Campaign Briefing

Save King George Hopital Campaign Committee members Bob Archer, Barry Fleetwood, Bill Howe and Andy Walker attended at Redbridge Town Hall

Points agreed were:

1) The proposed closure of KGH A&E lay at the root of the problems highlighted by the CQC last week.

2) A photoshoot to be organised outside the next meeting of The BHRUT board meeting.

3) AW to request sight of plans to extend Queens A&E and ask whether the publicised potential reduction of services at Barts Trust were being taken into into account.

4) AW to write to BHRUT seeking information about whether increases in A&E attendance being driven by population growth as main driver.

5) AW to write to Mr Hunt, Secretary of State for Health, seeking a definition of clinically safe. The test set for closure of KGH A&E.

Come to the next save KGH planning meeting

Next planning meeting of Save KGH group Monday 23rd December 10am Ilford Town Hall

 Open to everyone who wants to work to keep KGH open

   Agenda

   1) Apologies
   2) Minutes and matters arising
   3) Discussion and response to BHRUT being put into special measures   
   4) AOB
   If you cannot make it, perhaps you could send me ideas for how to move the campaign forward.

  Below is the recent Redbridge Council press release on the last save KGH public meeting together with links to Recorder stories on KGH.   Andy 07956 263088

 King George Hospital A&E Campaign Public Meeting

A group of cross party MPs and Councillors from Redbridge made the case for keeping King George Hospital (KGH) Accident and Emergency open at a public meeting on Friday 6 December at Redbridge College. MPs Mike Gapes and Lee Scott attended the event to argue against the closure, as did Councillors from the Borough echoing the views expressed at November’s full Redbridge Council meeting, where there was a unanimous vote to oppose the move. Some of the concerns raised about the closure included: * a fear that some residents were in danger of losing their life * Redbridge was one of the fastest growing boroughs in the UK and so needed its own A&E * Barking, Havering, Redbridge University Hospitals NHS Trust (BHRUT) was failing to hit A&E four hour waiting targets, and Queens would be unable to cope if KGH A&E were to close. Averil Dongworth, Chief Executive of BHRUT, Dr Heath Springer, Clinical Director at Redbridge Clinical Commissioning Group (CCG), and Conor Burke, Chief Officer for CCG in Barking and Dagenham, Havering and Redbridge  were there to answer questions from the public and explain how the process would work and what the CCG’s vision is for new services on the KGH site.   Mrs Dongworth said Queens was the busiest A&E department in the country, but would be able to cope with the new KGH A&E closure once new building works had been carried out at Queens. In a joint statement, the Group Leaders from Redbridge Council, Councillor Keith Prince, Councillor Ian Bond, Councillor Jas Athwal and Councillor Filly Maravala, said: “We are baffled how BHRUT can say KGH can be safely closed in 2015. We are nearly in 2014 and as yet we have not seen the plan of this new building at Queens. “The Council has written to the Secretary of State on several occasions opposing the closure. Residents can rest assured that we do all we can to keep KGH A&E open.” Residents can link to this page on the BBC’s website which will enable them to put in their post code and see how well their local hospital is performing each week on A&E waiting times. http://www.bbc.co.uk/news/health-25055444- See more at: http://www2.redbridge.gov.uk/cms/news_and_events/latest_news/2013/december/king_george_hospital_ae_campa.aspx#sthash.REIpQgIx.dpuf     

 The Recorder story on the meeting is here http://www.ilfordrecorder.co.uk/news/news/trust_chief_queen_s_isn_t_ready_to_take_patients_from_king_george_hospital_a_e_but_it_will_be_1_3091052 

 The Recorder story on special measures is here http://www.ilfordrecorder.co.uk/news/news/cqc_report_patients_are_at_risk_at_unsafe_king_george_hospital_a_e_1_3127111SentOlderNewerActionsReplyReply allForwardDeleteFlagMoveMark unreadMark as spamHi, andy. Set Your LocationSign outPrivacy | Legal | Help© 2013 Yahoo! Inc. All rights reserved

Can you phone a friend about the KGH meeting this evening?

Tonight, MPs Mike Gapes and Lee Scott will be arguing the case for keeping KGH A&E open. Averil Dongworth the Chief Executive of KGH and Queens Hospitals will say why the A&E must close in 2015. The start is 7pm today Friday 6th December, the place is Redbridge College at Little Heath where Barely Lane meets Chadwell Heath Lane. Lizzie Deardon of the Ilford Recorder is chairing. A good attendance in support of Lee and Mike would be great, if you are going please phone a friend and see if we can fill the room this evening. Andy

Can you help with Public Meeting for this Friday

MPs Mike Gapes and Lee Scott will debating the future of King George Hospital this Friday at 7pm at Redbridge Colleg with Averil Dongworth, the manager of Queens and King George Hospitals. Barry and I will leafleting for the meeting today at Ilford Station. On Friday Bill and I will be at Newbury Park. If you can help at a station, please let me know. Andy 07956 263088

Mr Hunt's office on the KGH situation

 Barry Fleetwood's correspondence with Mr Hunt's office below along with his commentary. 

SAVE KING GEORGE HOSPITAL ACCIDENT &EMERGENCY

Campaigning for your safety and your children’s' safety

Dear Minister

In reply to a question from Lee Scott MP, concerning the future of King George Hospital  A & E Department,you answered “King George will not be closed until there was an absolute certainty  of the safety  of doing so and that Queens would be able to cope”.

