Is CQC to make a finding?

The following appears in an Ilford Recorder Story regarding a CQC visit to Queens earlier this month:

 “The CQC will not make any recommendations in the report but the Department of Health is expected to take its findings into account when finalising the transfer of maternity services.”

 My hope is that the CQC will make a finding into whether the proposed closure of KGH maternity is safe. When Ofsted visits a school, it makes a public report available which contains findings about the quality of the education there. It seems reasonable to expect the CQC to do something similar regarding the closure process for KGH. Has BHRUT got the beds and staff in place at the units to look after the women safely who would have gone to KGH?

 We know the CQC is at Queens, but they also should go, have they already not have gone to, the other units who will be affected by the changes to make sure they can cope with the closure. If the closure does go ahead next year, my hope is that a cross party campaign will be set up for the return of maternity provision. A borough heading towards a population of 300,000 deserves a maternity unit.

Whether the CQC makes a finding about the safety of the closure of KGH maternity will set a precedent for what happens with the proposed A&E closure.

 The Recorder story is here. http://www.ilfordrecorder.co.uk/news/news/cqc_report_into_maternity_at_queen_s_hospital_awaited_ahead_of_closure_of_services_at_king_george_1_1754919

NHS responds to Photo Shoot

Andy, Thank you very much for your email. response in the New Year, as the CQC have been in to visit our Maternity Department recently and we are awaiting their draft report. Once this has been received, I will be able to answer your questions more fully. Averil Dongworth Chief Executive

Will the CQC act over KGH?

Thank you to everyone attending today. I have written to Averil Dongworth, Chief Executive of BHRUT asking if the CQC will be signing off the proposed closure of KGH maternity as safe.

Good to see a Recorder photographer there.

Mail on Sunday Press Link

The Link below is a recent Mail on Sunday story which mentions KGH. The December 9 paper had a picture of Iain Duncan Smith and others outisde Ilford Town Hall.

http://www.dailymail.co.uk/news/article-2245273/Scandal-secret-plan-axe-thousands-hospital-beds-doctors-warn-patients-risk.html

Neil Zammett on Maternity changes

The current position

 The NELC cluster PCT is following the plan agreed by their Board on 19th September 2012. This involves a number of “gateway” checks on the readiness of the units in East London (Queen’s, Barking, Newham, Whipps and the Homerton) culminating in an update on progress and a recommendation on the closure of the KGH obstetric unit at their January 2013 Board meeting. The safety and quality checks are being led by Christina McKenzie an external consultant. There is no reference to the involvement of CQC that I can find in their papers.

 Part of the plan is changing the catchment areas for units in November 2012 so that around 1000 maternity bookings transfer from BHRUT, largely Redbridge residents, to Newham and a similar number from BHRUT to Whipps. A new component to the plan is the transfer of 1000 bookings from Whipps to the Homerton to “make room” for the women from BHRUT. Because of the obvious “lead time” on maternity booking need to be transferred in advance of expected births. To my knowledge there is no formal, explicit statement by CQC either in terms of a letter, electronic communication or minute from a meeting which would correspond to the statement in the Secretary of State (SOS) letter. There are qualified statements in general support of the plan in their concluding report on their special investigation of BHRUT, but their conclusions also include cautionary statements about the sustainability of perceived improvements.

My views

 I think the SOS letter has highlighted an important point which is CQC assurance on service quality. I think it is singularly unfortunate that the letter was delayed in circulation for almost a month and this does give us less time to act. Members may wish to ask why such an important communication was delayed for so long. I had assumed that CQC had been in touch with the SOS office and given the necessary assurances but clearly this is not the case. I also assumed that CQC would have had a formal meeting, or exchange of correspondence, with NELC at which their approval would have been recorded. On the face of it this again appears not to have happened. We have therefore the very serious situation where the SOS believes that nothing happens until CQC have given an assurance while NELC have changed catchment areas without this assurance. I would also say that there is a point at which the decision becomes a fait accompli and attempting to reverse it becomes riskier than proceeding. Obviously it is right that CQC approval should be sought before this point. In the circumstances I believe it is vital that we seek urgent clarification from the SOS office of their understanding of the position of CQC, particularly as patient safety is involved.

Correction to previous post

The NHS have asked me to correct the date in the previous post. KGH maternity is proposed to close in late March 2013, not February 2013 as I stated earlier. My apologies for the error. NHS email follows

Thanks Andy.


 I’m sorry this letter has caused confusion. It doesn’t relate to the proposed closure of King George to maternity deliveries in late March 2013, but relates to the transfer of a small number of mothers-to-be to Whipps Cross, part of Barts Health. These women generally live closest to Whipps Cross, and in an area that will be served by Barts Health community midwives. Only women in the early stages of pregnancy, due after 1 st February, are being asked to transfer, which is where the 1 st February date came from. This is part of the commissioner-led maternity plans, and if you have any queries on this, you may find it most helpful to contact Zoe at NHS North East London and the City in the first instance.

