Does CQC have some work to do?

Below is my email to Lord Howe sent earlier today, it seems that the CQC need to tell Mr Hunt, the Secretary of State for Health that the planned closure of KGH maternity in February next year is safe.
I can't find a record of this happening hence the email.


Earl Howe
Parliamentary Under Secretary of State for Quality (Lords)

Dear Lord Howe

Thank you for writing to Redbridge Council, in your letter of 29.10.12 you write.

"..no changes will take place until until the Care Quality Commission...has assured the Secretary of State and other local health services are of a high standard"

However, King George Hospital maternity unit is to close in February 2012 without the CQC saying it is safe to do so.

I would be grateful if you could let me know if you agree that the CQC must say the closure process is a safe one before the unit can be closed.

My recollection is that Mr Lansley gave assurances about the CQC and the closure of hospital units when endorsing the IRP decision on 27.10.11 but I cannot find his letter, please could you send me a copy of his letter of that date.

The Press Release below suggests the Secretary of State is to be written to by the CQC, but Mr Lansley's letter of 27.10.11 may have a stronger wording.

The most recent CQC report I can find is 27 June 2012 (there may be a more recent one)
and states at http://www.cqc.org.uk/media/cqc-says-more-needs-be-done-barking-havering-and-redbridge-university-hospitals-nhs-trust

"The progress report shows that, of the 81 recommendations made in the investigation report last October, 27 have been met and 48 partly met to date. Structures across the Trust have been changed as a result of CQC recommendations, although it is too early to say in many cases whether permanent improvements have been achieved.

While the Trust has made improvements, especially across maternity and radiology services, emergency care still remains a serious concern. More also needs to be done to improve staffing across the Trust. The Trust is struggling to deal with increased complaints, which may have been sparked by the CQC investigation.

Matthew Trainer, Deputy Director of CQC in London, said:

“The direction of travel at the Trust is encouraging but - as they acknowledge - they still have some way to go before they are consistently delivering the quality of care that local people are entitled to expect."

This does not appear to meet the criteria set down by Mr Lansley before King George maternity can be shut.

Yours sincerely

Andy Walker
DoH press release 27.10.11

However, no changes will take place until the Care Quality Commission, which published its own report on local services today, has assured the Secretary of State that the services provided by Queen’s Hospital and other local health services are of a high standard.  The IRP recommendations also require a vision for the future of King George’s Hospital in Ilford to have been presented prior to implementation.

As the IRP report makes clear, the proposals set out in Health for North East London, first published for public consultation in 2009, offer the best possible configuration of local health services to provide a high quality NHS in the future. The Secretary of State for Health has accepted the IRP’s recommendations in full, but they will only proceed to implementation when actions agreed by the Trust in cooperation with NHS London and the wider local NHS, in response to the Care Quality Commission’s inspection report, are implemented, and the Secretary of State has been assured of their effect.

CQC mystery?

Thank you to the Redbridge resident who drew my attention to a recent letter from Earl Howe, a minister from the Department of Health, to Redbridge Council which gives the impression that the Department of Health expects the CQC to give approval as safe any plans to close KGH maternity.


I don't recall seeing any such plans.

The CQC report here

cqc-says-more-needs-be-done-barking-havering-and-redbridge-university-hospitals-nhs-trust

does not seem to say it is safe to close KGH maternity.

I will make enquires and write further in due course.

Iain Duncan Smith photo shoot

Many thanks to Iain and everyone else for attending.

Iain's message of support can be read at.

http://www.guardian-series.co.uk/news/10068257.Lansley_was_wrong_on_King_George___IDS/

Iain Duncan Smith MP to do photo shoot

Iain Duncan Smith MP is to do a photo shoot in support of the campaign to keep open King George Hospital A&E and maternity units on Friday 23rd November at 11am outside Ilford Town Hall.

It would be helpful if we could could get 40 or so people there to support Iain on the day. If you cannot make it please pass the message on to friends and family.

Many thanks to Iain for helping the campaign and to Helen Zammett for organising the photo shoot

Consultation and disclosure-Key to maintaining good government

Neil Zammett writes

I attended Redbridge Health Scrutiny on 22^nd October, an extraordinary meeting just to deal with closure of A&E and Maternity at King George. It was a long and eventful meeting which raised a number of important issues;

· The right to consultation,

· The timely disclosure of documents

· The use of presentations instead of papers for meetings

Although the Committee did not identify these issues as a theme to me they all relate to Standards in Public Life which were laid out in detail by the Nolan committee. Just as a reminder Lord Nolan was charged by the Government with identifying the essential aspects of standards which were perceived at the time to have been “slipping”.

