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Topic: Depth of North Mid A&E crisis revealed

Depth of North Mid A&E crisis revealed
15 Jun 2016 20:34 #2158

Basil Clarke Basil Clarke's Avatar Topic Author

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north middlesex hospital by night

An article in the Guardian has revealed that there is a serious risk that the Accident & Emergency Department at the North Middlesex Hospital may be forced to close in the near future because an acute shortage of doctors means that it is unable to provide a sufficient level of patient safety.

North Mid has one of the busiest A&E departments in the country, treating up to 500 cases per day.

Though it has been clear for some time that there were serious problems with the North Mid's A&E, their gravity was kept under wraps until yesterday's Guardian article, based on confidential documents that were leaked to the newspaper.

Earlier this month the Care Quality Commission issued an ultimatum to the hospital to bring its A&E services up to an acceptable level by August.  A press release referred to "delays in the initial assessment of patients, in their assessment by a doctor and in moving them to specialist wards and that there were insufficient middle grade doctors and consultants".  In response, the hospital admitted that "we currently have only seven out of 15 emergency department consultants in post and seven out of 13 middle grade emergency doctors. It’s a strain on our A&E team and it’s making waiting times for some patients unacceptably long.  We have undertaken extensive recruitment exercises and despite our best efforts have, so far, been unable to fill all the posts."

The Guardian article reveals that the General Medical Council and Health Education England have stated that the shortage of consultants means that junior doctors are not receiving adequate training and are having to undertake work for which they are not fully qualified.  The two bodies have said that as a consequence they may have to remove all 26 junior doctors from the A&E department, forcing it to close.  Managers of the Royal Free, University College and Barts hospital trusts have reportedly warned that such a closure would have catastrophic effects.

Sources and further information

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North Mid A&E crisis - how did it come about?
15 Jun 2016 20:39 #2159

Basil Clarke Basil Clarke's Avatar Topic Author

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How has this situation come about?

Different commentators have laid the blame at different people's doors.

MPs Joan Ryan and David Lammy have linked the crisis at the North Mid to the controversial closure of Chase Farm's A&E department in 2013. However, at the time compensatory changes to capacity were made at Barnet Hospital and the North Mid and the North Mid's A&E was performing adequately up until September 2015. In my view, the Chase Farm closure may have been a factor, but is unlikely to be the main cause.

The Care Quality Commission's press release (issued on 6 June) is phrased in such a way as to suggest that the blame lies with the North Mid's management and that they just need to bang a few heads together to fix the problems. There is no hint that there may have been any external factors outside the hospital's control that might have led to the crisis.

In his statement issued today, David Burrowes MP, while acknowledging that Enfield is not receiving a fair share of the London health budget, also seems to place some of the blame on the hospital's management. He says that the hospital is "failing in its duty of care towards [its doctors and nurses] and to the public" and says that the NHS has a "duty of care to my constituents".

Judging from the BBC's report on today's Prime Minister's Question Time, David Cameron seems positively relaxed about the situation and this afternoon boasted about what his governments have done to help the North Mid: "If we look at what has happened since 2010, there are 120 more doctors, there are 280 more nurses recruited by the trust. The health secretary will continue to monitor this closely."

In my view, all the above assessments fail to notice the elephant in the room: the chaotic situation caused by the coalition government's total and continuing re/dis-organisation of the NHS and the current government's failure to fund the health service adequately. These are the main reasons for the crisis, and they have been exacerbated by the movement of poorer people out of central London into Enfield and the huge increases in the cost of buying or renting a home in north London. Both of these latter problems are also consequences of government policy. To suggest that the hospital bears the main responsibilities for its problems is, in my opinion, a case of victim blaming. While I agree with David Burrowes that the NHS has a duty of care to his constituents, it can only exercise it if it has the resources to do so - I also believe that the government is failing in its duty of care to the NHS.

