Agenda item

To receive a briefing from London North West University Healthcare NHS Trust in relation to the operating hours at the Urgent Treatment Centre at Central Middlesex Hospital.

Prior to the consideration of the item, the Chair agreed to consider a request which had been received to speak under item 6, in relation to the Urgent Treatment Centre at Central Middlesex Hospital, from a member of the public, Amandine Alexandre, who highlighted the following points:

·       Amandine Alexandre began by stating that, from the 1 February 2026, the Urgent Treatment Centre at Central Middlesex Hospital had ceased operating between 9pm and midnight. It was emphasised that this had constituted a significant alteration to the service, yet patients had not been informed of the change before the reduction in opening hours had taken effect. The speaker reported that they had become aware of the new hours only through a photograph that had been posted on Facebook on the 2 February 2026.

·       The speaker believed that this absence of communication, prior to the introduction of new operating hours, represented very poor practice on the part of London North West University Healthcare NHS Trust. It was further stated that this lack of communication had nevertheless been entirely in keeping with the consultation process undertaken by the Trust in October of the previous year.

·       Amandine Alexandre recalled that the consultation had been extremely brief, lasting only a couple of weeks at most. It was stated that this had predictably resulted in a very limited number of responses from patients, with only 42 participants. The speaker contrasted this with the 570 signatures that had been collected for a petition hosted on the Council’s website earlier in the year.

·       The speaker advised that there was considerably more to be said about both the decision itself and its consequences for patients. The speaker stated that the Trust had encouraged patients to make use of community pharmacies and their GP practices as a mitigation for the loss of the late evening service at the Urgent Treatment Centre. The speaker reported that they had identified only one pharmacy within 2.5 miles of their home that remained open until 10pm.

·       Amandine Alexandre also referred to the difficulties encountered when attempting to access their general practitioner services and cited the example of being required to complete a form described as Patches. It was stated that each use of the form had caused them to feel as though they were being cross examined by a barrister in relation to an offence they had not committed.

·       In concluding their presentation to the Committee, Amandine Alexandre encouraged the Committee to remind London North West University Healthcare NHS Trust of the standards that patients were entitled to expect. It was further emphasised that the NHS existed to serve patients and should not implement significant changes to services without appropriate consultation and without ensuring that patients were properly informed. Amandine Alexandre described the request as simple but important and expressed the hope that the Committee would take action.

The Chair thanked Amandine Alexandre for addressing the Committee and then invited Pippa Nightingale (Chief Executive Officer, London North West University Healthcare NHS Trust) to deliver a briefing in relation to the Urgent Treatment Centre at Central Middlesex Hospital.

In presenting the briefing, members noted that the Urgent Treatment Centre (UTC) at Central Middlesex Hospital had reduced its opening hours from 8:00am - 00:00pm to 8:00 am - 21:00pm, with the final patient registration at 20:00pm.The Committee were informed that the London North West University Healthcare NHS Trust (LNWH) currently operated 3 urgent care centres - namely, Central Middlesex Hospital, Ealing Hospital and Northwick Park Hospital. Members heard that data collected by the Trust had demonstrated that between 21:00 and 00:00 significantly fewer patients were attending the Central Middlesex Hospital site. It was explained that the urgent care service during this period had been staffed by a minimal clinical team, consisting of 1 doctor and 2 nurses. The Committee were advised that, in light of the very low numbers of patients presenting in those hours, this staffing model had not represented an efficient use of resources. Pippa Nightingale then outlined operational issues that had arisen at the Central Middlesex Hospital site prior to the change. Members were informed that patient pathways had become disjointed, with some individuals using the facility for urgent care needs that would have been more appropriately addressed through alternative clinical routes. It was reported that the service had been seeing between 40 and 50 patients who, as a consequence of the disjointed pathways and limited diagnostic availability in the late evening, experienced extended waiting times and, in many cases, required transfer to different sites to complete their care. The Committee were further advised that following the revisions to the operational model and opening hours, there had been a marked improvement in performance. It was stated that the Trust had achieved 100% compliance with patients being seen within 4 hours at the Central Middlesex Hospital Urgent Treatment Centre. Members were informed that this outcome represented the intended improvement in patient flow and clinical pathway efficiency arising from the revised operating hours.