Residents are faced with one A & E closing and the alternative Queens – according to the CQC failing, and there has been no improvement over the past 2/3 years.We would therefore like you to quantify “an absolute certainty” i.e does that mean  3 clear inspections by the CQC with no criticsm, 168 hours Consultant  Cover per week,6 months without the 4hour rule being broached etc.

We cordially  invite you to join Mike Gapes MP, Lee Scott MP and Mrs Averil Dongworth –BHRUT Chief Executive on the Platform  for our Public Meeting on Friday 6^th December at Redbridge College, Barley Lane, Redbridge RM6 4 XT, at 7 pm to present your answer. The Meeting is being Chaired by Ilford Recorder reporter Lizzie Dearden.

We look forward to seeing you on the 6^th. If by some unfortunate occurrence you are unable to attend, we would ask to substitute one of your senior Ministers to take your place.

Mr Hunt’s Reply

Our ref: DE00000822696 

 

 
Thank you for your correspondence of 15 November about the future of the A&E department at Barking Havering and Redbridge NHS Trust (BHRT).

I am afraid that the Department is unable to accept your invitation, as it would not be appropriate for a minister to attend.

In 2011, and following an independent review of the proposals for local service change, the then Secretary of State for Health decided that implementation of the proposals by the local NHS under 'Health for North East London' should proceed, but only after improvements at both Queen’s and King George hospitals had been demonstrated.

When making this decision, the Secretary of State for Health instructed NHS London (whose responsibilities for this issue have now passed to NHS England) to give assurances that the local NHS had undertaken the necessary actions before implementing changes.   

The reconfiguration of services is a matter for the local NHS, and it would not therefore be appropriate for a minister to now apply tests or measures that must be met before these changes are made.

For maternity services at King George Hospital, such assurances were given and these changes were successfully implemented in March.

The Department understands from NHS England that the local NHS is planning to implement the agreed changes to emergency services at BHRT in 2015. 

NHS England is expected to give its assurance to the Secretary of State for Health that the local NHS has undertaken the  actions necessary prior to these changes.  This will include, not exclusively but as a minimum, ensuring it is safe and that there is sufficient capacity in the system.

King George hospital is not closing.  A GP-led urgent care will be open 24 hours a day, seven days a week at King George’s and a range of other services are being planned for the site.  Local people will be able to access specialist services at other hospitals when necessary.

I hope this reply is helpful.

Yours sincerely,
 
Charles Podschies
Ministerial Correspondence and Public Enquiries
Department of Health

We have a number of comments to make on the Ministers reply

1.To attend a Public Meeting to defend HIS policies to the electorate and taxpayers seems to us entirely appropriate.

2. His refusal  to attend personally Is understandable, but not to send a representative??

3. One might be minded to consider that he finds his own policies indefensible, certainly the High Court does.

4.”Secretary of State for Health instructed NHS London (whose responsibilities for this issue have now passed to NHS England) to give assurances that the local NHS had undertaken the necessary actions before implementing changes.”

The Minister appears to be abdicating all responsibility for this reconfiguration.somewhat at odds with his assurance in the House in reply to a question from Lee Scott ““I will go back and make absolutely certain that no changes will be made until it is certain that they are clinically safe.” Is the Minister in charge?

5 The point of this letter was for him to quantify what is “absolutely certain” he cannot make such a statement without being able to quantify “certain “ or does he propose to employ guesswork or a fortune-teller ?,

“and it would not therefore be appropriate for a minister to now apply tests or measures that must be met before these changes are made”

He has already applied tests “absolutely certain” but refuses to answer a direct question to support his statement to the House. Unless he is waiting to appoint Russell Grant as a Special Advisor.

6.”For maternity services at King George Hospital, such assurances were given and these changes were successfully implemented in March” This is not an example that is relevant,as A & E is much more complex, and in any case 6 months is not enough time to judge whether the change for Maternity is yet successful.

More beds need to be opened now to avert an A&E crisis at Queen’s and King George

