Agenda item

The Scrutiny Committee will receive an up-date on the arrangements in place 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.  This will reflect recent concerns raised following  Care Quality Commission inspections at Northwick Park Hospital.  Senior Representatives from the Northwest London Hospital Trust and the CCG will be at the meeting to answer questions.

The Chair advised that the committee had received an update on the closure of the A&E Department at Central Middlesex Hospital (CMH) at its last meeting on 6 August 2014.  However, since that time, the Care Quality Commission (CQC) had published a report following its inspection of Northwick Park Hospital (NPH), and had rated the A&E service as ‘Requires Improvement’. Members had raised concerns about how this affected plans to close CMH A&E and senior health colleagues were present to address members’ queries.

At the invitation of the Chair, Rob Larkman (CO Brent, Harrow and Hillingdon CCGs) introduced the briefing report before the committee which set out the response of the North West London Hospitals Trust (NWLHT) to the CQC report and addressed the implications of the report for plans to close CMH A&E. He explained that the closure of CMH A&E formed part of the Shaping a Healthier Future (SaHF) proposals which aimed to improve hospital based services across the whole of North West London. The proposals had been made by medical professionals working in North West London and had been extensively consulted upon in 2012. They had been reviewed and supported by an independent panel of medical professionals and had been agreed by the Secretary of State, who had recommended that in light of concerns regarding safety and sustainability, the CMH A&E department be closed as soon as practicable. Since the publication of the CQC report on NPH, NWLHT together with the CCGs had revisited and reaffirmed the decision to close CMH A&E on 10 September 2014 having concluded that it remained both safe and necessary to proceed.

Chris Pocklington (Deputy Chief Executive of North West London Hospitals Trust (NWLHT)) explained that the findings of the CQC report had been anticipated and were fully supported by NWLHT. He outlined four key themes identified by CQC in relation to NPH A&E; workforce shortages, lack of clinical leadership on the floor, pressure on beds leading to long waiting times, and patient privacy and dignity. In describing planned improvements, he emphasised that NWLHT was of the view that the closure of CMH A&E would enable many of the concerns identified by CQC to be addressed. In closing CMH A&E, staff would be transferred to NPH A&E, increasing the number of consultants and nursing staff available. Prior to the publication of the inspection report, NWLHT had already appointed a team of senior clinicians to lead the A&E department. The ongoing pressure on beds at NPH would be eased by the creation of 20 new beds due to open on the closure of CMH A&E. It was also considered that further benefits would derive from the opening of the new A&E department at NPH later in the year, including improved patient experience.

Rob Larkman concluded the presentation by emphasising that the feedback received from the CQC actively reinforced the decision to proceed with the closure of CMH A&E.

In the subsequent discussion a member questioned why the issues identified by the CQC report had not been addressed with the committee at the previous meeting and why permission had not been sought from the CQC to release the relevant information to members. It was further queried whether the Brent CCG had been aware of the findings of the CQC report at the previous meeting of the committee.

The committee also requested further detail on the findings of CQC inspection report regarding NPH A&E and queried when the new A&E department at the hospital was due to open. Queries were raised regarding the creation of 20 additional beds at NPH on the closure of CMH A&E. A member challenged whether this increase was sufficient to address the concerns highlighted by the CQC, particularly given the anticipated increase in patients following the closure of CMH A&E. The committee sought confirmation of the timescales for increasing bed capacity to the required standard and turning-around performance at NPH. It was subsequently queried why CMH A&E was being closed before the various pressures on the hospital were tackled. Emphasising the need to increase bed capacity at NPH, a member sought confirmation of the number of beds that would be removed across North West London’s Hospitals under the SaHF programme. 

Addressing issues of workforce shortages at NPH, the committee questioned whether a sufficient number of staff from CMH A&E were prepared to take up new posts at NPH A&E, particularly given that the staff configuration at CMH had been deemed unsustainable. Comment was sought on concerns that had been expressed by NHS Harrow and Greenbrook Healthcare regarding the physical capacity of the Urgent Care Centre (UCC) at NPH to cope with any increase in patients following the closure of A&E at CMH. A Member noted that the changes to hospital configuration across North West London were predicated on improvements in the delivery of primary and community care and queried the progress achieved in implementing GP hubs across Brent, and Harrow. The committee questioned whether it was accepted that there would be significant issues caused by the closure of CMH A&E.

