The Health and Adult Social Care Policy and Accountability Committee met on Wednesday, 19 July 2023, to discuss the delayed rebuilding of hospitals within the Imperial College Healthcare NHS Trust and an update on post-COVID syndrome services. The committee heard that funding for the rebuilding of St Mary's, Charing Cross, and Hammersmith hospitals has been delayed beyond 2030, prompting the Trust to explore alternative funding models, including potential commercial partnerships and land sales. An update was also provided on the post-COVID syndrome service, highlighting efforts to improve referral rates and ensure equitable access across different demographics.

Hospital Rebuilding and Funding Delays

Dr. Bob Klever, Paediatrician and Director of Strategy, Research and Innovation at Imperial College Healthcare NHS Trust, provided an update on the significant challenges facing the Trust's hospitals, including St Mary's, Charing Cross, and Hammersmith Hospital. Many of the buildings are outdated, with some dating back to 1848, leading to wards being closed due to disrepair and impacting patient care and staff experience. The Trust faces 25% of the NHS's backlog maintenance across its three hospitals.

The New Hospital Programme announced funding delays beyond 2030, although some funding is available for business case development. For St Mary's, a total rebuild is necessary, and the Trust is exploring a model that combines public and commercial funding, potentially through land sales. Approximately 40% of the current hospital land would be needed for the rebuild, leaving 60% for other development opportunities, particularly in life sciences, which could attract commercial interest.

Charing Cross and Hammersmith Hospitals are slated for phased rebuilding, involving significant investment in hundreds of millions of pounds to replace poor infrastructure while building on existing good facilities. The Trust is working to develop robust business plans to present to the government, aiming to bring forward the funding and construction timelines.

Concerns were raised by councillors regarding the potential for Private Finance Initiative (PFI) schemes, with Dr. Klever acknowledging the historical financial issues associated with PFI but stating the Trust is open to exploring various funding options, including commercial partnerships, with a strong emphasis on value for money and patient benefit. The Trust is also actively pursuing philanthropic funding, particularly for research initiatives in partnership with Imperial College London.

The committee discussed the potential impact of estate failures on service provision, with Dr. Klever explaining that capacity is already stretched, and failures can lead to delays, patients being stuck in A&E, and issues with ambulance services. The Trust is working collaboratively with local authorities and the wider health and care system to understand current and future patient needs, utilising data from the GLA and exploring innovative solutions like hospital at home and better integrated care.

Northwest London Adult Community Based Specialist Palliative and End of Life Care Review Programme

Dr. Lindsay Williams, GP in Brent and Northwest London lead for end of life care for care homes, presented an update on the palliative and end of life care review programme. The committee commended the progress made, noting the improved document compared to previous iterations and the focus on addressing thorny issues. The proposed model of care aims to provide more personalised and culturally sensitive care, extending service hours and incorporating a home hospice model.

Key discussions revolved around the need for 24/7 care, with the current proposal including an advice line and extended visiting hours from 8 am to 8 pm. Concerns were raised about the lack of detailed data underpinning the proposals and the generality of some statements, with councillors emphasizing the need for concrete plans and clear leadership structures. The importance of addressing health inequalities and the needs of carers was also highlighted, with reference to the Rowntree report on the financial burden of unpaid care.

The committee sought clarification on the distinction between engagement and consultation, with the understanding that the current document is for engagement on the what of the model of care, and a formal consultation on the how will follow if significant service changes are proposed. The timing of the engagement period, particularly during the summer months, was questioned, with a commitment to consider extending the timeline to ensure adequate public feedback.

Specific points raised included the need for clearer criteria for hospice bed allocation, the staffing and quality of care in nursing and care homes providing enhanced end-of-life care, and the representation of organisations like HAFSON and the frailty group in the documentation. The team acknowledged these points and committed to addressing them in future documents, including the detailed model of care engagement document to be published soon, which will include data, population modelling, and information on service access criteria.

Post COVID Syndrome Services Update

Melissa, Assistant Director for Local Care Programme for Northwest London ICB, provided an update on the post-COVID syndrome services. The current model involves GP referrals to a single point of access, with six providers across Northwest London offering care. Challenges have been identified with the initial digital referral process, leading to some patients being returned for missing information, though these patients are case-managed.

The service is moving towards a community first model due to shorter waiting times in community settings, with an aim to reduce waiting lists for acute services to a maximum of six weeks. The community offer is patient-centric, with various modes of contact including face-to-face, online digital, and direct digital platform access.

Inequalities in referral rates were highlighted, with a disproportionate number of referrals from white females in their forties, and a lack of referrals from certain GP practices and from male and Asian populations. Efforts are underway to actively increase referral rates from under-referring GPs and to capture all patients, including through digital animations and potentially self-referral options.

Concerns were raised about the impact of isolation on long COVID sufferers, with a push to ensure face-to-face appointments where necessary, balanced with patient preference for digital access. The funding for the service is currently short-term from NHS England, with no secure funding for the next year, necessitating work to find a sustainable solution. Research into long COVID is ongoing, with a portion of funding allocated to Imperial Healthcare Partners. The service is also exploring learning from ME research and addressing the recognition of long COVID symptoms by GPs. A working stream is also underway to address the needs of children and young people affected by long COVID.