Download - NHS Hammersmith and Fulham Clinical Commissioning

NWL wide contingency plan to maintain
services levels during and post A&E
closure
Karl MunslowOng
Paper x.x
SaHF Implementation Programme Board
3 July 2014
To support the safe transition of A&E services from HH
and CMH a regional contingency plan is being developed
Joint closure of Hammersmith Hospital (HH) Emergency Unit and Central Middlesex Hospital (CMH) Accident
& Emergency (A&E) is planned for 10 September, subject to satisfying assurance requirements from NHS
England /TDA and the Hammersmith & Fulham and Brent Clinical Commissioning Groups (CCG).
A key component of the assurance process will be assurances the system has adequate measures to ensure
safety is maintained during and after transition. The Programme‟s Clinical Board has considered mechanisms
to support safety during transition and concluded that a NW London wide contingency plan be developed to
manage A&E and associated „downstream‟ capacity during transition.
The requirement for the contingency plan was driven by:
• The wide catchment areas of both Central Middlesex Hospital and Hammersmith Hospital A&E activity
• The spikes in activity that were seen at Barnet and Chase Farm post A&E closure
• The need to ensure there is system wide support for Northwick Park Hospital and St Mary‟s Hospital
given most of the A&E activity will move to these sites post closure of HH and CMH
The Clinical Board also recommended that the contingency plan look at:
• How emergency GP referrals could be managed post closure
• How GP elective referrals could be managed post closure
The contingency plan that is being developed is aligned with local plans and is being overseen by the NW
London System Operational Group consisting of CCGs, Providers, London Ambulance Service (LAS) and
Shaping a healthier future (SaHF) programme.
This paper provides an update on the process to develop a system wide contingency plan and the
NWL System Operational Group.
2
We have a clear plan for the development of the NW
London system wide contingency plan
The NWL System Operational Group consisting of CCGs, Providers, LAS and SaHF Programme will
provide oversight and coordination of the NWL response to the closures. In particular review performance
across NWL and make decisions about further short terms solutions.
The plan is being progressed in alignment with local plans, at a sector level the strands of the plan that are
being progressed are:
June
Mobilise
project, team
and
governance
Undertake
capacity and
activity
modelling
July
August
September
October
Winter 2014
Develop model to
test resilience of
emergency care
departments
Review of LAS Intelligent
Conveyancing including how
we improve use of UCCs
Review of system capacity variables - workforce
and beds (both acute and intermediate care)
Confirming which
winter schemes could
be started early (or
continued)
Enact early or continue winter schemes
Divert GP referral patterns through working with
GPs to manage referrals for Urgent/Emergency
Service transition
3
Activity modelling to
support contingency
planning
LSOA level analysis showed that the current activity at
CMH and HH has a wide footprint across NW London
Note:
This is based
on where a
patient lives
NOT where
the patient
journey
started.
It is therefore imperative to view which sites can expect to receive activity from
closures at CMH and HH
Activity density maps were built from CSU data breaking down UCC attendances, A&E
attendances and NEL admissions , at CMH and HH, by LSOA from 12/13.
5
We analysed LSOA level activity data set to determine the
impact closures might have on other sites
1• By reviewing HSTAT Travel time data, we identified the LSOAs which were closest by journey time to the
remaining 7 A & Es in NW London
2• We compared this against the actual activity from 12/13, reallocating activity from each LSOA to the
nearest of the remaining 7 A & Es in NW London
3•
Finally we have reduced these totals to take account of the activity that will be retained at both Central
Middlesex and Hammersmith Hospital
ADDITIONAL A&E
Attendances / day
Retained at CMH
0
0
0
0
Retained at HH
0
0
9
9
Northwick
Park
From HH
From CMH
30
From HH
19
18
16
6
24
From CMH
5
From HH
8
Ealing
8
2
2
10
From CMH
Charing
Cross
2
7
36
St Mary’s
By reviewing the closest
hospital by journey times –
we have effectively
established a catchment area
ADDITIONAL NEL
Admissions / day
From HH
11
11
From CMH
3
1
2
3
0
0
From HH
3
1
From CMH
0
From HH
1
WMUH
3
Hillingdon
1
0
0
1
From CMH
0
From HH
1
C&W
0
0
0
1
From CMH
0
3
0
0
6
We also undertook a travel survey of patients attending
both CMH and HH
• Patient travel survey data was collected to support the Travel Advisory Group. This work surveyed a
number of patients attending both Central Middlesex and Hammersmith sites.
• For any respondents using the A&E or UCC department the question was asked “What would be the next
alternative location for care after the hospital they are currently attending”
• The tables below presents how people responded:
Central Middlesex Hospital
Hammersmith Hospital
Alternative
Locations
Respondents
%
Alternative
Locations
Respondents
%
Notes:
Walk in centre or GP
89
42
Walk in centre or GP
94
57
Northwick Park
41
20
Charing Cross
24
15
St Mary‟s
29
14
St Mary‟s
9
5
Other
18
9
C&W
8
5
• Questions did not consider
hospital sites outside of NW
London (e.g. The Royal Free this could account for the 9%
other at CMH)
Hammersmith
13
6
Central Middlesex
7
4
Ealing
7
3
Ealing
6
4
Charing Cross
3
1
Other
5
3
C&W
1
0
Northwick Park
4
2
Hillingdon
1
0
Hillingdon
2
1
WMUH
1
0
WMUH
2
1
• Questions did not consider that
both CMH and HH would be
closed
• This was a small sample size for
both sites
7
We would ask the Programme Board to note progress
made to date
•
This paper provides an update of the work done to date on the contingency
planning and the process to implement the plan
•
The Implementation Programme Board is asked to note progress and provide
comments on:
•
The role of the NWL System Operational Group
•
The strands of the plan that are being progressed at sector level
8

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