Agenda item

Following the update on Sickle Cell Care provided by London North West University Healthcare NHS Trust (LNWH) to the Committee in September 2025, a briefing note has been provided which details further updates to Sickle Cell Care in North West London and the associated transfer of the Medical Day Care Centre at Central Middlesex Hospital to Ealing Hospital.

Lisa Henschen (Director of Transformation, LNWT) thanked the Committee for the opportunity to discuss the changes proposed to the Medical Day Care Unit and Sickle Cell Care at Central Middlesex Hospital, with the Trust looking to transfer the Day Unit from Central Middlesex Hospital to Ealing Hospital. She advised that London North West University Healthcare NHS Trust (LNWT) had been working closely with the Central Middlesex Hospital Medical Day Care Clinical Team over the last few months, who currently provided a combined service for Sickle Cell patients and a range of nurse-led day treatments and procedures for patients under a medical consultant, such as intravenous drips, iron infusions and injections which took around 2-3 hours and were considered semi-urgent. This had been reviewed closely in the context of the expansion of Sickle Cell Services that LNWT was looking to undertake. The Trust had successfully secured additional NHSE funding to expand the day care facility for Sickle Cell patients to better meet the needs of the local population and compliment the new inpatient pathway. She advised of two advantages to merit the transfer of the Medical Day Care Unit to Ealing Hospital, including the expansion of Sickle Cell Care in the way the Trust envisioned, and the alignment of Medical Day Care with the emergency pathway. The Trust recognised that Day Care Services were very important to the urgent care pathway, with many patients visiting an Emergency Department requiring Medical Day Services. Moving the Medical Day Care Unit to Ealing Hospital would align it with the hospital’s Same Day Emergency Care Services and relieve pressure on the hospital’s emergency department, freeing up acute space for critically ill patients and reducing waiting times. The same would not be possible at Central Middlesex Hospital because it had no emergency department or Same Day Emergency Care Service. She advised that the report provided further information on the volume of patients and specialties available, and added that the transfer was not a cost-driven exercise but a financially neutral service improvement initiative. There were plans for two workshops and an online survey to garner public feedback, as the Trust was aware of the travel implications for those currently using the Medical Day Care Unit at Central Middlesex Hospital. The Trust would also be looking to see whether this facility was needed at Northwick Park Hospital, learning from the transfer to Ealing Hospital.

Dr Arnab Datta (Care Group Clinical Director, LNWT) highlighted that LNWT had been focused on recognising the need to ensure equity and equality for Sickle Cell patients. Through a series of collaborations with the Sickle Cell community, and alongside Imperial College Healthcare NHS Trust as the other major Sickle Cell care provider, the Trust had recognised that expanding Sickle Cell care as a Day Care Service at Central Middlesex Hospital would contribute to better quality management of pain in a daycare setting without the need to use an emergency department, enabling early and proactive management of symptoms and improving the quality of life of patients. He added that, from 15 September 2025, Sickle Cell inpatients or those needing urgent or emergency care were being seen in Hammersmith Hospital, bypassing the need to attend a busy emergency department, allowing patients to be seen sooner and avoid long waits. He highlighted that, through these improvements in Sickle Cell Care, equity and equality was improved, with all patients now receiving the same level of acute care, access to the same triaging service and the same initial assessments, which also led to admission avoidance.

The Chair thanked NHS colleagues for their introduction and invited comments and questions from those present, with the following points raised:

Prior to the transfer, the Committee asked to understand what work would be done, or had already been done, to ensure carers’, families’ and service users’ views were factored into the transformation. Lisa Henschen advised that the online survey asked 5 core questions asking respondents to confirm whether the change being sought would have a positive, negative or neutral impact, any concerns they had and any further suggestions they had. There were also public events due to be held to garner viewpoints in Central Middlesex Hospital as well as an online event on the evening of 15 December 2025.

The Committee asked how the Trust would report on, monitor and review the proposed changes in the context of patient wellbeing and overall health outcomes. Lisa Henschen responded that the measures would relate to what the Trust wanted to achieve. For example, length of stay on wards in Ealing Hospital would be tracked to see whether patients could be moved more quickly through the system, along with the number of people using the Medical Day Centre at Ealing, how many came through the emergency pathway and were moved to the Medical Day Centre, and patient satisfaction, which she felt would be key, particularly in the early stages of the move. Patient feedback would be gathered through Friends and Family Tests asking how people experienced their care on the day, which was the regular mechanism but would be tailored to focus on Medical Day Care users to capture their experience.

