Health chief claims ‘full privatisation’ threat has led to casualty unit closure

Dr Mark Spencer said services at Central Middlesex Hospital must change

The Shaping a Healthier Future consultation has attracted much criticism from residents.

Under every option for the programme, meant to transform healthcare in eight London boroughs, Central Middlesex Hospital in Harlesden will lose its accident and emergency department. Last week, hundreds of protesters against the plans marched through Brent.

Here, Dr Mark Spencer, the medical director of the scheme, tells the Times why it must go ahead and tries to answer residents’ concerns.

BK Times: “Northwick Park Hospital currently deals with 92 per cent of redirected A&E admissions, how will it be able to cope when the other hospitals close their A&E?”

MS: “NWP been given �20m to build a new A&E centre with a new admission ward and support service. It is subject to planning permission but should be running within a year.”

BK Times: “You say no risk assessment will be carried out until the consultation is complete, but how can you have a valid consultation unless the relative risks of each option are clear?”

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MS: “Looking at the different options they are very similar so there are not different risks to assess. The wider risks are covered in a pre consultation business case, which included manpower concerns at the A&E at CMH.

“People’s other anxiety is around access to emergency services but we have assessed that and we think the majority of people will still be seen in their local hospital.”

BK Times: “The bodies making these changes will not exist by the time they are complete, so there’s no accountability. Who will be held responsible if things go wrong?”

MS: “Services will be commissioned by a clinical commissioning group, which is ran by NHS Commissioning Board Authority (CBA) – the office are responsible for specialists and health care and will help with delivery of changes. They are fully functioning from October 1, and will take responsibility for the scheme next April.”

BK Times: “You yourselves admit that much of what is in your plans for community care is not yet in place. So how can you push ahead with the reorganisation plans?”

MS: “We can’t put in place community services until a financial plan is agreed. Each of the boroughs has already designed an out of hospital plan which are in place and they have a financial allocation alongside those.”

BK Times: “How do you get from Central Middlesex to Northwick Park by public transport?”

MS: “Off the top of my head, I don’t know. But if you go to the official website there is a link connected to Transport for London (TfL) which shows you the time taken to travel between hospitals.”

BK Times: “CMH primarily serves Harlesden and Stonebridge, both have very high levels of poverty and health needs. How can you hope to tackle health inequalities by making health care less accessible to those in greatest need?”

MS: “We have a team of people working with TfL to see what we can do to help them address the possibility of improving transport links. I understand Brent Council also want to extend a bus route from CMH to travel up to NWP to make it a direct journey.”

BK Times: “The changes will put a massive extra burden on the ambulance service yet there is no detail in the proposals for the training and employment of more paramedics, is this a priority?”

MS: “We have been talking with London Ambulance Service (LAS) and they have estimated they will need another eight full crews across the area, which we will fund ourselves. LAS did the modelling and the mapping and are saying that eight will give the same access quality as now.”

BK Times: “Research by Professor Nicholl at Sheffield University shows that a greater travelling distance to A&E will increase the chances of deaths in transit. Will the people of Brent be at risk?”

MS: “The findings are for category A* patients only who are at serious risk already. However, the increase is only one per cent for every 10k travelled.

“In this case we are talking about a much shorter distance and by having better care at the destination we think we are actually reducing the risk.”

BK Times: “Will there be ambulance transport from the Central Middlesex UCC to Northwick Park for patients the UCC is unable to treat and how many extra journeys, ambulances, staff will this need?”

MS: “Yes, if a patient attends the UCC and needs admitting to an A&E we will always have an ambulance available to transport them.”

BK Times: “Why did consultation say in advance that the A&E department at CMH would close under all options?

MS: “The background to our consultation showed that some of the sites were precarious; we did extensive research and wouldn’t recommend closure until absolutely sure the site was inadequate.”

BK Times: “What is the timescale for the A&E closure?”

MS: “We expect the A&E department to be open for another 2 years by which time the new building at Northwick Park will be functioning. The overall scheme is set to be implemented over 5 to 6 years but we hope it will be quicker than that.”

BK Times: “Some say that Shaping a Healthier Future is a recipe for further outsourcing privatising of the NHS locally?”

MS: “I don’t understand that theory; the UCC at CMH is run by a private company but has been for about 3 years, that’s the only private aspect of the whole scheme.

“There’s nothing in these changes that are privatising any services what so ever. The risk is actually that if we don’t make these changes hospitals will go into deficit and there could be full scale privatisation.”

BK Times: “How will patients (or those bringing them to the hospital) know whether their case is for UGC or A&E?”

MS: “We have time to explain details but most people will get it right as its common sense. If they don’t think they are seriously ill they need a UCC.

“Anything that would need a general anaesthetic or seems an immediate danger would not be dealt with by an UCC. You can phone 111 and be given best advice about where to get what care.”

BK Times: “Hundreds of residents marched through the streets to oppose the closures, what would you say to them to convince them that the plans will work?”

MS: “I am very keen for people to know that most services will continue, we will still have urgent care and better care by travelling slightly further. Centralising some services provides far better care.”