Neil Zammett writes The BHRUT Board paper for November show that A&E services at Queen’s and King George have now reached a tipping point. The Trust acknowledges that it needs around 100 extra beds to cope with winter pressures but so far has only identified about 30. Performance on the four hour target of 95% shows a sharp deterioration in the latter part of October, see the graph below taken from the BHRUT Board papers, which if extrapolated would see a dip to around 70% sometime in November. This is unprecedented for this time of year. The Trust’s own forecast shown as a dotted line is pure speculation. The reason for this sharp decline in performance is the relocation of services from King George to Queen’s as part of the implementation of the Health4NEL plan. The Background Back in July this year I blogged about the performance of A&E at Queen’s and provided a detailed evidence base for my concerns: Allowing for seasonal fluctuations performance has deteriorated year by year. This is associated with bed closures at the Trust, 114 by September 2012. I proposed that there should be a moratorium on bed closure across NE London until A&E capacity had been reviewed. I also proposed a phased opening of beds at BHRUT to cope with winter pressures, 60 in September/October and further 30 in January 2014. In reality BHRUT closed Holly Ward in September as part of a planned relocation of services from King George to Queen’s to enable 7 day working losing a further 30 beds, making a total of nearly 150. The Trust initially claimed that this was because they needed fewer beds because of an improvement in cover from senior specialist doctors. It is important that we are all clear about bed closures because the November BHRUT board papers, summarised below, acknowledge that bed shortages at King George and Queen’s “...are the dominant reason for failure of four hour target sic.” (Page 125) This supports the conclusions of my earlier Blog. Previously the Trust has been emphasising the lack of permanent senior medical staff in A&E as the main reason for poor performance and advanced this as a reason for closing King George A&E to blue light cases at night. Now it is clear that this is a more minor factor. An update from the November BHRUT Board papers Details of the A&E position and bed availability are mentioned at different places in the November BHRUT Board papers and for ease of reference are summarised below as direct quotes: • Mr Burgess (Deputy Medical Director) confirmed...as part of Health4NEL the Trust was closing beds at King George Hospital; one in September (Holly Ward) and another ward which would be identified, to close in March 2014... The Trust was looking at six wards coming out as part of its reconfiguration programme. (Page 13) • The trust bed requirement sees an underlying seasonal increase of c100 beds (driven by general medicine and geriatrics). With limited headroom sic and an average occupancy of 97%, this translates into a significant bed capacity gap. (Page 19). • In planning for 7 day working the medical teams had expected to realise a reduction in length of stay (LoS)...Close monitoring of the impact of all these changes was undertaken weekly and what became apparent was that the 4 hour access target was deteriorating due to the reduction in bed capacity, pathway issues in these specialties and the impact of the new rotas. (Page 31) • During September seven day working was introduced and three specialties transferred between sites. The charts show no overall changes in LoS and from the previous section in the number of discharges. (Page 130) Action by the Trust In response to the rapid deterioration of the 4 hour access target the Trust moved Elm Ward into Holly giving an extra 9 beds and has now also opened Japonica Ward’s 24 beds at King George. Beyond this and a general statement that more capacity may be needed in January/February 2014 no further action has been identified. My report back from the meeting indicates that there was little if any discussion by non-executive directors on this item. Comment It is very hard to see the logic behind the statement that the Trust needs around 100 extra beds to cope with winter pressures and the initial closure of Holly Ward. Even now with the Ward re-opened and Japonica the Trust only has a third of the required capacity. Obviously the expectation that seven day working would reduce LoS is part of the explanation for this but to put patient safety on the line for an untested change in working practice seems a very dubious decision. In fact the whole relocation exercise seems to have been a bridge too far for the Trust. Looking at the LoS graph on page 130 of the Board papers I would say the figures for August to September this year are in fact significantly higher than for 2012 and bed closures depend crucially on this reducing. Again how Holly Ward could have been closed given these data is a very real question for the BHRUT Board. All of this adds up to an escalating crisis driven by a desire to fulfil the Health4NEL strategy and the bed closures it requires. The truth is that Queen’s and King George need more not less beds. Action is needed There is an urgent need for BHRUT to identify 60-70 additional beds to see them through the winter period. The CCGs and the National Trust Development Agency should be working through the Urgent Care Board to ensure these are in place. On a longer timescale the BHRUT Board should be looking with the CCGs at how the decision to relocate services was made and how ward closures are tied in with their plans and communicated to the public. They have now published a clinical strategy to implement the Health4NEL plan but this is largely narrative and does not contain the essential linkages to ward closures, bed numbers and other metrics. Based on the current performance The Board and its partners should be reviewing the viability of the plan as well. Finally, Redbridge Council should be raising concerns both through its Executive and Health Scrutiny. It is important in this that reassuring the public is balanced by the “critical friend” approach and accurate information. As an example a recent delegation to full Council was told that the closure of Holly ward was for redecoration. This was not the full picture and led to confusion and a series of letters to the local Recorder newspaper in which I was eventually involved. There are lessons here for everyone but action to open more beds is essential now to avert the emerging crisis.

Sir David Nicholson, Chief Executive NHS England, confirms 2015 closure date for KGH A&E

I copy below recent letter from Sir David

 Roger Hampson Chief Executive London Borough of Redbridge Town Hall PO Box 2 High Road Ilford Essex IG1 1DD

 NHS England 4W12 Quarry House Quarry Hill Leeds LS2 7UE

 28 October 2013

 Dear Roger

 Re: Barking, Havering and Redbridge University Hospitals NHS Trust service changes affecting Redbridge residents

 Thank you or your letter of the 29 July 2013, where you raise the concerns on behalf of the Council of the London Borough of Redbridge of the Accident & Emergency (A&E) services at Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT). The concerns around the delivery of A&E services at BHRUT are well understood and I apologise for the long delay in responding to you. The NHS Trust Development Authority (NHS TDA) and NHS England have been working with BHRUT and local Clinical Commissioning Groups (CCGs) on their urgent care improvement plan. NHS England is leading a tripartite approach together with Monitor and the NHS TDA to improve the quality of A&E services. Key to this is a system wide approach led by the local urgent care board that includes local providers and commissioners. NHS England has convened a series of tripartite panels to review A&E Recovery & Improvement Plans. Significant concerns were identified through the panel review process. The panel raised specific concerns in relation to a high vacancyrate across the Emergency Departments in BHRUT and the need to implementseven day working to improve patient experience and address delayed transfers of care. NHS England is working with local CCG commissioners to address these issues.

