NWL Consultation questionnaire response to Shaping a healthier future

Ealing Hospital SOS has produced this response guide to help people understand that the consultation does not cover all options and is designed to get support for the NWL preference to close 4 A&E departments and restrict the availability to their preferred hospitals. Q1 Improving hospitals would be as good a change as closing them. The case is not well made: for example, elderly people nowadays are much fitter than in the past and not necessarily a drain on the NHS it just means there are more people, a case for more hospitals, not fewer. Tend to disagree Q2 Is up to you to describe; our view is: Improving hospitals would be as good a change as closing them, if not better. Q3 This asks you to rank lots of desirable things from absolutely vital to not very important but all the questions except the last lead to your agreement to doing things for yourself or trusting in community services that do not yet exist. Dont know is the safest answer, if enough people give it. Q 4a You have to believe that all these promises will happen; they do not yet exist. At the moment they are just delivering a vision. It has to be Dont know until you can see the new buildings completed and all the community staff employed. Q4b Be careful! Apart from asking at Q7 why these things are not happening already, you must be aware that these answers are all about reducing the number of hospitals, rather than improving across the board (see sub-heading on p26.) So support is not just support for good hospitals, its for fewer of them a trick question. Dont know is a safe answer, as they know that no-one would be daft enough to disagree with excellent hospitals whatever that might mean, and anyone saying yes is saying please close 4 A&Es. Q5 Health Centres are at near capacity, NWL themselves say that access to GPs is difficult (see p15) and the Council is cash-strapped so cant guarantee extra social care these community services dont yet exist. Will they be World Class? Strongly disagree is the only safe answer, otherwise you are saying: Yes, please shut my hospital and send a health carer around when you have employed one. Q6 This is a sneaky way of asking Shall we shut some hospital services down? They have produced no evidence for better care on fewer sites why not have just one huge hospital in London or Leicestershire? Strongly oppose. Q7 Please explain to them whether you are convinced by their promises or not and ask who will be accountable if they fail to deliver the alternatives. (It wont be them, it will be groups of GPs under the arrangements for April 2013 onwards.) Ask them, for example, what the rapid response helpline number is and who is running it it is at the moment a vision only. Q8 This is the crunch they are asking you to agree to a 2-tier hospital scheme with Major hospitals and minor ones, that they call Local. These are hospitals from which they will have taken away A&E; and then they will remove Maternity (not always included anyway), Intensive Care, childrens care and any other emergency treatment you would expect. See St Marys in Sidcup or Queen Marys in Roehampton all skeleton hospitals

start with the removal of A&E. A local hospital is a polyclinic and should not be called a hospital. Strongly oppose will help to save hospitals. Q9 Please comment at length, if you wish. You might wish to make the point that NW London will not be there to ensure that the vision is successfully in place and are putting the future health and well being of patients into doubt. Q10 No-one has seen what a GP Network looks like or how good it will be; its not yet been tried, but this Plan depends on 37 or 38 of them being invented. There is no reference in this document to computerised information-sharing among GPs and, given the 12 billion disaster that was the NHS national computer system (now cancelled) do you trust NHS NWL to come up with the technology? Strongly oppose has to be the answer, because you cant say yes just to a dream. Q11 Ask where is the 120 million? At the moment its just a plan for a budget, taken from savings. Where will the 130 beds 'in the community' be? Health Centres are already at near capacity, you can't get a GP appointment easily, so where is all this 'community service'? Who will have access to your medical records? Q12 The second trick question, like 4b. OK, if you agree that they provide safe care. An Urgent Care Centre is a downgraded A&E, with exclusions on what they will treat. Where they are currently provided, they are mostly by the private sector with GPs drafted in. You wont need UCCs if you had A&Es at all hospitals. The question suggests that UCCs are in all hospitals (should continue to be provided) but they are not all apart from one have proper A&Es, 24/7. Say no to UCCs the poor persons A&E. Strongly disagree. Q13 This is virtually the same as Q12, only it is do you think UCCs are great? Why shouldnt every hospital have a proper A&E? They cost only 2.65% of total NHS spending in London. Strongly disagree. Q14 Comment as you wish. You might wish to say that your preference is to have A&Es in all the hospitals that currently have them. Q15 The third trick question: you only get an elective hospital in these plans when you downgrade an existing one thats the only way they will find spare space. On p16 they say NHS buildings in NW London are generally not in a good condition they cant have it both ways. They are, in any case, stuck with places like West Mid with its massive PFI debt, so they might as well do something with it if they close its A&E (which they cant!) Strongly oppose. Q16 This elective stuff is an admission: they can sack people and close wards, but they are stuck with the buildings. The NHS already runs elective and emergency services under one roof; are they suggesting that their proposed changes mean a deterioration in service, making this impossible? Ask why they think the local NHS will be incapable of running elective and emergency services under one roof in the changes they plan. It is a management problem only. Q17 This is important: it means how happy are you for us to downgrade 4 of the existing 9? These wont be 5 new, bigger and better hospitals, they will be the same ones with more emergency cases each. Strongly oppose is not strong enough. Q18 You might agree that this is a good idea, but its a trick you are at the same time agreeing to the (5) Major hospitals idea. Ask for a paediatric unit in every hospital, but they wont let you have that. Not sure is your only option.

Q19 Basically the same as 18 you are buying in to the 5 Major hospital scheme. Its an absurd question anyway under this consultation you dont get the choice about Hammersmith as in all 3 options it will be a specialist hospital, so why ask? There is no logical answer to this. Not sure is your only option. Q20 Feel free to comment. An answer to their sub-question about the number of hospitals could be 9 major hospitals as now, because they are not there by coincidence they are located where people need them. Q21 Like 18 and 19, they think youre happy with just 5 proper hospitals; now they are asking whether you agree with how they got here. Like a cheap airline landing you 200 miles from where you want to be and asking if you enjoyed the flight. Up to now they have tried to lead you by the nose: Strongly disagree is clear. Q22 Another trick its not about criteria for any good hospital, but about how you choose 5 and downgrade the other 4. You can play noughts and crosses with this if you like; but Dont know deprives them of agreement to their plan. Q23 Beware! They are asking if there are any other reasons you can think of to support their 5-proper-hospital plan. Comment as you see fit. For example, public opinion on closures should be in there. Q24a to 26b These are devious. They assume you actually want at least one of these Options, including the preferred one. Each one means closing 4 A&Es. People in each area will vote for what scraps are left by NWL. Not sure/dont know is the only safe answer they leave you. Q27a&b If you want to say goodbye to Central Mid, nows your chance. It is probably honourable to say Strongly oppose. Q28a to 29b This is to reinforce their plan for just 5 hospitals; they want your vote. Not sure is your only option. Q30a&b Depends whether you want Maternity without A&E. As it should have an A&E, Strongly oppose. Q31 Try keeping what we already have, and have invested in for 65 years.

Q32 Two years ago they persuaded us it was a good idea to put it there; now they are asking whether they should move it. Will they ever make their minds up? Strongly disagree. Q33 They have made no evidence-based case for moving it other than Imperial 'would like to move these services.' Looks like an afterthought. Strongly disagree Q34 Feel free to comment. Youve read 80 pages; nows your chance! Try to keep all hospitals, and especially A&E, open.