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North Mid A&E crisis - how did it come about?
16 Jun 2016 17:32 #2160

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I am a volunteer at the NMUH and have been for about 15 years in was called the Patients Representative Forum, now called the Eye & Ears, unfortunately closing the Chase farm A&E has not helped and problem with Whipps Cross as well, Barnet has the same problem as NMUH, lack of Money is a big factor, unfortunately the A&E when built under the new PFI building was not built with any expansion capacity, and I don't care how many doctors or nurses you throw at it will continue to have problems, its called capacity, if any thing it will get worse, as this government has deemed we must build more houses in Enfield and Hornsey but no plans to add the facilities to cope with it, plus we have a migrant population the in their own country normally go to a hospital with medical problems not a local doctor, unfortunately the last bit of property at the NMUH site that would allow expansion the Trust board has because it is strapped for cash decided to sell to a firm that want to convert it into a school, so the CQC want to get its act together and help not hinder, our MPs are not a lot of help all wind and no blow.

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North Mid A&E crisis: Statement by Enfield Council
18 Jun 2016 20:01 #2161

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The following statement has been published on the Enfield Council website:

Here is the text of a statement regarding North Middlesex Hospital that was endorsed by Enfield Council's Cabinet last night.

Statement to Cabinet from Cabinet Member for Health and Adult Social Care:
As Cabinet Member for Health and Adult Social Care I wish to comment on the recent worrying media coverage about ongoing concerns at North Middlesex Hospital.

Following the publication of the CQC warning notice, The Leader and I wrote to the Secretary of State for Health – Jeremy Hunt to express our very significant concerns regarding the challenges that North Middlesex University Hospital NHS Trust are facing and seek his personal intervention to ensure that all support and resources are made available to bring an immediate and sustainable solution to this situation.

The North Middlesex A&E is one of the busiest Emergency Departments in London and serves a very deprived area with significant health needs in the local population. The Trust has been under considerable strain not least as a result of a lack of emergency department Consultants, resulting in performance and quality issues. North Middlesex University NHS Trust has been given until 26 August 2016 by CQC to make the improvements.

The Council has continually engaged with North Middlesex University NHS Trust, NHS commissioners, regulators and neighbouring trusts to encourage a whole system response that ensures the support required to the Hospital is provided. A Programme Oversight Group has been established by the NHS to take forward the required support to the Trust at which the London Borough of Enfield will be represented.

I have no doubt the issues with North Middlesex University NHS Trust are compounded by the financial underfunding of Enfield CCG, which has to find an additional £7 million in savings on top of £14 million already planned this year, which is in addition to an underlying £49 million structural deficit. This must be an impediment to supporting North Middlesex University NHS Trust and I will continue to raise this issue with the NHS.

Finally, we must not forget that when Chase Farm Hospital lost it’s A&E, local people were repeatedly assured that there would be a safer and better service available to them, like me they will be gravely concerned to hear such worrying reports about the service on the North Middlesex site. On their behalf we will continue to do all we can to support the hard working front line staff at North Middlesex Hospital and to press the Secretary of State to ensure that he makes sure local NHS services have the resources and support they need to provide local people with safe, high quality services in the emergency department at North Middlesex Hospital and beyond.

Cllr Alev Cazimoglu
15 June 2016

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Depth of North Mid A&E crisis revealed
22 Jun 2016 22:44 #2168

Basil Clarke Basil Clarke's Avatar Topic Author

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A new report in the Guardian provides yet more alarming details of the crisis at the North Mid, based on a leaked internal NHS report:

North Middlesex A&E staff describe unit as unsafe and unsupported

By contrast, Healthwatch Enfield's website has this rather bland statement:

The past week has seen considerable national media coverage of problems at the A&E department of North Middlesex University Hospital NHS Trust. Have you got experience of accessing services at “North Mid”? At Healthwatch Enfield, we are always keen to hear about your experiences, positive and negative, so why not get in touch?

You can contact us by email at or by phone on 020 8373 6283.


One hopeful development is that Barts Hospital is looking into the possibility of sharing A&E doctors with the North Mid. However, the Barts spokesman who mentioned this is also quoted as referring to "the national shortage of senior A&E doctors" - an indication that the crisis at the North Mid isn't simply caused by poor local management (which is what the Care Quality Commission has implied) so much as reflecting the dire situation in the NHS at national level. While it's true that there are allegations of a "bullying culture" in the way the hospital is managed, my guess is that this is because the hospital's managers are themselves being subjected to bullying, albeit of a more subtle nature, from above. This is what happens when unfair and unremitting pressure is applied from above and is passed down the management chain.

