2012 - present

Shaping a healthier future -background

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• 9 February 2012: Case for change published

• July – October 2012: Public consultation across NW London

• February 2013: Decision by JCPCT over improvements to healthcare in NW London

• October 10 2013: High Court judge dismisses Judicial Review bought against the programme

• October 2013: Independent Reconfiguration Panel agrees with recommendations of SaHF programme. Also says closures of A&Es and Hammersmith & Central Middlesex should happen “as soon as practicable”

• October 30 2013: Secretary of State accepts IRP report.

Shaping a healthier future timeline

Assuring a safe transition for the closure of Central Middlesex and Hammersmith Hospitals Accident and Emergency Departments6 August 2014

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No ItemIntroduction, overview and context for the planned CMH A&E and HH A&E transitionsKey enablers for A&E service transition

1. Imperial readiness

2. NWLHT readiness

3. LAS readiness for transition

4. CMH/HH Joint communications plan

Assurance Framework and Evidence

Next steps before 10 September transition

Contents

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Introduction, overview and context for the planned CMH A&E and HH A&E transitions

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• Following the case for change in February 2012 and public consultation across NW London from July – October 2012, the NW London JCPCT made the SaHF decisions in February 2013 and these were accepted by the Secretary of State following the IRP’s review in October 2013.

• The IRPs recommendation was that the Emergency Unit at Hammersmith Hospital and A&E Department at Central Middlesex Hospital should be closed “as soon as practicable”.

• Plans have been developed with all major stakeholders through the Shaping a Healthier Future Clinical Board, Programme Board and other SaHF governance structures.

• Providers led operational planning supported by SaHF governance

• Public information campaign is co-designed with the Trusts, CCGs and patient representatives

Clinicians, providers and commissioners are prepared to deliver service transition on 10 September

“Changes to A&E at Central Middlesex and Hammersmith hospitals should be implemented as soon as practicable”

“Commissioners and providers of acute hospital services across north west London must ensure that changes required to secure

safety and quality for patients are made without delay”

IRP Recommendations

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• Analysis of activity at the two sites led to two main conclusions:

– The area of overlap between each service is significant

– There is a wide footprint for both services –reaching into multiple boroughs

• A clear rationale for the joint closure of the A&Es at Central Middlesex and at Hammersmith was agreed:

A clear rationale for the joint closure of the A&Es at Central Middlesex and Hammersmith was agreed

– Uncontrolled short term patient flow. Given the proximity of the two sites whichever service were second to close may receive additional patient flow from the first having a critical impact on performance and patient safety.

– Simplified communications. A coordinated message is more effective for communication to the public.

• A joint closure date was therefore proposed and agreed by both Imperial and NWLH Trusts and CCGs

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Commissioners were required to assure themselves that this wouldbe a safe transition and a review process was put in place

Hammersmith

Central Middlesex

22 JulyCCG

assurance that HH

A&E can be safely closed

23 JulyCCG

assurance that CMH A&E can be safely closed

H&F CCG

Brent CCG

Agree the process for

seeking assurance

that HH A&E can be

safely closed

H&F CCG

Agree the process for

seeking assurance that CMH

A&E can be safely closed

Brent CCG

H&F CCG - Lead Commissioner for St Mary’s (receiving site)

CCGs that are affected to a lesser extent

Brent (and Harrow) CCG – Lead Commissioner for Northwick Park

H& F CCG - Lead Commissioner for St Mary’s

ICHT

EHT

Trust confirmation of readiness for transition

NWLHT

EHT

Trust confirmation of readiness for transition

ICHT

June July August September

Service transition

Service transition

Readiness m

onitoring and delegated

authority

Readiness m

onitoring and delegated authority

LAS

NHS England and NTDA Review

LAS

CCGs that are affected to a lesser extent

8 May –

CC

G C

ollaboration Board to agree to the process and

delegated responsibility for assurance to Brent and H

&F

CC

Gs

Key enablers for A&E service transition

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• Providers have ensured new receiving sites (St Mary’s and Northwick Park) have sufficient capacity in A&E and inpatients

• Providers ensure remaining services on sites are safe and UCCs have been enhanced

• We have also enabled cross-system work on capacity resilience

• London Ambulance Service fully involved and new pathways agreed. They have confirmed their readiness.

• A joint public communications campaign

Support of service transition

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• Imperial have worked with the SaHF programme and CCGs through the Project Delivery Group

• Progress has also been tracked through Imperial’s Trust Board and Hammersmith Hospital Emergency Unit committees

• Hammersmith Hospital Emergency Unit sees up to 140 patients per day. It is expected 80 of these will remain due to the advanced specification 24/7 Urgent Care Centre

• Assumed majority of activity (up to 60 patients a day) will remain within Imperial College Healthcare Trust sites and planned accordingly

Imperial are ready for the A&E transition on 10 September

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• North West London Hospitals NHS Trust Board is confident and approved delivery of 10 September closure at its Trust Board meeting on 25 June

• Activity assumptions supported by SaHF programme modelling and other Trusts have confirmed readiness for the minimal amount of additional activity

• Urgent Care Centre at Central Middlesex Hospital is current operating to the updated agreed pathways. Work to date has included additional training, communications and restructuring the UCC layout

• Remaining areas of focus include 22 additional beds opening at Northwick Park Hospital (Carroll Ward)

• Projected A&E performance shows the Central Middlesex Hospital A&E transition will improve the performance of Northwick Park Hospital A&E

NWL Hospitals are ready for Emergency Unit transition on 10 September

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• London Ambulance Service has engaged with the service transitions through every level of SaHF programme governance

• Operational Research in Health undertook a study to assess the impacts of changing the configuration of A&E services across North West London and the effects this would have on the London Ambulance Service.

