Tuesday, April 17, 2012

C-sections back at KGH

The letter below is good news from senior NHS managers stating that planned C-Sections are back at KGH. I cannot recall such an expansion of services at KGH being in the original plan to close the maternity unit at KGH and hope it represents a move to keeping maternity services at KGH.

Becketts House
2-14 Ilford Hill

Tel: 020 8478 5151

5 April 2012

Dear colleague

Maternity services at BHRUT

Last year we wrote to tell you about some changes to local arrangements for maternity
services in north east London. We did this because of the concerns of patients, local
stakeholders and the Care Quality Commission (CQC) about the quality and safety of
services – particularly at Queen’s Hospital. 
A number of measures were introduced to address these issues, which are outlined in the
action plan circulated by Barking, Havering and Redbridge Hospitals Trust (BHRUT) to
stakeholders and on the website http://www.bhrhospitals.nhs.uk/aboutus/mhb.php.

The Trust has been working hard to improve the quality and safety of its maternity services
and to address the concerns raised by the CQC in 2011. BHRUT now has one of the highest
midwife to birth ratios across London and Essex, enabling all women to have one-to-one care
during labour. Anaesthetic cover has been enhanced to ensure timely administration of pain
relief and operations where necessary, and improvements have been made in the
promptness of assessment and treatment of women presenting in labour or with
complications in pregnancy. NHS London, local commissioners and the CQC continue to
monitor progress closely.

Some of the arrangements put in place were intended to be temporary, including moving
some activity away from BHRUT to take some pressure off the service and to provide the
Trust with the space to make the important changes needed.

This included Homerton Hospital providing some elective (planned) caesarean sections for
women under the care of BHRUT over the winter period. This will change from April 2012
with a new planned c-section service at King George Hospital, providing extra capacity and
enabling all planned c-sections to be provided locally.

Cont’d ……….


As agreed in the original plan communicated last September, from 1 April BHRUT is once
more offering Essex women the choice to book their births at BHRUT. BHRUT will continue
to work closely with Essex commissioners to enable this and to manage capacity across
North East London and Essex. In the longer term additional capacity is planned for Queen’s
Hospital to enable the centralisation of services onto the Queen’s Hospital site, as per the
Health for north east London proposals for change.

Looking more broadly across east London, commissioners are working with all five north east
London maternity services to ensure that all women, wherever they live in north east London,
are able to access a variety of services that meet their needs, before, during and after their
pregnancies. Newham, Whipps Cross, the Royal London and Homerton Hospitals are all
developing additional capacity for maternity services to support this aim and to ensure that
there is enough capacity across north east London to meet demand and enable choice both
now and in the future.

As part of this work, NHS North East London and the City has awarded Newham University
Hospitals Trust the contract to provide community midwifery services at Barking Community
Hospital. The team are currently working to set up the service and local women will soon be
able to be referred here for maternity care.

We will continue to keep you updated on progress with overall plans, as well as specific local
changes. Helen Brown, Director of Performance and Delivery in the NHS NELC
Commissioning Support Service is leading the work on maternity service improvement across
north east London and Deborah Wheeler, Director of Nursing, is the lead for BHRUT.

As ever our priority is to ensure that local women and babies have safe and high quality care
and we will continue to build on the progress made.

Yours sincerely

Alwen Williams
Chief Executive, NHS NELC

Averil Dongworth
Chief Executive, BHRUT

Agenda for meeting on Friday 20 April at 12 at Ilford Town Hall

Agenda for Save King George Hospital Meeting of Friday 20 January at Ilford Town Hall at midday in room 43.

1) Apologies

2) Agreeing and matters arising from minutes

3) Collection of issues to be discussed under any other business

4) Progress report from AW on public meetings

5) I received the following email on the 12 April and would like to discuss it: (my emphasis)

Dear Councillor Walker
We publish information against the agreed national clinical quality indicators for emergency care.
These include the time for initial assessment (95% should wait under 59 minutes from arrival to initial assessment). This isn’t the same as a black breach, as a patient may still have had an initial assessment and be classified as a black breach (for example, if they are still using an LAS rather than BHRUT wheelchair).
These clinical indicators do not include temporary closure of health services to some ambulances, as this system of ambulance diverts exists to protect the quality of care (for example, to make sure a patient can get a resuscitation bed by going to a hospital with one free) .
However, I can appreciate the public interest in both the number of black breaches and ambulance diverts. For March, there were 151 black breaches and 9 periods where ambulances were diverted from the Emergency department (usually for periods of one to two hours). This indicates a very busy month and that our patients weren’t always getting the prompt, local treatment we would hope they would be able to access. As you know, we are working with commissioners and primary care partners to address these whole system issues, including better access to primary care alternatives to A&E and reduced delays discharge from hospital when a patient is clinically fit. A story about A&E issues during March and some of the inappropriate attendances we received is on our website: http://www.bhrhospitals.nhs.uk/ournews/news2012item.php?id=1840
With regard to our website and publication of information, as I’ve said we are committed to transparency and hope to be able to better display information of public interest such as this in the future. If you would like to make any suggestions about this, I’d be very pleased to receive them.
Kind regards
Imogen Shillito
Director of Communications
Barking, Havering and Redbridge University Hospitals NHS Trust

