Agenda item

Emergency Services at North West London Hospitals

Members of the Health Partnerships Overview and Scrutiny Committee will already be aware of the problems facing Northwick Park Hospital’s Accident and Emergency department and the recent risk summit that resulted from concerns over its ability to provide a safe and adequate service


Tina Benson, Director of Operations, informed the Committee that the report addressed the emergency care pathways, the work required to enable improvements and the strategies that had already been put in place.  It was reported that there had been a positive impact with the target for 95% of A&E patients to be seen within four hours being met for the past two months.  It was reported that there were no incidents of patients being treated in the ambulance in June and an average of two cases per week where patients had to wait in the ambulance for 30 minutes.  It was clarified that bed capacity was a key issue in the A&E department and to cope with surges in demand, a lower occupancy level was required.  Concern was expressed regarding the bed occupancy level in the future winter months and weekly meetings were taking place between CCG and GP representatives to ensure pathways were in place to enable more bed spaces  to be released in the A&E department.  Tina Benson drew the Committees attention to a non compliance of section 19 of the Health Social Care Act 2008 following an unannounced visit by the CQC. It was explained that the non compliance related to a do not resuscitate form that had not been countersigned by the consultant and an action plan had been put in place to address this.  Internal audits had been carried out successfully.  St Marks had been revisited by the CQC and found to be compliant and Northwick Park Hospital was awaiting a revisit from the CQC to assess its compliance.


During discussion, members queried the use of Central Middlesex Hospital.  It was explained that the hospital was being used proactively with an increase in conveyances and a maintained 24 hour urgent care centre.  It was reported that the emergency department operated from 8am-7pm with patients being seen by the urgent care centre after 7pm.  It was highlighted that an enhanced recovery service was offered at Central Middlesex Hospital that enabled a faster recovery rate and increased survival rate for surgery on fractured hips. 


Jon Knott, London Ambulance Service informed the Committee that there had been a 6.2% increase in admittance to Central Middlesex Hospital and a decrease at Northwick Park, demonstrating the successful support of Northwick Park Hospital.  It was highlighted that there had been an increase in accessing alternative services rather than calling an ambulance.  It was also pointed outthat a number of residents located in the South of the borough werebeing taken to St Mary’s Hospital.  Members queried why residents from the Harlesden ward despite living in close proximity to Central Middlesex Hospital were taken to St Mary’s.  Jon Knott explained that each hospital provided different services and specialisms and it may be more appropriate in certain cases to bypass the local hospital and go to one that had a centre of excellence.  Members queried the “non conveyed” figures for ambulance attendances and how these arose.  It was confirmed that  one of the reasons that patients may not be conveyed would be if they have passed away.  Other reasons would be that it was not necessary to convey them because they could be treated on site, or that  the patient had been miscategorised.  It was explained that if it was unclear what category a case should be placed in at the time a call was taken they would always be placed in the higher category. 


During discussion members queried whether an increase in service had been seen due to the recent heat wave.  Tina Benson informed the Committee that Brent had been largely unaffected by the heat wave and due to good performance, had been able to assist other hospitals that were struggling to meet demand.  In response to queries regarding the number of consultants at weekends, it was explained that this had not yet happened although an advert was placed seeking five consultants and hoped to have them in place by October to add support at weekends.  In response to diverted ambulance en route to the maternity department, it was clarified that some ambulances are directed to go elsewhere either due to preference of pressures at the hospital.  In response to queries regarding the new A&E department at Northwick park Hospital and whether this would require extra doctors, it was clarified that it was due to be completed in May 2014 and would be the same size but adjacent to the theatres and designed to improve flow creating efficiencies and increased nursing staff.  In response to queries regarding high ED users, it was explained that a group had been established to review the data and governance arrangements with work being undertaken with GPs regarding the top 2000 callers and what action can be taken to stop them attending hospital where appropriate.




That the report be noted

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