NHS managers were quizzed by health and legal experts as an independent commission investigated cuts that led to pressure on Northwick Park Hospital's A&E services.

The 'Shaping a Healthier Future' programme, set up in 2012 by clinical commissioning groups across nine north west London boroughs, plans to reduce nine hospitals to five major hospitals, with the other four either planned for closure or classified as local hospitals without full A&E units.

Changes began in 2014 with the closure of the A&E facilities at Central Middlesex Hospital and Hammersmith Hospital - but patients raised concerns as waiting times at Northwick Park's A&E unit remain among the worst in the country.

Brent, Ealing, Hammersmith & Fulham, and Hounslow councils set up a commission chaired by Michael Mansfield QC to examine the impact and implications of the plans.

A meeting held at Brent Civic Centre on Saturday saw a range of patients, health service providers and elected members provide information to the commissioners.

Dr Mark Spencer, medical director of the SAHF programme, was unable to explain why the business case for the reorganisation was still not finalised when two A&Es have already been shut, adding: “I’m not the person to answer financial questions.”

Meanwhile Dr Stephen Hirst, a retired GP from Chiswick, described the SAHF programme as a “juggernaut that has started and was impossible to stop.”

Councillor Muhammed Butt, leader of Brent Council, said: “All along we have warned about the impact that the Shaping a Healthier Future Programme would have for residents.

“The ridiculously long A&E waiting times that followed the closures late last year demonstrated that our worst fears had become reality.

“The Shaping a Healthier Future programme is now getting the independent scrutiny it needs and I look forward to hearing the Commission’s findings so we can protect the interests of patients.”

The commission was set up to undertake an independent review of the proposals and will now consider all written and oral evidence submitted, before publishing a report on their findings in July.