Monday, October 29, 2012

Press from Photo Shoot

The Ilford Recorder is below

And the Wanstead and Woodford Guardian below

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."

Saturday, October 27, 2012

Photo from Today

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

Friday, October 26, 2012

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.

Tuesday, October 23, 2012

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.

Tuesday, October 16, 2012

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 8th 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 3rd 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 15th 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.

Friday, October 12, 2012

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 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)
(Y+2) -8%

(Y+3) -7%

(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 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
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.