Review endorses temporary overnight closure of A&E at Central Middlesex Hospital
The temporary overnight closure of A&E services at Central Middlesex Hospital introduced in November 2011 should continue, according to an independent NHS review.
However, patients arriving overnight at Central Middlesex Hospital will continue to be seen in the GP-led urgent care centre, which is open 24 hours a day, seven days a week next to A&E. The centre can treat patients with most minor injuries and illnesses and is supported by an onsite medical team from the hospital.
The Safety review of A&E services to patients at The North West London Hospitals Trust was carried out by a team of independent clinicians on behalf of NHS North West London. The team spoke to a broad range of staff from a number of clinical areas at Central Middlesex and Northwick Park hospitals in November.
The team concluded that: “The Central Middlesex department has become too dependent on locums of variable quality and reliability and … it was better to close the department at night in a planned way and redistribute the patients than to risk a sudden and unplanned failure of the department.”
They agreed that the number of patients who might need to be seen by an A&E department elsewhere, rather than the Urgent Care Centre at Central Middlesex, was small enough not to overload neighbouring hospitals, including Northwick Park.
The report will be formally considered by The North West London Hospitals Trust Board on 26 January, and an executive summary and action plan will be available at the meeting.
NOTES TO EDITORS:
1. The review team was asked to undertake a risk review of:
• A&E staffing levels
• A&E clinical governance processes
• working relationships
• current clinical risk and mitigation
• short and longer-term mitigation of these risks
2. The review team is also recommending:
2a. A&E Staffing
The processes for appointment of consultants and other staff need to be revised. The recent A&E departmental medical staffing business plan which recommended an increase in senior and middle grades should be reviewed with consideration given to increasing the establishment.
2b. Clinical Strategy
There is an urgent need to formulate a regional strategy for hospital services which makes best use of the current sites. Space and staffing inadequacies in A&E and the Urgent Care Centre at Northwick Park will require an investment plan if the Trust is to resolve current issues and then fulfil the role of being the major emergency facility in North West London.
2c. A&E relationships and clinical governance
The Trust should consider giving A&E clinical representation higher status within the Clinical Directorate. Regular meetings should be established and used to improve communication, involvement and ownership of staff at all levels in the decision making processes of the Trust.
Review infrastructure and staffing of the NPH department – the Trust needs a clear strategy for the development of the department.
2d. Patient flows
Institute a system of regular joint review (ward/board rounds) by the floor consultant and nurses in charge of the NPH department.
• Review of patient flows and systems in A&E at Northwick Park
o The Trust is opening 28 winter pressure beds – consideration should be given to making permanent the extra capacity
• Theatre capacity issues need to be addressed:
o Dedicated emergency list issues need resolving
o Anaesthetic cover for dedicated emergency lists and out of hours needs review with, perhaps, more consultants
o There needs to be an increase in theatre capacity at Northwick Park or a significant proportion of work moved to the CMH site (eg, the neck of femur service, elective joint replacement, urology, gynaecology and short-stay emergency surgery, such as hand surgery, plastics and drainage of abscesses to free theatre time, reduce delays and, therefore, free beds)
2e. Urgent Care Centre
The Trust and NHS Harrow should work together on contract details for the UCC at Northwick Park to ensure that the boundaries and co-dependencies of A&E and the UCC are clear. The service specification for the UCC for Northwick Park needs to match as far as possible that provided by Care UK at Central Middlesex.
The decision about the provider for this service needs to be communicated urgently to enable the A&E department to effectively plan its workforce and recruitment.