Saturday, January 18, 2014

How will Queens cope if KGH A&E Closes?

Bary Fleetwood writes

The A&E Question of Queens and King George


                                                    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

(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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