Changes to Health Services in London

Part of Oral Answers to Questions — Prime Minister – in the House of Commons at 12:33 pm on 30th October 2013.

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Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health 12:33 pm, 30th October 2013

With permission, Mr Speaker, I would like to make a statement on the “Shaping a healthier future” programme, a locally led review of NHS services across north-west London.

The NHS is one of the greatest institutions in the world. Ensuring that it is sustainable and that it serves the best interests of patients sometimes means taking tough decisions. The population of north-west London is growing and will reach approximately 2.15 million by 2018. About 300,000 people have a long-term condition. However, there is great variation in the quality of acute care. In 2011, there was a 10% higher mortality rate at weekends for emergency admissions, and the number of hospital re-admissions differs considerably across the area. The Independent Reconfiguration Panel expressed concerns that the status quo in north-west London was neither sustainable nor desirable, and might not even be stable.

In order to address these challenges, the NHS in London started the “Shaping a healthier future” programme in 2009. It proposed significant changes to services, including centralising accident and emergency services at five rather than nine hospitals; 24/7 urgent care centres at all nine hospitals; 24/7 consultant cover in all obstetric wards; a brand new trauma hospital at St Mary’s hospital, Paddington; brand new custom-built local hospitals at Ealing and Charing Cross; seven-day access to GP surgeries throughout north-west London; the creation of over 800 additional posts to improve out-of-hospital care, including a named, accountable clinician for all vulnerable and elderly patients with fully integrated provision by the health and social care systems; and increased investment in mental health and psychiatric liaison services.

These changes represent the most ambitious plans to transform care put forward by any NHS local area to date. They are forward-thinking and address many of the most pressing issues facing the NHS, including seven-day working, improved hospital safety and proactive out-of-hospital and GP services. The improvements in emergency care alone should save about 130 lives per annum and the transformation in out-of-hospital care many more, giving north-west London probably the best out-of-hospital care anywhere in the country.

The plans are supported by all eight clinical commissioning groups, the medical directors of all nine local NHS trusts, and all local councils except Ealing. It was as a result of a referral to me by Ealing council on 19 March 2013 that I asked the Independent Reconfiguration Panel to conduct a full review.

The panel submitted its comprehensive report to me on 13 September 2013 and I have considered it in detail alongside the referral from Ealing. I am today placing a copy of the panel’s report in the Library, alongside the strong letters of support for the changes that I received from all local CCGs and medical directors. The panel says that “Shaping a healthier future” provides

“the way forward for the future and that the proposals for change will enable the provision of safe, sustainable and accessible services.”

Today I have accepted the panel’s advice in full and it will be published on the panel’s website.

The panel also says that while the changes to A and E at Central Middlesex and Hammersmith hospitals should be implemented as soon as practicable, further work is required before a final decision can be made about the range of services to be provided from the Ealing and Charing Cross hospital sites.

Because the process to date has already taken four years, causing considerable and understandable local concern, I have today decided it is time to end the uncertainty. Therefore, while I accept the need for further work, as the IRP suggests, I have decided that the outcome should be that Ealing and Charing Cross hospitals should continue to offer an A and E service, even if it is a different shape or size from that currently offered.

Any changes implemented as part of “Shaping a healthier future” should be implemented by local commissioners following proper public engagement and in line with the emerging principles of the Keogh review of accident and emergency services.

I have today written to the chair and vice-chair of the health and adult social services standing scrutiny panel of the London borough of Ealing council, the chair of the IRP Lord Bernie Ribeiro, the chief executive of NHS England and local MPs, informing them of my decision.

These much-needed changes will put patients at the centre of their local NHS, with more accessible, 24/7 front-line care at home, in GP surgeries, in hospitals and in the community. More money will be spent on front-line care, which focuses on the patient. Less will be wasted on duplication and under-performing services.

Let me be clear that, in the joint words of the medical directors at hospitals affected, there is a

“very high level of clinical support for this programme across NW London”.

Local services will be designed by clinicians and local residents and will be based on the specific needs of the population.

None of these changes will take place until NHS England is convinced that the necessary increases in capacity in north-west London’s hospitals and primary and community services have taken place.

I want to put on the record my thanks to the IRP for its thorough advice. As the medical directors of all the local hospitals concerned said in their letter to me, these changes will

“save many lives each year and significantly improve patients care and experience of the NHS.”

When local doctors tell me that that is the prize, I will not duck a difficult decision.

I commend this statement to the House.