Events

Charing Cross Hospital open door event

Hospitals are part of the fabric of the community and touch people’s lives in many ways – as a staff member, volunteer, patient or visitor. In November 2017, we organised an open door event at Charing Cross Hospital – to mark and celebrate the hospital’s past, to share and clarify current plans and to look to the future.

Our presentation

Following small group tours of Charing Cross, the main event began with a presentation by our then chief executive Ian Dalton CBE, our then medical director and now interim chief executive Professor Julian Redhead and director of nursing Professor Janice Sigsworth.

The full presentation is here. Key points included:

Proposals and decisions about Charing Cross Hospital

In 2012, the local healthcare commissioners for north west London (then called primary care trusts) published the Shaping a healthier future service strategy. They undertook a full public consultation on plans for a more integrated approach to care, with the consolidation of specialist services onto fewer sites, where this would improve quality and efficiency, and the expansion of care for routine and on-going conditions, especially in the community, to improve access.

Charing Cross was envisaged as a ‘local hospital’ within this network of services, building on its role as a growing hub for integrated care offered in partnership with local GPs and community providers.

After developing the proposals further with feedback from the consultation, the local commissioners put forward their service change strategy for approval to the Secretary of State for Health. In October 2013, on the recommendation of the Independent Reconfiguration Panel, the Secretary of State supported the proposals in full, though adding that Charing Cross Hospital should continue to offer an A&E service, even if it was a different shape or size to that currently offered. He also made clear that there would need to be further engagement to develop detailed proposals.

The Trust published its own clinical strategy and estates plans in 2014 that included outline proposals for Charing Cross to become a ‘local hospital’.

Since then, the Trust and local commissioners (now called clinical commissioning groups or CCGs) have put a hold on subsequent work to engage patients and the public in the development of detailed plans for Charing Cross due to increasing demand for acute hospital services. This continuing rise has meant we need to focus first on the development of new models of care to help people stay healthy and avoid unnecessary and lengthy inpatient admissions.

A commitment to NOT progress plans to reduce acute capacity at Charing Cross unless and until we could achieve a reduction in acute demand was formalised in the North West London Sustainability and Transformation Plan (STP) published in 2016. STPs are five-year plans for the development of health and care services across geographic areas produced by a range of NHS, local authority and third sector organisations.

The STP for north west London added that Charing Cross will continue to provide its current A&E and wider services for at least the lifetime of the plan, which runs until April 2021.

Given that attendances across all of our A&E departments and urgent care centres have increased by six per cent over the past two years – and urgent admissions by 11 per cent – we can make a firm prediction that it will be some years further into the future before acute demand has reduced sufficiently for us to look to reduce inpatient bed numbers or A&E capacity. And there is an even longer lead time to plan and build the new facilities that will be required.

Looking to the future

As with any of the Trust’s hospitals – or the hospitals of any other trust come to that – we cannot say that there will never be any change at Charing Cross. What we can say is that we will be open about the challenges and opportunities that face us and will use the insight, views and ideas of our staff, patients, partners and wider stakeholders to help develop the best possible plans for the future.

Change happens in different ways. Transformation in healthcare is often driven by research discoveries or new technology and our Trust has been at the forefront of these sort of developments – not least at Charing Cross. We have pioneered the iKnife, enabling surgeons to know instantaneously whether the tissue they are cutting is cancerous, and we will soon be one of the first centres to offer a 24/7 thrombectomy service, a revolutionary treatment for some types of stroke.

We also learn from insights and service improvements that work elsewhere, such as our initiative with partners to test an ‘accountable care’ approach with a small population in Hammersmith and Fulham. This is where we are working in partnership with local GPs and other health and care providers to create genuinely integrated services that help people stay as healthy as possible and to get fast access to care when it is needed.

Other developments emerge from how we adapt to changing needs and demands. At Charing Cross, for example, we have a great story to tell about our growing expertise in providing care for frail, older people. Today, there are half a million more people in England aged over 75 than there were in 2010. And there will be 2 million more in ten years’ time. No one wants to have an unplanned stay in hospital but for this section of our community, it brings real risks – especially around a rapid loss of functional ability and permanently reduced independence. Yet, more than two fifths of emergency admissions at Charing Cross Hospital are now of patients aged 70 or more, many with a number of chronic health conditions.

