Shaping a Healthier Future update November 2014 26 November 2014 1. Introduction Shaping a Healthier Future (SaHF) is the programme to reshape hospital and out of hospital health and care services in North West London. North West London has a growing and ageing population, and at present, specialist care is too thinly spread over too many sites and some facilities are inadequate. A major public consultation on the proposed changes was carried out in 2012, and in 2013, with the Decision Making Business Case recommendations were agreed by the Joint Primary Care Trust (JCPCT) in February 2013. The decision was challenged by Ealing Council and an Independent Review Panel was set up to the review the DMBC recommendations. The Secretary of State for Health announced his decision on 30 October 2013 and, on the advice of the IRP (Independent Review Panel), supported the recommendations in full and determined that the Central Middlesex Hospital (CMH) and Hammersmith Hospital (HH) Accident and Emergency (A&E) departments should close as soon as practicable. These changes will concentrate specialist hospital services into fewer sites allowing us to provide more senior consultants’ expertise more of the time at those sites, leading to better results and safer services for our area’s two million patients. 2. Closure of A&E at Hammersmith Hospital and Central Middlesex Central Middlesex and Hammersmith Hospital A&Es closed on 10 September 2014 in line with the Secretary of State’s recommendations. The closures were safely delivered, with unprecedented levels of public awareness via a joint programme/Trust communication campaign. 24/7 Urgent Care Centres continue to operate at Central Middlesex and Hammersmith Hospital sites. They are safely operating and attendances levels are being monitored with further local communications being planned to ensure residents are clear these services remain open 24/7. Fewer transfers have been required between UCCs to alternative A&E departments, which is a positive sign that the communication messages have been clear and effective. Pan-NW London system monitoring arrangements have been in place during and following service changes, and we are working together to manage peaks in demand and performance through a daily call and weekly Operations Executive. This has enabled surges to be managed and any necessary action to be taken quickly with involvement from key stakeholders. It is recognised that A&E units are under increasing pressure across the country, which has attracted some national media coverage. Before and after the Central Middlesex and Hammersmith Hospital A&E closure dates, NW London hospitals indicated the increasing trend in demand on Emergency Departments and the changing trends in patient demands on the service, i.e. greater peaks and troughs throughout an individual day. Adjustments have been made to LAS Intelligent Conveyancing in line with managing demand across NW London. The latest all type performance data for A&Es across London can be found below: w/e 19 Oct 14 w/e 26 Oct 14 w/e 2 Nov 14 w/e 9 Nov 14 4 weeks ave Imperial 92.06% 94.05% 93.24% 93.02% 93.08% Chelsea and 95.11% 96.04% 93.75% 94.58% 94.89% Westminster North West 92.78% 94.16% 93.72% 93.56% 93.55% London Trusts North and East 91.98% 93.07% 93.38% 92.80% 92.80% London Trusts South London 93.34% 93.51% 92.31% 93.12% 93.07% Trusts Total London 92.64% 93.51% 93.13% 93.11% 93.10% Performance (The standard for all type performance is 95%. All type data includes minor injury units and walk-in centres, and of these, the number discharged, admitted or transferred within four hours of arrival. It also includes the number of admissions via A&E, and any waits of over four hours for admission following decision to admit). 3. Transition of maternity, inpatient gynaecology and inpatient paediatric services from Ealing Hospital We are implementing a robust decision making and assurance process for the transition of maternity, neonatal, inpatient paediatrics and inpatient gynaecology services from Ealing Hospital as part of the Shaping a Healthier Future programme. Ealing Hospital currently has the fewest deliveries of any hospital in NW London and the number of women choosing to give birth at Ealing Hospital is also falling. The unit would become unsustainable if the numbers of births fall below the critical mass needed for training of junior doctors. With the current levels of activity it is only able to achieve 60 hours of consultant presence on the labour ward. All other units are moving towards achieving the 168 hours required by the London Quality Standards (LQS) and have extended consultant presence faster than expected. Ealing CCG is already providing a large financial subsidy to Ealing’s maternity unit and there is no scope for the unit to increase its staffing establishment. As we move forward women will increasingly receive a clinically better and safer service elsewhere. On 8 October 