 There are on-going meetings with BHRUT and commissioners scheduled with the tripartite panel to further review progress. The health economy has been awarded £7m for winter 2013/14 to facilitate delivery of additional schemes to support A&E and community health services. Following concerns expressed by the Chief Executive of BHRUT regarding the Trust’s ability to maintain the safe delivery of accident and emergency services at Queens Hospital site, Barking & Dagenham, Havering and Redbridge CCGs commissioned an external clinical review. The review was carried out by the London Clinical Senate and concluded in September. The overarching findings from the review were that, whilst staffing issues were acknowledged, there was no evidence of any immediate risk to patients from the high number of medical staffing vacancies in the A&E services. Performance of A&E departments across London are considered in the context of neighbouring health economies.

The potential risks, quality implications and safety issues are also reviewed for neighbouring Trusts where one Trust is under pressure. We are not aware of any plans for North East London NHS Foundation Trust (NELFT) bed closures and no decisions on potential bed closures are expected to be taken until the outcome of the clinical review and the capacity planning exercise for the winter. Changes to King George Hospital A&E are not expected to take place until 2015 under Health for North East London programme. They will be supported by increases to the capacity of Queens Hospital and we are currently awaiting business cases in support of that. Assuming all goes to plan, we would expect local CCGs to lead a safety and capacity review prior to the final operational change taking place, to ensure patient safety is in no way compromised and that there is sufficient capacity in the system.

Yours sincerely

Sir David Nicholson
Chief Executive

Mr Hunt makes a commitment on KGH A&E

Well done to Lee Scott MP for getting Mr Hunt the Secretary of State for Health to make the following commitment in Parliament last week about the proposed closure of KGH A&E.

“I will go back and make absolutely certain that no changes will be made until it is certain that they are clinically safe"

The Recorder covers the story at the link below.

http://www.ilfordrecorder.co.uk/news/news/king_george_a_e_will_not_be_closed_until_it_is_safe_health_secretary_1_2963008

Photoshoot Today

Many thanks to everyone attending photoshoot today

Holly Ward redecoration is a red herring

Neil Zammett's letter sent to Ilford Recorder today.

Dear Sir,

 

 

Further to Averil Dongworth’s letter I would like to point out that redecoration is a red herring and that whether it is Holly or another ward, one will be closing.  Filling it with other services just confuses the issue further-we will still have one less ward to support acute admissions via A&E.

 

Around 150 acute beds have now been closed at Queen’s and King George over the last three years or put to other uses.  During this time the performance of A&E has consistently declined and is now at an all time low allowing for seasonal factors.

 

At the end of August this year Lord Howe, a health minister, wrote to the Council to say that “It remains the case that A&E services at BHRUT must demonstrate further improvements before the planned changes, which were first proposed under the Health for North East London reconfiguration programme can take place.”

 

Beds are not the only determinant of performance of course but it very hard to see how closures on this scale are consistent with the Minister’s statement, given the decline in A&E performance.

 

Now that the Independent Clinical Review has established that medical staffing is not a short term safety issue what local campaigners want is a clear plan for the future.  Indeed this is one of the main recommendations of the Review’s report.

 

The challenge for Sir Peter Dixon and his Board is to be open about their long term finances and ward closures and not to”paper over the cracks”.

 

Yours sincerely,

 

Neil Zammett

NHS reply to post on Dr Mitchell

You ask on your blog how Andy Mitchell can say hospitals are at breaking point but still back plans to centralise services.

The answer is right there in the opening few paras.

Dr Mitchell stated that the public must face up to the reality that hospitals are overstretched and that patients receive an inadequate service.

“They don’t understand how watered down these services are. What we cannot do is carry on with the idea that all hospitals provide a whole range of services. That is completely unsustainable and would become, frankly, unsafe, and is becoming unsafe in many areas.

Andy Strickland

Head of Communications BHR CCG

NHS Chief says London hospitals "unsafe"

Dr Mitchell, medical director for NHS England, says London hospitals are unsafe.
How his remedy of closing A&Es like KGH will make things better is a mystery to me.
More athttp://www.independent.co.uk/news/uk/home-news/nhs-unsafe-and-unsustainable-says-health-service-chief-for-london-8877263.html

Well done to Bill Howe and Redbridge residents

Well done to Bill Howe for organising a deputation on King George Hospital last night at Ilford Town Hall.

Bill asked Cllr Prince, the Leader of Redbridge Council and other group leaders to seek a meeting with Boris Johnson and Roger Evans to persuade them to support the save KGH A&E campaign. Cllr Prince and Cllr Maravala, the Leader of the Redbridge Independents agreed to Bill's request.

The Recorder writes about the deputation here http://www.ilfordrecorder.co.uk/news/news/meeting_with_boris_johnson_planned_in_fight_to_save_king_george_hospital_a_e_1_2757389

"Delhi to Dubai"

The Telegraph reports here: http://www.telegraph.co.uk/health/healthnews/10308522/Scandal-hit-hospital-looks-for-foreign-doctors-to-fill-urgent-staff-shortages.html that BHRUT is looking overseas for medical staff. With NHS planning to axe large numbers of medical staff by 2015 as part of the plan to close KGH A&E, it is no surprise that UK staff will not work for BHRUT. The closure plan must be dropped now.

Why has BHRUT the worst vacancy rate?

