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Frequently asked questions
- What is ‘Shaping a healthier future’?
- Exactly what changes are going to happen?
- What is happening to each hospital?
- When will these changes happen and what happens next?
- I have heard that one of the local councils is opposing this – won’t that prevent the programme from happening?
- What does this programme actually mean for me?
- If I currently receive regular care at my local hospital for a long-term condition such as diabetes or arthritis, how would I be affected?
- But won’t there be more risk if I have an emergency? Where will I go if the A&E at my local hospital has gone?
- What about heart attacks and strokes?
- I have heard this will leave large areas such as boroughs without a major hospital?
- But I am worried about travel times…
- I responded to the consultation – how have my views been taken into account?
- Isn’t this all about money?
What is ‘Shaping a healthier future’?
‘Shaping a healthier future’ is a major programme of improvements which the NHS is planning to implement across the eight boroughs in NW London (Brent, Ealing, Hammersmith & Fulham, Harrow, Hillingdon, Hounslow, Kensington & Chelsea, Westminster). The principal changes aim to centralise specialist services which people need when they are really seriously ill, localise the most common services people need for everyday illnesses and injuries, and integrate all of these services with others – such as social care – across the whole population of around 1.9m people in this part of London.
The programme has attracted a lot of interest because it is proposing changes to emergency units, or Accident & Emergency Departments, at nine of NW London’s hospitals. The NHS wants to centralise specialist emergency services at five of these (Chelsea & Westminster, Hillingdon, Northwick Park, St Mary’s, West Middlesex) so that really excellent emergency and major trauma care can be delivered thoroughly, 24/7, at all times of the day and night.
At the other hospitals (Central Middlesex, Charing Cross, Ealing, Hammersmith) you would still be able to attend Urgent Care for less serious injuries and illnesses with a full range of outpatient services including for children and pregnancy. So more than two thirds of patients would continue to attend the same hospitals they do now – in some cases, this will be more like 80% of patients still going to the same place.
So rather than a reduction in services as some have claimed, this is actually an increase in investment in five major specialist centres, maintaining other hospital services where they are now, and improving other services in the community such as GP surgeries to make care more joined up, across the piece.
There are quite a few specialist hospitals in NW London too, treating things like heart conditions and cancer – for example Royal Brompton and Harefield, the Royal Marsden, the Royal National Orthopaedic Hospital – but this programme is not proposing any changes to these.
Exactly what changes are going to happen?
The programme was consulted on over the summer and, as a result, extra changes have been considered. These were discussed at an NHS meeting on 19 February (by the Joint Committee of Primary Care Trusts (JCPCT) of NW London) and the following proposals were agreed to go ahead:
- Investing over £190m more in out-of-hospital care to improve community facilities and the care provided by GPs and others across NW London.
- Investing in five major hospitals at: Chelsea and Westminster; Hillingdon; Northwick Park; St Mary’s; and West Middlesex.
- Developing two hospitals – Central Middlesex and Hammersmith – as hospitals specialising in ‘elective’ or ‘planned’ care (for example, pre-planned procedures such as hip operations), as well as having a 24/7 Urgent Care Centre.
- Looking at further proposals for Ealing and Charing Cross Hospitals, which were originally going to be ‘local’ hospitals (also with Urgent Care Centres) but may now have more services put into them, depending on further planning and costing work.
You can see a full list of the 13 proposals agreed by the JCPCT here
What is happening at each hospital?
Chelsea & Westminster – a local hospital and a major hospital
Hillingdon – a local hospital and a major hospital
Northwick Park – a local hospital and a major hospital
St Mary’s – a local hospital, a major hospital, a Hyper Acute Stroke Unit (moved from Charing Cross Hospital) and a specialist ophthalmology hospital (moving the Western Eye Hospital onto the site)
West Middlesex – a local hospital and a major hospital
Central Middlesex – a local hospital and an elective hospital
Charing Cross – a local hospital
Ealing – a local hospital
<p>Hammersmith – a specialist hospital with obstetric-led maternity unit and a local hospital <p> </p>When will these changes happen and what happens next?
This is a large programme of change and so will not happen overnight, but will take between 3-5 years in total. Improvements to services outside hospital – such as GP and other local NHS facilities in your community – will happen first. The major changes to hospital would not happen until these community facilities have first been improved.
I have heard that one of the local councils is opposing this – won’t that prevent the programme from happening?
