Written submissions of Andy Slaughter, MP for Hammersmith, to the

North West London Health Care Commission:

1. I am the MP for Hammersmith, a position held since 2010. Prior to that I
was MP for Ealing, Acton & Shepherds Bush 2005-10. I served as a
councillor in Hammersmith & Fulham 1986-2006, and as Leader of the
Council 1996-2005. I am very familiar with the structure and operation of
the NHS in north-west London and the Shaping a Healthier Future (SaHF)
proposals.
2. My principal concerns arising from SaHF relate to hospital services. These
include the closure of Hammersmith Hospital Emergency Department in
September 2014 and the proposals for Charing Cross, namely the
demolition and clearing of Imperial Healthcare Trust buildings from the
entire 16 acre site, with a sale of approximately half the site for residential
use and the retained NHS facilities being directed in the main to primary
care, treatment and minor elective surgery. This will result in the removal
of 93% of inpatient beds and all consultant emergency medicine, including
the hyper-acute stroke unit, intensive treatment, and type 1 accident and
emergency.
3. The loss of both A&E departments in the borough is part of a wider loss of
four of the nine A&E departments in NW London proposed by SaHF.
Already the intense pressure on A&E, inpatient beds and the London
Ambulance Service has increased following the Hammersmith and Central
Middlesex closures. Targets are regularly missed by wide margins and the
pressure on staff and patients is intolerable. There is already insufficient
capacity in the system.
4. A secondary concern is travel. This affects both patients and visitors, in
particular those who do not have access to cars, who are elderly or
disabled. Much of the borough has high levels of deprivation and chronic
ill health and low car ownership.

5. There is a lack of new provision of alternative services. Despite the
advocacy of alternatives to relieve pressure on A&Es from the integration
of social care to diverting patients to primary and community care services,
few additional services have so far been put in place ahead of the A&E
closures. However, most west London hospitals already have triaging
between GPs, urgent care and A&E services all of which are available, for
example, on the Charing Cross site. As such, it is difficult to say that A&Es
are overloaded because of a lack of primary care alternatives. The College
of Emergency Medicine has recently expressed the view that most people
who go to A&E need A&E care.
6. There is little evidence to suggest that the type of reorganisation proposed
is sound in clinical terms. Whereas the changes to date – such as the
centralisation of specialisms on a particular site – have had merit, in the
context of general emergency medicine there is no particular evidence to
say that having fewer larger units is going to prove beneficial in terms of
the quality of care or the saving of lives. In contrast, the downside is
obvious: fewer centres and further to travel. There is a difference, as the
College of Emergency Medicine has stated, between the centralisation of
major trauma and stroke services on the one hand and the pooling of
emergency services generally.
7. It appears therefore that the sole benefits of SaHF are cost savings, or
generating capital receipts by land disposal.
8. From the time the SaHF proposals were put forward in June 2012
consultation, justification and implementation have been equally poor.
There has been no genuine attempt to engage with the public or to talk
with the users of the services in an open way, which would engage their
actual opinions. Rather, there has been an attempt to divert public opinion
down the route already envisaged by the proposers. Allied to this is the
lack of independent clinical evidence put forward. Many independent
clinicians and professional bodies doubt whether this is the right approach.
9. As such, it cannot be said that due process has been followed in terms of
establishing a case, or in terms of consulting with the public, a point which

my constituents frequently mention to me. Despite SaHF affecting two
million people in west London, most feel they have no ownership of the
proposals and that their views are disregarded.
10. The quality of management and in some cases the quality of service in the
acute sector is unsatisfactory, and yet the cuts and closures are going
ahead oblivious to that. In the last year, the Care Quality Commission
reports for most of the major hospitals in west London, including those
managed by Imperial Healthcare Trust, have found that they require
improvement, and that the existing standards of emergency care are not
good enough.
11. We are trying to implement major change on a system that is currently
broken, and on organisations which, in many cases, have gone through
repeated management change, and which suffer from high staff turnover
and low staff morale. Whilst staff are doing an extremely good job under
very difficult circumstances, they are not getting the support they need
from the organisations themselves. It is a bad way to introduce major
change.

Dated 11 March 2015.
I confirm that this statement is true to the best of my knowledge and
understanding.
Andy Slaughter MP