Writing in this week's Enfield Gazette, Bill Linton of Enfield Green Party alleges that as a consequence of government policy "breakdowns within the NHS are not only inevitable - they are intentional". His contention is that "the NHS has for years been starved of funds, partly because that's all part of austerity and partly so that in due course Mr Osborne (or his successor) can say, 'Oh look, it's not working - better privatise it". And he concludes that "It is North Mid's bad luck to be one of the first dominoes to fall".

Evidence that the situation at the North Mid is not an isolated case came this week in a statement by the Royal College of Nursing. Janet Davies, RCN chief executive and general secretary, said: “Having once been the preserve of the worst weeks of winter, overwhelming pressure and major incidents have sadly become the new normal in our hospitals."

Whether or not you buy into Mr Linton's argument that the NHS is being deliberately run down, it is certainly the case that the NHS was in a far healthier condition when Messrs Cameron and Osborne took over than it is now. Six years of budget cuts, continuous reorganisation and criticism of health service employees have taken their toll.

In my view, the fact that such an important hospital in one of the wealthiest cities anywhere in the world has reached such an existential crisis is a national scandal and the government needs to sort it out urgently. It makes me very angry, and scared too of the consequences of an accident or serious illness.

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North Mid A&E crisis: Statement by Enfield Council
23 Jun 2016 10:50 #2169

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Excuses Excuses.

I lived in this area in the 1970's / 80's and no one wanted to go nowhere near the North Mid . The reputation was that you were lucky to come out alive. My father died there 8 years ago , before I could get him moved , and to this day I have no idea why he died. The wards were filthy and I had to clean up my fathers room which had blood all over the surfaces.
It seems to be the same story for all hospitals in Enfield and it is and always has been down to bad management.
So blame the migrants all you like but they were not an issue in the 80's and you still had a problem . Shame on you

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North Mid A&E crisis: Statement by Enfield Council
24 Jun 2016 16:18 #2175

Donald Smith Donald Smith's Avatar

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The contribution from Peter Smith reads
the new PFI building was not built with any expansion capacity,

There seems to be some misunderstanding as that the A & E under the original PFI was intentionally built with "excess bed capacity"
so that the treatment area would not need to be "touched" at a later date. In the most recent works by the transfer of the A & E from Chase Farm it was only the additional beds that were to be added under what I will described as Phase 2. [For more information contact the project manager ]

The Commissioner of services at NMUH is Haringey CCG under the guidance of commissioner Jill Shattock. Currently each week Jill Shattock (haringey CCG)., Aimee Fairburns (enfield CCG) under take a teleconference with stakeholders. It seems strange to me that it was only recently a root cause analysis identified that patients were being discharged "too late" in the day and that by transferring patients to a zero overnight stay ward beds would be released from the acute accommodation and from the A & E treatment area. By releassing patients by lunchtime there would be improved bed utilisation

Both Barnet, and Enfield JHOSC representatives claimed that Delayed Transfers of Care (DTOC) were not being caused by lack of their respective care package provision.

Those who wish to follow through, should be at the Annual Meeting of NMUH to be held at the hospital on 30th June 2016 from 11:45 to 14:00. It would be helpful if advance questions can be e-mailed to the Board Secretary Molly Clark, .

Those wishing any special buffet food (such as gluten free) should contact Diana Mohair

In the most recent NHS England statistics in the public domain the number of A & E attendances actually declined as performance worsened

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North Mid A&E crisis: Statement by Enfield Council
01 Jul 2016 10:34 #2178

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Sorry Don we of the NMUH PRF were in from the beginning of the new build and live in the real world , we asked Kevin if the new build could expand if needed he said no, so we new what has happened now was coming, we hoped that the old trust building would remain so that could be used to build additional capacity but short sightedness has come into play, the firm that runs the hospital catering wanted to use the old trust building as a respite accommodation so patients waiting to be repatriated home could be accommodated freeing up bed space, but this has fallen on deaf ears, so Don what is the trust going to do about it?

Peter Smith

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