Agenda item
Paediatric Services at Central Middlesex Hospital
Report to follow.
Minutes:
David Cheesman introduced the report and highlighted the main reasons for the proposal to close the Paediatric Assessment Unit (PAU) at Central Middlesex Hospital. These were because of the reduction in demand at the PAU following the opening of the Urgent Care Centre (UCC), the impact on PAU staff as a result of this and in particular concerns of them becoming de-skilled and the fact that the lack of patients meant that the service could not cover its own costs. David Cheesman referred to the table in the report outlining what services would be provided at Northwick Park Hospital and Central Middlesex Hospital respectively. Members attention was then drawn to the four tests in respect of considering the future of the PAU at Central Middlesex Hospital which focused on clinical evidence base, impact on choice, support from GP commissioners and public and patient engagement. Overall, there was clear clinical evidence in support of decommissioning the PAU. In respect of sickle cell patients, David Cheesman advised that the number of sickle cell patients admitted between March 2011 and September 2011 was quite small, however it was a high priority area. Following discussions with sickle cell patients and their parents, a model was being devised that best suited their needs and GPs’ views would also be sought in respect of this. Similarly, a suitable model was being developed in respect of safe guarding. Overall, the impact on choice had been assessed as negligible, whilst there was also sufficient support from GP commissioners.
Faraz Yousufzai (North West London Hospitals Trust) then provided information with regard to test four, public and patient engagement. He explained that an intensive and broad engagement involving a number of organisations had taken place between 1-15 September. It was proposed to close the PAU at the later date of 15 October as opposed to 1 October originally proposed to ensure that sufficient pathways were in place for patients, particularly sickle cell patients. The engagement had shown that there was agreement that changes needed to be made and that the PAU at Central Middlesex Hospital should be decommissioned. Faraz Yousufzai then drew Members’ attention to some of the chief concerns raised and North West London Hospitals’ response to them.
David Cheesman concluded by confirming that the North West London Hospitals’ recommendations were to close the PAU at Central Middlesex Hospital on 15 October 2011, subject to the sign off of critical clinical pathways by clinical leads and GPCE, however the paediatric outpatient service and Brent Sickle Cell service would remain at Central Middlesex Hospital.
During discussion by the committee, Councillor Hunter clarified that at the previous meeting of the committee, Members had deferred from expressing their views regarding whether a formal consultation was required until the report for this meeting had been considered. She acknowledged that there was strong evidence to support closing the PAU at Central Middlesex Hospital, however she enquired how the situation had arisen that funds had been spent on setting up the PAU, only for it to close a year after it had opened due to the success of the UCC that had opened in April 2011.
Councillor Daly commented that transport links for patients in the south of the borough were not particularly good which raised equality impact issues and she asked what measures had been undertaken to improve transport. With regard to the internal transport service, she enquired whether this was also available to visiting families of patients. Councillor Daly suggested that the overall impact to the proposals needed to be considered further and should obtain the views of patients and their carers from the south of the borough, whilst equalities issues should also be monitored. She stressed the need to provide good access to the sickle cell service for all patients in the borough.
Councillor Beck advised that TfL were in contract renewal discussions in respect of the R2 bus route and were undertaking engagement with stakeholders. He enquired whether North West London Hospitals’ Trust had submitted any views in respect of this.
The Chair requested that information be provided to the committee at the next meeting with regard to the impact on accessibility for patients, especially in respect of sickle cell provision. She enquired whether the staff at Northwick Park Hospital was sufficient in both numbers and experience to deal with sickle cell patients and also in respect of mental health to support both patients and their families. Confirmation was sought that all the critical clinical pathways would be in place by 16 October 2011 and she stressed the importance of effective communication to ensure this. In respect of the R2 bus route, she suggested that this be referred to the Highways Committee for consideration.
In reply to the issues raised, David Cheesman explained that when the UCC opened, it was not envisaged that it would be so successful and there were other UCCs that had not experienced anywhere near similar levels of success. The PAU’s costs were also significant, however it was receiving a relatively small number of patients. David Cheesman confirmed that North West London Hospitals provided an internal transport service for patients and this received positive feedback. In respect of non-ambulance transport, a mini bus service had initially been offered to patients’ families but as there had been low take-up of this service, they could now access a taxi service that operated between Central Middlesex Hospital and Northwick Park Hospital. David Cheesman stated that the views of patients and their carers in the south part of the Borough could be sought and that this be reported back at the next meeting. He confirmed that there was sufficient staff receiving training with regard to the needs of sickle cell patients and that the clinical pathways would be in place by 16 October and Brent LINk and the committee would be informed of these.
Jo Ohlson advised that when the PAU was proposed at Central Middlesex Hospital, it was part of a London-wide exercise to increase paediatric services across the city and it anticipated that it would receive considerably more visitors than was experiencing. The UCC proposal had been a local initiative and had received far more patients than had been anticipated. Issues regarding sickle cell patients and safeguarding had been picked up and North West London Hospitals would continue to be centres of excellence in sickle cell services. Every effort would be made to ensure that there was easy access to services and to promote choices for patients. It was acknowledged that there was a gap in respect of mental health provision at Northwick Park Hospital, however discussions were taking place with Brent CAMHS to address this.
RESOLVED:-
(i) that the North West London Hospitals' proposals to decommission the Paediatric Assessment Unit at Central Middlesex Hospital from 15 October 2011, subject to the agreement and sign off of the critical pathways by clinical leads and GPCE, be supported; and
(ii) that the proposal that the paediatric outpatient service and Brent Sickle Cell service remain at Central Middlesex Hospital be supported.
Supporting documents: