The challenges facing our local NHS hospitals - top managers address public meeting

From Brent Patient Voice 

I’m writing to extend a warm invitation to a forthcoming BPV PUBLIC MEETING on 12 September at 7pm at the Learie Constantine Centre, Dudden Hill Lane, NW10 2ET. (Refreshments from 6.30pm.)

The topic will be a presentation on the challenges facing the London North West Healthcare NHS Trust (i.e. Northwick Park, Ealing, Central Middlesex and St Mark’s Hospitals). As you will be aware these challenges are daunting. The flow of thousands of patients through the doors does not decrease. While some highly commended clinical  services are being provided, waiting times in A&E and for some types of appointment are falling seriously short. In addition the Trust is required to close a deficit of around £49.5 million. We are fortunate to have secured two members of the top management team to tell us how the Trust is coping. They are Dr Nigel Stephens, Deputy Medical Director and leading cardiologist, and Simon Crawford, Director of Strategy. We are also asking a GP, Prof Paul Thomas, Editor-in-Chief of the London Journal of Primary Care, to comment on how links between hospitals and GPs can be improved to benefit patients.

After the presentations and an interactive discussion, we’ll move for the last half-hour to the BPV AGM, including elections.

We very much hope to see you there.

Robin Sharp

Chair Brent Patient Voice

Local hospitals hit by cyber attack: advice from Health Trust

Statement from NW London NHS Trust

Since Friday's cyber attack, staff across the Trust have been working tirelessly to ensure patients are cared for safely.

We identified the virus at 12.45pm on Friday (12 May) in three PCs and two servers. As soon as the virus was identified we took immediate action to protect our systems from any data loss and further corruption. 

As a precaution we shut down a number of IT systems and some services are currently using paper-based systems. It is the precautionary measures we have taken that have caused most disruption, not the virus itself.

We continue to work with NHS Digital and will begin to switch our IT systems back on when we feel it is safe to do so.

In the meantime we are asking the public to help our staff and visit our emergency departments for serious and life-threatening injuries and conditions only. Please consider the alternatives, such as visiting your local walk-in centre, pharmacy or calling 111 for minor injuries and advice. This will help relieve pressure on our services. 

Advice for patients 

Patients are asked to attend their appointment or operation as planned over the coming days, unless they have been contacted and told not to attend. If patients or their loved ones need to get in touch about their appointment or operation, please call (instead of email) our main hospital switchboards:

 

• Central Middlesex Hospital: 0208 965 5733 
• Ealing Hospital: 0208 967 5000
• Northwick Park and St. Mark's hospitals: 0208 864 3232

We apologise for any delays and cancellations that patients will experience and we thank you for your continued patience and cooperation as we work to resolve these issues.

MORE

Since Friday's cyber attack, staff across the Trust have been working tirelessly to ensure patients are cared for safely.
We identified the virus at 12.45pm on Friday (12 May) in three PCs and two servers. As soon as the virus was identified we took immediate action to protect our systems from any data loss and further corruption.
As a precaution we shut down a number of IT systems and some services are currently using paper-based systems. It is the precautionary measures we have taken that have caused most disruption, not the virus itself.
We continue to work with NHS Digital and will begin to switch our IT systems back on when we feel it is safe to do so.
In the meantime we are asking the public to help our staff and visit our emergency departments for serious and life-threatening injuries and conditions only. Please consider the alternatives, such as visiting your local walk-in centre, pharmacy or calling 111 for minor injuries and advice. This will help relieve pressure on our services.
Advice for patients
Patients are asked to attend their appointment or operation as planned over the coming days, unless they have been contacted and told not to attend. If patients or their loved ones need to get in touch about their appointment or operation, please call (instead of email) our main hospital switchboards:

• Central Middlesex Hospital: 0208 965 5733 
  
• Ealing Hospital: 0208 967 5000
  
• Northwick Park and St. Mark's hospitals: 0208 864 3232
  

We apologise for any delays and cancellations that patients will experience and we thank you for your continued patience and cooperation as we work to resolve these issues.
- See more at: http://www.lnwh.nhs.uk/about-us/news-and-media/latest-news/cyber-attack-information-for-patients/#sthash.fVPMmwLk.dpuf

