May 18 Save Our Hospitals March

At the Save our Hospitals march yesterday. With the CQC saying earlier this year that a cap should be put on admissions to A&E at Queens (see http://www.bbc.co.uk/news/uk-england-london-21249500 ). It seems dangerous to close a string of London A&E departments when the Newark experience (see blog below) suggests there will be an increase in emergency patient deaths if A&Es are closed.

Evidence that A&E cuts cost lives

Lee Scott's claim in February 2010 that to close King George A&E will mean that "people will die" appears to be gaining supportive evidence.

The Mail on Sunday claims a 37% increase in death rates since Newark A&E was closed. The story is here http://www.dailymail.co.uk/news/article-2323141/Shocking-proof-Accident-Emergency-closures-cost-lives-Death-rate-jumps-THIRD-department-closes.html
I have written to Averil Dongworth, the local NHS  Chief Executive to ask if she will examine what has happened at Newark and report if it means King George A&E should be kept open to prevent a similar spike in the death rate.

I will publish Averil's response on this site.

Balancing ‘good news’ with risk assessment-how the two discourses are managed

Neil Zammett writes

We all have a stake in Queen’s and we want it to succeed and provide good services but this has to be balanced by a realistic assessment of how the Trust is performing.

I have been very impressed by the Trust Chair’s, Sir Peter Dixon, statement in response to the Francis Enquiry which was published in their last Board papers.  I think it is exemplary and I would commend it as a model to those who read this Blog.  I have reproduced an extract from his paper below:

“In discussing the obstacles to the achievement of the sort of culture which puts patients at the centre and insists on nothing but the best, the report also outlines the sort of behaviours which prevent this happening:-

• A lack of openness to criticism;

• A lack of consideration for patients;

• Defensiveness;

• Looking inwards not outwards;

• Secrecy;

• Misplaced assumptions about the judgments and actions of others;

• An acceptance of poor standards;

• A failure to put the patient first in everything that is done.

I endorse this totally”

Despite the protests and the Council motion the maternity ward at King George has now closed.  I was outside Beckets House before the NELC meeting with fellow campaigners just to show my personal commitment to local services and solidarity with the women of Redbridge whose views and opposition to the closure are recorded in the Opinion Leader report commissioned by Health4NEL.

I was stunned to read the story of the last baby born in the Recorder and the Guardian and along with a lot of other people astonished to find out that the parents had rushed there from Queen’s after being kept waiting in a corridor for 40 minutes.  So much so that I had to mail a member of the Council’s Health Scrutiny Unit to make sure that I had understood the sequence of events correctly. Apparently I had.

It now emerges that the story of the final birth at King George was originally intended to be a “warm” one promoting the service at Queen’s.  What the public do not know is that there were two BHRUT press releases relating to the birth of baby Dovydas. The first on the 19^th, which is available on the Trust’s webpage, quotes a midwife making very positive comments about the new unit at Queen’s.

The second press release issued a day later on 20^th, which does not appear on the Trust’s webpage states that Mr Donatas had to wait “a few minutes...” not the forty he claims but a new edition of BHRUT News which I received on 26^th March appears to backtrack and admits that “... there will occasionally be bottlenecks in triage ...”

I am delighted that little Dovydas and his mother and father are all well but what is unclear to me is how these “bottlenecks” will impact on the service at Queen’s and if they will lead to additional risks for women.  My concern is that if it had not been for the publicity associated with this birth we would all have been totally unaware of the problems with triage that evening. 

Queen’s, along with other units in East London went through a supposedly rigorous quality assurance process before the decision to close the ward at King George was taken and yet this happens.  In my recent Blog “No room at the Inn” I observed:

“Women may have to travel further to have their babies and possibly change units at short notice because of daily spikes in demand. Under these conditions they will have no choice ...”

Mr Donatas agrees “If they hadn’t got space then, what’s going to happen now? Will they go to Whipps Cross or further away?”  We are very fortunate that he has such a clear view of the public interest.  Many of us would simply have been grateful that in the end all had gone well and not said anything.

