health care provider Care UK which runs the Urgent Care Centre at Central Middlesex.

Urgent Care Centres are designed to take the pressure off A & E departments by dealing with minor injuries and less serious illnesses. Fine, but one of the reasons people go to their doctors or to A & E when the doctor isn’t available, is that they are not medically qualified so don’t necessarily know how serious (or not) their condition is. One of the NW London NHS documents gives the example of a mother who takes her baby to A & E with a high temperature. She is told that the baby is just teething. One of the functions of qualified medical staff should be to reassure patients. What about the case where the baby’s high temperature is not caused by teething but is a symptom of meningitis? Meningitis is hard to diagnose, but if not treated very quickly, can be fatal. There have been reports of Urgent Care Centres failing to spot meningitis and sending a stroke victim home http://www.telegraph.co.uk/health/healthnews/5185165/Urgent-care-centres-putting-patients-lives-at-risk-doctors-warn.html

 

As a patient, Care UK’s record doesn’t fill me with confidence: 

X-rays: At the CMH Urgent Care Centre, Care UK failed to carry out the required checks on 6,000 x-rays, missing such details as broken bones http://www.channel4.com/news/flaw-leads-to-review-of-patient-x-ray%20records. All x-rays should be reviewed by a specialist to make sure that nothing has been missed, they should also be checked against the child protection register and GPs should be informed when their patients have attended the UCC. Care UK neglected to do this and took more than a year to find the flaw in their system and start to review the x-rays. Channel 4 reports, ‘Asked how it had happened, Care UK blamed it on "a couple of changes in the management structure of the team that ran the centre". They also failed to report it to the Care Quality Commission. Care UK said that although it was not legally obliged to do this, it "probably should have told CQC, but nobody picked up the phone".’ What a caring attitude!

The contract to run the CMH Urgent Care Centre was given to Care UK by the former Brent Primary Care Trust. All eight Brent NHS clinical directors wrote urging them not to sign the contract, but were told they were too late. Former members of that PCT are now non-executive directors of Care UK and NHS Brent is tied into a contract with Care UK that they cannot get out of.

Friends in high places: The wife of Care UK’s then chairman gave £21,000 to Andrew Lansley when he was shadow Health minister to help run his constituency office in the run up to the general election, an investment that has certainly paid off when you see how many contracts the firm has been awarded in the NHS and social care sectors. 

Tax avoidance  Care UK, which operates NHS treatment centres, walk-in centres and mental health services, has a reduced tax bill by taking out loans through the Channel Islands stock exchange and coming to an agreement with HMRC Guardian 17.3.12 Care UK join the likes of Vodaphone and Jimmy Carr in claiming that they’ve done nothing wrong.

There’s more about Care UK, but I’ll leave that for the next instalment. What’s your experience of Care UK or specifically of the Urgent Care Centre at Central Middlesex?