Defending the decision to keep A&E at Charing Cross and Ealing

Guest blog by Anne Drinkell

The proposed closure of Charing Cross as a major acute hospital was part of a NW London project called ‘Shaping a Healthier Future‘. The proposal was to close around 300 of Charing Cross’s 360 acute hospital beds, its A&E Department and associated acute services. There was a similar plan for Ealing Hospital. Over the years since it was first proposed in 2012, ‘Shaping a Healthier Future‘ morphed into the equally Orwellian sounding ‘Sustainability & Transformation Plan‘ and aimed to cut £1.3 billion from healthcare budgets in the eight NW London Boroughs as its contribution to the £22 billion “savings” required across England by 2021.

We were asked to accept that closing 565 acute beds in NW London and reducing the health budget by £1.3 billion would lead to significant health improvements because alternative community health services would be expanded, so there would be less need for acute hospital beds. This seemed at best naïve and at worst cynical. Campaigners feared that acute beds would be irrevocably lost, leading to a huge increase in demands on community health services that were already massively over stretched.

Pedalling unrealistic projections about how much acute sector work the community sector could take over was a feature of many of London’s Sustainability and Transformation Plans and provoked this response from the well-respected health think tank the King’s Fund:

Even if additional investment is made in services in the community, reductions in hospital use on the scale proposed are not credible. Heroic efforts will be needed simply to manage rising demand with existing hospital capacity.

A Freedom of Information request revealed that NW London’s plan was predicated on slashing the number of outpatient appointments by 222,370 and planned hospital admissions by 49,875. Think about it. Faced with a rising and increasingly elderly population many with multiple illnesses, the plan was to reduce numbers of planned outpatients and operations (cataracts, knee and hip replacements etc.)

As a former community matron, nurse practitioner and district nurse I’m committed to expanding community services – for many people home is the best and safest place to receive care. In NW London over the last seven years there have been some excellent examples of community health projects reducing clients’ unnecessary hospital admissions. The bigger story however is of an under resourced community sector struggling with rising demand – unable to stop rising numbers of A&E attendances and hospital admissions. The lesson is that developing community health care requires time, testing and resources. It can’t be done on the hoof and on the cheap, something Shaping a Healthier Future did not learn.

Save Our Hospitals has never campaigned for Charing Cross to deliver the full range of every clinical service. We’ve always acknowledged that there are conditions where there’s good evidence that treatment is better delivered in specialist centres, concentrating expertise and resources, even if at a greater geographic distance. We have consistently championed the work of the major trauma centre in St Marys, the Heart Attack Unit at Hammersmith and the Hyper Acute Stroke Unit at Charing Cross Hospital.

However there are also times when patients need urgent but not necessarily specialist medical consultations and the time lag between emergency and treatment is critical – for example severe anaphylaxis or an acute asthma attack. In these cases having a local A&E is of crucial importance even in London because although distances between London hospitals are comparatively short, ambulance response times and traffic delays can lead to dangerously long journeys.

It is simply not true that around 30% of Accident and Emergency attendances are unnecessary. Studies have shown that NW Londoners use their A&Es more appropriately than other parts of the country and Professor Tim Orchard former medical director, now Chief Executive of Imperial College NHS Trust, which runs Charing Cross Hospital, is on record as saying that the vast majority of A&E attendance are appropriate. That’s why Imperial spent millions in 2018 actually expanding the A&E at Charing Cross.

Shaping a Healthier Future‘s predictions were spectacularly inaccurate, forecasting a huge reduction in A&E attendances across NW London of 64,175 over 5 years. In reality A&E attendances and hospital admissions soared, particularly after the closures of Hammersmith and Central Middlesex A&Es. It led to well publicised delays in ambulance arrival and transfer times, A&E waits and planned and unplanned treatment delays. The rising need for acute care nationally has led the Royal College of Medicine to call for 5,000 more acute beds across England.
Locally the surge in demand created a ripple effect throughout NW London. In the Observer in 2018 senior anaesthetist Dr Johansson described Imperial’s hospitals:

We have seen a 40% increase in Blue Calls – the most seriously unwell, ambulance-delivered cases……. Patients on the routine operating lists…. on the day they have their operation cancelled……. The conditions in A&E were just awful. There were patients everywhere. Patients on trolleys in corridors. ….. The whole system was absolutely paralysed. It wasn’t lack of staff in the emergency department that was the problem: our Trust has been very good at providing adequate staffing. It’s the bed blockade: we cannot get our patients to where we need them to be – on the wards – because of the lack of beds…… there is a real problem getting our critically ill patients into ITU because we are unable to get the patients who are already in there out on to the wards. Lately, we were getting to the stage where we couldn’t actually do emergency operations because we had too many patients waiting for intensive care beds.”

The government’s U turn on the closures is belatedly acknowledging what has been obvious to senior clinicians and hospital managers for some years, who have repeatedly stated in minuted board meetings that closures would be unsafe in the foreseeable future as NW London couldn’t cope without the acute capacity in Charing Cross Hospital.

Reversing the closure decision makes our NHS safer for Chiswick residents. Of course our health services must change to meet future challenges. Hopefully the process this time will include genuine consultation with local people. There may well be proportionately more community care and further specialisation and centralisation, based on clinical evidence and long term adequate resourcing. If this leads to better clinical outcomes necessitating fewer hospital beds that would be welcomed by most people. What’s unacceptable is a rushed series of hospital closures primarily on financial grounds with little evidence that community alternatives were viable and plenty that closures would trigger an acute care crisis. Avoiding that scenario is good news – though it’s scandalous that policy makers who signed off this plan, wasting many millions on spin doctors and private management consultants have not even apologised.

Anne Drinkell is Chair of the Save Our Hospitals campaign

Photograph above: Anne Drinkell, Chair of Save Our Hospitals, with Sir Richard Sykes, Chairman of the Royal Institution and Imperial College Healthcare

Photographs below: Support from a Pearly Queen, Anne (far right) handing in a petition with fellow campaigners, and the audience at one of the campaign’s rallies.

See also the case for moving A&E out of Charing Cross and Ealing hospitals:

A doctor’s view of Charing Cross Hospital A&E decision