London acute hospitals and their configuration

Service reconfigurations have now been proposed for each of the London sectors. These reconfiguration proposals include a reduction in the number of hospitals providing accident and emergency (A&E) services, acute medical, surgical and paediatric care, and obstetric-led maternity services, and the concentration of planned surgery. Across London, there would be a reduction of 8 full 24-hour A&E units if these proposals proceed.

This information relates to developments since December 2011 and first appears in the appendix of our report, Leading health care in London: Time for a radical response.

Developments across London

North-east London developments

Trusts and hospital mergers and acquistions

Barts Health NHS Trust
Trust created on 1 April 2012 following the approved merger of Barts and The London NHS Trust, Newham University Hospital NHS Trust and Whipps Cross University Hospital NHS Trust.

Service reconfiguration

Health for North East London
Key proposals:
  • Reduction in the number of hospitals providing traditional A&E and acute medical, surgical and paediatric care from six to five. King George Hospital (part of Barking, Havering and Redbridge University Hospitals NHS Trust) to no longer provide A&E and acute medical surgery, but instead to provide extended primary care and 24/7 urgent care services and new short-stay assessment and treatment services for adults and children.
  • Reduction in the number of hospitals providing maternity birthing services from six to five with King George Hospital no longer providing maternity delivery services but continuing to provide antenatal and postnatal care; a new midwifery-led unit to be developed at Queen’s Hospital (part of Barking, Havering and Redbridge University Hospitals NHS Trust).
  • Most planned surgery to move from Queen’s Hospital to King George Hospital.
  • Specialist paediatric care to be delivered at The Royal London (which will further develop its current role as a specialist centre) and Queen’s Hospital; Whipps Cross, Homerton and Newham to retain 24/7 paediatric services, but children needing specialist surgical or high-dependency medical care to be transferred to The Royal London.
  • Complex vascular surgery to be performed at The Royal London and Queen’s Hospital.
  • King George Hospital to also deliver diagnostic services, a child health centre, outpatient facilities including long-term condition management, cancer day care, renal dialysis and inpatient and day care rehabilitation services.

In December 2010, the Joint Committees of Primary Care Trusts (PCTs) approved the Health for North East London proposals. Following a review of the proposals by the Independent Reconfiguration Panel the Secretary of State for Health agreed for the changes to go ahead in February 2012.

Barking, Havering and Redbridge University Hospitals NHS Trust has consolidated its maternity services on the Queen’s site. Changes to A&E services are currently planned for 2015.

North-west London developments

Trusts and hospital mergers and acquisitions

Ealing Hospital NHS Trust and North West London Hospitals NHS Trust
Proposed merger approved by the Competition and Co-operation Panel in June 2012. The next step will be for the boards of the two trusts to develop a full business case.

West Middlesex University NHS Trust
Trust board decided in September 2012 that a stand-alone foundation trust application was not feasible and announced its intention to seek a partner. A range of organisations expressed interest in partnering with the trust. In April 2013, the trust board selected Chelsea and Westminster NHS Foundation Trust as its preferred partner. The next step will be to submit a strategic outline case to the NHS Trust Development Authority for approval to develop a business case.

Service reconfigurations

Shaping a Healthier Future (see www.healthiernorthwestlondon.nhs.uk)
Key proposals (of the preferred option presented and approved):
  • Reduction from nine to five hospitals with a 24/7 A&E and urgent care centre. These will be at Chelsea and Westminster Hospital, Hillingdon Hospital, Northwick Park Hospital (part of North West London Hospitals NHS Trust), St Mary's Hospital (part of Imperial College London NHS Trust), and West Middlesex Hospitals.
  • Central Middlesex Hospital (part of North West London Hospitals NHS Trust), Hammersmith Hospital (part of Imperial College London NHS Trust), Ealing Hospital and Charing Cross Hospitals to have 24/7 urgent care centres and will no longer have 24/7 A&E services.
  • Central Middlesex Hospital to be developed in line with local and elective hospital models of care.
  • Hammersmith Hospital to be developed in line with local and specialist hospital models of care.
  • Ealing and Charing Cross Hospitals to be developed in line with the local hospital model of care proposed by the CCGs.
  • The Hyper Acute Stroke Unit currently provided at Charing Cross Hospital to move to St Mary's Hospital, and Western Eye Hospital to move to St Mary's Hospital.
  • Investment of more than £190 million in out-of-hospital care to improve community facilities and the care provided by GPs and others.