The Evening Standard reports the following today at http://www.standard.co.uk/news/health/jeremy-hunt-gives-london-hospitals-55m-to-cope-with-winter-rush-8806602.html "Today’s cash includes £62 million for additional capacity in hospitals, such as consultant cover over the weekend. It comes after four London trusts were named as having the worst staffing shortfalls of casualty departments across the country. Barking, Havering and Redbridge trust, which runs Queen’s and King George’s, had 129 vacancies — 43 per cent of a total contingent of 302 staff. This included 12 consultant posts, plus 41 doctors and 75 nurses." The report gives the impression that BHRUT has the worst staffing shortfall for casualty departments in the country. A vacancy rate of this degree is bound to an obstacle to good healthcare. The plan to close KGH A&E and sack large numbers of medical staff is not going to attract staff and needs to be abandoned.

An Action plan for Maternity and A&E

Neil Zammett Writes

Maternity promises by NELC

The news from the CQC inspection of Whipps sent alarm bells ringing in Redbridge and Waltham Forest and woke everyone up to some very unpleasant facts about services. For Maternity in particular, the independent conclusions of the inspectors contrasted sharply with those of the ‘Gateway Assurance’ process carried out be NELC (North East London Primary Care Trust) before the service at King George was closed.

A survey of Redbridge women undertaken for Health4NEL showed overwhelmingly that they wished to go to King George. Nevertheless a significant number of Redbridge women were diverted to Whipps Maternity when King George closed on the understanding that the service there would be of an equivalent standard at least in terms of staffing levels and basic ‘readiness’.

The Gateway Assurance process was supposed to ensure this, although Whipps was only included at the last minute, but two major points of concern have now emerged at Barts Health: the time consultants are present on the labour ward and the midwife to birth ratio. The process was supposed to have confirmed a plan to achieve 98 hour consultant cover per week and a ratio of 1:30.

Bart’s Health however are currently operating at a much lower consultant cover level, certainly at Whipps and are working to a trust wide ratio of 1:32 for midwives. There seem to be no clear plans to increase this-certainly not in the short term.

The CQC report shows however that service quality at Whipps is deficient in a number of other important ways as well. The local and national press have described the “... catalogue of failings” which include unsafe equipment, uncaring staff and women in labour being diverted to other hospitals because there were not enough beds.

In addition to these very serious concerns the whole of the maternity service at Bart’s Health is going to be subject to a further inspection by CQC because of its high emergency caesarean rate.

It is very hard to see how this squares in any way with the Secretary of State’s commitment not to close until local services are of a good standard.

In fact the worst fears of local people have now been realised and the warnings that the closure of the service at King George was being rushed and the Gateway Assurance process skimped have been borne out by events.

Following the Lewisham judgement there is now an important legal angle as well because if local services were, and are, not of a good standard then the original commitment of the Secretary of State has not been met and the NELC decision may be unlawful. Certainly those board members and GPs who supported the decision have something to answer for.

Risks around A&E

If maternity is problematic the situation with A&E at King George is steadily becoming riskier. A clinical review commissioned by the three outer London CCGs is underway. It is led by an external expert primarily looking at medical staffing and the feasibility of a night closure at King George but the broader aspects of a possible night closure also deserve some attention.

How this proposal came about is shrouded in mystery. Letters from the Chief Executive of BHRUT would suggest that it arose as part of the radical thinking advocated by CQC in their report on their June visit. Recent enquiries have revealed that it was part of an overall plan to close King George presented at the June 4^th Barking and Dagenham Health and Well Being Board. The plan was written by the BHRUT Medical Director Dr Mike Gill and appears to be a response to the previous CQC visit in late 2012.

This plan has not been to a public BHRUT Board meeting or the Redbridge Health Scrutiny Committee. Its formal status is therefore unclear and it is pretty much an outline document, although there is a chart which clearly shows King George closing at night in August 2013 and finally in Quarter 2 2015.

What is very surprising is that none of the formal documents; the business case for the A&E extension/conversion at Queen’s and the Long Term Financial Model (LTFM) have not been put into the public domain by BHRUT. These are essential building blocks of both the closures at King George and BHRUT’s Foundation Trust application.

Given the scale of what is proposed proceeding publicly just on the basis of Dr Gill’s outline document in my view is totally unsound in governance terms and we all need to see these other more substantial documents.

There is also the impact that any changes will have on the emergency care services across East London. Although eight ‘blue light’ patients a night at King George does not sound much; if all were admitted with an average length of stay of 3.5 days some 28 beds, say a ward, would be required. Given the number of beds BHRUT have already closed it is hard to see how existing services would cope particularly with the winter approaching.

We also need to be clear about processes for consultation. Just recently a letter has been circulated following a routine monitoring visit by Redbridge Health Scrutiny Members to BHRUT making it clear that members were not “on board” with the night closure when the BHRUT Chief Executive had told the Urgent Care Board that they were.

At senior level people should know the difference between a conversation and an agreement and this embarrassing episode points up the need for proper consultation and communication through established structures.

As with maternity, what seems to be happening is a rush to close the service based on the old Health4NEL plan which is now largely discredited in terms of its efficiency and workload projections.

A way forward

Whether Redbridge Council seek a judicial review of the NELC decision is a matter for them but at a practical level we should all be calling for a level playing field in terms of standards of maternity care in East London. Central to this is a clear statement of current staffing levels, booking and deliveries for all of the units. We also need to see the plans to meet the targets set by NELC and to start with an understanding of what those targets were and how they were to be monitored.

