West London Humanists and Secularists

"Improving Healthcare for Two Million People in North West London"
A talk by Mark Spencer - Medical Director for NHS North West London - Meeting 18/05/12

This was a slightly unusual meeting in that it was intended as contributing towards a process of "consultation" with a cross-section of public opinion. (Representatives from the Quakers, our "hosts", were also present). Our speaker, Mark Spencer, is a local GP but also has a major role in the local development of the NHS, as clinical lead of "Shaping a Healthier Future", a project to reorganize NHS services, in particular hospital services, in the NW London region. The talk was a presentation of the current stage in their thinking. (This regional project should not be confused with a shorter term reorganisation of local hospital management, which involves merging Ealing and Northwick Park hospitals at management level.)

A key feature of the regional proposal is to distinguish four types of hospital with different services & facilities: local, major, elective and specialist hospitals. Since only "major" hospitals will provide acute services such as full A & E, urgent surgery and intensive care, this will involve centralising such facilities to 5 of the 9 non-specialist hospitals in the region. Dr Spencer stated that the main motivation for this change was improved clinical care. The latest medical treatments for acute conditions require increasingly specialised skills and facilities, with the result that at present survival rates for some acute conditions show unacceptable variation from hospital to hospital. In fact, from a purely clinical point of view, the ideal would be to concentrate acute provision in only 3 hospitals in the region, but because of the cost of such a major change the target of 5 had been chosen. Three hospitals would be downgraded to "local hospitals" and one may be converted to an "elective" hospital (for non-urgent surgery such as hernias).

On the controversial question of A & E departments, Dr Spencer pointed out the distinction between A & E proper and the "Urgent Care Centres" that are currently housed within A&E wings. Local hospitals would retain the UCC's - which is all that many visitors actually see. It is the more critical activities that would be centralised.

The initial assessment concluded that Hillingdon and Northwick Park ought to be major hospitals by virtue of their being relatively isolated, together with one each of three pairs of relatively nearby hospitals, namely Ealing/West Middlesex, Charing Cross/Chelsea & Westminster, and Hammersmith/St Mary's. A detailed evaluation of the implications of the eight possible combinations of selections from these pairs was then carried out, by about a dozen different criteria, including patient and staff experience and preference, financial considerations, the logistics of change and compatibility with research & academic requirements. This has left a shortlist of three options that are reasonably feasible, all with a major hospital at St Mary's (not Hammersmith). All three of the shortlisted options will now be the subject of consultation, although the most favoured option at the present stage of evaluation has West Middlesex and Chelsea & Westminster as the two remaining major hospitals. By contrast to acute care, Dr Spencer's emphasis for the case of out-of-hospital care was on localisation. The way forward for these services was seen to be the definition and application of required standards under such headings as individual empowerment, responsiveness, multi-disciplinary provision and communication.

Among the question raised by the interested audience, Dr Spencer was asked about the risks he saw in the proposed changes. He replied that the transition period would pose the greatest problems - implementation would probably take 5 to 10 years. He emphasised that patients always have the choice of which hospital they go to for a particular treatment. Under current national policies, he thought the proposed changes would lead to less privatisation as the public sector would be more financially viable. However, the distinction is a blurred one, for example most "Urgent Care Centres" are already run by private providers. Asked for an example of the improved services that a major hospital could give, he referred to keyhole surgery, for example for appendicitis, which is not routinely available at a hospital like Ealing and would greatly reduce the time spent in hospital - such stays being "more dangerous than bungee jumping or sky-diving". Another key service would be psychological support - found to have a major effect on survival of acute heart patients. Challenged on the psychological benefits of more frequent contact with doctors, he replied that for many diseases specialised nursing staff were better able to offer personal advice.

The slides from Dr Spencer's presentation may be found here .

Roger Haines 24.05 2012