Council leaders refuse to back proposal amid fears Ealing and Charing Cross hospitals could lose A&E and other services as focus shifts to ‘virtual’ care
Charing Cross hospital in London, one of the two facilities feared to be under threat of downgrade or closure under the sustainability and transformation plan. Photograph: Gregory Wrona / Alamy/Alamy
Council leaders have refused to sign up to a plan to “transform” NHS services amid fears two major London hospitals, Ealing and Charing Cross, are to be downgraded and will lose their A&E units and other acute services, the Guardian can reveal.
Plans being developed around England to tackle the NHS funding crisis involve increasing focus on “virtual” and outpatient care, and internal documents show there are plans in north-west London to close or downgrade its acute hospitals from nine to five.
Both west London hospitals are highly valued by local residents and have been the subject of campaigns to save them when they were threatened with closures in the past.
Leaders at both Ealing and Hammersmith & Fulham councils say they are determined that these hospitals should remain open with their A&E and operating surgeries and so have refused to sign up to the north-west London sustainability and transformation plan (STP), which is one of 44 such plans in development around England.
Critics of the plans fear that up to 500 acute beds could be lost if these hospitals are closed or downgraded.
The majority of the 44 plans – described by NHS England as internal documents – have not been published. The Guardian has seen two of the plans.
The STP for North-West London Collaboration of Clinical Commissioning Groups advocates:
• Reducing acute hospitals from the current nine in north-west London to five and reducing acute admissions by a third. The document says “... consolidate acute services onto five sites (the consolidation of acute services to fewer sites is not supported by the London boroughs of Ealing and Hammersmith & Fulham)”.
• The document also states that to replace the acute hospital closures there will be a “local hospital model” introduced. This has not yet been fully defined but is likely to be minor injuries/out of hours GP centres, rehab beds for elderly people after accidents, but no A&E, no medical or surgical beds, and no operating theatres.
• Making parts of the NHS “virtual” rather than using physical buildings for some consultations, and selling off some buildings that would become surplus to requirements as a result.
• Revolutionising the outpatient model by using technology to reduce face to face consultations by up to 40%.
• Give patients phone or face to face coaching to treat themselves.
Some of the proposals have support from experts and NHS professionals, as there are huge pressures on budgets as the UK copes with an ageing population.
However, the document says “unsurprisingly there are many risks to the achievement” of the ambitions in the plans.
Steve Cowan, leader of Hammersmith & Fulham council, told the Guardian that NHS officials were being forced to drive through the changes by the government. “We condemn the Tory government for drawing up these plans. This is about closing hospitals and getting capital receipts. It’s a cynical rehash of earlier plans and is about the breaking up and selling off of the NHS. It will lead to a loss of vital services and will put lives at risk.”
He added: “Our job is to protect the NHS and this plan is about dismantling it. This document is an affront to the sensibilities of the people of north-west London.”
Julian Bell, leader of Ealing council, said: “We refused to sign up to the STP plans because we do not support the closure of Ealing and Charing Cross acute hospitals … We have made it abundantly clear that we will campaign until our last breath to save Ealing and Charing Cross hospitals. We do support some of the proposals for more integrated health and social care but we feel we will be punished for not signing up to these plans.”
The document seen by the Guardian does not detail numbers of beds facing cuts in the two London hospitals. When asked why no numbers were specified for planned bed closures in the document, London North-West Healthcare NHS trust said: “The STP does not focus on beds because this ignores the fact that we are trying to deliver the best possible care for people, with no unnecessary delays or waits and with expanded services in the community to prevent avoidable admissions.”
The plan is regarded as one of the most detailed and comprehensive STPs produced so far and a strong indication of the government’s future plans for a radical transformation of the NHS.
NHS officials told the Guardian that any individual local council that chose not to engage with NHS partners would forgo the opportunity to join up social care and health services more effectively, but that would be their choice.
The risks highlighted in the plan include a failure to shift enough acute care out of hospitals, a possible collapse of the private care-home market and a failure to get people to take responsibility for their own health.
Council officials claim that pressure was exerted on them to sign off an executive summary of the draft plans quickly without seeing the full document. NHS officials have denied this.
The north-west London STP states that the demand for healthcare is projected to rise with an expected 53% increase in cancer cases by 2030 as well as an increase in conditions of old age such as dementia, yet the significant reduction in hospitals and acute beds is deemed the best way forward.
NHS England believes the STP process will bring many wider benefits including more joined-up care and that there is evidence to show care closer to home has advantages.
The pace of the planned changes is alarming critics. The north-west London plan states that changes need to be delivered “at scale and pace” in order to have a financially sustainable system by 2020.
John Lister, secretary of Keep the NHS Public, said: “The draft plan for north-west London really is a shocker. The assumptions they are making in this document are just enormous. No services anywhere will be safe with these plans. NHS managers are quite desperate when faced with massive and growing deficits, and are resorting to untested plans which will target the most vulnerable and the least mobile people.”
Diane Taylor - The Guardian