Exclusive: STP to press on with controversial London hospital changes

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Late draft of North West London STP backs pressing on with reduction in acute sites
Submission details £623m backlog in maintenance costs
Proportion of spend on mental health will remain the same

A late draft of North West London’s sustainability and transformation plan, seen by HSJ, says the patch will press on with moves to reduce the number of sites providing acute services.

The plan, dated 12 October, said that it will aim to “consolidate acute services on to five sites”.

Reducing the number of acute sites in North West London from nine to five was first proposed in the area’s 2012 Shaping a Healthier Future plan.

A spokeswoman for the STP said its last official STP submission to NHS England, on 21 October, included changes since the 12 October draft. She said this would be published “as soon as possible once they [NHS England] have had the chance to consider it”.

The Shaping a Healthier Future plan – which has been a subject of long-running controversy in the area – said Central Middlesex Hospitals, Hammersmith Hospital, Ealing Hospital and Charing Cross Hospital would become urgent care centres without 24/7 accident and emergency departments. Chelsea and Westminster Hospital, Hillingdon Hospital, Northwick Park Hospital, St Mary’s Hospital and West Middlesex Hospitals would retain full A&Es.

So far, Central Middlesex, Hammersmith hospitals have been downgraded to urgent care centres. Ealing Hospital has not, although maternity and paediatric inpatient services have been removed.

Despite backing proposed acute changes the North West London STP draft, leaked to HSJ, states: “There will be no substantial changes to A&E in Ealing or Hammersmith & Fulham, until such time as any reduced acute capacity has been adequately replaced by out of hospital provision to enable patient demand to be met.”

The STP draft says it intends for Ealing and Charing Cross hospitals to specialise in the management of the frail elderly with frailty units piloted at both sites, before full roll out.

The draft submission also outlines plans to consolidate of back office functions including; finance, HR and payroll, IM&T, procurement, estates and facilities, governance and risk and legal services. According to the document a business case was due to be submitted to NHS Improvement in October.

Financial modelling for social care within the STP references an assumption of the patch having a fully pooled health and social care budget by 2020-21.

References to social care finances state: “The residual gap of £19.5m [in social care] by 2020-21 is assumed to be addressed through the recurrent £148m sustainability funding for NW London on the basis that health and social care budgets will be fully pooled and jointly commissioned by then.”

The STP also includes an assumption that the proportion of spending on mental health will remain the same, but says there will be a shift from acute to community care.

In relation to estates’ costs the STP outlines a total backlog maintenance cost of £623m across all of its acute sites and says that without the ability to retain receipts from the sale of land it “will not be able to address the estates challenges”. NHS England has indicated to HSJ that it wants areas to be able to keep receipts, though it is unclear how this will be achieved.

A spokeswoman for the NW London STP said: “This version of the STP is an earlier draft, which builds on the one we published in June. We submitted our latest version to NHS England near the end of last month. We will make this available as soon as possible once they have had the chance to consider it.”