Well one incident doesn’t make a trend and this was apparently a personal decision on the part of Mr Donatas and his partner.  I would certainly agree that Queen’s has more than enough capacity, triage apart, but there is a very tight situation across East London as a whole. What we need to see is how many women have to switch units at short notice because of capacity problems.

Unfortunately this is not the only example of ‘information management’ in this press release.  It also says that “There will be no redundancies in these plans which will strengthen staffing at Queen’s and in the community.”  This is not the full picture because Queen’s will be losing over 50 midwifery and three medical posts because of the cap placed on the number of deliveries.  The Trust intends to lose these through natural wastage but this represents a major reduction in the workforce.

Many will remember that only recently the Trust was recruiting in Italy and elsewhere in Europe to build up the numbers. The reduction therefore represents a significant waste of public money and effort on the Trust’s behalf, although I would say that this is not their fault but more something which can be laid at NHS London’s door.

What is clear to me is that two quite separate discourses are going on here.  The first is PR led and is about presenting the Trust in a very positive light with the objectives of promoting morale amongst staff and reassuring patients and the public.  It enters the public domain through press releases and tends to receive a high profile.

The second is evidence based and is aimed at making a balanced risk assessment of the Trust and its services and making planned interventions to reduce and manage this risk.  The risk management discourse enters the public domain through a different route, largely reports and board papers which are published by various bodies such as CQC and until now, NELC and NHS London. It often has a fairly low profile as a consequence.

Of course I can see the logic behind the PR led discourse and I would support its aims. Unfortunately, it is also obvious to me that if there is too big a “gap” between that and the risk management discourse there are going to be problems of credibility and perceptions of openness.

The crucial bed forecast for BHRUT has been withheld for nearly six months now, despite my asking for it at just about every meeting I go to, and more recently the extraordinary board minutes for February have disappeared from the website. They appear to have been replaced by finance and quality reports for month 9 (December).

I have seen a copy of the minutes for the extraordinary February meeting which was exclusively to discuss a response to the CQC before their deadline of 27^th February when conditions would have been imposed.  While I can understand that there might be reasons for having a board meeting with the public excluded, I do not understand why there is no such statement to this effect on the website which would be the normal portal for public enquiries.

I hope Sir Peter Dixon reads this blog and more importantly does something about it.

NB  This blog was delayed because my daughter was admitted to hospital.  She’s fine now but I have been travelling to the Royal Free every day.

Pics and Press Links from March 7th

Pics and press from March 7th photo shoot outside NHS meeting that made the decision to close KGH maternity.

Wanstead and Woodford Guardian
 http://www.guardian-series.co.uk/news/rbnews/10275012.Campaigners_slam_health_bosses_after_maternity_closure_is_finalised/

Ilford Recorder http://www.ilfordrecorder.co.uk/news/news/decision_was_not_if_to_close_king_george_hospital_labour_ward_but_if_it_was_safe_board_says_1_1969889

THE FUTURE OF HOSPITAL SERVICE FOR REDBRIDGE RESIDENTS

Helen Zammett writes


 WHO WILL BE RUNNING YOUR LOCAL NHS IN APRIL 2013?

   The answer is your local GPs.  The primary care trust which organised the local health service will be replaced by a GP Commissioning Group.  Each Borough will have a committee made up of local GPs - one from each group of GPs, called polysystems and 2 lay members, one of which is responsible for representing the public's views.  They will hold the budget for the health services provided for residents in their borough and make the decisions on how it should be spent.  

  WHAT PART CAN THE PUBLIC PLAY IN THE NEW ORGANISATION?

 The organisation which represented the public's views on their local health service, the LINK, is being replaced Healthwatch, which is to involve the public in major decision making around local health services and social care.  

 WHAT IS HAPPENING IN OUR LOCAL HEALTH SERVICE HOSPITALS?

 In December 2010 the decision was made to implement a plan, which originally was to close Accident and Emergency and Maternity together at King George Hospital [KGH] in Redbridge in April 2013.   The KGH maternity unit is due to close in April 2013, with the births being moved to Queen's Hospital and Whipps Cross.  However, for reasons outlined below, now there is no given date for the closure of KGH A+E.   ACCIDENT AND EMERGENCY

 · The primary reason for not closing the A+E at KGH is that the number of patients attending them and being admitted to emergency care, has made it not possible at present.
    · From the end of October 2012 there has been a steady decline in the  performance of Queens and KGH, which has seen only 60 - 65% of patients seen within 4 hours - the target achieved by many other hospitals is 95%.

