Agenda item
Acute Services Review
The Health Select Committee has received reports on the acute services review at its previous meetings and members have also attended a briefing at the Harrow Overview and Scrutiny Committee on plans for paediatric and emergency surgery services at North West London Hospitals Trust. Officers from NHS Brent and North West London Hospitals Trust will attend the committee to update members on the project and also to give a pre-consultation presentation.
Since the committee met last an independent clinical review has taken place on the provision of emergency surgery services during the day at Central Middlesex Hospital. Further information on this development is included in a letter to Councillor Chris Leaman, included as an appendix to this report.
In addition, the chair of the committee had asked for the views of the Local Medical Committee on the acute services review. A letter from Dr Helen Clark, chair of the Brent LMC is also included as an appendix to this report.
Minutes:
Fiona Wise (North West London NHS Hospitals Trust) provided the committee with an update on the reconfiguration of emergency surgery and paediatric services across Brent and Harrow as part of the Acute Services Review.
The committee was made aware of the letter from Mark Easton (NHS Brent) to Councillor Leaman which set out the reasons for the decision, following the independent clinical review by the National Clinical Advisory Team, to stop emergency surgery at Central Middlesex Hospital. Fiona Wise explained that the London Ambulance Service would instead be taking patients to Northwick Park Hospital or another major acute hospital if closer than Northwick Park Hospital. The cessation of emergency surgery services at Central Middlesex Hospital would result in 7-10 patients per week requiring transfer from Central Middlesex Hospital to Northwick Park Hospital. She emphasised that high risk surgical work had already been moved to Northwick Park Hospital. She commented that Central Middlesex Hospital would remain a busy local hospital. This, she added, was all due to commence in December 2009.
Fiona Wise informed the committee of the implementation plan which was in place to ensure that the process ran smoothly. She explained that work had been carried out which looked at what was needed at Northwick Park Hospital not just to support the extra 7-10 patients per week but also how to support surgery generally. She concluded by providing the committee with some of the quality indicators that had been agreed between the PCTs. She added that this was subject to weekly reviews in the first instance.
In the discussion which followed around emergency surgery, it was asked whether the establishment of a new stroke unit at Northwick Park Hospital would have an effect on things, particularly capacity at the hospital. It was also asked what would happen with emergency surgery on children. Furthermore, an enquiry was made as to how these changes were to be communicated to people as consultation had not taken place. In response to the first question, Fiona Wise explained that the stroke unit would not affect things as there were separate plans in place for this. With regards to the second question, Fiona Wise explained that emergency surgery on children did not currently take place at Central Middlesex Hospital anyway. In response to the third issue, she explained that a draft communication plan was in place. Mark Easton added that it was important to ensure that the GP community were fully involved in the process and that they understood the new service. It was also important, he added, that people were reassured that the changes did not undermine Central Middlesex Hospital as an acute site. Fiona Wise also reiterated, following a question about the role of the ambulance service, that the ambulance service would decide where the closest place was to take a patient.
Fiona Wise then went on to update the committee about the proposed paediatric services reconfiguration. This she explained was a piece of work which was still being undertaken. She began by explaining the case for change. She noted that children and young people made up 25% of Brent’s population and that Brent’s birth rate was rising by 3% per annum. Furthermore, she stated, deprivation levels which impact on children and young people have increased. She added that there was currently too much dependence on hospitals and that 87% of patients at Central Middlesex Hospital were seen and had gone home the next day. She explained that the current local model of care was not aligned to Healthcare for London’s recommendation that ‘all local hospitals should have a paediatric assessment unit working as part of a wider network of children services across 1° and with a major acute partner.’
Fiona Wise then set out the options for change. Option one, she explained was to do nothing and retain a 24 hour inpatient facility at Central Middlesex Hospital. The other option, she stated, was to establish two consultant led paediatric assessment units, one at Central Middlesex Hospital and one at Northwick Park Hospital. She emphasised the fact that this option would mean that a unit would be set up at both Central Middlesex Hospital and Northwick Park Hospital. If option 2 was to go ahead, she noted that there would be an estimated cost saving of £0.5 million per annum. She informed the committee that the proposed paediatric configuration was expected to require a section 244 public consultation.
To conclude Fiona Wise updated the committee as to what the next steps were. She informed the committee that further deliberation would take place across Brent and Harrow and that there would be a need to secure NHS London support for the pre-consultation business case. Furthermore, she explained that the NCAT clinical review and Department of Health Gateway Review of the paediatric model would also take place before public consultation. She added that the Brent Health Select Committee was to review the formal proposals for paediatrics at the next meeting on the 9th December. She stated that the plan was for public consultation to then start pre-Christmas.
In the discussion which followed, a concern was raised that there may be a perception in the South of the borough that Central Middlesex Hospital was being undermined and that services were being centralised at Northwick Park Hospital. In response, Mark Easton explained that careful consideration would be given as to how to inform the public of proposals. He stated that the services being moved were small services and that the public needed to be informed that there was a plan to continue and develop a number of big services, such as outpatients, at Central Middlesex Hospital. Fiona Wise added that her management team were also looking at what was better placed at Central Middlesex Hospital as well as ensuring that there were viable services at both ends of the borough. She also commented that it was all part of a bigger drive to prevent people going into hospital in the first place and therefore it was also about how services can be developed elsewhere.
The committee reiterated the importance of informing the public as to how important Central Middlesex Hospital was and how it would remain so. Mark Easton commented that there was a need to publish a report on the Future of Central Middlesex Hospital. Marcia Saunders (NHS Brent) noted that it was also important to remember that Northwick Park Hospital was now a major acute facility and had greatly improved.
Dr Helen Clarke (Chair of Brent Local Medical Committee) commented that, as stated in her letter to the Chair of the Health Select Committee, she was surprised to find that the proposals, following the acute services review, had been sent to Brent and Harrow’s Overview and Scrutiny Committees before the Local Medical Committee had been consulted. She stated that there were a number of areas that GPs were concerned about. She explained that things had moved forward and NHS Brent had given their commitment to consult with GPs. She commented that there was likely to be a meeting of GPs held in October to discuss the issue. She was concerned however that if the meeting was not to go ahead it would be too late to be consulted before the next Health Select Committee. In response, Mark Easton commented that he would ensure that this was followed up.
Mark Easton noted that the paediatric service model and consultation plan was due to go to the next Health Select Committee on the 9th December. However, if the project was not sufficiently developed by December for public consultation to begin, then consultation and implementation on the changes to paediatric services would be delayed until after the local government and general elections in 2010.
RESOLVED:-
that the presentation on the acute services review and the letter from Mark Easton and Dr Helen Clark, as appended to the report, be noted.
Supporting documents:
- Acute Services Review Covering Report, item 8. PDF 58 KB
- Acute Services Review - Chris Leaman Letter, item 8. PDF 128 KB
- Acute Services Review - Helen Clark Letter, item 8. PDF 140 KB