Since Friday's cyber attack, staff across the Trust have been working tirelessly to ensure patients are cared for safely.
We identified the virus at 12.45pm on Friday (12 May) in three PCs and two servers. As soon as the virus was identified we took immediate action to protect our systems from any data loss and further corruption.
As a precaution we shut down a number of IT systems and some services are currently using paper-based systems. It is the precautionary measures we have taken that have caused most disruption, not the virus itself.
We continue to work with NHS Digital and will begin to switch our IT systems back on when we feel it is safe to do so.
In the meantime we are asking the public to help our staff and visit our emergency departments for serious and life-threatening injuries and conditions only. Please consider the alternatives, such as visiting your local walk-in centre, pharmacy or calling 111 for minor injuries and advice. This will help relieve pressure on our services.
Advice for patients
Patients are asked to attend their appointment or operation as planned over the coming days, unless they have been contacted and told not to attend. If patients or their loved ones need to get in touch about their appointment or operation, please call (instead of email) our main hospital switchboards:

• Central Middlesex Hospital: 0208 965 5733 
  
• Ealing Hospital: 0208 967 5000
  
• Northwick Park and St. Mark's hospitals: 0208 864 3232
  

We apologise for any delays and cancellations that patients will experience and we thank you for your continued patience and cooperation as we work to resolve these issues.
- See more at: http://www.lnwh.nhs.uk/about-us/news-and-media/latest-news/cyber-attack-information-for-patients/#sthash.fVPMmwLk.dpuf

Since Friday's cyber attack, staff across the Trust have been working tirelessly to ensure patients are cared for safely.
We identified the virus at 12.45pm on Friday (12 May) in three PCs and two servers. As soon as the virus was identified we took immediate action to protect our systems from any data loss and further corruption.
As a precaution we shut down a number of IT systems and some services are currently using paper-based systems. It is the precautionary measures we have taken that have caused most disruption, not the virus itself.
We continue to work with NHS Digital and will begin to switch our IT systems back on when we feel it is safe to do so.
In the meantime we are asking the public to help our staff and visit our emergency departments for serious and life-threatening injuries and conditions only. Please consider the alternatives, such as visiting your local walk-in centre, pharmacy or calling 111 for minor injuries and advice. This will help relieve pressure on our services.
Advice for patients
Patients are asked to attend their appointment or operation as planned over the coming days, unless they have been contacted and told not to attend. If patients or their loved ones need to get in touch about their appointment or operation, please call (instead of email) our main hospital switchboards:

• Central Middlesex Hospital: 0208 965 5733 
  
• Ealing Hospital: 0208 967 5000
  
• Northwick Park and St. Mark's hospitals: 0208 864 3232
  

We apologise for any delays and cancellations that patients will experience and we thank you for your continued patience and cooperation as we work to resolve these issues.
- See more at: http://www.lnwh.nhs.uk/about-us/news-and-media/latest-news/cyber-attack-information-for-patients/#sthash.fVPMmwLk.dpuf

A big 'THANK YOU' to the nurses of Brent

Yesterday was 'Nurses Day' and I was busy with interviewing all day but I would like to say a belated thank you to all the nurses who I have encountered in recent visits to Northwick Park, St Marks and Central Middlesex hospital.

I have been impressed by their efforts to explain procedures, minimise pain and provide support. What impresses me above all is their team work alongside other NHS staff often accompanied by a stress reducing sense of humour.

Thank you.

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

Mansfield slams NW London hospital plans: Brent Patient Voice responds with proposals and asks 'Why is the NHS silent?'

 From Brent Patient Voice

-->

Brent Patient Voice welcomes the findings of the Mansfield Report. BPV Chair, Robin Sharp, said: “We are pleased that Mansfield endorses the extensive evidence that we and many other independent people submitted. Why has the NHS greeted it with silence?”  

The Report of the Independent Healthcare Commission for North West London under Michael Mansfield QC was published on 2^nd December. It brings no comfort for the NHS chiefs in our area – and none for patients either.

The Report says that the Shaping a Healthier Future programme is “deeply flawed”. Launching the Report Michael Mansfield said that the planned reforms provide “no realistic prospect of achieving good quality accessible healthcare for all and any further implementation is likely to exacerbate a deteriorating situation.”

The Commission calls for the programme to be halted, for the decisions to close the A&E Department at Central Middlesex Hospital and the Maternity Unit at Ealing Hospital to be reversed, for the increasing size of the population in NW London to be properly established and factored into future planning, for the so-called “Implementation Business Case” to be published and for there to be a new public consultation on the plans which they believe to have changed significantly. They suggest that the local authorities should consider seeking judicial review if the NHS press ahead with the programme in current circumstances.