The proposals were approved by the Joint Committees of PCTs in February 2013.

For acute services, a target date of 2016 for implementation is currently envisaged, with improvements in out-of-hospital care to be in place before major changes to hospital services are implemented.

In March 2013, Ealing Council resolved to refer the Joint Committee of PCTs' decision to the Secretary of State for Health.

North-central London developments

Trusts and hospital mergers and acquisitions

Barnet and Chase Farm NHS Trust and Royal Free London NHS Foundation Trust
In March 2013, the Royal Free NHS Foundation Trust board decided to proceed with developing an outline business case for the potential acquisition of Barnet and Chase Farm Hospitals NHS Trust, with a view to completing the transaction in early 2014.

Service reconfigurations

Barnet, Enfield and Haringey Clinical Strategy
Key proposals:
  • Emergency care to be concentrated at Barnet Hospital and North Middlesex University Hospitals, with the expansion and redevelopment of emergency services at these sites; Chase Farm no longer to provide 24/7 A&E and instead to develop urgent care services including assessment centres for children and older people.
  • Consultant-led obstetric and neonatal services to be concentrated at Barnet and North Middlesex University Hospitals, with the expansion and redevelopment of services at these hospitals, including midwifery-led birthing units at both; consultant-led obstetric and neonatal services to no longer be provided by Chase Farm Hospital.
  • Chase Farm Hospital to be created as an elective care, outpatient, urgent care and diagnostics centre.
  • Improvements to local primary care and community services.

The Clinical Strategy was endorsed by the Secretary of State in September 2011, following endorsement by the Independent Reconfiguration Panel. In November 2012, NHS London approved the full business case for nearly £35 million investment at Barnet and Chase Farm Hospitals, to facilitate the change in service provision. In December 2012, the Treasury and Department of Health approved the full business case for £80 million investment at North Middlesex University Hospital, to create the capacity required by the Barnet Enfield and Haringey strategy.

Implementation is progressing, with the transfer of services scheduled for November 2013.

South-east London developments

Trusts and hospital mergers and acquisitions

Guy's and St Thomas' NHS Foundation Trust, South London and Maudsley NHS mergers and acquisitions Foundation Trust, and King’s College Hospital NHS Foundation Trust
In February 2013, the Board of King's Health Partners – an academic health science centre which brings together King’s College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley foundation trusts – agreed to proceed with the next stage of developing a full business case for proposals to create a new, single academic health care organisation. The full business case process will consider various organisational models, including a possible merger of the three foundation trusts. The full business case process is expected to conclude in autumn 2013.
Princess Royal University Hospital (South London Healthcare NHS Trust) and King's College Hospital NHS Foundation Trust
In January 2013, the Secretary of State accepted the Trust Special Administrator's (TSA) recommendation that Princess Royal University Hospital be acquired by King's College Hospital NHS Foundation Trust (see below).
Queen Elizabeth Hospital (South London Healthcare NHS Trust) and Lewisham Healthcare NHS Trust
The Secretary of State accepted the TSA’s recommendation that Queen Elizabeth Hospital merge (by acquisition) with Lewisham Healthcare NHS Trust (see below).
Queen Mary's (South London Healthcare NHS Trust) and Oxleas NHS Foundation Trust
The Secretary of State accepted the TSA’s recommendation that the core estate at Queen Mary’s Hospital be transferred to Oxleas NHS Foundation Trust (see below).

