Tuesday, September 4, 2012

BHRUT admits that there is likely to be a demand for 90 acute beds which had not been included in the Health4NEL Business Case

Neil Zammett writes
I am picking up in this blog the issues around A&E and maternity at King George because further information has been forthcoming in the September BHRUT Board papers. Nick Hulme who is the officer in charge of re-configuration told their July meeting that:
“Several meetings had taken place to discuss demand and activity assumptions which had changed significantly since the original plan. Mr. Hulme informed the Board that demand management assumptions had also been discussed and agreement reached with the Cluster that there was likely to be a demand for 90 acute beds across both sites, which had not been included in the original Health4NEL business case.”
This confirms that that BHRUT are now putting together a new plan which revises the bed numbers in the original. The figure of 90 is presumably the outcome of this work. It does not explain how these additional beds relate to the closure of A&E but it does confirm my view and that of many others that the original proposals were base on hopelessly optimistic assumptions. The original plan estimated that some 250 beds would have to close across the two sites to allow A&E at King George to shut. Presumably the latest study has estimated that only around 160 can be closed on their (unknown) timescale.
It is instructive to contrast the above quote with that from page 91 the original business case:
“The trust and local stakeholders recognise the challenge that this change represents. The reduction of 250 beds by 2013-14 represents 22% of the bed base. However a comparison of other trust’s length of stay against national benchmarks indicates that a considerable reduction in length of stay should be achievable. Without this reduction the closure of the King George A&E cannot take place.”
To date there has been no sign that the length of stay of emergency admissions at Queen’s can be reduced to a level which would allow the closure of A&E at King George. In fact the reverse is true, increased demand has led to appalling delays in transferring patients from ambulances and bed numbers have not reduced at all.
The new plan has not however been included in the September Board papers and there is no reference to it that I can find. Obviously the plan is a very significant document that is a matter of legitimate public interest.
Although Nick told us at the last JHOSC meeting that the new plan has a very provisional closure date of late 2014, a year later than originally planned, this date is dependent on central government approval for the scheme which was originally estimated to cost around £10 million there is no mention of this in the BHRUT Board minutes.
Neither is there any reference to his statement that approval will be dependent on the affordability of the scheme and the ability of BHRUT to come up with a plan for long term financial viability. As BHRUT is losing around £1.0 million a week at present I think the odds are pretty much stacked against this happening.
The situation for Maternity is rather different. The Cluster PCT has imposed a limit of 8000 births at Queen’s and women from the West of Redbridge are now being directed to Whipps and Newham. This “cap” was not part of the original agreed plan and will restrict choice for women. It will also help to force the closure of maternity at King George.
This will be done against a background of rising births in East London where we have amongst the highest rates in the UK and in Redbridge in particular where we have the second highest number of under-five’s in London.
The rationale for closing Maternity was largely based on the need for co-location with A&E and if it remains open then the whole plan needs revising. On its own closing Maternity at King George will not save any money and medical staffing requirements for a unit of under 2000 deliveries per annum are much less onerous than those for larger units.
Smaller units may also offer a more attractive recruitment environment and this remains an unknown quantity in East London where we are going to have massive units delivering over 9000 babies per annum, much larger than the current biggest unit at St Thomas’ with 6500 deliveries a year. No one knows if we will be able to recruit to these units
What we do know is that local women are very much against the closure of King George. Research conducted by Health4NEL has shown that while women have a good conceptual understanding of choices in childbirth the way that systems operate deny women that choice in practice.
The restrictions imposed by the PCT are going to make this even worse for local women with up to 40% not having the choice of a consultant led delivery, as opposed to about 2% now, and only a very few women having a choice of unit. Women right across East London will have to travel further to have their babies.
I would like to see the Council take the following simple steps:
1. Asking to to see and evaluating the revised plan for A&E at Queen’s. They need to check that this plan looks at least ten years ahead to allow for population growth locally and how the extra 90 beds are going to be configured 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 development.
2. Seeking an acceptance by health that the closure of A&E at King George now needs to be reconsidered in the light of the new demand 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.

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