Whipps Cross University Hospital

What is Fit for the Future?

What is Fit for the Future?

NHS Trusts and Primary Care Trusts in outer North East London are working together on an affordable programme of reconfiguration of health services and facilities.

Organisations involved

• Barking & Dagenham PCT
• Barking, Havering & Redbridge Hospitals NHS Trust
• Havering PCT
• North East London Mental Health Trust
• Redbridge PCT
• Waltham Forest PCT
• Whipps Cross University Hospital NHS Trust

The Fit for the Future project is coordinated by representatives from NHS London which replaced the strategic health authorities in London in September 2006.

Drivers for change

The local changes are consistent with national Government policy in respect of:

• Developing a new model of providing care outside of hospital.
• Improving productivity in acute hospitals - for example reducing the time patients spend in hospital and increasing the number of operations performed in our theatres.
• Increasing specialised centres for emergency care for major accidents and emergency patients - there are already examples of this in the North East London sector with the specialised Heart Attack Centre and Trauma Centre.
• Financial pressures with both hospitals and Primary Care Trusts.

Aims of Fit for the Future

• Improving quality and suitability of local health services.
• Addressing local health inequalities.
• Responding to Our Health, Our Care, Our Say – more services being provided in the community.
• Maximising the benefits of the new Queen’s Hospital - which replaces the former Oldchurch Hospital, Romford (opened at end of 2006).
• Bringing the whole health economy into sustainable financial balance.

Principles of Fit for the Future

• Service configuration should focus on patients can care rather than institutions.
• Health care should be provided in an out-of-hospital setting where appropriate and provide best value for money.
• Models of care should minimise the inappropriate use of acute care facilities.
• Opportunities should be maximised for greater local provision of care integrated with primary care.
• To take in account of the London wide strategy and any impact of local plans on neighbouring health economies.
• Enhance collaboration and cooperation with other public sector organisations.
• To provide equal access to health services across outer North East London.
• Improve the health of the local population as set out on "Choosing Health" and ensure their health needs can been met.
• Increase flexibility in the use of healthcare resources and deliver best value and affordability within the parameters set by Government.

Progress/ Timeline

July/August 2006

The boards of the seven NHS organisations approved the terms of reference for an appraisal of options for the configuration of health services.

This work was overseen by a project group consisting of Chief Executives of the seven organisations, social care leads from the four local boroughs, London Ambulance services and representatives from affected neighbouring primary care trusts.

This led to Five options: (The new Queen's hospital in Romford will be retained with a full range of emergency and elective services in each of the options).

Option 1:Do minimum - retaining King George and Whipps Cross as district general hospitals with A&E departments.

Option 2:Whipps Cross becomes an emergency focussed hospital with an A&E department. King George becomes an elective focussed hospital concentrating on planned admissions, with no A&E department. Both sites will have a full range of ambulatory (patients who walk-in) services together with urgent care centres for minor aliments and illnesses. King George will have a low risk midwife led birthing unit.

Option 3:King George becomes the emergency focussed hospital with an A&E. Whipps Cross becomes an elective focussed hospital, concentrating on planned admissions with no A&E department. Both sites will have a full range of ambulatory (patients who walk-in) services together with urgent care centres for minor aliments and illnesses. Whipps Cross will have a low risk midwife led birthing unit.

Option 4:Whipps Cross retains its current role and functions as a district general hospital with an A&E department (for patients requiring admission) and an urgent care centre for minor ailments and injuries. King George becomes an ambulatory hospital with no admitted care and no A&E department. King George will have an urgent care centre for minor ailments and injuries and a low risk midwife led birthing unit.

Option 5:King George retains its current role and functions as a district general hospital with an A&E department (for patients requiring admission) and an urgent care centre for minor ailments and injuries. Whipps Cross becomes an ambulatory hospital with no admitted care and no A&E department. Whipps Cross will have an urgent care centre for minor ailments and injuries and a low risk midwife led birthing unit.Underpinning all the options would be a new model of providing care outside of hospital to support earlier discharge and a reduction in emergency admissions.

September/ November 2006

A series of stakeholder workshops were conducted to enable the non-financial benefits of each option to be weighted and scored.

These workshops were attended by staff from all the organisations involved, key stakeholders and patient representatives.Criteria for the scorings included:

• Improving the quality of health services.
• To minimise travelling times for patients.
• Providing sufficient flexibility for requirements to change physical capacity.
• To provide a high standard of facilities.
• Supporting and developing a motivated workforce.
• To deliver change as quickly as possible.

A financial appraisal of each option was conducted by Finnamore Consultancy.

An 'out of hospital' workstream ran in parallel to this to develop a detailed set of proposals for the infrastructure necessary to deliver the level of care required outside hospital.

January 2007

A draft business case has been completed.

An executive summary from this is available from the March Trust Board papers.