 Kind regards,

 Imogen

 Imogen Shillito Director of Communications

Does CQC have some work to do?

Below is my email to Lord Howe sent earlier today, it seems that the CQC need to tell Mr Hunt, the Secretary of State for Health that the planned closure of KGH maternity in February next year is safe.
I can't find a record of this happening hence the email.


Earl Howe
Parliamentary Under Secretary of State for Quality (Lords)

Dear Lord Howe

Thank you for writing to Redbridge Council, in your letter of 29.10.12 you write.

"..no changes will take place until until the Care Quality Commission...has assured the Secretary of State and other local health services are of a high standard"

However, King George Hospital maternity unit is to close in February 2012 without the CQC saying it is safe to do so.

I would be grateful if you could let me know if you agree that the CQC must say the closure process is a safe one before the unit can be closed.

My recollection is that Mr Lansley gave assurances about the CQC and the closure of hospital units when endorsing the IRP decision on 27.10.11 but I cannot find his letter, please could you send me a copy of his letter of that date.

The Press Release below suggests the Secretary of State is to be written to by the CQC, but Mr Lansley's letter of 27.10.11 may have a stronger wording.

The most recent CQC report I can find is 27 June 2012 (there may be a more recent one)
and states at http://www.cqc.org.uk/media/cqc-says-more-needs-be-done-barking-havering-and-redbridge-university-hospitals-nhs-trust

"The progress report shows that, of the 81 recommendations made in the investigation report last October, 27 have been met and 48 partly met to date. Structures across the Trust have been changed as a result of CQC recommendations, although it is too early to say in many cases whether permanent improvements have been achieved.

While the Trust has made improvements, especially across maternity and radiology services, emergency care still remains a serious concern. More also needs to be done to improve staffing across the Trust. The Trust is struggling to deal with increased complaints, which may have been sparked by the CQC investigation.

Matthew Trainer, Deputy Director of CQC in London, said:

“The direction of travel at the Trust is encouraging but - as they acknowledge - they still have some way to go before they are consistently delivering the quality of care that local people are entitled to expect."

This does not appear to meet the criteria set down by Mr Lansley before King George maternity can be shut.

Yours sincerely

Andy Walker
DoH press release 27.10.11

However, no changes will take place until the Care Quality Commission, which published its own report on local services today, has assured the Secretary of State that the services provided by Queen’s Hospital and other local health services are of a high standard.  The IRP recommendations also require a vision for the future of King George’s Hospital in Ilford to have been presented prior to implementation.

As the IRP report makes clear, the proposals set out in Health for North East London, first published for public consultation in 2009, offer the best possible configuration of local health services to provide a high quality NHS in the future. The Secretary of State for Health has accepted the IRP’s recommendations in full, but they will only proceed to implementation when actions agreed by the Trust in cooperation with NHS London and the wider local NHS, in response to the Care Quality Commission’s inspection report, are implemented, and the Secretary of State has been assured of their effect.

CQC mystery?

Thank you to the Redbridge resident who drew my attention to a recent letter from Earl Howe, a minister from the Department of Health, to Redbridge Council which gives the impression that the Department of Health expects the CQC to give approval as safe any plans to close KGH maternity.


I don't recall seeing any such plans.

The CQC report here

cqc-says-more-needs-be-done-barking-havering-and-redbridge-university-hospitals-nhs-trust

does not seem to say it is safe to close KGH maternity.

I will make enquires and write further in due course.

Iain Duncan Smith photo shoot

Many thanks to Iain and everyone else for attending.

Iain's message of support can be read at.

http://www.guardian-series.co.uk/news/10068257.Lansley_was_wrong_on_King_George___IDS/

Iain Duncan Smith MP to do photo shoot

Iain Duncan Smith MP is to do a photo shoot in support of the campaign to keep open King George Hospital A&E and maternity units on Friday 23rd November at 11am outside Ilford Town Hall.

It would be helpful if we could could get 40 or so people there to support Iain on the day. If you cannot make it please pass the message on to friends and family.

Many thanks to Iain for helping the campaign and to Helen Zammett for organising the photo shoot

Consultation and disclosure-Key to maintaining good government

Neil Zammett writes

I attended Redbridge Health Scrutiny on 22^nd October, an extraordinary meeting just to deal with closure of A&E and Maternity at King George. It was a long and eventful meeting which raised a number of important issues;

· The right to consultation,

· The timely disclosure of documents

· The use of presentations instead of papers for meetings

Although the Committee did not identify these issues as a theme to me they all relate to Standards in Public Life which were laid out in detail by the Nolan committee. Just as a reminder Lord Nolan was charged by the Government with identifying the essential aspects of standards which were perceived at the time to have been “slipping”.

