Tuesday, November 26, 2013

Mr Hunt's office on the KGH situation

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

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 6th 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 6th. 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.

Monday, November 11, 2013

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.

Tuesday, November 5, 2013

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

Monday, November 4, 2013

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.