Essential insight into England’s biggest health economy, by Ben Clover

So long, SaHF

It’s probably a sign there’s an election coming when a long-running reconfiguration process gets the rug pulled on it during Commons health questions.

Launched seven years ago, Shaping a Healthier Future was an ambitious attempt to reorganise health services in north west London.

A senior figure in London once told London Eye “you can’t throw a stick in north west London without hitting an A&E”. Downgrading a swathe of them certainly wasn’t the only part of the plan, but it was by far the most eye-catching.

And it was the two most consequential bits of this programme that Hancock nixed last Tuesday – Ealing and Charing Cross hospitals’ emergency departments will now not be downgraded, he said. This will be a big relief to sitting MPs in that part of the world.

The logic of the geography of the patch had marked those units out for un-type one-ing (ie: losing their status as full A&Es).

Northwick Park and Hillingdon hospitals’ units at the edge of the patch would have made no sense to close. West Middlesex University Hospital’s unit is part of its PFI rebuild – a large stranded cost if you shut it. Chelsea & Westminster is also recently refurbished. St Mary’s is the trauma centre, so not going anywhere.

Central Middlesex’s unit has been downgraded, despite its being a PFI unit, but this process has been in train for a long time. Eventually there was a grudging acceptance that there wasn’t going to be a proper A&E there anymore, just an urgent care centre. The argument was that locals used the unit as a glorified GP surgery anyway, and wouldn’t notice. Why did they use it as a glorified GP surgery? Perhaps because primary care quality and access in Brent is historically poor.

Hammersmith Hospital’s A&E wasn’t a full A&E anyway but was, technically, downgraded in 2013 – the managers at the time must have wanted to seem like they’d got a win so tended to include it in the list of downgrades.

This just leaves Ealing and Charing Cross.

Charing Cross has the worst backlog maintenance issues of all the sites in the multisite Imperial College Healthcare Trust, which in turn has the worst backlog maintenance issues in the NHS. It would have made a lot of sense to rebuild this hospital, perhaps with different services in it.

The case for downgrading Ealing Hospital into a kind of “health campus” was never as clear (and note: If someone ever starts talking about your nearest A&E becoming part of a “health campus”, beware). The mutterings were that Ealing was subscale, but that was only really true because the threshold for being too small kept getting lower.

Health managers who have worked in north west London over several decades told me they agreed it was overbedded, and said the leadership in the patch deserved credit for attempting to address this.

Alone of the London sustainability and transformation partnerships, NWL had actually stated an ambition to reduce bed base by 500. But, perhaps unsurprisingly, it wasn’t popular and has now been very much rowed-back on.

There have been significant changes to the maternity, paediatric and community services. There has been expensive McKinsey-led integration work in inner north west London. This seems to have led to a reduction in admissions but, maddeningly, no corresponding fall in hospital bed days.

Perhaps the “let’s centralise, reduce beds, move care into the community” era has receded? Demand continues to grow.

The truth behind these conflicting explanations is very foggy.

Perhaps the overhospitalisation of patients in inner north west London was merely a function of the area’s overcapitation?

If so, then, as some of this money is now being redistributed in commissioning budgets, a real challenge for the rest of the capital will be to stop it being soaked up by hospital beds.