In continuing the presentation to the Committee, Pippa Nightingale reported that a comprehensive public engagement process had been undertaken. This included two engagement events held both in person and online attendance. It was further stated that a questionnaire had been disseminated through all patient communication channels and that engagement levels had been good. Members were advised that the feedback received indicated that there would be minimal impact on patients as a result of the revised operating model. It was noted that the Ealing site had been used as a point of comparison in understanding urgent care usage and patient behaviours. It was emphasised that urgent care attendance was distinct from attendance at a GP or a pharmacy, and that the changes had been configured to signpost patients to the right service in the right place. The Committee were further advised that, through the transition to the revised hours, no complaints had been received from patients.

The Chair thanked Pippa Nightingale for her presentation to the Committee and then moved on to invite members to ask questions in relation to the information presented, with the following being noted:

·       As an initial question, members noted that the reduction in operating hours represented a significant change from the previous year. Concern was expressed regarding the distance between the Trust’s three hospital sites and the potential impact on transfer times. Reference was made to winter pressures, during which large numbers of patients required triage and were often waiting in corridors. Views were sought on what would happen in circumstances where an individual had suffered a stroke and was not receiving timely care. In response, Pippa Nightingale (Chief Executive Officer, London North West University Healthcare NHS Trust) clarified that an individual experiencing a stroke would not attend an Urgent Treatment Centre but would instead be taken directly to an Accident and Emergency (A&E) Department. Members were advised that the Urgent Treatment Centre focused on minor illnesses and injuries. The importance of ensuring that patients entered the correct clinical pathway from the outset was emphasised so that they received the appropriate level of care.

·       In sharing a personal experience of attending the Urgent Treatment Centre, a member stated that there was a significant assumption that members of the public knew where they should go in an emergency, yet even as a councillor they had not been aware of the correct point of access during their own emergency visit. The member reported that they had queued for a long period before being referred elsewhere and had then waited an additional hour to be seen. It was questioned why services appeared so determined to direct patients to Northwick Park Hospital and whether the Trust was satisfied that this model was functioning effectively. In response, Pippa Nightingale (Chief Executive Officer, London North West University Healthcare NHS Trust) conveyed that national promotion was needed to encourage patients to use the correct triage routes in an emergency, including the use of NHS 111. The need to promote the Talk Before You Walk initiative was emphasised to ensure that patients received the correct clinical advice and were directed to the appropriate site. It was additionally stated that ensuring patients were routed to the correct pathway was essential to improving patient care and achieving more effective clinical outcomes.

·       Members noted that when the NHS initiated a reduction in operating hours for the Urgent Treatment Centre at Central Middlesex Hospital, residents often feared that services would eventually disappear altogether. Assurance was sought that the Urgent Treatment Centre itself would not be removed in the future. In response, Pippa Nightingale (Chief Executive Officer, London North West University Healthcare NHS Trust) advised that Central Middlesex Hospital had more services than ever before and that it was regarded as one of the best hospital estates in London. It was stated that significant elective and specialist services had been introduced, including a new endoscopy suite. Members were further advised that the Trust was making maximum use of the available facilities. It was additionally stated that the reduction in Urgent Treatment Centre hours was not driven by financial considerations but by the need to allocate resources where demand existed and where patients were presenting.

·       Concern was expressed that approximately 40 people had taken part in the engagement exercise, stating that this represented a very small proportion of the population served by Central Middlesex Hospital. Details were sought on what more could have been done to secure a higher response rate. In response, Pippa Nightingale (Chief Executive Officer, London North West University Healthcare NHS Trust) explained that the Trust always sought to engage as widely as possible, although engagement activity had to be undertaken within specific timeframes. It was further explained that the change in opening hours had to be implemented before the winter period, which was the busiest time of year for the service. Members were advised that engagement had been carried out through all the Trust’s communication channels, which were described as proactive channels with strong user voices. It was stated that engagement levels often varied depending on the nature of the proposed change. In this case, usage during the affected hours had been extremely low, meaning that relatively few individuals were impacted.

