Tuesday, December 4, 2012

Neil Zammett on Maternity changes

The current position

 The NELC cluster PCT is following the plan agreed by their Board on 19th September 2012. This involves a number of “gateway” checks on the readiness of the units in East London (Queen’s, Barking, Newham, Whipps and the Homerton) culminating in an update on progress and a recommendation on the closure of the KGH obstetric unit at their January 2013 Board meeting. The safety and quality checks are being led by Christina McKenzie an external consultant. There is no reference to the involvement of CQC that I can find in their papers.

 Part of the plan is changing the catchment areas for units in November 2012 so that around 1000 maternity bookings transfer from BHRUT, largely Redbridge residents, to Newham and a similar number from BHRUT to Whipps. A new component to the plan is the transfer of 1000 bookings from Whipps to the Homerton to “make room” for the women from BHRUT. Because of the obvious “lead time” on maternity booking need to be transferred in advance of expected births. To my knowledge there is no formal, explicit statement by CQC either in terms of a letter, electronic communication or minute from a meeting which would correspond to the statement in the Secretary of State (SOS) letter. There are qualified statements in general support of the plan in their concluding report on their special investigation of BHRUT, but their conclusions also include cautionary statements about the sustainability of perceived improvements.

My views

 I think the SOS letter has highlighted an important point which is CQC assurance on service quality. I think it is singularly unfortunate that the letter was delayed in circulation for almost a month and this does give us less time to act. Members may wish to ask why such an important communication was delayed for so long. I had assumed that CQC had been in touch with the SOS office and given the necessary assurances but clearly this is not the case. I also assumed that CQC would have had a formal meeting, or exchange of correspondence, with NELC at which their approval would have been recorded. On the face of it this again appears not to have happened. We have therefore the very serious situation where the SOS believes that nothing happens until CQC have given an assurance while NELC have changed catchment areas without this assurance. I would also say that there is a point at which the decision becomes a fait accompli and attempting to reverse it becomes riskier than proceeding. Obviously it is right that CQC approval should be sought before this point. In the circumstances I believe it is vital that we seek urgent clarification from the SOS office of their understanding of the position of CQC, particularly as patient safety is involved.

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