However we are deeply disappointed that neither the eminence of Michael Mansfield nor the extent of public concern revealed by the evidence have moved the NHS authorities responsible for Shaping a Healthier Future to be sensibly open about the current state of the programme or its likely costs.

Commenting further, Robin Sharp said “Our fundamental criticism of the whole initiative is that the NHS in NW London has broken its promise in the consultation document that out of hospital services will be in place before changes are made to hospital-based services. Two A&Es and one Maternity unit have closed. Where are the openings to take their place?”

In order to be constructive we propose:

·      That the NHS should publish an intelligible version of the Implementation Business Plan for Shaping as it now stands, with outline costs, as is normal for any major public project;

·      That full consideration of the future of Central Middlesex Hospital be resumed, including the option of restoring its acute status with a fully-functioning A&E, bearing in mind the inadequacy of a stand-alone Urgent Care Centre there and the continuing intolerable situation at Northwick Park;

·      That Council officers be instructed to work with GLA statisticians to provide reliable estimates of the size of the current Brent population and growth rates, taking account of births, deaths, net migration and planned major developments;

·      That in collaboration with all partners Brent CGG produce a clear account of their Out of Hospital Strategy, including the role of the new GP networks, to restore confidence in this vital missing element of the Shaping programme;

·      That full and meaningful patient consultation and involvement should be integral to all future consideration of these proposals.

Brent Patient Voice  5^th December 2015

Visit the Brent Patient Voice website HERE

How to support the Junior Doctors' action

STATEMENT ON JUNIOR DOCTORS' STRIKE

TO OUR FELLOW NHS WORKERS, TRADE UNIONISTS AND CAMPAIGNERS

On Tuesday 1st December it is likely that Junior Doctors across the UK will commence industrial action against the Governments continued threat of imposition of an unsafe new Contract.

This industrial action is the last resort for junior doctors in an attempt to prevent the Imposition of a contract that we feel would jeopardize the profession, patient care and the NHS for a generation.

This is not a decision that has been taken lightly and Doctors have united in the hope that this action will protect the NHS for future generations.

Our ballot result of 98% for strike action means that Junior doctors in England have given the BMA a huge mandate to proceed.

Over the last few weeks I have met many of you as individuals or as members of your organisations and on occasion have had the opportunity to speak alongside you at events. As one of the co-ordinators for the imminent strike action in north London the last few days have been incredibly busy and are getting busier still.

I apologise profusely if I have not had the chance to return some of your calls or email in time. It is highly unlikely that I will be able to respond in the next few days either. We still have a logistical mountain to climb!

I am also aware that many of you have had some fruitful contact with other BMA junior doctor’s representatives and activists. This is excellent.

On behalf of the entire BMA we thank you all for your solidarity.

I write to inform you of a few details with regards to the planned action and to invite you to come out and display your support for us on the days of action.

The action will begin with an emergency care-only model, which would see junior doctors provide the same level of service that happens in their given specialty, hospital or GP practice on Christmas Day. It will then escalate to full walk-outs. The action as proposed is:

Emergency care only — from 8am, Tuesday 1 December to 8am Wednesday 2 December
Full withdrawal of junior doctors' labour — from 8am to 5pm, Tuesday 8 December
Full withdrawal of junior doctors' labour — from 8am to 5pm, Wednesday 16 December.

The aim is to picket all major hospitals in England on all three days of proposed action. This means that most major district general hospitals will be included. Pickets will be in the vicinity of the main entrances and will start at 8am, continuing until at least 12.30pm. However, many picket sites will continue into the evening, especially at the larger hospitals.

Please see below for a list of the major hospitals in London. I include the nearest Tube stop to each. Along with the pickets there will be parallel “Meet The Doctors” events at these tube stations as well as nearby public spaces. We will direct you to these public spaces from the picket.

You may have read recently of the ACAS conciliation process which has begun. Our key requirement for a return to negotiation is that Hunt must abandon “imposition”.

Please turn up on the days of action, and give us your support. We will then inform you if other local events are planned on the day. If you are an allied health worker, trade unionist, or campaigner please do consider bringing along the banner representing your organisation, your working uniform or similar. We would appreciate it however if banners in explicit endorsement of specific political parties are not displayed and that any selling of campaign literature such as newspapers is discreet.
On the days of action, please do debate us, educate us and invite us to address your colleagues in your workplace or trade union branch.