• Operational Research in Health recommended allocating additional ambulance resource across the area

• These additional resources would mean no change to ambulance response times in reaching patients

• A full communications plan for staff has been developed and a review of Emergency Preparedness Resilience and Response (EPRR) plans for major incidents is underway

London Ambulance Service are ready for Emergency Unit transition on 10 September

LAS Complex Ambulance Hours required

Staff WTE

Brent 70 5Hanwell 70 5Isleworth 0 0

Total 140 10

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• SaHF have co-developed a communications strategy with the CCGs, Trusts and our patient representatives

• We want residents to know when the A&E will close, what services are available for urgent care at the site and what to do in an emergency.

• We need to:

– Reassure and not cause alarm

– Raise awareness that the two A&Es will close

– Ensure understanding that 24/7 UCCs remain on site

– Provide accessible and easy to understand information on the change

• The communications campaign will run for a minimum of 10 weeks

• Advertising material tested extensively with internal and external audiences

• We have placed a particular emphasis on listening to outcomes from focus group activity and our lay partners around wording and activity

• We have built on lessons learnt from the recent campaign at Barnet & Chase Farm hospital

A jointly developed public communication campaign launched on 28 July and will continue past 10 September

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Communications campaign• New website focused on changes to emergency care in NW London• Social media undertaken by the Trusts through existing channels• Door drops to 285,000 properties in the surrounding area• 400,000 leaflets and 11,000 posters to around 4000 key organisations and

community groups• Letter to parents, via schools, prior to the end of term and again just prior to the

closure (to mitigate the campaign over school holidays)• Half page adverts in local papers, increasing to full page in the two weeks prior to

closure• 16 billboards near the hospital sites• 81 bus panels on the inside of key bus routes• Information on screens in GP surgeries, where possible.• Advertising on the outside of council buses, where available• 150 bus stop adverts• 312,500 printed pharmacy bags which will ensure almost all patients for approx

10 weeks will receive information with their prescription• Face to face meetings with a range of community groups and hard to reach

groups• GP engagement and materials for GP surgeries• Staff engagement at hospital sites• Political and stakeholder engagement• Media responses, briefings and press releases

Assurance Framework and Evidence

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The agreed assurance framework addresses ten key delivery areas

Are correct policies and agreed pathways in place for safe transition of services to requisite level of quality?

Are correct policies and agreed pathways in place for safe transition of services to requisite level of quality?

Is the capacity available in receiving acute and OOH sites with agreed operational policies?

Is the capacity available in receiving acute and OOH sites with agreed operational policies?

Is a suitably capable workforce in place for a safe transition?Is a suitably capable workforce in place for a safe transition?

Has there been sufficient, patient and public engagement and is there a plan for this to continue?

Has there been sufficient, patient and public engagement and is there a plan for this to continue?

Has due consideration been given to activity and financial implications of transition? Has due consideration been given to activity and financial implications of transition?

Have all affected organisations understood the change and are prepared to manage the transition?

Have all affected organisations understood the change and are prepared to manage the transition?

Have travel/transport implications as a result of the reconfiguration been identified and addressed?

Have travel/transport implications as a result of the reconfiguration been identified and addressed?

Have statutory duties to prepare for responding to major incidents, and ensuring continuity of priority services been satisfied?

Have statutory duties to prepare for responding to major incidents, and ensuring continuity of priority services been satisfied?

Have equalities implications as a result of the reconfiguration been identified and addressed?

Have equalities implications as a result of the reconfiguration been identified and addressed?

Have travel/transport implications as a result of the reconfiguration been identified and addressed?

Have travel/transport implications as a result of the reconfiguration been identified and addressed?

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• Hammersmith and Fulham CCG had met on 22 July and also confirmed it was assured that it was safer to close the HH A&E on 10 September as a planned closure rather than keep the A&E open for longer and managed an unplanned closure.

• At its Governing Body meeting on 23 July Brent CCG assured itself that the changes are safe for Brent residents and the wider population of North West London (NWL) to be transitioned on 10 September

• Governing Bodies noted:

Brent CCG and Hammersmith & Fulham CCG have assured themselves for 10 September transition

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• Review meeting held on 1 July 2014 with the Shaping a Healthier Future (SaHF) team involving clinical and managerial representatives from the Trusts and CCGs.

• This included the Accountable Officers from both CCGs; Chair of Hammersmith & Fulham CCG; SaHF programme Senior Responsible Officer; SaHF Medical Directors; clinical and managerial representatives from NHS England (area and Regional team); and representatives from the NHS TDA including the Clinical Quality Director and North West London Portfolio Director.

• The stage 1 assurance report has recently been issued, headlines of this document are:

– Planning for the closure of the 2 A&E departments at Central Middlesex and Hammersmith Hospital is in line with the level of progress expected by mid-July

– The report highlighted the strong leadership, clear governance and collaboration of all of the stakeholders within NW London to deliver this complicated service transition

– The report makes a number of recommendations for the remaining time before 10 September, notably a focus on operational delivery and testing review to ensure any adjustments can be made and retested as soon as possible

– Site visit to take place on 5 and 6 August and a follow-up assurance session in early September prior to the closure

NHS England / TDA carried out a documentation review against five criteria in the assurance plan

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• A series of clinically led site review visits on 5 and 6 August 2014 to be led by North West London Area Team Medical and Nursing Directors, TDA Director of Nursing and representatives from the Clinical Senate (Urgent and Emergency care). These will include discussions with staff and a review of the pathway testing.

• The CCGs have been asked to submit further documentation in response to the first stage Assurance report by 8 August 2014.

• A specially convened meeting of the Transformation Board in late August 2014 will seek formal sign off from NHS England.

Further assurance work is planned

Next steps before transition on 10 September

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Next steps before 10 September service transition