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A tiny increase in patients plunged a London hospital into crisis after the closure of two neighbouring A&Es, a “hidden” NHS report has revealed.

Northwick Park, in Harrow, suffered the worst delays in the country when an extra 16 patients a day required admission to a ward – just four more a day than predicted.

The hospital’s emergency department and its sister A&E at Ealing normally admit more than 1,000 patients a week. But health chiefs failed to predict the impact of an increasing number of sicker patients – mainly elderly with multiple illnesses – who require care for longer periods, the report found.

London North West Healthcare, which runs Northwick Park and Ealing, recorded the worst performance in the country for at least three weeks last October and November for main A&E patients.

This followed the controversial closure last September of two smaller casualty units at Central Middlesex and Hammersmith hospitals. The NHS England (London) report, which critics said had been quietly “hidden in plain sight” on an NHS website, said the worsening A&E performance in west London last winter was part of a national trend and was “not related” to the closures.

Under the Shaping A Healthier Future shake-up of emergency and maternity care, Northwick Park was predicted to receive an extra 18 A&E patients a day, of which 12 would require admission.

“In practice, 16 additional patients per day required admission,” the report said. “The trust expected the patients admitted to have a length of stay of 3.5 days whereas their actual length of stay was 4.5 days.

“The review shows the combination of four additional patients per day with a longer length of stay meant the hospital had an effective bed deficit of over 20 beds, and this deficit drove the deterioration in the hospital’s A&E performance.”

Andy Slaughter, the Labour MP for Hammersmith, who uncovered the report, said: “What this shows is how absolutely fragile the NHS in west London is. Small peaks in demand can send the system into freefall.”

He warned more change was yet to come, with the planned downgrading of A&E units at Charing Cross and Ealing hospitals. “This report should be enough to make people stop, think and properly analyse the effects of going ahead with the rest of the Shaping A Healthier Future programme,” he said.

A spokesman for North West London Clinical Commissioning Groups said: “Nationally A&E performance was affected by a mixture of increased demand and acuity. This led to more people attending A&E and more patients having to be admitted and staying for longer and Northwick Park Hospital was no exception. On the whole our hospitals coped well.

“Since then a new, £21m A&E department at Northwick Park in December and the number of beds available to admit patients has increased, with further plans to increase bed numbers this year.”

Meanwhile, it emerged today that an urgent care centre being used to treat patients judged not sick enough for A&E is a “time bomb”, according to a doctor who revealed safety concerns.

Dr Mike Smith said Ealing hospital’s 24-hour service, which is run by locum GPs and nurses employed by private operator Care UK, is placing patients at risk because of a series of failings.

The revelations will intensify the row over plans to axe the adjacent hospital A&E under plans to concentrate emergency services in five west London “super hospitals”.

An ITV documentary, Exposure, to be shown tomorrow night, used undercover reporters to capture a number of concerning incidents. These included empty medicine cabinets, dire staff shortages, patients being told to take their own temperature and GPs unable to interpret X-rays.

One unnamed GP said there had been cases of women with potentially fatal ectopic pregnancies having to wait three hours to be seen by a GP. The maternity department at Ealing hospital closed earlier this month.

Dr Smith said: “We are going to reach a point where significant harm will come to a patient. This is a time bomb before something very terrible happens to someone in that waiting room.”

Care UK said stocks of medications were monitored closely. A spokesman said in relation to patients taking their own temperatures: “We accept that this does not appear to be good practice.”

Dr Mohini Parmar, chair of Ealing CCG, said: “Whilst we have not yet seen the programme, we take patient safety extremely seriously and as soon as we became aware of the allegations four weeks ago, carried out an urgent clinical visit to assess whether a safe service is being delivered. This found no immediate cause for concern and patients can continue to use the service with confidence. However, we have established a further independent clinical review to fully investigate the issues raised in the programme and make recommendations on any improvements that need to be made. 

“We are ensuring Care UK take any necessary steps to resolve the issues raised in the programme and should the independent review find any areas of poor practice we will take the necessary steps to ensure patients receive a clinically effective service.”