In London, Junior doctors will be striking at the following hospitals (as well as at other smaller hospitals within the capital). I list only the London hospitals as this is the geographical area of my involvement. As mentioned at the start of this email. Almost any hospital of any size in England will have a picket and a local event taking place.

St Bartholomew’s Hospital (St Pauls tube)
The Royal London Hospital (Whitechapel tube)
Homerton University Hospital (Homerton Overground)
Whipps Cross University Hospital (Walthamstow Central and Leytonstone
Newham University Hospital
Queen’s Hospital (Romford rail station)
King George (Ilford tube)
Great Ormond Street, (Russel Sq Tube and Holborn Tube)
St Marys, (Paddington Tube)
Northwick Park, (Northwick Park Met line)
North Middlesex (Silver St station)
Barnet, (High Barnet tube)
Royal Free, (Belsize Park tube, Hampstead Heath Overground)
UCH, (Euston Station/tube, Euston Square tube, Warren St tube)
Whittington (Archway tube)
St Georges (Tooting)
St Thomas' (Waterloo)
Guys (London Bridge)
Kings College Hospital (Denmark Hill)
kind regards and Solidarity,

Dr Yannis Gourtsoyannis, BMA Junior Doctors Committee

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

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.

Bid to delay closure of Central Middlesex A&E

At the very last minute Cllr Mary Daly is to move a motion at Brent Full Council tonight calling for a delay in the closing of Central Middlesex A&E.

The unit is due to close on  Wednesday.A demonstration will take place outside the hospital at 10am on Wednesday to make community opposition to the closure.

There are fears that Northwick Park A&E is not yet ready to take patients who would have gone to Central Middlesex and is itself already over-crowded and suffering delays.

Demonstrations on September 10th as A&E departments close

NW London Hospital's 'Requires improvement' rating raises serious questions about planned closures

Guest blog from local activist Sarah Cox on the Care Quality Commission's report LINK on the North West London Hospital s NHS Trust which includes Central Middlesex, Northwick Park and St Mark's hospitals.

-->

With only a few weeks to go before the A & E at Central  Middlesex closes for ever on September 10th, this report raises grave concerns. Patients from the most deprived areas of Brent which are served by Central Middlesex will be forced to travel to the A & E at Northwick Park which is short staffed and "requires improvement".

The report also reveals that:

Patient flow through Northwick Park Hospital was having an impact on people waiting in A&E, and pressure on the critical care units was so great that some people were being discharged too early and subsequently readmitted.

Time and again the Clinical Commissioning Group and the architects of the Shaping a Healthier Future project under which these closures are being implemented, have assured the community that, transformed into a Major Hospital in which all the services for a wide area are concentrated, Northwick Park Hospital would provide better services for patients. Time and again patients and community members who are concerned for the NHS expressed our doubts. Judging by this report, we were right to do so. The NW London Hospital Trust assured recent Overview and Scrutiny meeting of Brent Council, that Northwick Park Hospital will be ready to take on the extra patients when Central Middlesex A & E closes. Really?

This report is also critical of Maternity services at Northwick Park:

CQC also identified that maternity services required improvement to ensure women received a safe and effective service. Maternity was rated as Inadequate for responsiveness, as women could not always summon the assistance they required and individual needs were not being met.

 This is due to staff shortages, yet under the SaHF proposals, Hammersmith and Ealing Hospitals will lose their maternity services. Many patients who would have gone to Ealing for maternity care will have to attend NPH in future. Will it be able to cope?

Overall, Central Middlesex is rated good, but the report points out that many staff there feel isolated from the rest of the trust. Over the last few years, services have been transferred from CMH to NPH with staff often being required to move at a few days' notice. Many staff have said that they much prefer working at Central Middlesex, but are not given the choice.

Health campaigners believe that the changes being imposed on our hospitals are driven by financial considerations and the Government's policy of handing over our NHS to private companies who will run services for profit not the needs of the patients. 

REPORT SUMMARY

Navin Shah issues challenge on A&E pressures

From Navin Shah Labour Assembly Member for Brent and Harrow

New figures have revealed the increasing strain London’s Accident and Emergency departments are facing. The increased pressure on A&Es follows the closure of wards across the capital. In the past year 199,693 people were forced to wait more than four hours at an A&E in London, this is an increase of 18% on the previous year when 168,604 people waited more than four hours.