This is all the more important because BHRUT now have consultant cover of 98 hours and a midwife to birth ratio of 1:29, the best in London. It means that some Redbridge women have been transferred against their wishes to a lower standard service and this is a disgrace.

Redbridge Council has asked for a review of A&E services across East London and they are to be congratulated for doing this. What we need is a proper long term plan and more urgently a plan for this winter which takes account of the pressures on all A&E departments.

In summary what we should be doing for maternity is:

· A schedule of activity and staffing levels for all the units in East London

· A clear statement of expected standards

· Plans to achieve these standards

· Checking to see if the NELC decision is lawful

· Considering other options to achieve the standard of service promised to Redbridge women

And for A&E:

· A winter plan for 2013/14 for the whole of East London

· A long term plan to 2024/25 for A&E services

· The BHRUT LTFM and A&E extension business case to be published

Bin the KGH closure plan to help recruit Doctors

Thank you to the Redbridge resident who told me about the Evening Standard story here
http://www.standard.co.uk/news/london/air-ambulance-perk-to-help-troubled-aes-recruit-doctors-8787249.html

The Standard reports that Queens and King George have 9 emergency doctors, 12 fewer than required. In a welcome effort to recruit more doctors, Queens and KGH new recruits will be offered the "perk" of working with the London Air Ambulance service.

Perhaps the threat of closing KGH A&E in 2015 is a factor in the unwillingness of doctors to work for BHRUT. Why work at a trust which is struggling to cope with demand now and has a plan to close KGH A&E which will put even more pressure on the staff working at Queens?

Peter Cater calls for suspension of A&E closures

Thank you to the Redbridge resident for pointing out the Evening Standard article at http://lydall.standard.co.uk/  containing the following:

"Dr Peter Carter, chief executive of the Royal College of Nursing, said the High Court victory of Save Lewisham Hospital campaigners in blocking the downgrading of their unit should herald a capital-wide review of the demands being placed on A&E departments.
He said the RCN was not opposed to closures but would not support those that were a “smokescreen” for cuts where there was no clinical evidence of better patient care."

BHRUT make assertions about better care following any closure of KGH A&E. But where is the evidence?

Is the CQC supporting A&E closures?

The Mail on Sunday is running a piece here http://www.dailymail.co.uk/news/article-2389145/New-A-E-shock-units-face-axe-tough-new-hospital-safety-regime.html?ITO=1490&ns_mchannel=rss&ns_campaign=1490
This reports an interview with David Prior, the Chairman of the Care Quality Commission (CQC). The article contains the following:

“Mr Prior thought the CQC’s beefed-up inspection regime, which includes doctors and nurses from elsewhere and patients going into hospitals, would find that some emergency departments were unsafe. This may drive further reconfiguration, driven by patient safety, not driven by financial considerations,’ he said. Some hospitals simply did not have enough senior doctors to provide safe A&E care. ‘If you take A&E, the availability of consultant doctors 24/7 – or for at least 16 hours a day – is really important,’ he added. ‘Now it’s bloody hard for a small hospital to provide that kind of cover, because it’s so expensive. I think the reality is that some smaller A&Es will find it difficult.’ He went on: ‘If we are going to get reconfigurations in the NHS, I think it’s much more acceptable if it’s driven by patient safety and quality, than by financial reasons.’ Among the six ‘high-risk’ trusts to be inspected soon is the Barking, Havering and Redbridge NHS Trust in Essex. It runs A&Es at Queen’s Hospital in Romford and King George Hospital in Goodmayes, the latter due to close in 2015. ENDs

 The report concerns me because it seems Mr Prior may have pre-judged what needs to happen at BHRUT. Closing KGH A&E and sending staff to Queens will not make the service better because thousands of extra patients will be going to Queens. Neil Zammett’s proposal of extra staff and beds per his blog here http://savekinggeorgehospital.blogspot.co.uk/2013/07/a-at-queens-where-will-new-nhs-take-us.html are a far better way forward.

High Court says downgrade of Lewisham Hospital unlawful

The BBC reports here http://www.bbc.co.uk/news/uk-england-23518732 that the High Court has ruled the proposed downgrade of Lewisham Hospital casualty and maternity units as unlawful. Perhaps this could be helpful to keep open KGH A&E.

BHRUT aim to close KGH A&E in 2015

The Ilford Recorder reports at http://www.ilfordrecorder.co.uk/news/news/provisional_date_set_for_king_george_hospital_a_e_closure_in_2015_1_2284269

that BHRUT intend to close KGH A&E in 2015.

The original NHS plan to close the unit says at page 123 that 25% of the medical staff are to be sacked by 2015. The detail from the report is listed below.

For medical staff:

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)

2012/13 

(Y+2)

2013/14

(Y+3)

2014/15

(Y+4)

Overall change:

-8%

-7%

-10%

-2% 

How can patients not die if the closure is allowed to happen?

The Guardian report http://www.guardian.co.uk/society/2013/jul/17/barts-health-trust-losing-2m-week indicates cuts are likely to happen at Whipps making all the dangerous any closure of our A&E.

Both Redbridge and Waltham Forest need more medical staff, not less.

A&E at Queen’s-Where will the new NHS take us?

