Bary Fleetwood writes
The A&E Question of Queens and King George
LARGEST A&E TRUSTS
Patients attending per year
Barts
Trust
4 A&E Units
290,000
Heart of
England Trust 2
A&E Units
240,000
Pennine
Acute Trust 4
A&E Units
240,000
Mid
Yorkshire Trust
3 A&E Units
210,000
Lewisham & Greenwich Trust 2 A&E Units 210,000
Leeds
Teaching Trust 2
A&E Units 200,000
BHRUT
2/1 A&E Units 199,000
After Reconfiguration, BHRUT will be the
largest one unit A&E in the country, there must be serious doubt that they
can design and operate an A&E this size with any success
WORST TRUSTS WITH
GREATER THAN 4HOUR WAIT
(for w/e 15/12/2013)
Hospital
Seen in less than 4hours
1.Mid Staffs 76.0%
2.Portsmouth Hosp. 78.1%
3.Kettering General Hospital 80.2%
4.Southampton Univ.Hosp 80.9%
5.King's College Hosp 82.4%
6.East Lancashire Hospitals 83.0%
7.Milton Keynes Hospital 83.8%
8.BHRUT 85.1%
9.Somerset and South Glos. 85.2%
10.Nottingham University Hosp 85.4%
The absolute refusal of ministers and the Trust to even
reconsider the Closure of King George A&E is simply a disenfranchisement of
the Voters of BHR Trust Hinterland, but not only these three boroughs but
abutting boroughs you have an arc from
Epping through to Grays that may use Queens, this makes close to a million
people served by Queens.
We do not yet know how big the reconfiguration for Queens
will be but, it will certainly not be enough, and the irony is that as the
population of this part of London explodes, and the rest of the population
ages, it is likely that by 2020 (with perfect sight) the Trust will almost
certainly have to open another A&E because Queens will be in the same
position as it is now, trying to push a gallon into a pint pot.Currently Queens
A&E is trying to cope with 130,000 patients p.a. when its capacity is only
90,000 is it any surprise it cannot cope.The 2010 Consultation imposed on BHRUT
was flawed then and now bears no resemblance to reality 4 years and population increases later, but blinkered Ministers
NHS England and NDTA cannot be seen to admit they are wrong.We also know that
Queens will be the largest single A&E unit in the country, and we also know
that the very largest A&Es are not as effective as medium sized A&Es.The Raison d’etre for
closing KG in the consultation was to consolidate services and make them
better, saving money we were told was not a consideration, except we now know
that this was simply an outright lie, or outright stupidity by the authors.
Let us examine the Reconfiguration, most of which is now
public knowledge for King George, which will go from a modern Acute General
District Hospital to the largest Polyclinic in the world, with no A&E, not
what it was built for.The Trust has not been in the least bit honest,it has
laid out what bits of the hospital will be for what purpose, and said “Those
parts not used we will find uses for” which we all know is Trustspeak for
selling off as much as possible.
Although the Trust does not publish the A&E split
between KG and Queens (however this will shortly be remedied.)from the little
information that is available, it would appear that KG is close to the 95% 4
hour waiting time target ,whilst with an average last week of 84.1% the worse
than we think performance of Queens is hidden, it is probably somewhere near
76-79%.Nor will they publish the split of patients between KG and Queens the
only figures are from a very obscure
document “Quality Account” 2012-13 (this omission will also shortly be
remedied)
These figures are a year old so they have probably
increased, this does not agree with the other figure for Queens which is
bandied about and in several documents of 130,000 a year, there are anomalies
in the figures above as the daily figures do not correspond with the yearly
figures, The statistics reported to NHS England every week appear to support
about 200,000 patients a year in A&E for both KG and Queens, so what is
true, this produces a number of
questions
What figures can we believe?
Does the Trust actually know what the figures are?
.
Although the KG reconfiguration has been published,
absolutely nothing has been published for Queens
These questions remain unanswered
The current alleged capacity of Queens is 90,000 p.a. NO
Capacity has been promulgated for the Reconfiguration.
The cost of the Reconfiguration, appears to be unknown to
both the Public and The Trust itself,The Trust this Financial Year will have a
deficit of between £27 -£33 million, to add to the already existing £100M +
deficit, just how does the Trust propose financing the Reconfiguration?, The
reconfiguration is not going to be cheap, is likely to be many millions rather
than a few ,
Ministers , Trust Executives and CCG executives have all
used the phrase “KG A&E will not be closed until it is “Clinically safe to
do so”, The Minister has refused to name the criteria to be used, the Havering
MPAndrew Rosindell has ignored a request to ask the minister to name the
criteria and quantitive figures to measure “Clinically Safe”, NO-ONE seems to
know what this phrase means, one has to believe that CLAIRVOYANCY is the going to be the method of determining
“Clinically Safe”.