Chris Pocklington confirmed that the CQC report had been issued in draft to NWLHT at the time of the previous committee meeting, though the CCG had not been aware of the  findings of the report until its publication on 20 August 2014. He emphasised that NWLHT did not dispute the findings of the CQC report and felt able to provide a positive response to CQC, describing how the issues identified would be addressed. He reiterated that nursing and consultant staff from CMH A&E would transfer to NPH A&E. Tina Benson (Director of Operations, NWLHT) explained that formal consultation with staff had concluded just over four weeks previously. Only two members of staff had opted to remain at CMH and had been accommodated into other teams at the hospital. All other staff had confirmed that they wished to transfer to NPH. Chris Pocklington asserted that the decision to close CMH A&E was fully supported by the consultant and nursing staff at the hospital and Ursula Gallagher (Director of Quality and Safety, Brent, Harrow and Hillingdon CCGS) advised that the CCGs would not have supported the plans to close the A&E department at CMH if clinical staff had not backed the plans. Tina Benson further explained that CMH had been deemed clinically unsustainable not because staff members were overworked, but because staff were not able to maintain and develop their clinical skills due to the restricted number of patients using the A&E department.

Chris Pocklington further advised that the CQC had felt that there needed to be greater evidence that senior doctors were involved with the leadership and management of the Emergency Department. Since the inspection in May 2014, three Senior Doctors had been appointed to the Emergency Department and a Senior Physician had been appointed to lead the emergency pathway. The CQC had also identified the lack of bed capacity at NPH, though had commented that length of patient stay and mortality rates were good. Several measures were being taken to address bed capacity across NPH. In the immediate term this included the creation of the additional 20 beds at the hospital and the opening of the new Emergency department at NPH in November 2014, which was expected to deliver performance improvements. Plans were in progress to open a new modular ward in Autumn 2015 which would provide an additional 70 beds. It was expected that the opening of this new ward would enable NPH to bring waiting times down in the A&E to meet the national standard. Ursula Gallagher advised that the CCG had also commissioned additional beds at a number of locations, including Mount Vernon Hospital and various nursing homes to address the expected increase in service pressure over the winter months. The role of the short-term assessment, rehabilitation and re-ablement service (STARRS) in easing pressure on bed capacity was highlighted and it was emphasised that CQC had commented on the success of this service. Daily system-wide monitoring was now conducted via phone to ensure the provision of safe, emergency care across North West London.

Dr Mark Spencer (Medical Director, SaHF) confirmed that the SaHF strategy involved the reduction of 150 hospital beds across North West London over the next five years. He emphasised that SaHF aimed to improve primary and community care to minimise unnecessary hospital admissions; however, due to the requirement to close CMH A&E sooner than had been anticipated, there was a short term need to increase bed capacity at NPH. Responding to the query regarding improvements in primary care, Sarah Basham (Deputy Chair, Brent CCG) advised that there were GP Hubs in operation in every locality in Brent. These hubs enhanced patient access to GP services and the CCG was currently in the process of extending the model.  Rob Larkman explained that Harrow had an equivalent strategy aimed at improving access to primary care. Walk-in Urgent Care Centres had long been established at the Pinn Medical Centre and Alexandra Avenue Health and Social Care Centre and GP appointments were already offered in Harrow at weekends and in the evenings. It was confirmed that NHS Harrow and Greenbrook Healthcare had expressed concerns regarding the physical capacity of the Urgent Care Centre at NPH if patient attendances increased following the closure of CMH A&E but had decided that the closure was safe and that the system across North West London was able to accommodate this change.

The Chair thanked everyone for their contribution to the discussion and emphasised that it was clear that councillors and members of the public continued to hold concerns regarding performance of the A&E at NPH and the impact of the closure of the A&E department at CMH. He noted that there remained a number of areas that still required improvement and proposed that the committee receive a further update in six months time.

The committee agreed the Chair’s proposal and extended an invitation to the health representatives to attend the forthcoming round of Brent Connects Forums. A member requested that an item on maternity services at NPH be included on the committee’s work programme for the next meeting.

RESOLVED:

That an update on performance at Northwick Park Hospital Accident and Emergency Department be provided to the committee in six months time.