So, it’s particularly important that frail, older people whose health is deteriorating get to the specialist care they need as quickly as possible, bypassing A&E altogether, if possible. Amongst our more recent service developments here is OPRAC – the older person’s rapid access clinic on the ground floor. It provides fast, direct access to specialist assessment, diagnostics and treatment. The clinic has established great partnerships with community, social and primary care; it has specially trained, multi-disciplinary staff; and its facilities are tailored for older people with frailty. The team now see an average of 12 patients a week, two fifths of whom are able to avoid a hospital stay.

The investments we’re making to Charing Cross Hospital

We’ve recently seen some of our largest ever investments in new facilities and equipment, much of which has been made possible by the support of Imperial Health Charity.

Over the past 18 months, some £6 million has been spent on major new developments including: Riverside theatres; main outpatient clinics; a new acute medical assessment unit; our first patient service centre; and the main new facility for North West London Pathology. In addition, we’re spending almost another £8 million on replacing imaging equipment and installing two state-of-the-art LINAC radiotherapy machines so we can provide the most advanced cancer treatments.

And our maintenance spend at Charing Cross this year is another nearly £6 million, around a third of our total Trust spend on backlog maintenance.

We are currently working up a multi-million pound refurbishment and expansion of the A&E at Charing Cross, to begin early in the new year.

Questions and answers

You can watch the presentation and Q&A session that followed below. 

Q. What happens after 2021 which is when the pause outlined in the sustainability and transformation plan (STP) stops? Is this just a pause to the closure of Charing Cross Hospital?

A. The STP for north west London said that Charing Cross will continue to provide its current A&E and wider services for at least the lifetime of the plan, which runs until April 2021.

Given that attendances across all of our A&E departments and urgent care centres have increased by six per cent over the past two years – and urgent admissions by 11 per cent – we can make a firm prediction that it will be some years further into the future before acute demand has reduced sufficiently for us to look to reduce inpatient bed numbers or A&E capacity. And there is an even longer lead time to plan and build the new facilities that will be required.

Q. Will you sell some of the land on the Charing Cross Hospital site to fund the redevelopment of the St Mary’s Hospital site?

A. There are no current plans to sell any land on the Charing Cross Hospital site. If and when we develop proposals for a new hospital building on the Charing Cross site, we would anticipate that the costs would need to be partially funded by selling any land that was surplus to requirements. This is the same approach that we would expect to take at any of our hospitals. There is no plan and has never been a plan to fund the redevelopment of St Mary’s Hospital through the sale of land on the Charing Cross site.

Over the past 18 months, some £6 million has been spent on major new developments including: Riverside theatres; main outpatient clinics; a new acute medical assessment unit; our first patient service centre; and the main new facility for North West London Pathology. In addition, we’re spending almost another £8 million on replacing imaging equipment and installing two state-of-the-art LINAC radiotherapy machines so we can provide the most advanced cancer treatments.

And our maintenance spend at Charing Cross this year is another nearly £6 million, around a third of our total Trust spend on backlog maintenance.

Q. Strategic outline case 1 for Shaping a healthier future has not been approved by NHS Improvement. What does this mean for the programme overall?

A. Strategic outline case (SOC) 1 is the commissioners’ funding proposal for the changes set out in Shaping a healthier future relating to outer north west London. It does not relate to changes at any of our hospitals.

Funding to support changes relating to our hospitals will be part of a strategic outline case (SOC) 2. The development of SOC2 will require a significant amount of work – including widespread engagement with all of our stakeholders. We do not yet have a clear timeline for this process.

Q. Is the continued uncertainty over Charing Cross causing a collapse in morale and escalating problems with recruitment and retention?

A. There has been no decline at Charing Cross, despite any uncertainty about its future. One way this is evidenced is in the very significant investment, particularly in the last 18 month or so, in our buildings and infrastructure. In fact, the most recent CQC inspection of Charing Cross, focusing on medical care, saw the hospital’s rating progress from ‘requires improvement’ to ‘good’.

The Trust has lower vacancy rates than the average for acute teaching trusts in London and, for overall vacancy rates, Charing Cross is not a particular outlier in terms of our five hospitals. Staff engagement scores across our hospitals are improving, including at Charing Cross.

However, there are pockets of higher vacancy rates across our hospitals, including at Charing Cross. This is particularly the case for band 2-6 nurses and midwives in acute medicine. We hope that the innovative work of our acute medical team to improve the patient pathway, particularly at Charing Cross, will help attract more staff.

We are working very hard to reduce both vacancy and turnover rates across all of services and our hospitals and we are pleased to say we have increased our total headcount of nurses and midwives by 5 per cent this year alone.