Two of the areas he identified were openness and transparency and I believe that the three issues which the Scrutiny Committee identified fall fairly and squarely into these categories.

The right to consultation

Letting people know what is going on is a prerequisite of good standards. It is at the heart of openness and good governance. The present Government has reaffirmed its commitment to local people having a say partly through the localism bill and also the emphasis it has placed on local decision making in its reorganisation of the NHS.

But for Health Scrutiny committees there is an additional safeguard because since 1974 the right of consultation is backed up by a statutory obligation. This means that if action is taken to close, change the use of or “substantially vary” local services without consultation this act is unlawful or “ultra vires” to use the technical term.

There are two exceptions; where urgent safety issues prevail and where a pilot scheme is involved.

If a senior NHS manager were to knowingly act “ultra vires” it would raise serious issues about their judgement and the governance of their organisation.

On 22^nd the Redbridge Scrutiny committee voted, (after some considerable wrangling with the Chair, with only one member against) to seek consultation on the changes to the plans to close Maternity Services at King George. This was based on the inclusion of the Homerton Hospital in the plans and the continued presence of A&E at King George.

But there are other closures taking place which the committee has not been informed of; St George’s in Hornchurch is one and closure will have an impact on King George. Foxglove ward was closed based on more intensive use of St George’s now this is closed as well.

Safety was an issue at St George’s because the antiquated heating system could break down, but this does not remove the obligation to consult unless the situation is urgent and to my knowledge it was identified as an issue some years ago.

We also need to know what changes at King George have resulted from the closure of St George’s; have wards such as Foxglove been re-opened to accommodate the patients displaced from St George’s?

The timely disclosure of documents

After numerous requests the Maternity Workforce Strategy for East London was sent at the eleventh hour to the Committee. Dated May 2011 it has never been published or subject to consultation even though workforce issues were central to the case for closing the maternity unit at King George.

What this reveals is the shocking fact that we need to double the number of doctors in five years and increase the number of midwives by 40%. It also shows that some of the hospitals which will benefit from the closure, like the Homerton actually have lower staffing levels than Queen’s and King George and that Whipps will have to double the number of midwives because it has such a low starting point.

Members also wanted to see the new outline business case for A&E at Queen’s because this is key to understanding the timescale for potential closure at King George and also reasons for the delay. This was declined because work on the plan is continuing.

But without key documents like this the Committee cannot do its work and the plan has been circulating within the NHS for months.

The use of presentations

Documents are the stock in trade of statutory organisations because they form such an important part of the way they work. They are integral to the legal basis for decision making and the governance of the organisation. Increasingly documents have been replaced at scrutiny meetings by presentations. This creates all sorts of problems because members do not have time to prepare questions and the spoken word is capable of different interpretations particularly if the meeting is not recorded in some way.

Effectively, presentations undermine the processes of good governance if they are used in place of written papers. Of course used in a supplementary way they can be very helpful but they are now becoming the norm not just in Redbridge but at the Joint Health Overview and Scrutiny meeting which covers the four outer London Boroughs.

Bullet points are no substitute for properly argued papers which can be evaluated and challenged.

The impact on scrutiny and governance

The combined impact of these three issues is to undermine the work of scrutiny and to prevent elected members discharging their constitutional responsibilities. It also runs totally counter to the principles of openness and transparency established by the Nolan Committee and represents bad government.

We should remember that these principles and the statutory right to consultation are there to protect the public and maintain standards in public life.

The vote by the Redbridge Scrutiny Committee to request consultation the new Maternity plan represents a welcome step towards recognising this.

Duncan Smith MP supports campaign

Great to read Abul Taher's piece in the Mail on Sunday today. It includes the very welcome quote from Mr Smith "I will continue to support the campaign to prevent the closure of A&E services at King George's" Many thanks to Mr Khan from Chadwell for getting in touch with the MoS. Full piece at link below.

http://www.dailymail.co.uk/news/article-2227374/Dial-111-A-E-shambles-Flagship-new-NHS-phoneline-actually-INCREASES-ambulance-outs--PM-savaged-closures.html

Can you help Mail on Sunday report on KGH A&E?

Abul Taher of the Mail on Sunday is writing a piece on KGH A&E. 

If you know of any patients who would be adversely affected by the proposed closure it would be great if you  could ask them to contact Abul.