Two of the areas he identified were openness and transparency and I believe that the three issues which the Scrutiny Committee identified fall fairly and squarely into these categories.

The right to consultation

Letting people know what is going on is a prerequisite of good standards. It is at the heart of openness and good governance. The present Government has reaffirmed its commitment to local people having a say partly through the localism bill and also the emphasis it has placed on local decision making in its reorganisation of the NHS.

But for Health Scrutiny committees there is an additional safeguard because since 1974 the right of consultation is backed up by a statutory obligation. This means that if action is taken to close, change the use of or “substantially vary” local services without consultation this act is unlawful or “ultra vires” to use the technical term.

There are two exceptions; where urgent safety issues prevail and where a pilot scheme is involved.

If a senior NHS manager were to knowingly act “ultra vires” it would raise serious issues about their judgement and the governance of their organisation.

On 22^nd the Redbridge Scrutiny committee voted, (after some considerable wrangling with the Chair, with only one member against) to seek consultation on the changes to the plans to close Maternity Services at King George. This was based on the inclusion of the Homerton Hospital in the plans and the continued presence of A&E at King George.

But there are other closures taking place which the committee has not been informed of; St George’s in Hornchurch is one and closure will have an impact on King George. Foxglove ward was closed based on more intensive use of St George’s now this is closed as well.

Safety was an issue at St George’s because the antiquated heating system could break down, but this does not remove the obligation to consult unless the situation is urgent and to my knowledge it was identified as an issue some years ago.

We also need to know what changes at King George have resulted from the closure of St George’s; have wards such as Foxglove been re-opened to accommodate the patients displaced from St George’s?

The timely disclosure of documents

After numerous requests the Maternity Workforce Strategy for East London was sent at the eleventh hour to the Committee. Dated May 2011 it has never been published or subject to consultation even though workforce issues were central to the case for closing the maternity unit at King George.

What this reveals is the shocking fact that we need to double the number of doctors in five years and increase the number of midwives by 40%. It also shows that some of the hospitals which will benefit from the closure, like the Homerton actually have lower staffing levels than Queen’s and King George and that Whipps will have to double the number of midwives because it has such a low starting point.

Members also wanted to see the new outline business case for A&E at Queen’s because this is key to understanding the timescale for potential closure at King George and also reasons for the delay. This was declined because work on the plan is continuing.

But without key documents like this the Committee cannot do its work and the plan has been circulating within the NHS for months.

The use of presentations

Documents are the stock in trade of statutory organisations because they form such an important part of the way they work. They are integral to the legal basis for decision making and the governance of the organisation. Increasingly documents have been replaced at scrutiny meetings by presentations. This creates all sorts of problems because members do not have time to prepare questions and the spoken word is capable of different interpretations particularly if the meeting is not recorded in some way.

Effectively, presentations undermine the processes of good governance if they are used in place of written papers. Of course used in a supplementary way they can be very helpful but they are now becoming the norm not just in Redbridge but at the Joint Health Overview and Scrutiny meeting which covers the four outer London Boroughs.

Bullet points are no substitute for properly argued papers which can be evaluated and challenged.

The impact on scrutiny and governance

The combined impact of these three issues is to undermine the work of scrutiny and to prevent elected members discharging their constitutional responsibilities. It also runs totally counter to the principles of openness and transparency established by the Nolan Committee and represents bad government.

We should remember that these principles and the statutory right to consultation are there to protect the public and maintain standards in public life.

The vote by the Redbridge Scrutiny Committee to request consultation the new Maternity plan represents a welcome step towards recognising this.

Duncan Smith MP supports campaign

Great to read Abul Taher's piece in the Mail on Sunday today. It includes the very welcome quote from Mr Smith "I will continue to support the campaign to prevent the closure of A&E services at King George's" Many thanks to Mr Khan from Chadwell for getting in touch with the MoS. Full piece at link below.

http://www.dailymail.co.uk/news/article-2227374/Dial-111-A-E-shambles-Flagship-new-NHS-phoneline-actually-INCREASES-ambulance-outs--PM-savaged-closures.html

Can you help Mail on Sunday report on KGH A&E?

Abul Taher of the Mail on Sunday is writing a piece on KGH A&E. 

If you know of any patients who would be adversely affected by the proposed closure it would be great if you  could ask them to contact Abul.

His email is abul.taher@mailonsunday.co.uk  or phone him on 0203 615 3018