Agenda item

The consultation document sets out proposals to re-configure NHS services in North West London.

The proposed options include the closure of Charing Cross, Hammersmith or Chelsea and Westminster Hospital.

NHS North West London briefly updated the committee on the hospital reconfiguration and the consultation which would end on 8 October 2012.  The summary consultation document had been circulated in local newspapers and a flyer delivered to local households. A series of consultation roadshow events would be held, with events being held in Hammersmith & Fulham on 28 July and 19 September.

The Joint Health Overview & Scrutiny Committee, comprising seven of the North West London boroughs (Hillingdon was not participating) and the London Boroughs of Camden, Richmond and Wandsworth, which considered that the reconfiguration proposals would substantially impact on their residents, had met formally on 12 July and had agreed dates for four further meetings.

Members queried the underlying assumptions in the pre-consultation business case in respect of population predictions. Mr Elkeles responded that population figures were taken from the 2001 Census and the ONS predictions and the GLA growth rate for each borough. The predictions would be reviewed in line with the 2011 Census figures, which had just been released.

Members queried travel times and whether a risk analysis had been undertaken in respect of traffic jams. Dr Spencer responded that the travel times were based on a  LAS review of travel times to stroke units.  Data had been provided for both peak and off-peak times and for each of the service reconfiguration options. The data had been reviewed once and the results of a second review by a specialist travel firm would be available by the end of the consultation.

Councillor Cowan queried whether risk analysis had been undertaken in respect of a patient dying in an ambulance. Mr Elkeles responded that the maximum journey time was not materially different under the re-configuration options.

Councillor Ivimy suggested that a patient might be saved by a 20 minute ambulance journey, but die on route with a 40 minute journey. Dr Spencer responded that patients were stabilised within the ambulance, and there were only a small number of deaths. Dr LaBrooy added that a number of people who died in hospital could have been saved if moved quicker to another hospital. There was evidence that time spent in an ambulance was less important than being taken to the right place.

Action:

Information to be provided in respect of:

(a)   deaths during ambulance journeys; and

(b)   the types of Accident & Emergency cases where travel times are critical.

Action: NHS NWL

Members suggested that the proposals were based on the requirement to make savings to fund increased demand. NHS NWL responded by referring to the workforce challenges particularly in paediatrics and obstetrics, and the shortage of consultants to maintain rosters and quality in existing services. A Clinical Review working group had been established in November 2011 to make recommendations on how to maintain quality in line with the financial and workforce problems.

Councillor Graham referred to the Secretary of State’s four tests and queried whether the proposals, which would leave Hammersmith without an Accident & Emergency Department, had the full backing of GPs. Dr Spicer responded that the proposals had the full support of the Clinical Commissioning Group (CCG), which had developed the Out of Hospital aspects (OOH)

Dr Spicer responded to a query in respect of whether the CCG was representative of GPs in the borough that there was a spectrum of opinion amongst GPs. Dr Spencer added that the CCG in Ealing had unanimously voted to support the proposals. The role of the CCG was to reflect opinion, hold discussions with members and take decisions. There had been genuine patient engagement

Mr Elkeles clarified his comment in respect of petitions which had been reported in the press, He considered that petitions had limited impact when compared with a reasoned opinion, but would be taken into account.

Members queried whether Chelsea and Westminster Hospital had the capacity to cope with additional patients. Mr Elkeles responded that the proposals required an additional 80/100 beds. Chelsea and Westminster was a well designed site and it was practical to provide this additional capacity. The capital cost of moving Chelsea and Westminster facilities to Charing Cross was considerably more.

Members queried why surgeons did not move to different sites, rather than patients moving. NHS NWL responded that: premises costs were extremely high; if surgeons moved between sites, care would be compromised and guidance from the Royal College breached; and it was easier to move a patient that a surgical team.

Councillor Ivimy suggested that Charing Cross and Chelsea and Westminster should be a split site major hospital, with Chelsea and Westminster retaining paediatrics and an adult focus at Charing Cross. Dr LaBrooy responded that both sites would require a full range of diagnostic services to back up the emergency departments. Hammersmith Hospital, for example, would remain a major specialist hospital and retain full support for Obstetrics.