   KGH is doing better than Queens, where there have been waits of up to 11 hours.

   · The underlying problem of the two A+E departments is that they serve a much larger population than other A+E units in NE London.
 · Due to the pressure of patient numbers, Whipps A+E is now starting to have problems and were forced to purchase additional community beds recently.
  · Population increases and the national trend for more people to go to A+E, means that more people will use A+E year on year.
 · The fact that our local healthcare trust BHRUT [Barking, Dagenham Havering and Redbridge University Trust] has admitted that it has run out of contingency beds, underlines the seriousness of the problem.   · Between 6 November 2012 and 3 February 2013 KGH and Queens had 439 ambulance cases which were not seen within 30 minutes - the second highest in London [1st Croydon with 500, 3rd Lewisham with 159].   MATERNITY
 · The original plan proposed that women would go to their nearest maternity department, which would have meant that women would go to Queens, Whipps Cross and Newham hospitals.
   · The plan was approved on the basis that a further maternity facility would be built, up and running at Whipps Cross before the KGH unit was closed.  So far, this new facility has not even been approved for building by NHS London
.   · Because of lack of capacity at Whipps,  women from Waltham Forest will be redirected to the Homerton Hospital in Hackney.
  · A cap of 8,000 births a year will be imposed on Queens, which had births of up to 10,500 recently.  This means that 53 midwives will be lost from that hospital.  Midwives are in chronic short supply in the NHS and have proved hard to recruit.
   · Imposing the cap may be applied to other maternity units, which could cause long term capacity problems.
  · Studies showed that the KGH maternity unit was a popular option for Redbridge women.  When this closes, they will have less patient choice.  With the 8,000 cap at Queens and no new unit at Whipps, short term capacity in NE London will be limited.

  IF YOU WOULD LIKE TO PUT YOUR VIEWS FORWARD
  Speak, email or write to your GP Ask your GP to  join their Patients Panel   Speak or write to your GP representative on the Clinical Commissioning Group   Speak, email or write to your MP   Speak, email or write to your local councillor:   Speak, email or write to the councillor who is Redbridge Cabinet Member for Health, Cllr John Fairley-Churchill, 0208 708 0205 email:  cllr.fairley-churchill@redbridge.gov.uk. 44 Green Lane, ILFORD IG1 1YL

Like Oliver Twist Redbridge should ask for more

Neil Zammett writes 

Just recently the Public Health budgets for the next two years have been published by the DOH in a complicated format which shows the enormous differences in spend across London.  Apart from Bexley Redbridge has the lowest current and planned spend per head, now and in two years time.

                                                      Baseline 2013-14         Grant 2014-15  

                                                              £Per head                      £ per head

Tower Hamlets                                          113                                         116

Hackney                                                        112                                         117

Newham                                                       68                                           81

Barking and Dagenham                            60                                           71

Waltham Forest                                         38                                           45

Havering                                                       33                                           39

Redbridge                                                    32                                           38

Even though we have shared public health challenges with Inner London around Diabetes and Tuberculosis there is an enormous disparity in investment in these vital preventive services.   The supposed “equalisation” exercise has in fact seen the gap between Redbridge and most other boroughs actually increase.

It is not just Public Health where Redbridge is the poor relation; investment in family doctor service has been cut as well.  As part of the closure of A&E, Redbridge was supposed to be getting four more polyclinics now that is down to one in vacant accommodation at King George.  The bulk of new investment in primary care will be going into other boroughs.

There are also warnings that the overall allocation for next year, used to buy all of our hospital and other health services is short by well over £10 and possibly up to £20 million.  I have also heard that there are plans to reduce community beds at places such as Wanstead hospital.

Looking around; Havering has Queen’s, Whipps has a new A&E, Barking and Dagenham a new birthing unit, Newham a new A&E and maternity extension, the Homerton a maternity extension  and Tower Hamlets a billion pound new PFI hospital. 

