Hospitals downgrade plan ‘fatally flawed’
Wednesday September 12, 2012
NHS plans to downgrade west London hospitals are fatally flawed and will compromise local health services, according to a damning independent report released today (September 12).
Former NHS chief executive, Timothy Rideout, says there are fundamental flaws in NHS North West London’s controversial plans to scrap the A&E departments at Hammersmith and Charing Cross Hospitals, as well as the hyper acute stroke unit at Charing Cross.
In a scathing report, Mr Rideout - who is a specialist in change management, financial strategy and organisational turnaround within the health service, spells out a series of major concerns in the NHS business case. These include:
- A failure to explore genuine alternatives to A&E closures.
- Evidence that the “over-provision” of A&E departments, that NHS North West London claims to justify the closure of four units in the area, is not as marked as claimed. Nationally an average A&E department caters for 259,425 people. In North West London around 247,150 people are currently served per A&E (just 5% less than the national average). But, if the current NHS proposals go ahead, the remaining A&E’s would each need to cater for 395,440 people - meaning the area would have 52% less capacity than the national average.
- Using location as the main factor to decide downgrade options, rather than more relevant issues such as: the needs of local people or the current performance of local hospitals. For example, Charing Cross has the lowest mortality rate in North West London and the highest satisfaction score from patients, but this was not one of the criteria considered.
- Failure to independently verify the financial modelling used to determine the level of savings that the NHS needs to make.
- The ‘funnel effect’ of the chosen methodology in knocking out viable alternatives before they had a chance to be fairly compared.
- Lack of regard for the 40 per cent of inpatient admissions and 23 per cent of A&E admissions - people who will be dramatically affected by downgrading local hospitals.
Mr Rideout says the process that NHS North West London chose to decide that the borough’s two hospitals should be downgraded is ‘unsafe’ - and that, therefore, so are the proposals.
“There are fundamental problems with the whole business case used by NHS North West London,” says Mr Rideout. “There is a complete failure to take account of current clinical outcomes and a lack of regard for the scale of impact these radical changes will have on Hammersmith & Fulham residents.”
The excellence of current services will be put at risk as residents will be faced with increased travel times and delayed access to emergency care, according to the report. All this is combined with an inadequate public consultation earlier this year while the proposals were being drawn up - with just one in every 5,000 residents consulted.
Despite receiving MORE funding from central government, NHS North West London is ploughing ahead with budget savings of 4 per cent per year.
Cllr Nicholas Botterill, Hammersmith & Fulham (H&F) Council Leader, says: “The Rideout Report is a devastating critique of the failure of NHS bureaucrats to spend the extra cash that they are getting from Government to improve and protect front line health services.
“Instead, this detailed review shows how the unaccountable NHS bureaucrats have attempted to justify the downgrading of two local hospitals in the face of massive opposition from patients with no firm evidence that nurses or GPs agree with their wild conclusions."
The report also warns that the removal of 1,000 adult beds should not go ahead before new NHS structures come in to effect in April 2013, as it would be ‘highly inappropriate for formal decisions to be taken by Primary Care Trust on the eve of their abolition’. The report goes on to argue that major changes should not even be considered until the capacity of primary and community care, under the 'Out of Hospitals' strategy, has been significantly beefed up.
Cllr Botterill continues: “NHS North West London has failed to adequately consult the council, GPs or patients and their so call preferred option of downgrading Charing Cross and Hammersmith Hospitals is fatally flawed.
“To add insult to injury, under the current timetable, a dying organisation in the form of the current PCT is scheduled to make a major decision on the future health and wellbeing of thousands of residents as its last act before being dismantled. If this is allowed to continue there will be no accountability and no one to blame when lives are lost.
“We will now re-double our efforts to persuade the NHS North West London to think again.”
Timothy Rideout was brought in to help scrutinise NHS plans to downgrade local hospitals by H&F Council. Mr Rideout has more than 20 years experience in senior roles within the health service and was formally appointed to assist by the council’s Housing Health and Adult Social Care Select Committee in July.