His email is abul.taher@mailonsunday.co.uk  or phone him on 0203 615 3018 

Press from Photo Shoot

The Ilford Recorder is below

http://www.ilfordrecorder.co.uk/news/news/king_george_hospital_campaigners_mark_one_year_since_closure_decision_1_1674039

And the Wanstead and Woodford Guardian below

http://www.guardian-series.co.uk/news/rbnews/10013582.REDBRIDGE__Call_for_public_consultation_on_maternity_unit_closure_at_King_George/

This includes a quote from Neil Zammett below which made me smile


 "Over the last year we have seen many of the arguments put forward by campaigners have been proved right. Now they are unable to close the A&E department and the decision is moving backwards faster than the car in Back to the Future.We now want to have a public consultation on the maternity closure."

Photo from Today

Thanks to everyone attending today, great turn out in view of the weather.

Photo shoot Saturday 27 Oct 1pm ouside KGH

There will be a photo shoot tomorrow outside KGH at 1pm to say no to the proposed closure of A&E and maternity. Everyone welcome please pass the message on.

27 October is the one year anniversary of the decison to close the units.

Maternity Consultation and Mystery Document

Last night, a key Redbridge Council committee called for public consultation on the plans to close KGH maternity next year and change the catchment ares for over 2000 births a year.

The original plan was to close KGH A&E and maternity at the same time but this has been dropped with no definite date for the closure of A&E. The loss of the the A&E was an argument for closing maternity, now that A&E will remain open, why is the NHS not considering keeping maternity provision in Redbridge?

Let's hope the NHS do the right thing and agree to a public consultation on their planned changes.

What also emerged from the meeting is that there is a secret plan for the future of KGH and Queens called the Outline Business Case. How can the public and cllrs comment on these plans if they cannot be seen? This document needs to be disclosed quickly so that residents know what is planned for our hospitals.

How we move forward on A&E and develop a strategy for East London

 Neil Zammett writes 

 I attended the Joint Health Overview and Scrutiny Committee (JHOSC), the scrutiny committee which covers Havering, Barking and Dagenham, Redbridge and Waltham Forest on Monday 8^th October and took the opportunity to ask Averil Dongworth the Chief Executive of BHRUT what the current position on the closure of A&E at King George was. 

Her reply indicated that there has been no further progress since Nick Hulme told the previous meeting that there was a very provisional date of 3^rd quarter 2014, dependent on the outline business case (OBC), for an extension of the A&E department at Queens being approved.  She did say that she is not happy with the current situation; they are getting closer, however. 

In view of this I thought it would be useful to re-visit the forecasts in the original Decision Making Business Case (DMBC, see page 92).  These showed that around 250 beds would have to close by 2013-14 to allow for the closure of A&E at King George, while to date the Trust is showing 60-70. 

This is not a “near miss” but a very significant under shoot which warrants further explanation; how could the original forecast been so far adrift? 

There are three factors which affect future occupied bed numbers at any hospital.  The first is length of stay reductions primarily for emergency admissions, the second is the assumptions which are made about demand management again around emergency admissions and the third is growth driven by population change and referral patterns.

It is a particularly complex problem because length of stay reduction has to be balanced against growth in demand.  It is a bit like filling a tank with a hole in the bottom with water.  As the water runs out {length of stay reducing} water runs in {demand increasing} the water level {the number of occupied beds} rises or falls with the differences in rates of flow. 

Length of Stay 

In the original DMBC plan this was anticipated to be the biggest source of bed reductions with 331 going at BHRUT by 2016-17 and 250 by 2013-14. 

  

Nationally length of stay has been reducing for a long time and recent trends[1] from 2000-01 to 2009-10 show that in the decade it has reduced by 32% or just over 3% a year.  This is not the full picture because in later years, from 2007-08, the decline has slowed and “flattened” out.  

One of the problems with the forecasts in the DMBC was that local managers were allowed to input their own value for length of stay; so managers at the Homerton forecast a reduction of 6% in the five years to 2016-17 which is very unlikely, while those at BHRUT forecast a 29% reduction, equally unlikely given the national figures would suggest a value of 15-16%.

  

In my briefing note for January 2011 I drew attention to the need for some form of validation of the very large length of stay reductions proposed for BHRUT because this was such a critical part of the overall plan. 

Demand management 

Demand management is shifting elements of work and therefore hospital admissions to primary care and community settings, principally the GPs.  This results in lower demand for beds.

  

It was a much smaller component of bed reduction forecast in the DMBC and accounts for just 37 beds in BHRUT as a whole by 2016-17.    Over the East London as a whole the figure is just over 100 beds.  This is however dependent on GPs having the capacity to take on additional work particularly for long term conditions such as diabetes.

  

We know however that primary care in Redbridge has a high number of singlehanded practices, many buildings needing replacement or major refurbishment and a “bulge” of doctors nearing retirement age.  These factors make it very unlikely that demand management will yield the reductions forecast. 