2014, Ealing CCG Governing Body met and took the decision to begin planning for the closure of the maternity and neonatal unit at Ealing Hospital. Midwifery led community antenatal and postnatal care will continue to be provided in the Ealing but the full range of birth and neonatal services will now only be available at Chelsea and Westminster Hospital, Hillingdon Hospital, Northwick Park Hospital, Queen Charlotte’s Hospital and St Mary’s Hospital (part of Imperial College Healthcare Trust) and West Middlesex University Hospital. The NW London CCG Governing Bodies are currently being asked to delegate to Ealing CCG Governing Body the decision of the timing of the transition of maternity, neonatal, inpatient paediatrics and inpatient gynaecology services from Ealing Hospital, at its meeting on 26 November. Following the formal decision by Ealing CCG Governing Body on 26th November, commissioner led State of Readiness sessions will take place, where Trusts will provide assurance to the commissioners that the receiving sites will be ready for the changes to maternity, neonatal, inpatient paediatrics and inpatient gynaecology service. Receiving Trusts have confirmed that they will have sufficient capacity in place to support the maternity and neonatal transition by March 2015 and the paediatrics transition by June 2015. Ealing Hospital currently has 16 inpatient beds (12 Standard paediatric beds and 4 Paediatric Assessment Unit (PAU) beds). Feedback from receiving sites suggests that they are in a position to absorb up to 22 in-patient and PAU beds by summer 2015, subject to assessment of necessary workforce and infrastructure changes. Further assurance sessions will take place at the Governing Body meetings of the other NWL CCGs in January 2015. At these meetings each CCG will consider the assurance materials and be asked to confirm whether it is assured of the transition of maternity, neonatal, inpatient paediatrics and inpatient gynaecology services from Ealing Hospital. The earliest possible date for the closure of Ealing’s maternity services would be March 2015. Mums- to-be in the care of Ealing Hospital have been sent a letter explaining the situation. They have also been assured that there will be no immediate change and that Ealing’s maternity service remains open. An information line has also been set up where calls will be answered by the midwifery team. We are also carrying out engagement with GPs and key stakeholders. We will be keeping you informed as this work progresses. 4. Developments in primary care and out of hospital services To support the changes to hospital services, we are making improvements in primary care to ensure that services are tailored to patients’ needs. The diagram below shows how the transformation taking place across NW London has patients at the centre: Out of hospital and primary care estate Central London and West London CCG are investing in the estate needed to deliver more services in an out of hospital setting closer to home. For Central London, four out of hospital hubs are planned to deliver extended access to integrated care to patients. At St. Mary’s Hospital an integrated primary care hub is planned to provide fully integrated care between secondary and primary care. West London CCG has one out of hospital hub already in operation (St Charles Centre) and another is planned for the south of the area to deliver extended access to integrated care. Prime Ministers Challenge Fund Central London CCG’s GP practices and 50 of West London CCG’s (including those in Queen’s Park and Paddington) are taking part in Prime Minister’s Challenge Fund (PMCF), covering a population of over 440,000 patients. Around £520,000 is available to Central London’s GP federation and £675,000 to West London’s to help deliver outcomes against urgent, continuity and convenient care. Four practices in Central London (North West London Medical Centre, The Connaught Square Practice, Westminster and Pimlico Health Centre and Third Floor Lanark Medical Centre) and Halfpenny Steps in Queen’s Park and Paddington already provide a weekend walk-in clinic offering same day GP and nurse appointments to patients for 8 hours on Saturday and Sunday. PMCF provides further opportunity to build upon this convenient access. 19 practices already offer telephone consultations as an alternative to face to face appointments; 17 offer online appointment booking, and 21 practices offer longer appointments to those that need them. A Skype consultation pilot commenced in June 2014 at the Cavendish Medical Centre, offering consultations via video conferencing where physical examination of a patient is not necessarily required. The feedback from patients and staff has been positive so far. Integrated care Integrated care is about joining up the range of different health and social care services patients may receive to ensure they experience care as one seamless service, with their needs placed at the centre.