6) AOB

7) Date of next meeting

Monday, April 16, 2012

Minutes of meeting held on 13 January 2012

Minutes of meeting held on 13th January at Havering Town Hall

Attendance: B Archer, D Breading, K Darvill, J Evens, B Howe, P McGeary, D O’Flyn, A Walker. H Zammett

Apologies A Rosindell, L Scott

1) JE provided a report back from the public meeting held on 11 December
2) Discussion of way ahead, HZ presented the paper below which stimulated a discussion on way ahead.

United we stand, divided we fall

The strongest strategy is for the campaign to promote the idea of putting all local resources together to provide a focus for monitoring the progress [or not] of Barking, Havering and Redbridge University Trust  [BHRUT]

The most powerful body is the Health Scrutiny Committee, as it has statutory rights:

  • to call in witnesses from local NHS bodies
  • make recommendations which NHS organisations must consider.   

The Health and Social Care Act 2001 requires NHS organisations to consult with health overview and scrutiny committees when considering substantial development of variations in services. 

They will be forming a working group on 16 January, the role of which will be to monitor and scrutinise the performance of BHRUT.

The second most powerful body is the LINK.  This is the organisation whose role is to represent the public in communicating with the NHS with the purpose of improvements being made. 

Again, this has statutory powers:

  • It can ask for information or making reports and recommendations, all of which must be responded to within 20 working days
  • It can visit services to see what they are doing
  • It can tell overview and scrutiny committees what it has found and get a response from them
  • If necessary, it can report directly to the Department of Health


That the LINK join the Health Scrutiny Committee for the part of their meeting dealing with current progress [or not] of BHRUT.  This would be well publicised so that the public can attend to make their representations and ask questions.
Watch out for smoke and mirrors

As you know, Andrew Lansley, the Care Quality Commission [CQC] and the Independent Reconfiguration have made it clear that none of Health for North East London’s plans can go ahead until the quality of care at Queens and King George Hospital [KGH] have improved.

In spite of constant assurances of transparency and openness from health authorities in north east London, recent events have shown that previous underhand and devious tactics are continuing.  This has resulted in the current confusion about what is happening in our local NHS, particularly with regard to maternity and to a lesser extent, A+E.

We need to know exactly what is going on so that we can see whether or not real improvements are being made.  This can only be done by the Health Scrutiny Committee Working Party demanding specific facts:

A          CQC Action Plan

This lays down the measures which Queens and KGH must undertake, with targets, in order that improvements in care are achieved.  This is based on the 73 recommendations which the CQC laid down in order to bring this about.

B          Specific Data

Detailed data is needed on:

STAFFING                     Joiners, leavers, total number, establishment, agency, bank,
                                    Medical staff by grade split

CAPACITY                    List of operational wards, bed numbers

PATIENT DATA            Readmission rate, length of stay

MATERNITY                 Numbers of natural, planned and emergency caesarean births
                                    Numbers of newly recruited midwives who stay after initial training

A+E                              Number of ambulances turned away from Queens and KGH
                                    Number of patients not seen within 15 minutes

C           Information about neighbouring hospital trusts

Current emergency measures show that what one trust does impacts on others.  If services are to be reduced at KGH we must ensure that adequate capacity is available close by. 

Whipps Cross Hospital is a key part of Health4NEL’s plan.  However, the plan makes no provision for the fact that Whipps is merging with Barts, the London and Newham hospitals and is unsure of the local health service provision which it will be providing in the future.  The Joint Committee of Primary Care Trusts agreed to 620 beds at Whipps for 2010/11.  Instead between April 2010 and September 2011 the number of beds reduced from 551 to 428 – approximately 200 beds less than planned.

The London Hospital   There is much spare capacity in this new PFI hospital – reports vary from 240 “mothballed” beds to 5 spare floors.  Planned caesareans for Redbridge women were undertaken there over the Christmas period

What the campaign can do now

We know from the unanimous vote at the emergency Council meeting that our councillors support the views of the campaign.  However, with the complex and confusing situation regarding the NHS and their other work, they probably are not fully aware of the situation. 