Neil Zammett writes

Last week saw the publication of the latest CQC report on A&E at Queen’s based on their visits on 21st and 22nd of May. As before it is a catalogue of miserable news for patients with unacceptable delays, large numbers of ambulance diverts, shortages of key staff and large numbers of patients waiting for more than an hour in ambulances (black breaches). On this occasion however the visits took place in the spring/early summer when the pressures on A&E are normally easing

On the positive side some improvement in personal care and refreshments for patients waiting was reported.

In a hard hitting press release CQC point out that this has been going on since 2011 and state:

“The emergency department at Queen’s hospital in Romford is failing local people. This situation has been going on for far too long. Radical thinking is needed by the Trust Development Authority and commissioners.”

The evidence base

The former NELC cluster PCT produced occasional reports on A&E which were of good quality and contained year on year comparative data on the four hour wait performance at Queen’s.

(I cannot get graph up at 17.7 AW)

The March 2013 report shows that in 2012-13 the 95% performance was only reached in one week, 29th July and fell below 2011-12 for much of the rest of the year. The graph also shows the seasonality in performance very clearly

Rough comparison of more recent data shows that June 2013’s performance is some five percentage points worse than June 2012 which in turn was the worst year of recent times.

A more formal statistical analysis would show the significance of this year on year variation and this should be done by CQC and the commissioners. However, inspection shows fairly clearly that year on year the performance at Queen’s has declined steadily since the decision to close King George A&E in December 2010.

BHRUT’s response

Perhaps significantly the Chief Executive’s response to stakeholders does not contain an apology this time or the promise of an action plan but simply a reference to their June newsletter.

There is a restatement of some of the major points in the report and news that five joint appointments of A&E doctors with Barts are on the way. BHRUT feels the ambulance service should be taking more patients to Whipps and elsewhere and that they being unfairly loaded.

On the BBC News the Trust spokesperson also cited difficulties with accessing primary care as one of the reasons for the poor performance when commenting on the report.

As always there is reference to the increase in workload and the physical limitations of a department which was designed for a much smaller number of attendances. There are comments about continuity of care across the week and centralisation of specialties but no specific details.

What was not mentioned is the number of beds which have been closed as the Trust reconfigures to prepare for the closure of A&E at King George. It is also evident that BHRUT are keeping separate records of key indicators such as the number of “black breaches”, the number of patients waiting in ambulances for more than one hour. For January to March this year the Trust said it had 23 while LAS figure was 144.

The response of the CCGs, the “commissioners”

The Chair of Havering CCG in an interview on BBC news made it clear that the current situation in unacceptable and both for patients and commissioners. “They’ve done it for maternity now they must do it for A&E; it is a tougher nut to crack...”

There is more in the Ilford Recorder “Significant changes need to happen and they need to happen now...As strong GP commissioners we won’t hesitate to take appropriate action where we feel it is needed.”

There are no specific actions identified however.

Looking at the Emergency Care report to the April Redbridge CCG Board meeting gives some clues as to what the GP’s have in mind so far. It suggests using leverage through the contract and renaming the “Emergency care Standards Performance” group as an “Urgent Care Board”, enlarging its membership and getting it to meet more often.

It is not clear what “leverage” means or how the renaming of the board/group could promote change.

Previously CQC and the commissioners met with NHS London for risk “summits”-the last was in February this year. This meant that all the major parties agreed a way forward. With the demise of NHS London this important coordinating role appears to have lapsed.

Making Decisions

It is hard to read the latest CQC report without feeling that is more of the same and that the situation is now drifting without any firm managerial grip either within the Trust, the commissioners, CQC or NHS England.

There are also worrying signs that as performance worsens the organisations involved are squaring up to blame each other if a crisis occurs.

The NHS Trust Development Authority (TDA) and NHS England are keeping a low public profile and without the risk summits organised by the now defunct NHS London there appears to be no one to pull the different strands together.

To some extent they are all victims of a market structure which has emphasised competition and created a situation where accountability is now so diffused that decision making is both tortuous and slow. Before the current re-organisation things were difficult, now without NHS London they seem to be becoming impossible.

All of this has worrying echoes of the situation in Mid Staffordshire Hospital, not in terms of death rates, but decision making.

The Reasons for the crisis

Right from the outset it has been clear that Queen’s and King George are serving a much larger catchment area than other hospitals in NE London. Rough estimates would suggest 750,000 as opposed to 250,000 to 300,000 at the Homerton and the Royal London for example. It is no wonder therefore that more ambulances are sent to the two hospitals.

BHRUT have also been steadily reducing beds since December 2010 when the decision to close A&E at King George was made. A report to the Redbridge Health Scrutiny committee in September 2012 showed that 114 across the two sites had been closed and reallocated for different purposes. More recent correspondence states that another 60 beds are due to close soon. Quite where this leaves the acute bed base at BHRUT is unclear.

Closing beds when workload is rising is clearly counterintuitive and CQC have identified bed availability as one of the reasons for delays in A&E.

The underlying problem is that no one is prepared to face the unpalatable truth that closing the A&E at King George cannot be achieved without placing the whole of the A&E service across East London at risk.

We have already had a “major surge”, reported as a major internal incident by the commissioners at Queen’s in early January this year and a “significant internal event” at Whipps on April 11th. These happened on different dates but show the potential for a “domino” effect particularly as the Royal London has reported difficulties as well.

