Agenda item

On 4 November 2011 the Chair of the Health Partnerships Overview and Scrutiny Committee received a letter from North West London NHS Hospitals Trust informing her that Accident and Emergency Services are to close overnight at Central Middlesex Hospital. This service change came into effect from the 14 November 2011.  The attached letter outlines the reasons for closure.

Peter Coles (Interim Chief Executive, North West London NHS Hospitals Trust) introduced the item and referred Members to the letter from North West London NHS Hospitals Trust confirming that the Accident and Emergency (A and E) Services at Central Middlesex Hospital are to close overnight as of 14 November.  He stated that this was a temporary closure made to ensure patient safety and to maintain quality of service.  The closure was subject to an external review from NHS London and Peter Coles acknowledged that concerns had been raised with regard to lack of notice, however safety issues had necessitated the decision to be made swiftly.

Professor Rory Shaw added that a lot of patients arriving at A and E at night could be looked after by on-site GPs at the Urgent Care Centre (UCC), whilst there had also been a very significant reduction in patients attending A and E, particularly at night time.  There was also not enough work in A and E for trainees to gain the necessary experience and it was becoming increasingly hard to find weekend and evening staff to cover.  As a result, the committee heard that 40% of costs were on agency staff, with this rising to 85% at weekends in A and E and even then agency staff were becoming increasingly difficult to obtain which raised the risk of having to close the A and E ward at short notice.  This had led to London NHS, the strategic authority, to recommend the temporary closure of the A and E ward whilst the situation was reviewed.

During discussion, Councillor Ogunro enquired how service standards would be maintained if there was a serious accident on a large scale in the area during the night.  Councillor Cheese sought further details as to why patient numbers at A and E had dropped so significantly and on the difficulties of acquiring staff at night time and weekends.  Councillor Daly requested more details with regard to patient numbers at the UCC and what would be the impact of the changes on the Ambulance Service.  In addition, she felt that the move raised equality issues, especially with regard to ill children and she asked if an EIA had been undertaken.  She also sought views as to whether the GPs would be able to treat those requiring specialist services.  Councillor Hunter stated that she could understand the clinical reasons concerning the A and E closure, however in view that the letter was sent on 4 November, she expressed surprise that it was not mentioned at the Hospital Trust Board meeting on 2 November.

The Chair expressed surprise that staff could refuse to work in A and E at night time and during weekends in view that an emergency service was being provided.  She also expressed disappointment that the A and E closure had not been communicated at an earlier stage and commented that such a failure could affect the hospital’s image.

In reply, Dr Rory Shaw confirmed that appropriately qualified GPs were available 24/7 at the UCC, whilst acute physicians were also in attendance.  GPs would determine whether patients could be treated at the hospital and if the specialist treatment required was not available, they would arrange the appropriate transfer to another suitable site.  The UCC had proven to be a big success and was largely responsible for the reduction in patients to A and E.  Dr Rory Shaw explained that the hospital had previously thought that it could identify staff to work at the A and E, however he accepted that communication on the decision could have been made earlier.  Members heard that the ambulance service had not expressed any concern about the proposals.

David Cheesman (Director of Strategy, North West London NHS Hospitals Trust) added that soon after the UCC had opened, there had also been a dramatic reduction of admissions to the Paediatric Assessment Unit (PAU) which had also been closed for the similar reasons.  He advised that around 90% of all child patients at Central Middlesex Hospital were treated in the UCC.