Ealing council has indeed asked the Secretary of State for Health to consider the programme. This is a shame, as this process normally takes a few months and may delay implementation of much needed improvements to local services which the majority of clinicians, local GPs and other local councils want to see go ahead. However, the NHS will continue what planning it can and remains committed to working with Ealing Council and further developing its local community health strategies, of which Ealing Hospital will be a critical part.
What does this programme actually mean for me?
Most people (between 60-80%) will continue to be treated by the NHS in exactly the same place as they are now or in some cases, even nearer to (or more often within) their homes than they are now. This is because a large part of these plans are to improve care in the community. Each Clinical Commissioning Group or CCG – the group of GPs who are taking over responsibility for NHS services on 1 April 2013 – has set out plans for the services they will provide in each CCG area, or borough. Even when the changes to major hospitals and A&E departments are put in place, there will be little change to where you go.
Every hospital will retain an Urgent Care Centre which can treat most of the cases that currently go to an A&E and also have a full range of outpatient services including for children and pregnancy. If you need specialist major emergency care, it is likely you will not be trying to make a choice of where to go yourself, but would simply dial 999 and be taken to the best place for your care by the nearest ambulance (which would not, by the way, necessarily be based at the nearest hospital since most ambulances are parked up in special places so as to be spread evenly throughout NW London, regardless of where the hospitals are).
If I currently receive regular care at my local hospital for a long-term condition such as diabetes or arthritis, how would I be affected?
For virtually all such patients, this will not change at all and you will still get care exactly where you receive it now, or did so previously. The major change happening for long term conditions is that, if anything, you will need to travel less as the plans are intended to make care for these illnesses more commonly available in all NW London local communities.
But won’t there be more risk if I have an emergency? Where will I go if the A&E at my local hospital has gone?
These changes will actually mean you can expect better outcomes in more specialised units. Again, for the vast majority of people (60-80%), you will still go exactly where you do now. If you have an everyday emergency such as a broken limb, cuts or bruises, or a high fever, or have children or elderly relatives with these kinds of conditions, you will still be able to go to your nearest hospital and be treated in its Urgent Care Centre. This is where most people go now, and all nine hospitals in NW London are not only retaining their Urgent Care Centres, but getting more investment spent on them as part of this programme. Of course, if you have a really serious emergency, you would still call 999 as you do now and the nearest ambulance will take you to the best place for your care – most likely one of the ‘big five’ major hospitals with specialist emergency care.
What about heart attacks and strokes?
As now, you would be taken to a specialist heart attack centre at, for example, Hammersmith – these are not moving. For strokes, you would be taken to the specialist stroke unit which is currently at Charing Cross, but is moving to St Mary’s – there will be no impact at all on patients due to this move since treatment starts when the paramedic reaches you, not when you get to hospital.
I have heard this will leave large areas such as boroughs without a major hospital?
Many boroughs in London already do not have major hospitals and, in fact, Harrow has never had a major hospital in its borough since Northwick Park is actually in Brent. However, it is not the location of the major hospitals that is so important. What is important is that you can access everyday care easily and quickly in your community, whenever you need it, and that ambulances can take you to specialist major centres if you have a really serious emergency. This is exactly what this programme will achieve, and is why hospital doctors and GPs support it.
But I am worried about travel times…
If you are getting to hospital by yourself currently, it is highly likely you will still be going to the same hospital that you do now. We know that a small number of people may have to go to a different hospital and we have set up a special working group to look at this. The same is true of people visiting relatives and friends in hospital. Travel times for emergencies will be largely unaffected, as the London Ambulance Service have confirmed.
I responded to the consultation – how have my views been taken into account?
The consultation exercise in the summer of 2012 prompted more than 17,000 responses and even more names on petitions, both in favour of and against the proposals. A lot of further work was then undertaken to consider all the points raised and new proposals were made – for example at Charing Cross and Ealing hospitals – to seek to meet concerns and improve the programme. Importantly, there was no clinical evidence which suggested our plans would not improve the care in NW London and ultimately save lives.
Isn’t this all about money?
It is certainly true that the NHS does not have an endless pot of money and that, with an increasing and aging population, we need to make the money go further. However, the top priority has always been to do what is best clinically. That means that the doctors leading these changes first looked at what was best for the health of people in NW London. Only after that did we ensure that it could also be financially sustainable.