Now let us examine how big the reconfigured A&E should
be, currently we have for Queens any where from 130,000 to to 147,000 and for
KG anywhere between 73,000 and 100,000, (of course what this does point up is
that the Trust is simply not consistent with its figures-the Trust believes –
with no supporting evidence (and I believe it is simply a guestimate) that 30%
of KG A&E patients will transfer to Queens A&E when KG is closed. In my
opinion this is a fallacious argument probably a much higher percentage will transfer , when people want an A&E
they want an A&E not a pale imitation as is planned for KG So at the very
minimum according to the Trust (and we have already demonstrated their figures
are hugely suspect)there will be between 155,000 and 177,000 with a possible high figure of between 230,000 and 257,000, to add to this the NHS
recognises and has published that for a
new A&E for the first 6 months there is a 15-20% increase over and above
the normal number of patients.This takes no account of any increase in population
which will increase the call for A&E facilities especially for children. The
other point is that no mention has been made of
future use, even though the Trust is legally bound to publish a 5/10/20
year plan and forecast for a new A&E
We already know that very large A&Es’ perform
significantly worse than the smaller ones, which is frightening for Queens for
it to reduce its performance from an already dangerously low point.The people
of the three boroughs expect and deserve something infinitely better. The
original Consultation said that the reconfiguration would deliver a much safer,
better performing and more efficient A&E
if as is likely that the Unit might have to deal with nearly a quarter
of million patients a year does anyone actually believe that? And we have not
even considered the huge number of Consultants, middle range and junior doctors
that will be needed, along with nurses and support staff, none of which vacant
positions the Trust seems able to fill. We have yet to see the alleged 30+doctors
from India actually in place and REMAIN in place once here. One also has to
wonder about both their suitability ,experience and temperament to operate in
the high pressure of A&E.
Having said all this about Queens, the A&E itself is in
an impossible position, trying to put 130,000 a year into a 90,000 a year pot. Every
part of the system is responsible for the failure of Queens, CCGs Councils and
not helped by the failure of Scrutiny Committees and the CQC which gives
local GP practises with 18 day waits for
an appointment a clean bill of health, they have no incentive to improve, not
least the Councils themselves, where home care either is not in place or fails,
which means that the elderly infirm and disabled get taken to A&E instead
of being dealt with by carers and GPs.
The pressure on A&E can only be resolved by ensuring
that the other parts of the system work effectively, GPs with reasonable
waiting times, CCGs ensuring this is so, councils spend enough on home care,
and Scrutiny Committees making sure they all do their job correctly, otherwise
what you end up with is that A&E does the GPs job for them, and under those
circumstances every single A&E in the country will fail. We know that GPs
and CCGs are failing to relieve the pressure on A&Es there is no reason to
believe that the third part the Councils with home care, with budgets under
huge pressure are any different and failing despite Council spin to the
contrary.
Scrutiny Committees have so far have shown very
little evidence that they also have a grip on the situation or have any
effective influence on any of the participating partners.
It is a truism that all Outer London Hospitals have
suffered from decades of under investment and under funding, the money has all
gone to the “Glamorous” Teaching hospitals in Inner London, making them some of
the best in the world, but depriving the rest of London of desperately needed
funding-just look at how much equipment has been provided by groups of “Friends
of the Hospital”. The problem is not nearly as bad in the rest of the country,
where funds are spread much more evenly, rather than concentrated on Teaching
Hospitals, drawing money away from the very hospitals that treat the 1000s
everyday in Outer London. The
Government and NHS England urgently need to review the funding for all Outer
London Hospitals.
The cost of Reconfiguration has not been published
as yet however this is not going to be a cheap operation it will not be £2/3
million, We do know that the Chase Farm/Barnet Reconfiguration cost – hold onto
your seat- £114 million, so how much money was saved there? So our
reconfiguration is quite probably going
to be in the tens of millions, and one has to ask the question is it actually
going to save any money in the foreseeable future, would this money not be better
spent retaining both A&Es? The Trust is frankly bust, with an accumulated
deficit of over £100 million and forecast deficit of between £27 -£33 this year,
so the money has to come from somewhere else, hopefully not from the PFI
Partner, as the PFI agreement is partly responsible for the Trusts cash
problems, this really only leaves the NTDA (The NHS
Trust Development Authority)
In this climate is the NTDA
actually going to be able to rustle up this level of money? Bearing in mind
there may even be a change of Government in between. In all honesty, what makes
more sense is to invest this money in both A&Es, as has already been said
by 2020 it is quite possible that we will need another A&E anyway.
We have to praise the Staff of KG
and Queens A&E for doing an almost impossible job, with great skill and fortitude,
under an almost impossible pressure, this is due to enormous under funding, a
failure of other parts of the system and the stupidity of trying to enforce a
flawed and unwanted 4 year old consultation, with Senior management stuck
between a rock and a hard place.
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