Tuesday, July 24, 2012

Neil Zammett's Briefing

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

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