  

I would therefore be inclined to exclude demand management from forecasts, particularly as it is such a small figure and there is no evidence that it has occurred in East London over the past two years.

  

 Activity Growth 

Unlike length of stay, growth was determined by the team which put together the DMBC and used a combination of population forecasts, largely from the GLA and estimates of non demographic factors.  Without further information it is difficult to make detailed comments but overall the values used appear reasonable except in the case of Tower Hamlets where for some reason a negative growth factor appears to have been applied.

  

There does, however, appear to be an arithmetic error in the table on page 91 where an allowance for the growth at the supposedly closed King George hospital has not been included in the Queen’s figure.  This would add an extra 60-70 beds to the 107 shown.

Nationally admissions have continued to rise consistently by about the same amount as length of stay has reduced about 3%, roughly compensating for the impact of length of stay on bed numbers.

 Where does this leave us?

  

What this amounts to at BHRUT is that the value of length of stay used for a five year forecast was more likely to occur, on average, in around ten years.  A separate forecast for two years up to 2013-14, the notional timing of the closure of A&E, showed a 22% reduction which, on average again, would be more likely to be achieved in seven years using the national average of 3% per annum.

  

Additionally, individual hospitals are sensitive to local circumstances such as the availability of nursing home and community hospital beds with clinical practice and staffing levels being factors as well.  Predicting large reductions like this for one hospital over a two or three year period is a very risky exercise with a high margin of error- a point which again I wrote about in my briefing note of January 2011.

  

Although there was some sensitivity analysis in the DMBC, which quite rightly picked up length of stay as a key variable, this was presented separately from the main analysis of future bed numbers which made the results look much more precise that they actually were. 

  

Decision makers at the December 15^th 2010 JCPCT will have believed that they were looking at forecasts which were absolutely precise and showed that bed numbers at BHRUT in 2013-14 almost exactly matched the number necessary to close the A&E department at King George.

  

For an individual hospital the factors listed above add up to a very volatile forecasting environment.  Any results from future exercises therefore need to be treated with considerable caution as has been demonstrated with the current uncertainty about the closure of A&E at King George. 

We will not have the full picture of the Trust’s, and the North East London and the City PCT’s, latest thinking and methodology until the OBC is available and we get an opportunity to review the latest assumptions and projections.  

  

This is now a very important document because it will replace the DMBC as the basis for decision making, at least as far as A&E at King George is concerned.

  

How can we move forward? 

There is no doubt that the current situation is a very uncomfortable one. Now that the forecasts for bed reductions at BHRUT in the DMBC have been shown to be far too optimistic we need to have a new plan to move forward.  Given the experience of the DMBC, this plan to have a much higher degree of flexibility to allow for the volatility of the forecasting environment. 

Equally uncomfortable are the implications of the failure to close A&E at King George on anything like the proposed timescale on the overall financial and service position of East London.  I would add that this does not diminish the promising work done at Queen’s to improve performance in A&E on the four hour wait target and black breaches.

  

All of this points towards a review of the whole plan drawing on the experience of the past two years.  It should also address some of the shortcomings of the DMBC by extending the timescale to ten years which would allow for population growth to be more adequately reflected.  It needs to include the Royal London/ Barts PFI which will have a huge financial and service impact on East London and the issue of surplus acute beds in Inner London. 

The important issue of investment, debt and the long term financial viability of trusts is an integral part of any sound strategy. As it stands the plan, or what is left of it, looks very biased towards Inner London with Redbridge and Barking and Dagenham being the major losers.

  

There is also the linkage with maternity which is closing on the proposed timescale, albeit with a radically different plan including the Homerton and shelving the plan for a midwife led unit at King George. 

An uncomfortable situation again given that the co-terminosity of A &E and Maternity was one of the main planks of the DMBC.  Additionally there is the issue of workforce planning for obstetricians and midwives.  The DMBC contained some rudimentary spreadsheets but these were obviously inconsistent with some of the service changes. We still have no idea if we can recruit the number of midwives we need for the rising birth rate or if the proposed “super units” delivering over 9000 babies a year represent a viable recruitment platform. 

What we need is:

1.      To see and evaluate the revised plan for A&E at Queen’s, the OBC.  We need to check that this plan looks at least ten years ahead to allow for population growth locally and that it is consistent with a broader strategy for East London which looks at investment policy and the impact of the new Royal London/Barts development.

2.       To seek an acceptance by health that the closure of A&E at King George now needs to be reconsidered in the light of the new forecasts.

3.      Using Health Scrutiny’s existing powers to ask for formal consultation on the changes to maternity services and to make sure that systems are in place to enable the majority of women to have the choices about style of birth and location which are national policy.

