Agenda item

The purpose of this report is to update the Scrutiny Committee on the Brent CCG’s assurance process for the closure of the A&E unit at central Middlesex Hospital and Brent changes to related services to ensure a high quality of health care is accessible to residents.

The Chair briefly introduced the item and advised that members had requested a number of supporting documents from colleagues at NHS Brent Clinical Commissioning group (CCG) to assist the committee in undertaking detailed scrutiny of the assurance process for the closure of the A&E unit at Central Middlesex Hospital (CMH). The Chair expressed his disappointment that these documents had not yet been provided to the committee and received confirmation that they would be provided following the meeting.

Councillor Daly asserted that she could not support the plans to close Central Middlesex Hospital Accident and Emergency Department as she been provided with inadequate evidence to make a decision[1]. The Chair reminded the committee that the item related to the robustness of the assurance process for the closure of the A&E at CMH.

David McVittie, Chief Executive of North West London Hospitals Trust (NWLHT), was then invited to present the report to the committee. He advised that the plan to close the A&E unit at CMH pre-dated the Shaping a Healthier Future programme and had related to the under-utilisation of the site, which in turn had reduced opportunities for doctors to develop their skills and had driven recruitment difficulties. It was emphasised that at no time had CMH been unsafe and that average attendances for the A&E unit at CMH was far below that of Northwick Park Hospital (NPH) at 35 per day compared to 250. Admissions at CMH were also significantly lower and could have been reduced further if patients had been treated at NPH where there were additional facilities. Concerns regarding the historic performance of NPH A&E were acknowledged and the meeting was advised that there had been targeted investment in emergency physicians; for example the number of A&E consultants had been doubled to 14 over the past 18 months and two full time emergency surgery consultants had been recruited.

During the subsequent discussion, the committee questioned why the closure of the A&E unit at CMH had not been scheduled to coincide with the opening of the new A&E department at NPH. Members queried when the A&E unit at Ealing Hospital was due to close and sought comment on the recent Care Quality Commission (CQC) inspections of NPH and Ealing Hospital.  Noting the challenges that NPH had previously faced, it was further queried how NPH would maintain and enhance performance and service quality. The committee noted that the closure of CMH would result in a loss of £3.5million and it was queried how this would be recovered. It was also queried whether there was an existing, successful model for a hospital to have a stand-alone Urgent Care Centre.

The committee further questioned whether the figures quoted for average attendances at CMH reflected A&E usage following the implementation of restricted opening hours. Members queried why there were recruitment difficulties at CMH but not at NPH.  Noting that the number of A&E consultants had been increased to 14, it was queried how they were distributed between CMH and NPH, what recruitment targets were in place and what the timescales for those targets were. Further information was also sought regarding the measures in place to retain staff, particularly following changes to working hours. A concern was raised that the consultation period for patients had been too short and additional information was sought on the consultation activities undertaken. Noting that the committee had not had view of the Equalities Impact Assessment, it was queried what action had been taken to ensure that the needs of those with long term health conditions had been taken into account, for example those with Sickle Cell Disease who would be particularly affected by the closure of the Roundwood Suite at CMH.

Responding to the questions raised, David McVittie was emphasised that it was a difficult task to move A&E services and it had been considered safest to keep the introduction to the new A&E department distinct from the closure of the unit at CMH. The move from the existing to the new department at NPH would also be phased over a period of days. Staff were currently being rotated between CMH and NPH to ensure that they were familiar with the existing department and the available services at the hospital. There was no confirmed date for the closure of the A&E department at Ealing Hospital but it was broadly scheduled for 2017/18.

Members were further advised by David McVittie that the CQC inspection for Ealing Hospital had found that 3 of 7 areas examined had not met standards; however, the CQC report detailed that these were minor issues. The CQC report for NPH had only been issued in draft form and it was not therefore, possible to provide full details of the outcome. However, the draft report had indicated that the hospital was safe but required improvement in all areas. It had also highlighted that NPH had an outstanding Stroke service and STARS service. Staff had demonstrated that they could deliver quality services and compassion had been shown in every clinical area inspected. NPH did face issues of continued service pressure and there had been significant investment to address these issues. However, the assurance process had also looked at other measures that could be taken, including London Ambulance Service (LAS) routes and redirecting to other hospitals. 

David McVittie explained that the loss of £3.5m came from the reduction of work carried out at CMH. However, it was planned that the vacated space at the hospital would be occupied by other services, focussing around Brent Primary Care. It was not intended that there would be equivalent savings made in other areas to address this loss of income; rather it was accepted that there would be a large deficit for the next two years. It was emphasised that the plans had been approved by the Department for Health and that as safety was paramount, it was expected that additional funding could be made available if it was deemed essential. Dr Mark Spencer (SaHF Programme Medical Director) confirmed that hospitals in Southampton and Sidcup now had Urgent Care Centres but had previously had A&E units. In both examples the change had worked very well and the Urgent Care Centres were now hubs of their local communities.

David McVittie advised that the attendances figure for CMH represented the average per day for the last two years, during which time the A&E department was only open for 12 hours a day. This figure did not include attendances at the Urgent Care Centre. However, the number of attendances for CMH A&E prior to the unit’s reduced opening hours was still far less than the equivalent figure for NPH.

Addressing the committee’s queries regarding recruitment, David McVittie advised that of the 14 emergency consultants, 2 or 3 were based at CMH and the rest at NPH. It was intended that there would be a total of 18 emergency consultants eventually. There was no timescale for recruiting to these positions but recruitment efforts would continue. Professor Ursula Gallagher (Director of Quality and Safety, Brent CCG) advised that NPH represented a more attractive opportunity for doctors wishing to be practice emergency medicine. She highlighted that, in addition to numbers of staff, it was also important to consider the hours that the emergency consultants would be available and explained that it was intended increase these and move to a service led by a consultant ‘on the floor’. David McVittie added that it would be important going forward to clearly emphasise how staff would be developed by the organisation to increase retention of staff.

David McVittie explained that focus groups had been established to consult patients with specific medical conditions who would be affected by the closure of the A&E service at CMH. The focus group for patients with Sickle Cell Disease had been consulted on the intention to keep the outpatient and day care service at CMH and to have two dedicated beds at the haematology ward at NPH for emergency care. However, the process of engaging patients in the development of these plans had not yet been concluded. Sarah Bellman (SaHF Communications) outlined the programme of public engagement regarding the closure of CMH A&E. A public information campaign had been launched on 28 July 2014 which encompassed a new website, face to face engagement with community groups, distribution of half a million leaflets to residents, organisations and businesses and a range of outdoor adverts.  Information had also been provided in accessible formats including talking newspapers, a sign language video and a number of different languages.

The officers were thanked for their presentations. The committee agreed that a further update should be provided to the committee at a future meeting.

RESOLVED:

That an update be provided on the Central Middlesex Hospital A&E closure assurance at a future meeting of the committee.