• Adult emergency services
• Cancer
• Cardiovascular
• Commissioning support
• COPD
• Children and young people
• Dementia
• Diabetes
• Disabled children
• End of life care
• Immunisations and vaccinations
• Local hospitals
• London and South East England specialised burns project
• Major trauma
• Maternity
• Medically unexplained symptoms
• Mental health
• Paediatric emergency services
• Polysystems
• Quality and Safety Programme
• Staying healthy
• Stroke
• Tuberculosis
• Unscheduled care

Quality and Safety Programme

Improving the quality and safety of acute emergency and maternity services has been identified as one of the NHS in London’s key priorities to deliver by 31 March 2013. As a priority, the programme will address the current variations that exist in service arrangements and patient outcomes between weekdays and weekends, and between and within hospitals in London.

More than half a million patients are admitted to London hospitals as an emergency every year. They should expect to receive consistently safe, high quality care. However, figures show that patients admitted at the weekend have a significantly increased risk of dying compared to those admitted on a weekday. For London, this equates to more than 500 lives a year.

For maternity services, any preventable maternal death is unacceptable. Over 18 months (January 2009 – June 2010), 42 women died in London’s hospitals or at home whilst pregnant or within 6 months of giving birth. With a maternal death rate of 19.3/100,000 in 2009 and the first 6 months of 2010 compared to a national rate of 8.6 – this is a serious cause for concern. An external review found that 76% of the deaths had avoidable factors which, if managed differently, may have saved lives.

We have recently undertaken a review of emergency pathways for acute medicine and emergency general surgery patients, and commissioning standards have been developed to improve these services. These were fully endorsed by the London Delivery Group and the Clinical Senate earlier this year.

Compliance with these standards will ensure that the assessment and subsequent treatment and care of patients admitted to these services as an emergency will be consultant-led, seven days a week and consistent across all providers of these services. Similarly a review of paediatric emergency services has recently begun with the aim of developing clinical standards to ensure children also access high quality and safe care.

• Adult acute medicine – led by Professor Derek Bell, Professor of Acute Medicine, Chelsea and Westminster NHS Foundation Trust
• Adult emergency general surgery – led by Mrs Celia Ingham Clark, Medical Director, The Whittington Hospital NHS Trust
• Paediatric emergency medicine – led by Dr Gulamabbas Khakoo, Consultant Paediatrician, The Hillingdon Hospital NHS Foundation Trust
• Paediatric emergency surgery – led by Mr Simon Eccles, Clinical Director for Paediatrics, Chelsea and Westminster NHS Foundation Trust

The development of clinical commissioning standards will now be expanded to all adult acute emergency and maternity services to ensure they are consistently high quality and safe across all providers. This includes the following services:

• Critical care and anaesthetics – led by Dr John Coakley, Intensive Care Consultant and Medical Director, Homerton University Hospital
• Emergency departments – led by Dr Andrew Hobart, Emergency Medicine Consultant, South London Healthcare Trust
• Fractured neck of femur pathway – led by Mr Gavin Marsh, Orthopaedic Consultant, Croydon University Hospital
• Maternity services – led by Ms Jane Wilson, Consultant Obstetrician and Gynaecologist and Medical Director, Kingston Hospital and Prof Jacqueline Dunkley-Bent, Director of Midwifery, Imperial College Healthcare Trust

The programme is clinically-led and multidisciplinary clinical expert panels are being established to support the development of clinical commissioning standards and consensus on clinical dependencies for each of the four service areas.

The programme will also support the establishment of interventional radiology networks across London as a key enabler to delivering the standards agreed for emergency interventional radiology as part of the adult emergency services review, reinforced by national recommendations. 

• Interventional radiology – led by Dr Robin Evans, Consultant Radiologist, Croydon University Hospital

The senior responsible officer for the programme is Caroline Taylor, Chief Executive of NHS North Central London, who will work with the programme team from London Health Programmes.