There have been some rationalisations of hospitals located around West Middlesex

1.23  Figure 3 shows the hospitals surrounding West Middlesex as well as those barriers to travel between them such as the river Thames and the M4 motorway.

1.24  Ashford and St Peter's have both been recently downsized. There have also been changes of provision at Hammersmith and Queen Charlotte's hospitals. West Middlesex has seen an increase in the number of outpatient visits and diagnostic procedures while pressure on A&E services in London continues to climb.