Mr Elkeles confirmed that savings of £1.6million were required. Professional site values had been obtained for all North West London sites. Should the sites be sold , there could be significant variation in the market value, depending on the developments plans. NHS NWL had taken prudent values.

In response to questions in respect of how developments at  Charing Cross would be progressed, Mr Elkeles stated that, should a new local hospital be built on the Charing Cross site, the square footage required would be retained and the remainder of the site released. The current gym area was given as an example of where this could be sited.

Councillor Cowan queried the importance of the £1.6 billion savings. Dr Spencer responded that the clinical case for change had been developed first and the financial model afterwards. Mr Elkeles added that whilst NHS funding had increased, demand had grown faster and therefore delivery of services in places other than expensive hospital sites had to be considered. Savings and better outcomes could be achieved by looking after patients in the community.

Councillor Tobias queried developments outside North West London and the pairing of Charing Cross and Chelsea and Westminster. Dr Spencer responded that there were similar changes across London. Dr LaBrooy stated that the NHS intended to implement good cover with five major hospitals and equal distribution across North West London. Travel times had determined that Hillingdon Hospital and Northwick Park should  be designated major hospitals. Modelling of patient flows between two hospitals in pairs for the remaining six hospitals had demonstrated where patients would go should one of the hospitals no longer have an Accident & Emergency Department. All local hospitals would have an Urgent Care Centre and a range of services, which would differ.

Councillor Carlebach queried the continuance of medical research at Charing Cross in view of the likely site reduction.  Dr Spencer responded that this decision would be taken by Imperial College Healthcare NHS Trust (ICHT) in conjunction with Imperial College. He was aware however that an Academic Health Science Partnership was being formed through Imperial College which would be a conglomerate of all hospitals within North West London and also providers of primary care. This would present opportunities for research on a large scale, rather than being dependent on local patient flows.

Dr Spencer responded to a question that ICHT clinicians were members of the Clinical Working Group and that the Chief Executive and senior staff were supportive of the proposals. Under Option A, £100million net land sales would be required to fund the capital development. Whilst receipts from land sales were normally returned to the NHS, should a sale be made specifically to invest in local services, the capital would be made available to Charing Cross. Councillor Cowan commented that should the ‘capital be made available’, interest could be charged.

NHSNWL confirmed that should ICHT become a Foundation Trust it would retain the proceeds of the land sale.

NHSNWL estimated that three quarters of the £100 million would be met from land sales at Charing Cross.  This was a prudent figure, based on land values concluded in March/April 2012. The commercial figure could be higher, depending on plans for the whole site.

Action:

NHS NW London to provide a breakdown by site of the ‘backlog’ maintenance figure of around £53 million.

Action: NHS NWL

Councillor Vaughan commented that the NHS was moving from a simple to a complicated three tier system and queried how the NHS would educate the public. Dr Spencer responded that the changes would be implemented over the following three/four years and public education would be supported by the new ‘111’ number. Access currently was not a simple model; Accident & Emergency Departments were not standardised, but disparate services of which the public was not aware.

Mr Elkeles stated that all evidence presented to NHS London had been brought to the committee and presented by experts. In addition,  all analysis had been put into the public domain.

Councillor Ginn considered that whilst there was a strong clinical case, the proposals were finance based. The Council would want to extrapolate the link and to stress test the figures to ensure that they were positive for Hammersmith & Fulham, not just part of London.

Action:

NHSNWL to provide a definitive list of all individuals involved in the decision making process and declarations of interest.

Action: NHS NWL

RECOMMENDED:

1. That NHS NW London be invited to the September meeting.

2. The committee endorsed the appointment of external consultants to analyse the underlying assumptions in the pre-consultation business case.

In accordance with paragraph 27 of the Overview and Scrutiny Procedure Rules, the Committee extended the meeting by 30 minutes.