Agenda item
Central Middlesex Hospital - Urgent Care Centre Changes in Operating Hours
Thispaper from NHS Brent CCG looks at the urgentcare provisionin Central Middlesex Hospital (CMH) and report on the findings on its utilisation, impact on equality, health inequalities and overall quality of CMH UCC. Included inthiscase for change report are the alternative options that Brent CCG has taken into consideration to ensure the access toservices are providing best use of public money and better use of resources. The paper shows current usage of the urgentcare centre (UCC) as well as thepublic and stakeholder engagement plans.
Minutes:
The Chair welcomed colleagues from Brent Clinical Commissioning Group (CCG) to the meeting and noted that two members of the committee had conducted a site visit to the Urgent Care Centre at Central Middlesex Hospital to aid scrutiny of the proposals contained in the published report.
At the invitation of the Chair, Rashesh Mehta (Assistant Director, Integrated Urgent Care, CCG) introduced the report from the Brent CCG setting out a case for changing the operating hours of the Urgent Care Centre (UCC) at Central Middlesex Hospital (CMH). The committee was reminded that all CCGs had a statutory responsibility to ensure that the services they commissioned provided good value for money, were efficient and met local need. With regard to the UCC at CMH, it was explained that there were very few patients presenting between midnight and 8am. Irrespective of usage however, the provider of the UCC was required to have a full complement of staff. It was therefore considered an inefficient use of resources to deliver UCC services overnight at CMH. Brent CCG had considered three different options for the opening hours of the UCC: closing the UCC 8pm to 8am; closing between 10pm and 8am; and, closing between midnight and 8am. The latter had been selected as the preferred option. The CCG had carried out a series of engagement activities on the proposals with the public and other stakeholders, including the Brent Equality Engagement and Self-care (BEES) committee, Healthwatch, CVS Brent, members of the Carers Board and ran a bespoke workshop to include voluntary sector organisations and patients. Summaries of feedback received were provided in the report. The Governing Body of Brent CCG had subsequently considered the proposals on 25th June and approved them, subject to receiving confirmation of approval from the LNWHT A&E Delivery Board.
Sheik Auladin (Chief Operating Officer) advised that Brent CCG was required to make savings where value for money was not being achieved. The CCG had a deficit of £9million in the current year. It was clarified that all eight North West London CCGs were in deficit and recovery plans were in place at both a North West London level and local CCG level. It was simply not justifiable to continue to invest the level of resources at the CMH UCC site given the level of usage and the clear patient preference for sites which co-located UCCs and Accident and Emergency services.
The Chair thanked Brent CCG colleagues for the introduction to the report and subsequently invited questions from the committee.
Members questioned how the identified £450k per annum savings would be better directed in primary care. Clarification was sought regarding required staffing levels and the redistribution of the staffing resource. Members questioned comparative levels of use at the other UCC sites in Northwick Park and further queried whether anticipated population growth had been considered. The committee asked what consideration was given to the impact of additional travel of those redirected to alternative UCCs. Members questioned how out of hours GP services factored into the proposed service provision for the borough. The committee sought commitment to undertake the potential mitigating actions identified in the report, should the change in opening hours go ahead, to be implemented in a transition period, including patient transport between locations and a free phone to 111. In concluding their questioning, the committee questioned what feedback had been provided by GPs on the proposals.
In response to the queries raised, Sheik Auladin advised that the savings achieved by reducing the opening hours of the CMH UCC, which is commissioned by the CCG, would form part of the aforementioned recovery plan for Brent CCG. However, the CCG had planned for increased activity at other sites accordingly. It was clarified that a certain staffing complement was required to operate a UCC, irrespective of activity at the site, and it was considered a more robust option to redeploy that staffing resource across the five North West London UCC sites. The average attendance figure for CMH UCC between the hours of midnight and 8am for 2018/19 was 1 patient per hour. Comparative figures for the UCC at the Northwick Park site were approximately 40 to 60 patients over the same period and the West Middlesex University Hospital saw averages of approximately 36 patients. Both sites were co-located with A&E departments.
Addressing the committee’s query regarding population size, Sheik Auladin advised that data drawn from the census estimated Brent’s population at approximately 340,000. This was expected to grow by a further 40,000 over the next five years. However, data from the Brent GP register reflected a population size of approximately 380,000. Unfortunately, the funding provided to the Brent CCG was calculated in relation to the census data. All decisions taken by the Brent CCG about the capacity of local services therefore took into consideration the fact that the population size was in fact already far in excess of the official figure.
With reference to the risks and mitigation section of the report, the committee was advised by Dr MC Patel (Chair, Brent CCG) that it was unlikely that the costs of an overnight patient transport service sited at CMH could be justified as an efficient use of resources. It was clarified that anyone too unwell to travel to an alternative site should be directed as appropriate by the 111 service. If urgent, an ambulance would be called to take the patient to A&E. The 111 service could also arrange for a home visit by a doctor if deemed necessary. The installation of a free-phone at the CMH site through which patients could contact the 111 service was considered a reasonable mitigating action and would be explored further.
Commenting on the consultation with GPs, Dr MC Patel confirmed that engagement had thus far been at a client level. GPs fully understood the proposed change and the rationale. It was confirmed that the Clinical Directors of the CCG unanimously supported the proposal detailed in the report. Ian Niven (Healthwatch) advised that the CCG had received feedback from Healthwatch on the proposals as part of the consultation and engagement activity that had already taken place. The committee was further informed that a recent piece of work had been undertaken by Healthwatch which surveyed GP practices. The results of this survey suggested a low knowledge of the range of services available and it was crucial that this was addressed.
The Chair thanked everyone for their contribution to the meeting and confirmed that as reflected in the discussion held, the committee agreed that sufficient public involvement had taken place in relation to the proposal to reduce opening hours at the Urgent Care Centre at Central Middlesex Hospital.
The committee subsequently RECOMMENDED that the following mitigating actions detailed at section 4.1.5 of the report for consideration be pursued:
i) The provision of overnight patient transport service based on-site between 12 midnight and 8am for a set period of time after the change of hours.
ii) Installation of a free-phone outside the UCC which goes straight through to 111 between 12 midnight and 8am.
Supporting documents:
- Report - CMH Urgent Care Centre, item 8. PDF 3 MB
- Appendix - CMH Urgent Care Centre, item 8. PDF 1 MB