The overall conclusions are that Options 4 and 2 produce the greatest savings across the health economy as a whole and Option 4 is beneficial for most organisations.

However, further validation work is needed on the financial appraisal and this work needs to be completed before all the organisations can agree which option/s will go out to public consultation.

July 2007

Publication of Professor Ara Darzi's report into healthcare services in London titled 'Framework for Action'.

Details how Professor Ara Darzi believes London's healthcare needs to change over the next ten years. It also looks beyond the vision and identifies the key enablers that will turn the vision into reality.

NHS staff are being given the opportunity to have their say and feedback.

Staff can pick up a copy of the Executive summary of this report from Trust HQ. Or you can access the full report from the healthcare for London website: www.healthcareforlondon.nhs.uk

July/August 2007

Independent Clinical Review, being led by Professor Sir George Alberti, National Director for Emergency Access, and Professor David Colin-Thome, National Clinical Director for Primary Care.

Includes meetings with local clinicians to assess the implications of the proposals.

October 2007

The independent Clinical Review, led by Professor Sir George Alberti, National Director for Emergency Access, and Professor David Colin-Thome, National Clinical Director for Primary Care is published. See downloads to look at a full copy of the Review of Clinical Case for Change.

It backs the general direction of travel for the Fit for the Future Review and states that maintaining high quality acute services at three sites - Whipps Cross University Hospital, Queen's Hospital and King George's is not an option.

Therefore Whipps Cross University Hospital and Queen's Hospital should continue as full acute hospitals with King George's developed as a first class local hospital.

In addition it has been decided that further more detailed work still needs to be done to before Fit for the Future can go to consultation in addition to action to further develop capacity in hospitals and the community to support the changes.

Next steps

External review

An external clinical review of the models of care under the preferred options has taken place. This was led by Professor Sir George Alberti, National Director for Emergency Access, and Professor David Colin-Thome, National Clinical Director for Primary Care.

Click here to access the report.
Click here to access the response from NHS London.  

However following the publication of this clinical review it has been decided to put the Fit for the Future consultation on hold while further work is done to develop services both in and out of hospitals further.

Overview and Scrutiny

The paper will then go to the relevant local councils for approval from their overview and scrutiny committees on the preferred option/s to go to public consultation.

NHS London

NHS London will then finally approval which option/s will go out to public consultation.

Public Consultation

Once all the processes above have been completed the public consultation will begin.

There is no current date for the consultation begin.

What it means for Whipps

The publication of the independent Clinical Review recommends that Whipps Cross University Hospital and Queen's Hospital should continue as full acute hospitals with King George's developed as a first class local hospital.

This means that Whipps Cross University Hospital would remain as a District General Hospital retaining its A&E department  - as set out in option 4 of the Fit for the Future project.

Click here to read our response.

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Following the publication of Professor Ara Darzi's report into healthcare services in London titled 'Framework for Action', Lucy Moore, Chief Executive and Stephen Jacobs, Chairman made the following response:

"We would like to offer some reassurance to the local community and our staff, following the the NHS London report on restructuring health services in the capital.

"Far from casting further doubt on the future of Whipps Cross, the new study of the Future for Hospitals in London, gives us the opportunity to become one of the major Acute Hospitals serving the residents of North East London.

Our proposed new building programme looks forward to a bright future which I believe staff and the local community will want to support."

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So far, the Fit of the Future project has highlighted Option 4 as the most beneficial overall - look at the Progress/ timeline section for more information.

If this option progresses to public consultation and implementation, the benefits to Whipps Cross would be:

Securing a long-term high quality, local provision of healthcare for the communities we serve.

Retention of the depth and breadth of clinical services at Whipps, which underpins the Trust's Clinical Service Development Strategy.

Allows us to maximise the use of the Whipps Cross site for both emergency and elective care, ensuring a sustainable future for the hospital.

Significant capital investment has been included in the financial appraisal for Option 4, which will allow for the long over-due improvements to the infrastructure (buildings and equipment) of the hospital.

Please note Option 4 has not yet been designated as the preferred option - please look at the Progress/ timeline section for more information.

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How to find out more about Fit for the Future

Look at the Outer North East London Fit for the Future website: www.onel-fitforthefuture.nhs.uk

In addition to regular updates on Fit for the Future, which will be placed on this site, Whipps Cross University Hospital has also appointed three key spokespersons for the project.

The ambassadors are involved in Fit for the Future and can update you on the project so far and the Trust's involvement.

The ambassadors are:

• John Hogan, Medical Director
• Rachel Webb, Deputy Director
• John Peters, Consultant Urologist

You can contact these spokespersons by clicking on the following link to the Trust e-mail address: info@whippsx.nhs.uk

Documents to download

You can download the following information

• Briefings
• Board Papers
• Frequently Asked Questions - October 2006
• Press releases
• Reviews

Please click on the relevant document below to download: