I attended the JHOSC, Joint Health Overview and Scrutiny Committee on Tuesday 10th July when Nick Hulme speaking on behalf of BHRUT announced as part of his presentation that the closure of A&E at King George will be postponed. An exact date cannot be given at this time but it now seems more likely that any closure will be towards the end of the calendar year 2014. This however is by no means certain. Key points from Nick's presentation included:
· A new building development at the 'Front End' of A&E to improve workflow in the department · Displacement of some existing outpatient activity at Queen's to community settings to free up space for A&E.
· A new bed forecast for Queen's based on more realistic assumptions about length of stay.
· All of this to be included in a report to the BHRUT Board as an outline business case at the beginning of August · The original closure date of the autumn of 2013 to be scrapped.
· All of this to be subject to Department of Health and possibly Treasury approval
Obviously this came out of the blue particularly as at the Redbridge Scrutiny meeting a week or so before we had had no news of a major change of plan. It is not just the projected delay but the fact that the closure is now highly conditional, not just on CQC but the new major development in A&E fitting in to a long term plan for Queen's.
One of the key factors in approval for the scheme will be affordability; if it costs too much the closure of A&E at King George will be off the agenda for the foreseeable future. I was very pleased to see a more grounded approach being taken. As a campaigner my concerns have been with the highly optimistic assumptions underlying the plan. Nick referred to the use of "best in class" length of stay as an example of this.
I have always supported the principles of Darzi's London review; centralisation, specialisation and a shift of work into primary care settings. The point is however you have to be realistic about the timescale, what you can do safely in ten years you cannot do in two. Nevertheless I also felt that there was a case based on the principle of maintaining local services and access to them. It was an enormous shame that our local Redbridge PCT did not put this case forward. Maternity I am still campaigning about the need for consultation on the changes to women's services and the impact they are going to have on choices for women.
Nick Hulme refers to previous work on women's attitudes which I presume is the "Opinion Leader" report which was done at a late stage of the original Health4NEL project. But this did not look at the impact of capping the number of deliveries at Queen's to 8000 and showed that women in East London have very little choice as things stand at the moment. In the future they are going to have even less. Up to 40% of women will have to have a midwife led birth as opposed to around 2% now and increasingly the will have to be directed to units because of capacity issues. What is really worrying is that women are largely unaware of this. What the Opinion Leader report showed is that although women have a good conceptual understanding of choices in maternity services these 'go out of the window' once the administrative process starts.
We need a total rethink about the way in which women are informed with better information and a change of attitude from health professionals. Women in particular want continuity of care from midwives and a choice of where and how to give birth. I suspect one of the reasons why the Opinion Leader report has been given little prominence is that it showed clearly how much local women were against the closure of the unit at King George, even when promised better services at Queen's.
I continue to campaign.
Who is going to make the final decision on closures at King George? The CQC follow up report indicated that they will be doing no more special reviews of BHRUT, just routine inspections. They still have major concerns about A&E but have reduced those for maternity to moderate. Who decides whether it is safe to close A&E and maternity and when? Heather Mullin told the Redbridge Scrutiny meeting the "GP's will decide" but I don't think this is quite right. The original decision was made by the Joint Committee of Primary Care Trusts (JCPCT) and formed the advice to the Secretary of State who made the decision. Any revised advice will have to be made by its successor body. Up until March 2013 this will be North East London and the City PCT (NHS NELC). After this I think it would have to be NHS London or a body with delegated powers which would be based on the CCG's, clinical commissioning groups, across East London. So the GP's would be involved but only through their formal organisation and it would not be just local GP's who would decide. The commissioning groups include lay members and independent hospital doctors and nurses. NHS London, or rather its successor body, would obviously want a say as well and some form of involvement of the CQC, probably a meeting, to include their views would almost certainly be part of the process. But when could this happen? Given the news about A&E it seems most likely to be towards the end of the 2012/13 financial year but it could be delayed until the end of 2013 to see how maternity services cope. Of course if the new scheme for A&E at Queens is not approved then 'all bets are off'. Neil Zammett 17th July
Tuesday, July 24, 2012
Friday, July 20, 2012
Report on July Public Meeting
Thanks to everyone who attended the meeting at Ilford
Central Library this evening. A special thanks go to Bob Archer, Susan Francis,
Bill Howe, and Bob Littlewood for collecting over 2500 signatures earlier this
week to allow a debate on King George Hospital at Redbridge Council later this year. The exact date will follow
later.
The meeting agreed to work towards achieving a big turn out
on Saturday 27 October at 1pm outside King George Hospital to mark first
anniversary of the proposed closure. The idea being to celebrate the A&E
and maternity still being there and to call for the closure plans to be
abandoned.
