STRUCTURE: The health secretary has rubber stamped plans to downgrade Chase Farm Hospital’s emergency department and take forward a possible merger with North Middlesex University Hospital Trust.
A Department of Health statement said Andrew Lansley had “accepted” the findings of an assessment by the Independent Reconfiguration Panel into the future of Barnet and Chase Farm Hospitals NHS Trust in north London.
Under the plans, accident and emergency, and maternity services for the Enfield area will be centralised at Barnet Hospital and North Middlesex Hospital – with Chase Farm losing its maternity unit and having its A&E downgraded to an urgent care centre.
In addition, NHS London will be asked to “to assess the feasibility” of Chase Farm Hospital joining North Middlesex University Hospital NHS Trust, “with a view to ensuring this happens if the assessment of the merits of doing so supports this”.
The move marks the latest step in the protracted decision making process over the future of the trust, which has been the subject of a series of delays driven by local and national politics, and is being seen as a test case for other sensitive reconfiguration plans.
In 2010, Mr Lansley asked that plans, accepted by the previous government in 2008, for service changes at Barnet and Chase Farm Hospitals be assessed against his four key tests for reconfiguration, including a clinical evidence base underpinning the proposals, support from local GPs, and “genuine” public engagement.
Enfield Council was also offered an opportunity to develop alternative proposals for the future shape of local health services.
In its assessment, the IRP concluded that “the status quo has real downside risk in terms of the current safety and sustainability of local services” and that, when measured against the four tests, the process which led to the development of the reconfiguration plans “appears to have been robust and the consideration of the evidence compiled thorough and well-balanced”.
It also ruled against the alternative proposals submitted by Enfield Council, which it said “does not…provide any credible alternative to the current proposals or address the increasing and real concerns about the safety and sustainability of current services that underpin the clinical case for change”.
Lastly, the IRP noted the negative impact on North Middlesex Hospital should Chase Farm continue to take A&E patients.
It said: “Serious concerns have been raised about the implications of not completing the implementation of the strategy for services at the North Middlesex Hospital following its refurbishment under a PFI scheme.”
The DH statement said: “Services at Chase Farm will change, but the hospital will remain open.”
Mr Lansley said: “I know how strongly many local people and their representatives feel about this, and about the future of Chase Farm in particular. However, the safety and sustainability of local NHS services have to be the priority for all involved, and, as the IRP advice makes plain, both are at significant risk unless decisions are taken.
“This is not about money. We are not making cuts to local services. In fact, tens of millions of pounds have been spent on local hospitals to support these changes. We must be prepared to take a hard decision in the interests of putting patients, safety and local services first.”
But he added: “The IRP’s report does not prevent the local NHS and GPs via the clinical commissioning group from determining how they want to commission urgent and emergency care services for their local community in future.
“The NHS needs to learn from what has happened in Barnet, Enfield and Haringey, and to ensure that, as far as possible, plans for change are evidence-based, supported by local GPs, have involved engagement with the local community, and promote real choice for patients.”
NHS Confederation chief executive Mike Farrar backed the “absolutely right”, but “difficult”, decision made by the health secretary.
He said: “Chase Farm has been a major test case for the whole NHS. It was critical that we got to the right place, both for the local community affected and to send out a signal that the government is prepared to back serious change wherever the case has been clearly made.
“There are a number of places where we need to make similar decisions for service changes of varying sizes up and down the country. In some cases, this will involve taking out posts and beds where it is in the interests of patients. The NHS needs to do more to explain to people why that is the case.”
He added: “Where the case is made, it is vital that there is political support of the kind we have seen today so we can get these changes made as quickly as possible. This is essential to avoid serious financial or quality failing, which are major risks to patient care.”
King’s Fund chief executive Chris Ham said: “Today’s announcement signals a welcome willingness from ministers to embrace the need for change.
“With some hospitals struggling to provide safe services and growing evidence that many specialist services are best located in fewer facilities that can provide world class care around the clock, this is the first of many difficult decisions that will need to be taken about the provision of hospital services in different parts of the country.”
North Middlesex University Hospital chair David Hooper said: “At last, now the work begins, and we can work towards giving the people of Enfield and Haringey a first class health service rather than the second rate version that some seem to prefer.”
But Doug Taylor, leader of Enfield Council, accused the health secretary of not listening to the residents of Enfield and said the council would continue to “lobby tirelessly” for the services to be retained at Chase Farm.
He said: “Closing the A&E and maternity departments at Chase Farm Hospital is a slap in the face for local people who overwhelmingly support retaining these services. Enfield Council believes these services meet a genuine need in Enfield and their closure would have devastating effect on healthcare in our borough.”
He added: “Enfield’s population is predicted to increase by 40,000 over the next 20 years and birth rates are predicted to increase by 8.3 per cent in coming years, so there is a desperate need for the Chase Farm Maternity and A&E units to be retained to meet future need,” he said.
“I would urge the government to reconsider this decision and listen to what the people of Enfield have said, namely that they value their local hospital and believe it provides vitally important healthcare to those most in need.”
12 September 2011