Serious concerns about financial management at Imperial College Healthcare NHS Trust, and consequential service cut-backs, have been raised with the Chief Inspector of Hospitals.
The Chief Inspector is currently reviewing Imperial’s performance ahead of a decision on its Foundation Trust application for new financial freedoms.
Hammersmith & Fulham Council has written to the Chief Inspector, after hearing from senior Imperial clinicians concerned about the impact of the trust’s current £2.5 million budget deficit. The Chief Inspector is being asked to investigate widespread reports that the trust’s financial position is leading not only to the rushed closure of Hammersmith’s A&E, but also to cuts to critical care services and bed closures.
The Evening Standard reported on Wednesday that a senior member of staff sent a memo about the deficit to section heads with the title: "Finances – urgh!"
The memo apparently reports that the surgery and cancer division ‘does not have adequate control of spending’ with a series of drastic measures being introduced to curb the overspend, including the ‘closure of unfunded intensive care beds’. The memo threatens the scrapping of the trust’s application for foundation status.
The council says the state of the Imperial budget shows it is not ready to take on foundation status, a critical step in NHS plans to reorganise health care in north west London, which include the closure of all four local A&E departments and the sale of the majority of the Charing Cross Hospital site.
Local campaigners and H&F council have been fighting these closure plans, saying they are being rushed through to balance the books, without adequate alternative arrangements being put in place.
St Mary’s hospital in Paddington is expected to take over most of the cases displaced by west London’s A&E closures, with Hammersmith Hospital A&E closing on Wednesday. The council argues St Mary’s is already overstretched and struggling to cope with its existing cases.
Stephen Cowan, leader of the council, says; "The management and the board of Imperial are simply not up to the job and that is putting lives at risk.
"I raised the board’s failure to question capacity at St Mary’s and the closure of Hammersmith Hospital’s A&E with Imperial’s CEO on 20 June 2014. At the time neither she nor her team had any answers on how they planned to deal with this or why their board hadn’t once queried it. At the second meeting on 14 July 2014 they informed me that they would be opening a new ward to increase capacity at St. Mary's.
"We do not believe that the opening of the previously decommissioned Lewis Lloyd ward at St Mary's Hospital is an adequate response to the closure of Hammersmith A&E. We have anecdotal evidence from patients that another previously decommissioned ward, Victoria and Albert ward, has only one lift which when broken can take several days to fix. In at least one instance this resulted in a patient being man-handled down the stairs by staff members.
"Now we hear that a £2.5 million overspend at Imperial’s hospitals means a cost-cutting frenzy is taking place. That raises huge concerns that need honest and open scrutiny. The public, who pay for and rely on, these services, have the right to know what is going on."
"This does not look to me like a well-managed organisation that is ready to take on the extra responsibilities of foundation trust status and I am urging the Chief Inspector of Hospitals to investigate this further as part of his current inspection of the trust’s competencies."
Health managers say their proposals to reorganise hospital services, set out in their Shaping a Healthier Future document, are designed to improve the quality of emergency care, by ensuring patients are taken to centralised, specialist services, with back-up from the full range of medical and surgical specialists. They say Charing Cross will retain its A&E, although they admit that they do not yet know how emergency services there will be changed.
The case against west London’s hospital closure plans
The closure of four A&E units across north west London would mean that there are 395,440 people per A&E, 52% more than the national average.
Population growth has been seriously underestimated. Our figures show that by 2039 there is a potential discrepancy of 72,659 given the amount of development that is planned.
Replacing A&E units with Urgent Care Centres is inadequate and made worse by the fact that Imperial intends to refer to them as A&Es. This will cause patient confusion and delay.
There will be an unsustainable pressure on the remaining acute beds across the area, leading to delays in treatment and a reduction in the quality of care.
There will be increased pressure on primary health care without the necessary plans and investment being in place to accommodate this demand.