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Health chiefs today published plans for a £500m shake-up of care that will eventually see two hospitals, including one of the most famous in London, downgraded to “local” status.

NHS officials in North-West London want to remove critical care, blue-light ambulances and potentially all surgery from Ealing hospital. A second phase of changes would see Charing Cross, in Fulham, also become a “local hospital” to help save £1.1 billion over the next decade.

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The proposals, which involve expanding Northwick Park, West Middlesex and Hillingdon hospitals, have had to be split in two because of uncertainty around the redevelopment of St Mary’s hospital (above) due to Irvine Sellar’s adjacent “Paddington Cube” development.

This means that the plan is to downgrade Ealing – which has already lost its maternity and paediatric departments – by 2022, with no changes starting at Charing Cross until at least 2021.

Westminster council’s planning committee is due to consider the cube application tonight. Labour councillors have called for them to be rejected after Imperial College Healthcare NHS trust, which runs St Mary’s and Charing Cross, and the London Ambulance Service warned proposed road closures could make ambulance access to St Mary’s “unsafe” and would threaten the viability of its major trauma centre (see excerpt from planning documents below).

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UPDATE DECEMBER 7: Westminster council last night granted planning permission for the Paddington Cube after an 11th hour deal to guarantee ambulance access to St Mary’s. See here for the Evening Standard story: http://www.standard.co.uk/news/london/renzo-pianos-775m-cube-building-given-green-light-to-transform-tatty-paddington-a3414026.html

Today’s proposals, for which NHS approval and Government funding is being sought, are part of the sustainability and transformation plan for the eight nowth-west London boroughs from Westminster to Hillingdon. It is thought to be one of the first STPs in the country to reach the funding stage. They build on the controversial Shaping a Healthier Future centralisation in north-west London.

A draft business case proposes investing £300m in refurbished hospital sites, £140 million on “out of hospital hubs” – which will include GPs and community and mental health services – and £69m in GP surgeries. Urgent Care Centres would be retained at all hospitals that currently have an A&E.

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The report said: “In keeping with the Secretary of State’s explicit request, Ealing and Charing Cross hospitals will continue to offer an A&E service although it may be in a different shape or size from that currently offered.”

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Coverage of the story in the Evening Standard

A further £314 million would be required to make changes at Charing Cross, which are being fiercely resisted by Hammersmith and Fulham council. Update: Ealing councillors say they are opposed to the changes proposed for Ealing hospital. One health source said: “We are definitely intending to deliver the model of care at Charing Cross as well.”

The aim of the changes is for more people to be cared for at home, and to increase the number able to die at home rather than in hospital. GPs will be told to prescribe more statins, the cholesterol-lowering drugs, to reduce the risk of cardiovascular disease in people with diabetes.

Health chiefs say that earlier changes, which saw the closure of the A&Es at Central Middlesex and Hammersmith hospitals, helped to improve community care – resulting in fewer patients having to be admitted to a hospital bed.

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