4.      Asking for a proper workforce strategy for maternity services in East London which shows how increases in demand are going to be met.

5.      Pressing at least for the continuation of the existing consultant led unit at King George to act as a buffer for increased demand.

Right of Reply in response to Dame Ruth attack?

Below is a copy of an email sent to Karl Mercer of the BBC earlier today

Dear Karl

Following a meeting of the save King George Hospital group earlier today I have been asked

to write to you about your piece of yesterday, for which I copy a link in case anyone did not see it http://www.bbc.co.uk/news/uk-england-london-19916547 carried statements by Dame Ruth Carnell attacking MPs and others who have campaigned against A&E and Maternity closures.
The clear implication of her remarks was that campaigners were irresponsible and were causing patient suffering. Comments I,and I expect the MPs and cllrs I have copied in, object to.

It seems fair that you do a similar piece letting the leading London campaign MPs defend themselves against these serious allegations. Perhaps Dame Ruth could debate the issue with some MPs and/or council group leaders, it would make good TV.

Dame Ruth is being irresponsible if she stands by the plan in BHRUT to King George A&E and Maternity and sack 25% of the medical staff in the area by 2015. The below comes from page 123 of the NHS business case document.

Health for north east London proposals will mean a reduction in medical staff at BHRUT but this represents no more than a 10% reduction in total medical staff in any given year: 2011/12 (Y+1)

2012/13 

(Y+2) -8%

2013/14

(Y+3) -7%

2014/15

(Y+4) -2%

This dangerous plan would have led to much suffering if implemented appears to have thrown out, but we do not know what the replacement is. I have heard a verbal report from an NHS manager that a large sum of money will need to be spent on a new A&E extension at Queens hospital, but as to how big and when this extension will be built is still unclear. To build a new A&E extension at Queens when there is a perfectly good one at KGH seems daft, especially when public money is tight and schools and housing could be built instead.

 Dame Ruth gives the impression that there is a medical consensus for the closure plans. This is not the case.

The Mail on Sunday recently carried a piece here http://www.dailymail.co.uk/news/article-2213984/You-stop-A-E-cuts-140-doctors-sign-damning-letter-David-Cameron.html?ITO=1490 with 140 Drs coming out against A&E closures. I know of BHRUT drs who cannot see Queens coping if King George A&E is shut, but they will not go the press because their contracts forbid them to.

The MoS has another piece here where the closure of an A&E has led to waiting times tripling http://www.dailymail.co.uk/news/article-2200339/NHS-Cuts--Savage-consequences-revealed-pensioner-waits-6-hours-ambulance.html

A Sheffield university study which found the closer a patient was to A&E upon collection the better their chances of survival were has been described as outdated to me by NHS managers. Until I see some clinical evidence for this assertion, I will continue to believe the finding of the study that for some conditions such as difficulty with breathing being close to a hospital is vital. An extract from the MoS about the study is at the 2nd link above.

I recently attended a school appeal on medical for a five year with acute asthma where the child's consultant said it was vital for the child's safety that he went to this particular school as it was close to King George A&E.

It would be great if you could come down to Queens/KGH at some point in the future and let campaigners tell our side of the story.

 Regards

Andy

NHS reply to earlier post

Andy Strickland Media Manager for ONEL writes

When writing about St George’s hospital in Hornchurch, you say: ‘If BHRUT were not planning to spend large sums of money on an unnecessary A&E extension at Queens it might have the money to keep the existing estate (i.e. at St George’s) up to standard.’

Just to clarify, St George’s is not a BHRUT hospital. The site is owned by NHS North East London and the City (NHS NELC) and services are provided by North East London Foundation Trust (NELFT), not BHRUT. So a bit unfair to criticise BHRUT on this one I’m sure you’ll agree. They aren’t involved in any of the decisions currently being taken about the bed-based services at the hospital or the longer term plan for the site as a whole.

Can you help BBC?

The BBC is to do a piece on maternity closures per the below.

If you know some "concerned mums" who would be willing to talk on the radio about the plan to close maternity at KGH, please could you ask them to contact Madeline on the number below.

From: Madeleine Briggs <Madeleine.Briggs@bbc.co.uk>
Subject: FW: KING GEORGE HOSPITAL MATERNITY
To: "'andy.walker@talk21.com'" <andy.walker@talk21.com>
Date: Thursday, 27 September, 2012, 12:55

Hello Andy Walker,

I’m a producer at BBC Radio 5live, you may have received a mobile phone message from me.

Next Tuesday on Shelagh Fogarty’s programme we are taking an in-depth look at Maternity and as one strand we will be looking at the closure of units.