Hopefully the “radical thinking” CQC are talking about is recognition that an A&E with a significant acute bed base needs to be maintained at King George for the foreseeable future to ensure patient safety.

CQC however have missed a central point, radical thinking is going to have a price tag associated with it. The improvements in maternity services at Queen’s were only achieved by substantial investment in staff in both medical and midwifery staff by the commissioners. Whether it is more doctors or more beds it is going to cost money which the local commissioners do not have. This is particularly true of Redbridge who have taken a £20 million “hit” in their allocation this year.

The way forward

One of the most worrying aspects of the current situation is that no new thinking has been brought to bear on the situation and here is no new action plan. CQC are right that radical thinking is necessary but have not helped the decision making process by specifying what that might be.

The following is a practical way forward:

Resumption of the risk summits to be chaired by NHS England

An immediate moratorium on bed closures cross NE London

An urgent review of A+E services across NE London to look at capacity and demand and to include a statistical analysis of historical data.

BHRUT to open 60 additional beds in September/October 2013 and a further 30 beds in January 2014, funded by NHS England

Six additional A&E consultant posts to be funded by NHS England

CQC to step in and resolve the dispute about black breach figures with LAS and BHRUT

Neil Zammett

July 2013

Addendum

Just before this Blog was due to be published the CCGs circulated a note outlining their response t the CQC report. By and large this follows the line taken in their comments to the press and the Board paper referred to above.

There are additional statements about community teams, improving discharge services and improving the quality of services in community hospitals and home. There are no details however and the response does not mention the beds that are planned to be closed in community hospitals which are the subject of a separate enquiry by the Redbridge Health Scrutiny Committee.

It seems very doubtful that the actions mentioned would meet the requirement for “radical thinking” from CQC.

NZ

Can you help BBC with Queens Story

Jim Wheble of BBC London is looking to talk to people who have had a poor exeprience of Queens A&E.

Contact him at Jim.wheble@bbc.co.uk if you can help.

A&E target missed

The stats below are taken from the BHRUT website, they appear to have been published yesterday:

A&E 4 Hour treatment This is the percentage of patients who complete their care in the emergency department within 4 hours. The target figure is: 95% over the last four weeks, we achieved: 87.8% ENDs

The below is a quote from Averil Dongwoth's letter to Cllr Ryan on the Redbridge council website dated 9th May

 "In terms of plans for the year ahead...which will reduce the need for inpatient beds by approximately 60 beds"

 I hope Averil will be reviewing the plans to cut 60 beds until the A&E statistics improve.

 The plans to close KGH A&E need to be abandoned.

Decisions from 14 June Save King George Hospital Meeting

Apologies Cllrs  Ruth Clarke, Vanessa Cole,  Paul McGeary

Attendance

Bob Archer, Bill Howe Helen Zammett,  Andy Walker

BH briefed meeting about moves to reclaim monies from overseas governments whose citizens use NHS are being tightened up.

HZ very concerned about press coverage that beds at Wanstead hospital to close. If it happens is likely to put more pressure on King George Hospital (KGH) and Queens.

Following discussion on future campaigning agreed to:

a) Photo shoot outside KGH on Saturday 26 October at 1pm to mark 2nd anniversary of closure decision with a call for the KGH A&E closure plan to be dropped and maternity to return to KGH .

b) A petition calling for the return of maternity to KGH and the dropping of the closure plan plan to be presented to September full council.

c) A public meeting to be held in autumn

d) AW to pursue what evidence was provided to by Barking Havering Redbridge University Trust to Independent Reconfiguration Panel in 2011.

What's going on at BHRUT?

A local resident sent me this headline earlier today from Health Service Journal of 18 June. I could not find anything on BHRUT site about it. I phoned press department and told it was correct.  

Troubled trust avoids regulator ‘cap’ on A&E

about Queens A&E.  This lack of reporting a key issue does not appear to be the transparency demanded by the Francis report. We should find out important developments from the BHRUT direct rather than the press. BHRUT need to issue a press release on this issue ASAP. 

The latest BHRUT Chairman’s report of April this year I can find at
http://www.bhrhospitals.nhs.uk/Downloads/about/bhrut-trust-board-papers-0513.pdf says:

“4. Never Events:

We have now had three surgical never events in the past few months, fortunately

without major harm to patients, and I remain concerned that the Trust’s approach is

inadequate. It is simply not good enough for individuals, including senior clinical

colleagues, to shrug their shoulders and accept that “these things happen”.”

Suggest never events need to kept track of too as a key performance indicator on the council website.

Closing KGH A&E sacking medical staff and putting thousands more patients into Queens must increase the chances of more never events which is why the campaign to keep open our A&E must succeed.

Meeting of the save KGH committee & A&E Review Link

The next meeting of the save KGH committee will take place on:

Friday 14th June from 12-1pm in room 43 at Ilford Town Hall

By then more information should be available about the press report which has the quote

"Hunt said the review, to be led by NHS England's medical director, Sir Bruce Keogh, would tie together the vexed issues of whether there should be closures of accident and emergency units across the country; how to get elderly patients out into the community to free up hospital beds; and how the GP contract could be altered to get family doctors to become accountable for the care of vulnerable older people outside A&E"

The full article is here http://www.guardian.co.uk/politics/2013/jun/06/a-and-e-crisis-jeremy-hunt

All KGH supporters welcome

Regards

Andy