Tuesday, July 17, 2012
Queens and KGH Temporary Closures
Got the letter below earlier today from London Ambulance Service. Seeking clarification about how many of blue light ambulances are involved but the evidence is clear that if KGH A&E and maternity closes lives will be put at risk. What London Ambulance call "redirects" I see as temporary closures to ambulances. Walk/Drive in cases are never turned away.
Governance and Compliance
London Ambulance Service
4th Floor
London
SE1 0EH
17th July
2012
email:foi@lond-amb.nhs.uk
Our Ref:1083
Your Ref:
Dear Mr
Walker,
REQUEST UNDER THE FREEDOM OF INFORMATION ACT 2000
Further to your enquiry made under the provisions of the
Freedom of Information Act 2000, which we received on 11th July 2012,
you requested the following information:
1) The number of ambulance diverts from King George and
Queens Hospitals on a monthly basis from January 2012 through to June 2012.
2) The number of diverts for each hospital to be shown
rather than a aggregate figure.
3) How long each divert lasted for.
4) How many ambulances were diverted at each occasion.
5) What types of patient were being diverted, ie all
patients or only certain conditions.
Our response
is as follows:
|
Queens Hospital Romford
redirects
|
||||||
|
|
ED
|
Maternity
|
HASU
|
|||
|
|
Occasions
|
Duration
|
Occasions
|
Duration
|
Occasions
|
Duration
|
|
Jan-12
|
11
|
14 hrs
|
2
|
over 8 hrs
|
0
|
|
|
Feb-12
|
15
|
24 hrs
|
3
|
over 24hrs
|
0
|
|
|
Mar-12
|
15
|
31 hrs
|
2
|
over 8 hrs
|
0
|
|
|
Apr-12
|
9
|
16.5 hrs
|
0
|
|
0
|
|
|
May-12
|
4
|
7 hrs
|
1
|
over 4 hrs
|
2
|
10 hrs
|
|
Jun-12
|
3
|
5.5 hrs
|
2
|
over 8 hrs
|
0
|
|
|
King Georges Hospital ilford redirects
|
||||
|
|
ED
|
Maternity
|
||
|
|
Occasions
|
Duration
|
Occasions
|
Duration
|
|
Jan-12
|
0
|
|
0
|
|
|
Feb-12
|
1
|
1 hr
|
0
|
|
|
Mar-12
|
0
|
|
0
|
|
|
Apr-12
|
0
|
|
0
|
|
|
May-12
|
0
|
|
0
|
|
|
Jun-12
|
0
|
|
0
|
|
We do not
keep information on the number of ambulances diverted on each occasion.
The attached
Emergency Department Capacity Management and Closure Policy provides
information on how patients are affected by redirections.
We hope that
this answers your request. If you are dissatisfied with our response you have
the right to seek a review in line with guidance from the Information
Commissioner.
In
the first instance, this should be addressed in writing to:
Carmel
Dodson-Brown
Assistant
Director Corporate Services
London
Ambulance Service NHS Trust
46 Loman
Street
London SE1
0EH
who
will provide a response within 20 Days of receiving the review request:
Should
you remain dissatisfied with the outcome of the review by the Assistant
Director of Corporate Services then a final review request should be addressed
to:
Sandra Adams
Director of
Corporate Services
London
Ambulance Service NHS Trust
220 Waterloo
Road
London SE1
8SD
who
will arrange for a panel of Non-Executive Directors to review the case.
If you are unhappy
with the findings of the panel you can then write to the Information Commissioner
at:
Information
Commissioner’s Office,
Wycliffe House,
Water Lane,
Wilmslow,
Cheshire SK9 5AF
Tel: 01625 545 700
Fax: 01625 524 510
If you
require further clarification, please do not hesitate to contact us.
Yours
Sincerely,
Information Governance Department
Thursday, July 5, 2012
National Audit Office Report
The National Audit Office has published a report available
here http://www.nao.org.uk/publications/1213/nhs_financial_sustainability.aspx
The worrying
thing is that the BHRUT deficit gets a mention as the quote below taken from
the press release below
Among these, between 2006-07 and 2011-12, the
Department issued a total of £356 million to South London Healthcare NHS Trust
and its predecessor bodies, and £195 million to Barking, Havering and Redbridge
University Hospitals NHS Trust.
National newspaper
pieces are at links below
Ilford Recorder letter published today
Dear Sir or Madam
The recent CQC report covered in the Recorder last week
makes it clear that Queens and King George Hospitals need more doctors and
nurses, not fewer, which is what would happen if King George A&E and
maternity were to close.
The closure plan meant 8% of medical staff were to be
sacked by the end of this year. However, while this will not be happening now,
the public and the medical staff have the right to know what NHS management
intend to do with staffing levels for this year and a clarification from the NHS
in the Recorder next week would be welcome.
Yours sincerely
Bob Archer, Judith Freedman, Loraine Sladden, Andy Walker, Helen Zammett
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