27. North West London

In October 2018, the chief executives of NHS England and NHS Improvement wrote to all STP leaders instructing them to come up with new five year plans by autumn 2019. The new five-year plans will replace those which were drawn-up in 2016 based on the previous five-year funding settlement to 2020-21. The new five year STP will be developed based on a new NHS England budget.

The letter notes that “It will be extremely important that you develop your plans with the proper engagement of all parts of your local systems and that they provide robust and credible solutions for the challenges you will face in caring for your local populations over the next five years.”

NOTE: The information on this page relates to the original STP drawn up in 2016, however much of the information is still relevant and could be part of the new STP.

Original STP Document

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What concerns have been raised about your STP?

Health planners are trying to reduce NHS deficits and think about ways to re-organise care. However getting the large deficit under control could prevent facilities being developed that can cope with the health and care social needs of local people.

Proposed changes

Closure of the majority of Charing Cross hospital, leaving only 13% of the hospital remaining. Ten major services will be axed, including: 24/7 A&E, emergency surgery, intensive care and a range of complex emergency and non-emergency medical and surgical treatments. This would place further strain on Northwick Park and St Mark’s Hospitals.

The closure of these hospitals acute sections would see 500 - 600 hospital bed losses.

Closure of Ealing Hospital A&E and the possible complete closure of the hospital's acute service (i.e. emergency care).

Following the closure of several North West London A&E departments, local hospitals have reported a considerable drop in performance standards. Only 60% of people were seen within the four hour A&E target waiting time. (Standards dictate that 95% of patients should be seen within this time limit)

The Centre for Health and the Public Interest has found that poor residents were much more likely to be affected by A&E downgrades or closure.

In official documents leaked to the HSJ and reported by the Independent, as a high over-spending area North West London may be asked to implement additional cost-cutting measures, including:

Longer waiting times for elective care;
Closure of wards and theatres;
Staffing cuts;
Ending funding for some treatments and prescriptions;
Delaying or avoiding funding newly approved treatments.

For more information, see below.

What are the aims of the STP?

To eliminate a projected 2020/21 deficit of £1.41 billion;
A shift of patient care from the acute setting to community setting;
Increased integration of health care;
To encourage healthy lifestyles;
To reduce health inequalities and unequal outcomes for the top three killers: cancer, heart diseases and respiratory illness;
To reduce unfair variation in the management of long-term conditions – diabetes, cardiovascular disease and respiratory disease;
Overall, the STP aims to move care from an acute setting into the community.

Like other areas this STP aims to transfer services out of hospital and into the community. The concern is that cuts in hospital care will be made, helping to achieve savings, but without proper investment in community health services.

What’s happening in hospitals?

The plan is for many of Charing Cross hospital's services to be moved into community services, although how this would work in practice remains unclear. The remaining services would be a series of outpatient and GP clinics, X-ray and CT scans, a pharmacy and an urgent care centre for “minor injuries and illnesses”.

The campaign group Save Our Hospitals has seen a North West London Delivery Plan for the STP, which it says contains the following:

The loss of 3,658 NHS jobs in north west London in 2017/18, rising to 7,753 job losses by 2020/21.
Almost 50,000 planned admissions and 222,370 outpatient appointments cut by 2020/21.
The loss of 500 to 600 hospital beds with the closure of Charing Cross and Ealing as major acute hospitals.
A reduction in A&E attendances by 64,175 in the next five years.

Campaigners also claim the plans, which will save £1.4 billion from local health and social care services up to 2021, could leave the councils struggling to cope with the cost of paying for social care.

The 'Can we afford to close any more A&E departments?' report said: “North West London is further down the STP pathway than any other region in England and there are important lessons to learn.

“One is that in these high-density city areas the closures aggravate already existing health inequalities. Another is that the overall quality of emergency care, which is already deteriorating nationally, will be pushed to danger point and beyond if further closures such as those planned for North West London are proceeded with.”

What are the extra cost saving initiatives?

In June 2017 the HSJ reported on discussions between NHS Improvement and NHS England on what certain high over-spending CCG areas will be required to do to enable them to spend less money and remain within a budget known as a 'control total' for 2017/18; this is the capped expenditure process (CEP). The 14 CEP target areas include North West London. The measures under discussion include the following:

Limiting the number of operations carried out by non-NHS providers so the funding stays within the NHS. Considerations differ between areas but include both limiting patients’ choice of providers, and reducing work which is outsourced by NHS trusts. In some cases it would require the NHS to find the capacity to carry out more operations;
Systematically drawing out waiting times for planned care, including explicit consideration of breaching NHS constitution standards. Some plan to target delays at specialties/areas where waits are currently lower than average;
Stopping NHS funding for some treatments, including extending limits on IVF, adding to lists of “low value” treatments, and seeking to delay or avoid funding some treatments newly approved by the National Institute of Health and Care Excellence;
Closing wards and theatres and reducing staffing, while seeking to maintain enough emergency care capacity to deal with winter pressures;
Closing or downgrading services, with some considering changes to flagship departments like emergency and maternity - though these would normally take too long to deliver savings this year;
Selling estate and other “property related transactions”;
Stopping prescriptions for some items, as suggested by NHS Clinical Commissioners earlier this year.

The commissioners in the area told the HSJ that they have been told to examine “difficult decisions” and “think the unthinkable”, including modelling changes which are normally avoided as they are too unpleasant, unpopular or controversial.

What new models of care are being developed?

Under NHS England plans all STP areas will develop into Integrated Care Systems (ICS), previously known as Accountable Care Systems (ACS). This is a new model of care that aims to integrate hospital, community and social care and could involve a new type of contract and capitated (i.e., fixed budget) funding. For further details see our pages on New Models of Care and Accountable Care Organisations.

Your STP consultation

27. North West London

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