The SaHF programme in our view was a preconceived solution that was imposed on the North West London health system without there being any clear problem that it was designed to solve.The following recommendations are made:
In particular there was no proper assessment of the needs of the whole area to which the health and social care system would respond.
1. We recommend that the SaHF programme is abolished / suspended, thereby saving a considerable sum at one fell swoop.
2. We recommend that an independent review of the North West London health system is undertaken under the auspices of a joint health and local authority initiative that builds its case on a thorough assessment of the needs for health and social care of local populations, at local levels.
3. There must be no presumption that so-called ‘reconfiguration’ of acute services is the solution to what may not be a problem at all.
4. In addition there must be no presumption that the solution will involve a top-down approach across the whole area as SaHF assumed; there should be an openness to consideration of local solutions possibly at the borough level where these can be shown to work.
5. The NHS and local authorities must agree to work together to achieve a joint aim to provide good accessible health and social care to all local populations within a sustainable financial model.
6. We recommend that the attempt to close Ealing and Charing Cross hospitals is immediately stopped; that a guarantee is given to sustain acute health services on these sites – with no more double talk from NHS leaders – until the above review is complete and any associated business cases are taken through to Full Business Case level, which is likely to be at least five years.
7. We recommend that in the light of current failures in the system in North West London there is an independent review of the emergency system under the auspices of the above joint health and local authority initiative; and that this as a matter of urgency examines the closure of Hammersmith and Central Middlesex A&E departments with a view to opening these, if that is what the review suggests is needed, and what local people want. Local people must be given honest and genuine choices; the opportunity cost of retaining these sites as A&Es must be made apparent.
8. We recommend that there is a review of primary care services in the region, and that following this review, immediate steps are taken to rectify any issues. However any investment must be based on a clear business case that relates costs and benefits to changes across the whole system.
9. Likewise we recommend that there is a review of OOH services in the region, to establish a clear case if it exists for OOH acting as a way of reducing demand for acute services, and also as a way of reducing total system costs. Following this review, any investment in OOH services must be based on a clear business case that relates costs and benefits to changes across the whole system.
10. In the case of changes that take place in primary care and OOH services as a result of the reviews outlined above, there must be a clear business case presented that makes a clear case for system- wide improvement arising out of these changes, and this should be consulted on with the relevant local populations; there should be no assumption that this is the population of the whole of North West London.
The full report can be read here:
The commission's final public session will be held at the Brent Civic Centre on Saturday 9 May 9am-5pm. Brent Trades Council and Brent Fightback are among those who have submitted evidence. It would be good to have as many health campaigners as possible at this session. More evidence will be heard