We can encourage residents to contact their councillors about the importance of giving the Health Scrutiny Committee all the support it needs to ensure that the real facts about our local NHS are known.  Also to request public involvement via the LINKs presence at the Health Scrutiny Committee meetings as well as publicising these meetings and encouraging residents to participate.

After all, many believe that insufficient improvement will take place to allow the Health4NEL plan to be implemented.  We need to make sure that this is clearly evident ENDS

3) It was agreed that AW write to Averil Dongworth on the following points:
a) Ask Averil Dongworth, the Barking, Havering and Redbridge University Hospitals NHS Trust Chief Executive to produce a monthly report detailing how she is working towards meeting the targets set in the CQC report. This report to be published on the Health for NE London website along with waiting list and medical staffing figures.
b) To seek an assurance that the two month deadline for cesarean sections to be brought back into the Trust to prevent women having to travel to Hackney is on track to be met.
c) Ask for A&E temporary closures to be published on the Health for NE London website within 48 hours. Never again should people rely on the bravery on an ambulance driver speaking out at a public meeting to find out Queens A&E had to close to ambulances because it could not cope.
d) To invite Averil to meet us on a quarterly basis for a discussion of her report

4) AW to write to MPs requesting they meet with NHS senior management re the current unsatisfactory performance of our NHS

5) It was agreed to hold a public meeting in the summer in Havering and an autumn meeting in Redbridge

6) Date of next meeting 13 April (later changed to 20th)       

Ilford Recorder letter

Dr Spiteri’s claim that the problem of patients being stuck in ambulances outside our A&E departments for more than an hour was due to people turning up with “cuts and sprains” does not stand scrutiny.
NHS board minutes for 7 March at http://www.bhrhospitals.nhs.uk/aboutus/tb4.php give two reasons for the Queens and King George A&E difficulties. Bed flow is a problem, patients staying in hospital, although fit to leave hospital. The second reason, lack of medical staff, appears the more serious. The board say the Trust is up to 200 beds short of that “required to sustain 95% performance, so there was a fundamental capacity issue”. A 60% vacancy rate for senior level staff in the Emergency Department is given. Surprisingly, the Trust is considering making the Emergency Department “not so reliant on Doctors”. So many people have been ill recently that another four dependency wards have been opened.
Dr Spiteri is a prominent advocate of the plans for closing King George A&E, which are built on reducing length of stay and cutting medical staff by 25%. The plan is not working, instead things are getting worse, and the Trust admits as much. In the light of such damning evidence will Dr Spiteri agree that these dangerous closure plans should be abandoned?  
The next meeting of the save King George Committee takes places on 20th April at Ilford Town Hall at midday, more information at http://www.savekinggeorgehospital.blogspot.co.uk/
Yours sinerely
 Bob Archer
Judith Freedman
Bill Howe
Bob Littlewood
Paul McGeary
Lorraine Sladden
Andy Walker
Helen Zammett

Redbridge Council Health Meeting

Alwen Williams, the Chief Executive of the local NHS came to Redbridge Town Hall recently to take questions from the Redbridge Health Committee.
Alwen reports that planned C sections should be coming back to BHRUT this April, although an exact date was not given. Perhaps one of the most interesting points of the night came from Neil Zammett , he argued that the current crisis in our A&E is caused by under capacity. BHRUT estimates around 60,000 people a year will be non-elective admissions (this means staying a night or more at hospital after coming to A&E) at Queens and KGH A&E, but the real figure is around 75,000. If Neil is correct, it would be dangerous to close KGH A&E. This begs the question of why NHS bosses are still set on the closure next year. Heather Mullin, a senior NHS manager has promised a capacity review shortly which will hopefully address Neil’s concerns.
Joyce Ryan, the Chairman of the committee, spoke for everyone on the committee when she made it clear that progress towards a better NHS for Redbridge residents was not going at the speed expected and that the constant stream of bad publicity was unfortunate. There was a a unanimous view that more information about A&E performance, particularly regarding black breaches and temporary closures of A&E to ambulances should be put up on the BHRUT site on a monthly basis .
BHRUT did respond to this point on 4th April stating A&E information was disclosed at http://www.bhrhospitals.nhs.uk/aboutus/plans.php However, I cannot find weekly black breach figures here or the how often how our A&E are closed on a temporary basis to ambulances and I will continue to push for this information to be published on the BHRUT site.