Service reconfigurations

TSA review of South London Healthcare NHS Trust and the NHS in south-east London.
Following the review by the TSA, in January 2013 the Secretary of State accepted the TSA's recommendations, with some amendments. The key changes to services and organisations are as follows:
  • South London Healthcare NHS Trust to be dissolved by October 2013.
  • As above, Princess Royal University Hospital to be acquired by King's College Hospital NHS Foundation Trust, Queen Elizabeth Hospital in Woolwich to be merged with Lewisham Healthcare NHS Trust, and Queen Mary's to be transferred to Oxleas NHS Foundation Trust and developed into a 'hub' for the provision of health and social care in Bexley. Over the next three years, the hospitals are required to make £74.9 million of efficiencies.
  • A reduction in the number of obstetrician-led maternity units from five to four, replacing the current unit at University Hospital Lewisham with a stand-alone midwifery-led birthing centre; and each obstetrician-led unit to also have a midwifery-led birthing centre.
  • University Hospital Lewisham to become a centre for non-complex elective procedures to serve the entire population of south-east London.
  • The co-location of paediatric emergency and inpatient services with four A&E units, with paediatric urgent care provided at Lewisham, Guy's and Queen Mary's hospitals.
  • Lewisham hospital to have a smaller A&E service with 24/7 senior emergency medical cover and the ability to admit patients requiring short, relatively uncomplicated treatments or a temporary period of supervision; patients with more serious conditions will be taken to King's, Queen Elizabeth, or St Thomas' Hospitals.
  • The Department to pay for excess costs of PFI buildings at Queen Elizabeth and Princess Royal Hospitals and to write off the accumulated debt of the trust.

South-west London developments

Trusts and hospital mergers and acquisitions

Epsom and St Helier NHS Trust
A transaction to de-merge Epsom and St Helier NHS Trust's two component hospitals to enable Epsom Hospital to be acquired by Ashford and St Peter's Hospitals NHS Foundation Trust was halted in October 2012. This was due to Ashford and St Peter’s Hospitals NHS Foundation Trust being unable to develop a financially viable plan for Epsom Hospital.

Service reconfigurations

Better Services Better Value (BSBV)
The Case for Change published in October 2011 originally considered only the four south-west London acute hospitals (Croydon, Kingston, St George's and St Helier), because a transaction was then in train for a de-merger of the Epsom and St Helier Hospitals NHS Trust (with Epsom Hospital to be acquired by Ashford and St Peter's Hospitals NHS Foundation Trust, as above).
In August 2012, the BSBV Programme Board put forward its preferred option:
  • The centralisation of emergency care at Croydon, Kingston and St George's Hospitals, each with expanded emergency departments, an integrated urgent care centre and children's A&E.
  • Centralisation of maternity care in three expanded obstetric-led maternity units, to be located at Croydon, Kingston and St George's Hospitals, with co-located midwifery-led units.
  • St Helier Hospital to cease providing emergency and maternity services but to retain a stand-alone urgent care centre, and to develop a planned care centre for non-emergency surgery.
  • Dedicated children's assessment wards at Croydon, Kingston and St George's Hospitals, with specialist paediatric staff centralised at St George's.
  • Major improvements in GP and community services.

However, in autumn 2012, the Programme Board agreed to delay consultation and look again at proposals in light of the suspension of the proposed merger of Epsom Hospital and Ashford and St Peter's NHS Foundation Trust (which led to the inclusion of Epsom Hospital in the review), and NHS Surrey's wish to be more fully involved.

Key proposals now include:

  • Three hospitals, rather than the current four, to have an A&E department and obsetrician-led maternity units, alongside midwifery-led units.
  • A network of inpatient children's services at three acute hospitals with St George's as the hub, improved children’s community services, and all five hospitals to continue to see children with urgent needs and as outpatients.
  • Further work to be done on the feasibility of a stand-alone midwifery-led maternity unit.
  • A planned care centre for all inpatient surgery for the region, on a separate site from emergency care, also providing day case surgery for the local population.
  • Outpatient and day surgery facilities in all five hospitals.

There are also plans for improvements to out-of-hospital services (laid out in the plans produced by each of the local CCGs). Proposals include increased investment to improve out-of-hospital care, with more services offered in the community (GP surgeries, local care centres and local hospitals) and at home.

In February 2013, the BSBV Programme Board agreed that further work was needed to engage local stakeholders, particularly Surrey Downs, and in May 2013 developed a draft pre-consultation business case. The seven CCGs have now agreed to form a local committee (also including NHS England) to decide whether the proposals should go to public consultation. The committee is expected to meet once NHS England has completed its assurance process which aims to ensure that the programme is ready to move forward to public consultation.