·       Questions were raised around whether the engagement process had been sufficiently comprehensive, particularly in terms of the number of individuals who had been consulted and who had responded. It was noted that data indicated that a petition containing 570 signatures had been submitted opposing the reduction in hours. Members queried whether the petition had been considered by the Trust before implementing the change and whether an Equality Impact Assessment had examined the demographic composition of individuals who might require access to the Urgent Treatment Centre. In response, Pippa Nightingale (Chief Executive Officer, London North West University Healthcare NHS Trust) advised that the exercise undertaken had been an engagement process rather than a formal consultation and that the changes did not meet the NHS threshold for a statutory consultation. It was  reported that engagement activity had taken place and that written and verbal feedback from both face to face and virtual sessions had been collected and analysed. It was noted that the petition had not been submitted until after the change had been implemented. Engagement had commenced in October 2025, the revised hours had taken effect in February 2026, and the petition had been received subsequent to that date. Members were further advised that the Trust continued to monitor the situation and had not received any complaints or identified any clinical issues arising from the change. Members heard that feedback had been positive in terms of staff being able to see patients more efficiently.

·       Members expressed concern about pressure on Northwick Park Hospital, which was described as extremely busy and were keen to seek details on why the reinstatement of two A&E Departments was not being considered. Members further expressed a desire to see a holistic service provision across the borough. It was also questioned whether the Trust believed that the right facilities were located in the right places. In response, Pippa Nightingale (Chief Executive Officer, London North West University Healthcare NHS Trust) highlighted that this issue formed part of a wider strategic discussion across London regarding A &E services. It was also noted that consideration of Office for National Statistics (ONS) population data, including evidence that populations had shifted from inner to outer boroughs, had informed service planning, including additional capacity that had been introduced at Northwick Park Hospital over the previous 2 months to manage increased demand.

The Chair thanked Pippa Nightingale for responding to the Committee’s questions and then moved on to invite her to provide an update on the position at Northwick Park Hospital in relation to sickle cell and the hydrotherapy pool:

·       In providing an update, Pippa Nightingale (Chief Executive Officer, London North West University Healthcare NHS Trust) advised members that the hydrotherapy pool at Northwick Park Hospital had closed in August 2025. It was explained that, following the closure, the Trust had worked with Local Authorities and local sports centres to ensure that hydrotherapy facilities continued to be available within the community. It was reported that provision had been established within approximately 2 to 3 sports centres, supported by staff from London North West University Healthcare NHS Trust but operated by Local Authority?run facilities. It was confirmed that patients had been accessing those facilities successfully. Members were further advised that direct referral pathways were in place to the Hospital in Stanmore, and that this arrangement was functioning smoothly, with no recent concerns raised regarding patient experience or service capacity.

·       Turning to sickle cell services, Pippa Nightingale described the programme as a progressive plan that had been developed with extensive patient engagement, particularly from the sickle cell community in Brent. Members were informed that significant improvements had been made and that the response from patients had been very positive. It was reported that a 24/7 tertiary access centre had opened in Hammersmith, specialising in haematology and sickle cell care. Patients were able to contact the centre directly, and paramedics were able to convey patients there during a crisis. This ensured that all patients had access to a tertiary facility when in the most acute stages of illness. The centre had been operational since January 2026. As part of Phase II, the Dedicated Sickle Cell Day Service had now opened at the Central Middlesex Hospital site. It was explained that the previous medical day service had been moved because sickle cell patients had reported anxiety when sharing clinical space with patients who were attending to receive antibiotics or who had active infections. The medical day service had therefore been relocated to Ealing Hospital, where demand was highest, and the day service at Central Middlesex Hospital was now fully dedicated to sickle cell patients and staffed by specialist clinicians. It was confirmed that this change had been well received by the sickle cell patient community. With regard to Phase III, Pippa Nightingale informed members that the next stage of the programme was to extend the opening of the Dedicated Sickle Cell Day Service to 7 days per week, as it was currently operating 5 days per week. Members were informed that the Trust aimed to deliver this within the next 6 months. Pippa Nightingale concluded by noting that Brent had one of the largest sickle cell populations in the country and that the borough now had an exemplary sickle cell pathway in place.

In seeking to bring consideration of the item to a close, the Chair thanked Pippa Nightingale and members for their contributions towards scrutiny of the briefing on the ‘Reduction in operating hours at the Urgent Treatment Centre located at Central Middlesex Hospital’. As a result of the outcome of the discussion, the following recommendations were AGREED:

RECOMMENDATIONS

·       That the reduction in operating hours be reconsidered on the basis of a more comprehensive engagement exercise, enabling a wider range of service users and stakeholders to contribute to the assessment.

·       That population growth data be provided, together with analysis to identify the broader strategic context for service provision and to determine whether any gaps in provision existed.