Current issues in the delivery of health care in NW London - Report for H&F Health Care Audit by Boyle and Steer - March 2018



1. The original analysis on which SaHF was based failed to take adequateaccount of likely increases in population over time. The current population isalready greater than SaHF had estimated for 2022, and SOC1 projects it will grow by 14% by 2026.

2. NW London has a different pattern of use of emergency services with greater use of minor A&E units than other parts of London, and the rest of England. Attendances at acute A&E units have fallen by 16.5% since 2011/12 compared with an increase in the rest of London of 10.5%, and in England of 8.8%. However attendances at minor A&Es have increased dramatically, so that taking all attendances together there has been an increase of 12.2% compared with 3.5% in the rest of London and 7.7% in England.

3. There is no evidence that NW London uses more A&E emergency services than other parts of England, or London. The level of emergency admissions through A&E in NW London has fallen between 2011/12 and 2016/17. But this was more than compensated by a dramatic rise in the number of emergency admissions taken through alternative routes, eg direct admission by GPs, which went from over 12,000 to over 29,000 over the same period. This translates into a small rise of just over 8% in total emergency admissions; at the same time, emergency admissions in England as a whole increased by almost 14% and in the rest of London by 16%.

4. There has been a considerable deterioration in A&E pe rformance measured as the proportion of people attending A&E who are not dealt with within four hours. NW London, in the first quarter of 2011/12, was better than the rest of England and London, and well within the margin of the government target of 5%. However, more recent performance and in particular since the closure of two A&E units in NW London (on 10 September 2014) shows a considerable deterioration, and now performance in NW London is consistently poorer than elsewhere In England or London.

5. Another measure of A&E quality is how long it takes a patient to be admitted to a bed once the decision has been made to do so. In many cases this can take up to 12 hours, and increasingly over 12 hours. Performance in NW London has deteriorated sharply since the closure of two A&Es. In the third quarter of 2017/18, 5.3% of patients in NW London A&Es waited up to 12 hours for admission, 2.7% in other parts of London, and 4.1% in the rest of England.2

6. Throughout January and February 2018, the Imperial Trust sites: St Mary’s and Charing Cross, have been experiencing severe pressure and have had to declare black alerts on almost all days, indicating severe bed shortages and an inability to cope. Over the winter of 2018 LNWHT and Hillingdon trusts consistently had ambulances waiting longer than is appropriate to discharge patients into the care of the hospital, and sometimes twice as long as the England or London average. One in five ambulance patients in NW London
waited more than 30 minutes.

7. Acute bed capacity has fallen in NW London by 270 beds between 2009/10 and 2017/18. SaHF indicated that over 1,000 beds would eventually be closed. At the same time NW London hospitals have a lower LOS than the England average, possibly indicating that they are already operating more efficiently than elsewhere. In the winter of 2017 they also had very high bed occupancy levels, upwards of 95%, indicating extreme pressure on the system.

8. There is no evidence that there has been a successful diversion of hospital activity into out-of-hospital facilities although SOC1 still claims the intended hubs will result in a reduction of 22,000 emergency admissions.

9. Partial implementation of a programme of closures of acute services before an adequate business case was produced, has increased the pressure on the health system and had a detrimental effect on the delivery of services in NW London. It is becoming almost impossible to run the system due to a lack of financial resources combined with a lack of acute bed facilities shortfalls in staffing throughout the area.

10. The deterioration in A&E services suggests that any plans for further closures of acute services at Charing Cross and Ealing are ill-founded. These should be halted and sufficient resources made available to retain existing services and staff.