We would be keen to speak to a couple of people from your campaign…

Would you be able to help put me in touch with some concerned Mums etc

Regards

Madeleine

Madeleine Briggs
Producer
BBC Radio 5 live - Daytimes ( +44 (0)161 3356506

@ Madeleine.Briggs@bbc.co.uk
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Extension & Maternity Mysteries

 Last night at a Council meeting I asked Dr Mike Gill, a senior BHRUT manager, about how many beds the proposed A&E extension at Queens was going to have in it. His reply was something along the lines about the size of the building being down to financial modelling which meant he could not be specific about the number of beds. Perhaps money, rather than clinical reasons, is driving what is going on at BHRUT. 

Later on, the same meeting was told that money was so tight a boiler could not be replaced at St Georges Hospital in Hornchurch which meant beds were going to have to be closed. If BHRUT were not planning to spend large sums of money on an unnecessary A&E extension at Queens it might have the money to keep the existing estate up to standard.  

Maybe the special council meeting on 22 October about KGH will write to Mr Hunt with this latest news. It is incomprehensible that BHRUT want to spend many millions on a new A&E building  at Queens to allow the closure of KGH A&E. Neil Zammett asked a question about whether the final decision on KGH maternity had been made yet and was told it had not been. It seems Clinical Commissioning Groups will have a say in the matter, which is contrary to the press reports indicating the final decision has been taken.

I have sent this post to BHRUT in case they want to comment.

Press links are below:

http://www.ilfordrecorder.co.uk/news/news/no_more_births_at_redbridge_s_only_maternity_unit_from_early_2013_health_chiefs_decide_1_1524286

http://www.guardian-series.co.uk/news/rbnews/9943440.REDBRIDGE__Maternity_unit_to_close_in_early_2013_at_borough_s_only_hospital/

Redbridge to write to Mr Hunt

Last night Redbridge Council agreed to write to Mr Hunt, the Secretary of State for Health asking him to "review" the proposals to "reconfigure" A&E and Maternity at KGH. I have written to the Chief Executive and party leaders drawing their attention to press articles about what happens when a A&E is shut and the remaining A&E struggles to cope, in case they feel any of this information should be included in the letter to Mr Hunt.
 A quote from David Rose follows taken from the Mail about what happens when an A&E department is closed. He writes:
 "As emergency cases are forced to travel elsewhere, the number of patients waiting in those departments for longer than the official four-hour target before being seen has more than tripled."
 The article mentions a Sheffield university study which found ambulance travelling longer distances to an A&E led ‘an increased risk of death’. The article can be read in full here http://www.dailymail.co.uk/news/article-2200339/NHS-Cuts--Savage-consequences-revealed-pensioner-waits-6-hours-ambulance.html The conditions needing care quickly are "anaphylactic shock, choking, drowning or having an acute asthma attack" according to link here. http://www.dailymail.co.uk/news/article-476632/Why-A-E-cutbacks-cost-lives-Labour-told.html

Dr Michie speaks out about what will happen if Ealing A&E is shut: ‘The consequence of closing Ealing A&E will be more dead babies and very sick children,’ said paediatrician Colin Michie. ‘The idea of shutting the A&E without providing extra capacity elsewhere is quite frightening. There is a complete disparity between the plans and reality.’
 Taken from http://www.dailymail.co.uk/news/article-2203809/A-E-shutdown-farce-backlash-begins.html#ixzz275XDpvAD The Sheffield study pre-dates the closure decision, however, I have raised it with NHS managers and never had a satisfactory reply for why it does not mean Redbridge residents will be put at risk if KGH A&E is shut.

Mr Hunt to save A&Es?

The Independent is running a story that Mr Hunt is about to do a U turn on A&E closures. It is not confirmed. http://www.independent.co.uk/news/uk/politics/hunt-paves-way-for-uturn-on-casualty-unit-closures-8157189.html

The Secretary of State should think again about plans to close A&E and Maternity services at King George

Neil Zammett writes

 

As I have been asked to present the petition asking the Secretary of State to reconsider the decision to close A&E and Maternity at King George to the Council I thought it would be useful to review where progress on the plans has taken us. 

A&E remains in a state of flux.  Two years on from the original decision and a year after Andrew Lansley’s qualified support for closure we still have no firm plan or date.  BHRUT are working on an outline business case which was supposed to have been agreed by their Board in August but was still under preparation when a question was asked of the Chair at their September Board meeting. 

Snippets of information from Trust meetings suggest that a revised bed forecast has identified 90 beds not included in the Health4NEL plan and that 3^rd quarter 2014 is the earliest very provisional “guesstimate” of the date when A&E will be closed.  Given the further delays in the business case this has now probably slipped into 2015.

