As I write, it will have been more than a whole year since the target time for Accident and Emergency was met across the country. Record numbers of people are visiting A+E units, emergency waiting times are higher and ambulance response times longer. It is clear the £3 billion re-organisation of the NHS has not changed the NHS for the better, but wasted scarce resources, accelerated privatisation and left London in particular lacking the strategic management we desperately need.
It seems a strange time for a programme of Accident and Emergency closures to be taking place across London- in the midst of an A+E crisis. Yet that is exactly what is happening. Hammersmith and Central Middlesex A+Es will close in September, and now the plans for the down-grading of Charing X A+E have been confirmed. Demand will now shift to St Mary's, which has been making plans to deal with the additional patients from elsewhere in West London.
Over the longer term, as Charing X emergency services are also down-graded, St Mary's will re-build, aided by the sell-off of almost half the land the hospital currently occupies (as well as more than half the land now used by Charing X hospital, and the Western Eye and Samaritan hospitals).
There had been concerns about what this will all mean to Westminster residents, as trade-offs will have to be made to allow for the fact that St Mary's become a ‘major hospital' for the whole of West London. There have already been some service reductions in routine areas at St Mary's relating to particular specialties so Westminster patients are being treated at other sites, like Charing X- and there will be more in future- particularly in respect of day case specialist medicine and day case surgery. What is essential is that support services, including transport, are available for people who find it difficult to travel further afield- this is something I have been pushing on for the last year!
Similarly, the expectation is that a smaller number of Accident and Emergency units should also be reducing the number of patients admitted through A+E- which itself depends upon a significant raising of capacity in GP and other community services. This, though, comes at a time when there are real concerns about the strain upon the GP service. Exactly when council, primary and community services should be expanding to take the pressure off hospitals, keeping people out where possible, and enabling patients to return to their homes swiftly after treatment, they are the areas where the squeeze is on.
It is now crunch time for the NHS locally, and my fears are not that the direction of travel is wrong, but that change is taking place in the wrong order- with hospital closures happening before the alternatives are in place. Services are too fragmented and everyone's eye has been off the ball due to the massive, costly re-structuring imposed in the last three years. We need to scrap this NHS Act and get focused on what really matters, for the sake of all of us who rely on the NHS.