Redbridge has nothing.

In all of this Tower Hamlets and Inner London more generally are the big winners but Redbridge stands alone as the Borough which loses most and on all fronts. Isn’t it time for us to start asking for a bit more and not to be bashful about it?  If Oliver had the courage do it so can we and it’s time for our CCG and other representatives to start making some noise.

Public representation and CCGs

How the public are going to be represented in the new style NHS is like so much else these days-a complicated arrangement.  The former LINKs (local involvement networks) are being transformed into Healthwatch with a brief to represent the public as an independent body.  For those who remember the CHCs (community health councils) they are going to be much the same although in Redbridge complaints will be dealt with by a body covering several boroughs. They become operational on 1^st April this year at the same time as our CCG (clinical commissioning group) goes live.

The CCG itself will have two lay members one for governance, mainly financial issues, and the other to represent the views of the public.  How they are going to do this is not entirely clear given the size and complexity of the population here in Redbridge.

To add to the mix there is a CCG Engagement Forum made up of representatives of the PPGs (patients’ participation group) at individual GPs practices across the Borough.  They also have a role in informing GPs about public opinion.

It also now looks as if the local authority Health Scrutiny Committee will continue and we can add to this the Joint Health Overview and Scrutiny Committee and I personally welcome this. Confused? Well who wouldn’t be.  Here in Redbridge we have additional problems because of the history of public opinion being so strongly opposed to the closure of A&E and Maternity at King George, baggage which the CCG has inherited.

To build confidence they need to ensure that they have representation which is truly independent and have a demonstrable commitment to linking with existing community networks and organisations.

The DOH are worried about this as well and have commissioned an external report on embedding patient and public engagement in CCGs.  To quote from a statement in the Health Service Journal taken from the study

”Some are concerned that CCGs may pick lay members who act as champions for them rather than challenging decisions.”

The test we should be applying is one of credibility looking at the track record of representatives in terms of their connections with local networks and speaking out on issues such as closures and also their association with the NHS. 

We need to recognise that any representative will have to deal with the baggage the CCG has inherited particularly as the most senior staff are so closely associated with the previous PCT’s history of poor quality consultation.

They deserve our support.

Let’s have clear financial accounting

If all of this wasn’t enough we also have a simmering problem with the way in which the finances of trusts and PCTs/CCGs are reported.  Regular readers of this Blog will know that I have been pointing up the amount of non-recurrent reserves and other special funds which have been propping up the spending position in NE London for a while now.

This means that a quick look at financial reports and year end accounts does not show the underlying position, although I have calculated that there is some £120 million of non-recurrent funding of various types supporting Barts Health and BHRUT alone.  How much of this is going to be “bridged” for future years is not clear to me. NHS London due to close this March is forecasting a surplus overall  for 2012-13 of £150 million including the use of reserves but understandably they have not produced draft balance sheets and I &E (income and expenditure) statements for 2013-14.

My concerns are that we are being lulled into a false sense of security which could affect key decisions. Barts Health is slipping badly on its savings target which is ironic because the savings were one of the main reasons for creating the giant trust in the first place.  Similarly with BHRUT I am not clear how their savings plan reports compare with the baseline they set at the start of the year or whether the additional money they have received for over performance (treating more patients than planned) is artificially generous.

I would like to see a separate section of financial reports and accounts introduced as an accounting standard which required trusts and PCT/CCGs to show the true underlying financial position more clearly.

NHS Correction on major incident

I have asked to put the below at the request of the NHS

 A spokesperson for NHS North East London and the City said: “Barking, Havering and Redbridge University Hospitals NHS Trust experienced a major surge in demand for its accident and emergency service in early January. This was incorrectly reported as a “major incident” in a paper to the NHS North East London and the City Board last month. “The Trust reported the surge to NHS North East London and the City (primary care trust) and it was agreed that staffing in the Emergency Department would be increased and 16 beds would be opened to deal with the increase in patients. It is usual when there is a surge in demand for the service for this to be reported to the primary care trust so the hospital and PCT can work together to ensure services are available for patients. “We apologise for any misunderstanding as a result of using the phrase major incident.”