Cllr Andrew Brown: Proposed merger of Chelsea & Westminster with West Middlesex Hospitals – Good for patients or a huge risk?

andrewbrownA guest post from Cllr Andrew Brown, Conservative spokesman for Health and Adult Social Care

Yesterday evening I attended, with my colleague, Cllr Joe Carlebach, a public meeting arranged by Chelsea & Westminster Hospital Foundation Trust. The purpose was to engage with local residents and councillors. The Chair, executives and governors of the hospital spoke initially about the challenges and also successes of the hospital, including the CQC report, but also the excellent A&E waiting times and world class HIV & sexual health services. The white elephant in the room however was the acquisition of West Middlesex NHS Trust, by Chelsea & Westminster.

There has been a serious lack of local scrutiny of this decision, and to give credit to the hospital’s Chair and executives, they gave a full, and in my opinion, genuine apology about the lack of communication on this issue and in general. It is refreshing to see that from an NHS body. But it is unfair for Chelsea & Westminster (C&W) to take all the responsibility for this lack of scrutiny, a point made by several people at the meeting.

Whilst C&W could have asked to present to our Health, Adult Social Care and Social Inclusion Policy and Accountability Committee – catchy title isn’t it – that is not really how the committee functions. The vast majority of attendees are asked to give evidence by the committee. There have been numerous occasions over the last year when important NHS issues have been discussed, such as A&E waiting times, or Shaping a Healthier Future, where C&W’s presence would have been welcomed and could have provided valuable information and the opportunity to discuss and scrutinise the proposed merger/acquisition.

Cllr Carlebach and I had to argue for Chelsea & Westminster to be called before the committee, as they are a very important provider of acute hospital services, especially paediatrics to a significant proportion of LBHF, but especially the south of the borough. It was revealed this evening that Labour’s cabinet member for health, Cllr Lukey, has not until last night, met the acting chief executive of Chelsea & Westminster, who has been in post for some time. This is concerning to say the least.

Onto the merger/acquisition itself. C&W were approached by West Middlesex NHS Trust a couple of years ago to investigate a merger. As a foundation trust, C&W have to acquire West Middlesex. This has to be agreed by the TDA, the Trust Development Agency. So far the acquisition has been approved by the Competition and Markets Authority. It is now being reviewed by Monitor, the NHS financial regulator, and then final approval is needed from the secretary of state for health.

Worryingly, this is all due to happen within the next few weeks, with the final acquisition proposed for September.

What I find most alarming is that we have so far, despite asking for it, received no in-depth clinical case, outlining how this will improve patient care, improve outcomes and save lives, and no financial case at all. We do not know what services will move between sites, or what additional services will be offered other than a brief suggestion of cardiology cath-labs, bariatric surgery (to tackle morbid obesity) and ophthalmology.

The Chair, pointed out the challenges facing NHS trusts due to increasing demand from an aging population and increased chronic disease, and how trusts have to work together and specialise to cope with demand, improve outcomes and reduce backroom costs.

At a time when there is great uncertainty in the NHS, especially in North West London, he conceded that this is a risk, but that it would also be a risk not to proceed with the merger. Chelsea & Westminster’s budget is currently in surplus but forecasted to fall into deficit.

Without the key clinical case and financial case it is impossible to scrutinise this decision or believe the risk is worth taking. Especially when we consider that C&W is soon to appoint a new permanent chief executive, needs to make significant changes to improve its CQC rating of requires improvement, and needs to improve its own leadership structure. There are also significant leadership challenges at West Middlesex, and hanging over that hospital is a PFI contract, a disastrously managed policy of the last Labour Government, that is a significant reason for the financial challenge facing the NHS.

We will hopefully have the opportunity to scrutinise this decision in great detail on the 7th July at the next health scrutiny committee. Only then will we be able to come to a conclusion on whether this will be good for patients’ outcomes and experiences, and save lives, and something that we should support, or whether the risks are too great. I hope that residents interested and concerned about changes to healthcare in our borough will attend that meeting.

If the acquisition is given the final go-ahead by the regulators and government, it is ultimately the decision of Chelsea & Westminster’s governors whether to go ahead. If there is significant uncertainty and local opposition against this proposal they will have a difficult decision to take. However if this proposal had received greater scrutiny during its process, we could have a lot more confidence that the decision was the right one. The fault for that has to be shared by Chelsea & Westminster and Hammersmith and Fulham Council, and its Labour administration.

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