In terms of reporting, monitoring and reviewing the changes within haematology, Dr Arnab Datta advised that this would focus quantitatively on data relating to admission avoidance and the quality of pain management. He added that there were national metrics through the Sickle Cell dashboard that the Trust was required to submit on a yearly basis, so those metrics would also be assessed and it was hoped improvements would be seen in those figures. In terms of qualitative assessment, that would be done through engagement with patients and their experience of the service through the good relationships the Trust had built with Sickle Cell patients. Keisha Osmond-Joseph (Consultant Nurse – Haemoglobinopathies) highlighted the hard work of the Trust to build a good rapport with the Sickle Cell community in Brent, with a local Sickle Cell group which formed part of a wider regional collaboration with Imperial College London NHS Health Trust. Any changes made to Sickle Cell Care was always communicated to those groups and feedback obtained. The feedback relating to the changes proposed to expand the Sickle Cell service at Central Middlesex Hospital was positive with patients in agreement. Patients were most concerned about being able to access red cell exchanges, managing their pain, reducing hospital admissions, and avoiding emergency departments which these improvements to Sickle Cell care allowed. She explained that patients had a poor experience of emergency departments as they were not well equipped to manage pain relief in a swift manner, so the emergency department bypass units, such as at Hammersmith Hospital, had been widely welcomed by Sickle Cell patients nationally.

The Committee highlighted the comment in the briefing report regarding the Equality Impact Assessment for the transfer of the Medical Day Unit to Ealing Hospital, which stated that there would be a negative impact for patient experience, specifically for groups with disabilities. They asked what that negative impact was and whether officers were confident it could be mitigated. Lisa Henschen replied that the negative impact noted was on the basis that some patients would need to travel further to access the Medical Day Unit at Ealing Hospital, and a higher proportion of people with disabilities were likely to be using Medical Day Care. The Trust would be writing to all patients who had used the service more than once, providing information on how to get to Ealing Hospital, and were planning to look at Medical Day Care options at Northwick Park Hospital which would increase residents’ travel options. Long term, the Trust was speaking with other medical service providers as it was recognised that some Medical Day Care did not necessarily need to be delivered in a hospital setting and could be delivered in Integrated Neighbourhood Hubs, bringing services closer to communities. She confirmed that the Trust was in active conversations about Neighbourhood Hubs with CLCH as the community provider, considering a range of services that could move in the future. She added a caveat that there were no guarantees of what services would move currently.

In considering the response in relation to the negative travel impact for those with disabilities as a result of the transfer, and the mitigation detailed in the report regarding provision of transport for eligible patients, the Committee highlighted that the transport service was highly stretched already and asked if there were plans to expand that service, particularly considering the closure of other services in the same area. Lisa Henschen advised members that there were no plans in relation to expanding the transport service, but the Committee’s feedback had been heard and would be brought back to be discussed with transport colleagues. Simon Crawford (Deputy Chief Executive Officer, LNWT) added that the Trust was looking at access to transport broadly with ongoing conversations particularly around the emergency pathway and contracts supporting discharge out of hospitals, and information would be made available to patients making their own travel arrangements on how to claim expenses.

The Committee asked whether, aside from transport, there were any other potential risks or detrimental consequences of the transfer. Members were advised that no other significant risk had been identified. It was thought that the transfer would bring benefits for the Day Care team who were currently isolated, and linking the Medical Day Unit with the emergency pathway would benefit patients.

The Committee felt that, often, with a change or transfer of service, people could get lost in the system, and asked what steps would be taken if the Trust found that it was losing contact with the people they knew were ill but could not make that transition. Karen Keogh (Head of Nursing, LNWT) advised that many of the patients attending the Medical Day Unit more than once only did so around once a year, and it was quite a small group of regular service users. Dr Arnab Datta explained that there were very robust patient databases in place so, if there was a drop, the Trust would identify that early and staff would use existing resources to reach out to those patients and bring them back into care where necessary.

Given that the transfer constituted another service being moved away from Central Middlesex Hospital, the Committee asked to receive information on the strategy for the hospital, expressing that hospitals should be accessible locally and if services were continually stripped out for operational reasons then they may not be serving their purpose. In response, Simon Crawford agreed to return to talk about the strategy and highlighted that significant activity had been moved into Central Middlesex Hospital as well, such as the Elective Orthopaedic Centre, St Mark’s, and the Community Diagnostics Centre. He described it now as a busy and thriving hospital.

As no further issues were raised, the Chair drew the discussion to close and invited the Committee to make recommendations with the following RESOLVED:

i)               To receive the overall strategy for Central Middlesex Hospital and the Trust’s Strategy across its multiple hospitals, to understand the balance of services.

ii)              For the Chair to discuss with LNWT the possibility of a future NHS Estates strategy paper.

iii)             LNWT to ensure a robust system is in place for monitoring and evaluating the impact of the support provided to families, carers and service users impacted by the changes.