Brent Labour Council has written to the Independent Reconfiguration Panel asking them to look into the Shaping a Healthier Future proposals (SAHF). The Independent Reconfiguration Panel is the body tasked with providing advice on contested NHS reorganisation to the Secretary of State for Health. The IRP will make their recommendation on Shaping a Healthier Future in September.
The submission to the panel makes the below points:
Out of Hospital Care
- SAHF says changes to out of hospital care are needed to deliver planned changes to acute care. We have seen no guarantees that out of hospital care will get the investment needed to deliver these improvements.
- We need clarity on exactly what the thresholds are for the reduction in demand that will need to be met before the reconfiguration of acute services is allowed to begin.
- We need to be convinced that delivering services out of hospital will be cheaper. We have seen no evidence to support this assumption.
GP Support and “Hubs”
- We have seen little evidence that GPs will be prepared to make changes to the way they work or provide the additional services/support that is required.
- One of the key elements of the Out of Hospital Strategy is the provision of additional local medical centres (“hubs”). Yet evidence to date suggests that efforts to move GP practices into purpose build medical centres have not succeeded.
- We need more clarity on what services are planned for each hub and assurances that no existing services are going to be removed.
- The panel must establish with the CCGs what evidence they have that their new attempts to increase GP access will succeed where previous attempts have failed.
Changes to acute care
- We have seen little tangible evidence to support the models for individual services leading to reduction in demand on acute services.
- An example of a proposed service change that causes us concern is the provision of maternity beds at Northwick Park. Under the proposals there will be an increase from 69 to 70 beds by 2015/16, but a 20% increase in births at the site. This appears to be based on the questionable assumption that a 15% reduction in average length of stay can be achieved by 2015/16. We ask the panel to establish what provision has been made if North West London Hospitals fails to deliver the numbers proposed?
- We would also be interested to hear why SAHF believes it can succeed in reducing acute demand through faster discharge where previous attempts have failed.
Central Middlesex Hospital
- North West London Hospitals and Brent CCG support the closure of Central Middlesex A&E but that does not alter the fact that there is strong public opposition.
- Has there been any research done on the evening closure of A&E at Central Middlesex that is already in place, and its effect on neighbouring hospitals?
- It is proposed that Central Middlesex be an elective hospital with an Urgent Care Centre. However, there is a complete lack of information on precisely what elective services will be delivered at the site, and what catchment area they will serve.
Northwick Park Hospital
- Northwick Park has one of the worst “four hour waiting times”. Is it really prudent to give extra A&E responsibilities to a hospital that is incapable of delivering adequate A&E services and what is being put in place to manage these increased risks?
- In addition, the response to the current A&E crisis at Northwick Park has been to utilise facilities at Central Middlesex. What back-up options will there be in the future once Central Middlesex’s emergency facilities have been removed?
Equalities and Population
- Many residents in Brent suffer deprivation and hardship. It is an area with a high proportion of BME residents and residents with English as a second language. We have sought assurances that these communities will not be unduly disadvantaged.
- Clinical priorities are cited as more important, but we should not ignore the fact that the mental health and recovery of patients can be dependent on regular visits and support from family and friends and we urge the panel to push for clarity on the effect that the changes would have on low cost transport options for patients and visitors.
We are not opposed to change without good reason but are concerned about the lack of clarity in key areas of these proposals, including:
- The ability to deliver better out of hospital services
- That Northwick Park Hospital will be able to provide additional acute services for an expanded population
- The future of Central Middlesex Hospital
For the full submission click here to download