Charing Cross is a major acute and teaching hospital in Fulham. It was opened in 1972 on the site of Fulham Hospital as part of the University of London Medical School, now Imperial Medical School. With Hammersmith, Queen Charlotte (maternity), St Mary’s and Western Eye Hospitals it forms the Imperial Healthcare Trust, one of the largest and most prestigious trusts in the UK and part of the first academic health science centre. It is a centre for research, working with Imperial College. Charing Cross is the second largest of nine acute hospitals in the NW London region.
The nine acre site is close to Hammersmith Broadway and the M4, important as a strategic location for major emergencies, but is also a busy DGH serving a growing population and one with acute health needs. Parts of the site are owned by Imperial College, West London Mental Health Trust and Maggie’s Centre and it is an integrated health campus which includes primary care and treatment services.
In June 2012, ‘Shaping a Healthier Future’, a plan inter alia to reduce acute services in NWL, was announced after 2 years of secret work by management coonsultants McKinseys. This proposed the closure of four of the nine A&E departs in the sub-region (to be replaced by GP-staffed urgent care centres) and the downgrading of Ealing and Charing Cross Hospitals to the status of local hospitals.
The original proposal to close and demolish the entire Hospital at Charing Cross, build an urgent care centre on one corner of the site and sell the rest for private residential property was modified (in February 2013) to allow for some treatment and primary care services and about 50 recovery and day beds to be built on the site.
This was designated a ‘local hospital’, which led to a change of position by local Conservatives who have since supported the scheme. Otherwise opposition has been consistent and vocal from all political parties but particularly Labour. A dedicated Save our Hospitals group has worked tirelessly to oppose Shaping a Healthier Future since 2012.
Under SaHF, Charing Cross would lose 336 of 360 acute beds, all consultant emergency services and its A&E. Ealing Hospital is facing a similar demolition and downgrading programme. A&Es at Hammersmith and Central Middlesex Hospitals have already closed. The remaining 5 hospitals (St Mary’s, Chelsea & Westminster, West Middlesex, Hillingdon and Northwick Park) would see some expansion in services but overall there would be a loss of over 500 acute beds in the sub-region, which has a population of over 2 million.
Primary, community and social care services are supposed to improve to reduce the pressure on acute services. All 11 West London Labour MPs have been critical of the plans: even where hospitals are getting extra resources these are seen as inadequate to meet growing demand and displacement from the downgraded sites.
There have been no further announcements since February 2013, save to reaffirm the principles of SaHF which has been seem as a prototype for the Keogh review of acute services, heralding a reduction of A&E services across the country. The next phase – a financial and operational plan to get NHS England, DoH and Treasury approval (the Implementation Business Plan) - has been constantly delayed. The funding for the scheme – specially around St Mary’s, Paddington and Charing Cross is complex and expensive.
In August we were told the Business Plan had been split in two – only the Ealing part of the scheme would be brought forward now (though even this has now been postponed for a further period of months). The plan for the Charing Cross project has been put off until sometime next year, though this could slip further.
SaHF has now been subsumed in the NWL STP. This has the interesting effect of this STP being advanced of the others (it is one of only two of 44 covering the country so far published in full) and in many ways an insight into how they will work elsewhere. But the delay in bringing forward the Business Plan means that the proposals for Charing Cross are already outside the 5-year STP framework – in other words there is no chance of work actually beginning on site until 2021 at the earliest.
In one way this is good news – the demolition was originally due to start now, and the scheme looks increasingly unaffordable and undeliverable. But it has created huge uncertainty, which is reflected in difficult to attract staff, rapidly changing management and financial crisis.
Imperial HCT is over £50m in debt this year with no reserves. The CCG budget is flatlining, meaning there are insufficient resources to deliver improvements in other services. Imperial is missing its important targets – eg on A&E waiting times and 18 weeks.
The tone of both Imperial and the CCG have changed in the past few weeks in private meetings and now in public (see Imperial Chairman Richard Sykes comments to campaigners picked up by BBC London). They concede there are insufficient resources to deliver the programme and that staff are at breaking point.
Since setting up Save our Hospitals in 2010 I have raised SaHF and Charing Cross regularly in the Commons, most recently in the Opposition Day debate this month. The council election campaign in 2014 was fought on the future of Charing Cross and resulted in Labour winning control in H&F which had been classed as a safe Tory borough.