What we have already heard
We have previously engaged extensively on a very similar proposal, so we have already heard about groups that would potentially be impacted by these changes. The consultation feedback highlighted the following:
- There may be additional challenges for residents known to face healthcare inequalities to access the medical care they need, such as people from Black, Asian and ethnic minority communities, or people with existing health conditions or people with autism or learning disabilities.
- There may be an impact on children and families with disabilities as the additional travel to a centre of expertise may be particularly difficult for this group.
- Some older children may be negatively impacted by having to miss more school if needing to travel further for appointments.
Concerns were also raised in relation to people living in deprived parts of North Central London, given that they may incur additional travel costs under the proposals as well as, potentially, needing to take more time off work.
Impact on travel and access
We have developed an interim Integrated Impact Assessment to explore the impact of our updated proposal for emergency surgery on local people, particularly on people sharing protected characteristics and vulnerable groups.
This is an interim report. A final integrated impact assessment will be developed after the engagement period, using the feedback received during the public consultation and additional engagement, and will be considered by decision-makers.
Travel and access to emergency surgery
- Children and young people would continue to access emergency care at their local emergency department (A&E).
- A small number of the sickest children (around 100 per year), who require highly expert care, would be transferred by ambulance or specialist transport from their local hospital to centres of expertise at The Royal London Hospital or The Chelsea and Westminster Hospital where specialist staff and equipment would be available to assess and treat them.
- This means there would be no change to where children access emergency paediatric surgical care and people would continue to access care at their nearest local emergency department (A&E).
- However, there may be an impact for families and carers visiting children who have been transferred to The Royal London Hospital or The Chelsea and Westminster Hospital from a local hospital.
- Parents and carers of children who have transferred to The Royal London Hospital or The Chelsea and Westminster Hospital may need to travel up to 27 minutes (at peak travelling time by car) longer, on average, compared to travelling to their local hospital.
We realise this additional travel time is considerable and may be inconvenient for some local residents, but our view at this stage is that the improvements in care that the proposed model would bring would outweigh this. Currently, in many cases these children would already be transferred elsewhere for their emergency surgical care. We are very keen to hear ideas for mitigations during this engagement period.
Impact on people with vulnerabilities and populations
We looked carefully at the potential impact of our proposal on people with vulnerabilities, including people protected by the Equality Act 2010 and people living in deprived areas.
Two geographical areas were identified as having residents who may be more vulnerable to the impact of our proposals due to facing barriers to accessing services as they live in areas of deprivation and have high levels of children and young people with poor health.
As a result of the proposals, people in Tottenham and Edmonton and Cricklewood and Dollis Hill may need additional support to:
- access hospital sites if the children or the families and carers are disabled or have learning disabilities, have poor health or do not speak or read English fluently
- travel to hospital by taxi could cost up to an additional £40 for people living in Tottenham and Edmonton
- access services online as some families and carers of young children and people may not have internet access or may not be used to using digital technology
- care for other family members as they may be a lone parent.
Initial mitigations have been developed which start to address potential impacts of our proposals as identified through the in-depth interim Integrated Impact Assessment analysis and the engagement with service users.
These initial mitigations include:
- Communicating around implementation should changes be agreed
- Mitigations for those who may need extra support to access an unfamiliar hospital
- Information about how to travel to a hospital site
- Providing as much care locally as possible
- Support with the costs of travel to hospital
- Supporting sustainability
- Supporting people who may be more vulnerable to the impacts of our proposals
We would like to hear more ideas for mitigations during the engagement period. These will continue to be iterated and developed prior to decision-making and beyond.