 

Length of stay was identified in the original plan as the key variable in closing A&E and to date some progress has been made.  This has released 70 of the 250 beds originally identified for closure but clearly there is still a long way to go.  One of the problems is that emergency workload has increased and just recently the Trust has experienced an increase in length of stay. 

This is partly due to a lack of community beds a situation which the interim Chair of the Trust, George Wood, sees as worsening in the winter months.  News has just been released that St George’s in Hornchurch; a large local community hospital may close before the winter which will obviously increase the pressure on Queen’s.

 

Without seeing and evaluating the new business case, and the BHRUT interim Chair has promised that this will be a public document, I cannot take a firm view but all the indications are that a closure of the A&E at King George can be ruled out for at least the next two years.  

This reflects the views expressed not just by the Save King George Campaign, but local GP’s and the Council as well.  In the longer term the picture is much less clear and would depend on the Trust’s ability to maintain a reduction in length of stay and some stabilisation in the number of admissions.  We should remember that the original proposed closure date was around the turn of the financial year 2012-13, next March or April at the same time as Maternity. 

In the case of Maternity a detailed plan has just been published in the September Board papers of the cluster PCT, East London and the City. An initial view shows that as expected a “cap” is going to be placed on the number of deliveries around 8000 for BHRUT and that new catchment areas are going to be defined for each unit.   Unlike A&E the planned closure date of the King George maternity unit is March 2013, in line with the original plan.

 

This will involve about 800-1000 births transferring from BHRUT to each of Whipps and Newham.   In a major change from the original plan however, an equivalent number of births will transfer from Whipps to Homerton to make room for Redbridge women. 

This is because of physical capacity constraints at Whipps, a point raised by campaigners in the original consultation.  It should be noted that the detailed plan has yet to be agreed by all of the trusts involved.   The good news is that the cap is temporary which would allow BHRUT to re-open King George as demand increases. 

 

Taking A&E and Maternity together my initial reaction is one of considerable surprise. The underlying concept of the initial plan was the link between the closure of A&E and Maternity- if you close one; you have to close the other.  Now Health Trusts are effectively pursuing separate plans with Maternity to close in March 2013 and A&E remaining open for an indefinite period.  This totally undermines the thinking behind the original plan.

 

Many of the original concerns remain.  The plan will still result in very large units with about 9000 deliveries at Queen’s, Newham and Whipps in the medium term.  

Choice will obviously be reduced because women will not be able to opt for the popular King George unit and perhaps most significant of all; we still have no workforce plan for midwives.  It is important to realise that we are taking not just one but several major steps at the same time. The average size of a unit in London is around 4500 deliveries and only a tiny proportion of women have midwife led deliveries as opposed to the 40% planned.  We have no experience of recruiting to or managing units with 9000 deliveries.

 

There is also the problem that the original plan only looked five years ahead and thus understated the impact of population change. There is currently no provision for growth beyond 2015-16 which could be around 7000 additional deliveries per annum in East London, the size of a large maternity unit.

 

There are however some fresh concerns.  The new plan is more complex and is being implemented at high speed.  Ensuring that all the units involved can manage this pace of change brings new risks and in particular the day to day management of capacity issues.  When recording improvements a Queen’s CQC were particularly keen that adequate time should be given to ensure that improvements were sustainable.  In my view the new plan does not do this.

 There is a risk that significant numbers of women booked to one unit will have to be re-directed to another at short notice.  Underlying this is the issue of choice for women.  The original work of Health4NEL showed that women have a very good conceptual grasp of the choices they should have but that the “system” prevents them from exercising these choices in practice.  Although the new plan does mention choice it also recognises that women may have to travel further to exercise this and does not address the relationship between capacity and choices of location and mode of delivery.

 

There is also the vexed question of consultation.  As the decision is not to be made formally by East London and the City PCT until January 2013 there is enough time for this. Because the “caps” are temporary they would not qualify for formal consultation under the regulations.  However, given that the catchment area changes are a package and the Homerton proposal is new I would argue that the whole should be subject to formal consultation. 

 

In summary, the cluster PCT has made significant changes to the original agreed proposal of which the three most important are:

 

1.     Postponing the closure of A&E at King George for at least two years from now to an unspecified date in the future.

 

2.     Changing the Whipps Cross and Homerton catchment areas for maternity to affect large numbers of women in Waltham Forest. 

 

3.     “Uncoupling” Maternity and A&E which undermines the original logic of the plan to close Maternity. 

 

I suppose the postponement of the A&E closure could be seen as a victory for the campaign but I remain very fearful about the future of Maternity and issues around long term capacity and recruitment.  What seems to me to be missing here is a sense of strategy, taking a sensible look at the long term and balancing demand, investment and income. 

 

I guess I am talking abut vision.

 

For all these reasons it is a good time for a review of the original decision by the new Secretary of State.