The local A&E unit at Central Middlesex Hospital in Brent now operates at reduced hours with more suspected cuts to follow. Northwick Park Hospital in Brent, which is on the boundary of Harrow is the nearest A&E unit that is open for a twenty-four hour service. This will put so much pressure on Northwick Park Hospital with people waiting much longer hours at the A&E Department. Both Central Middlesex Hospital and Northwick Park Hospital fall under North West London, which has seen 12,778 people wait more than four hours over the past year.

Overall, two A&E units in London have been closed, two are to be “downgraded”, three are set to be closed and a further three are under threat of closure. In the past year all but one of London’s Hospital Trusts with A&Es failed to meet the key waiting time target of 95% of patients seen with 4 hours. In 15 out of 22 trusts this target was missed for over half of the last year. Navin Shah, local Labour London Assembly Member, is calling on the Health Secretary to urgently review the situation, and for the Mayor to lobby government for the resources that London’s NHS needs.

Navin Shah, local Labour London Assembly Member, said:

We were told that closing A&Es wouldn’t lead to longer waiting times, but the evidence shows that Londoners are waiting longer to be seen. In the past 12 months nearly 200,000 people across London and 12,778 people in North West London have been forced to wait for more than four hours at A&E. These figures are a damning indictment of the failure to properly plan our NHS services. 15 out of 22 Hospital Trusts have failed to meet this key target.

Last year we all celebrated the NHS’ 65^th Birthday, one year on the government’s botched top down reorganisation is putting severe pressure on our local services. Continuing to either close or downgrade London’s A&Es will make the situation even worse. NHS staff work hard to look after us all when we are at our most vulnerable, but they need the resources to be able to deliver the service we all expect. Central Middlesex Hospital now operates an 11 hour A&E service, which adds further pressure to Northwick Park Hospital’s A&E service. I am deeply worried that following these A&E closures, waiting times will continue to be high and Londoners will continue to suffer as a result.

1.    Navin Shah is the Labour London Assembly Member for Brent and Harrow.

Figures for 2013/14 taken from here: http://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/weekly-ae-sitreps-2013-14/ and for 2012/13 from here: http://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/weekly-ae-sitreps-2012-13/

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.

Ealing a step nearer Judicial Review on hospital downgrading

Ealing Council has secured an oral hearing at the High Court on Wednesday, 9 October as it presses for a judicial review (JR) of plans to downgrade four local hospitals.

The council initially applied for a JR in March after the NHS approved plans to shut A&E departments and downgrade other services at Ealing, Central Middlesex, Hammersmith and Charing Cross hospitals despite increasing demand for emergency services.

This application was turned down so the council sought the oral hearing to press its case. If it is successful at the oral hearing, the council will be able to pursue a full JR.

Councillor Julian Bell, leader of the council, said: "The fight to ensure local people have the health services they deserve goes on. We will present our case forcibly at the oral hearing and pursue all other opportunities to ensure there is proper consideration of our serious concerns about what amounts to the largest experiment in NHS history.”

Concerns about the safety of the NHS plans and the ability of remaining services to cope have been raised by local campaigners as well as the council. The NHS has itself admitted that 'blue light' journeys to hospital will be longer for one in three patients if the plans go ahead.

The council has also referred the issue to the secretary of state for health, Jeremy Hunt MP, who responded by ordering an independent panel to review the NHS plans. The panel’s report will be presented to Mr Hunt by 13 September and his decision is expected around 40 days later.

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.

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

Central Middx and Northwick Park A&Es overwhelmed

Campaigners lobby Sarah Teather over the closures

The Evening Standard today reports that  Maeve O'Callaghan-Harrington, head of emergency planning at NW London Hospitals Trust, emailed local GPs  last week advising them that the casualty units at Northwick Park and Central Middlesex  were full. 

Northwick Park had 19 patients waiting for beds and patients were also waiting for beds at Central Middlesex. Central Middlesex A&E is already closed overnight and would be closed completely under the 'Shaping a Healthier Future' proposals. Central Middlesex A&E patients will be expected to go to Northwick Park instead and that is also where patients from the Urgent Care Centre would be transferred if the UCC cannot treat them.

The Standard reports Andy Burnham, shadow health secretary as commenting:

As this email shows London A&Es are struggling as it is and it is not at all clear how the Government can close so many without putting lives at risk. The planned closures in northwest London look drastic and the onus is on the NHS and the Government to provide clinical evidence for how they can be justified.

Local NHS campaigners have repeatedly drawn attention to the pressures on Northwick Park even before the closure of Central Middlesex A&E  and the absence of any kind of risk assessment on the possible repercussions for the safety of patients if the closure takes place.