Recorder letter

In 2011, Mr Lansley, then Secretary of State for Health, gave safety as a key concern when deciding to close King George Hospital A&E in principal. A&E 4 hour waiting times are a vital component of whether a hospital is safe. Recent Parliamentary research shows
 King George and Queens 144th of out 145 hospital trusts for A&E waiting times in England.  To even consider closing King George Hospital A&E damages Hospital staff morale and so patient care. This is why went to 10 Downing Street last week to ask the Prime Minister to intervene and throw out the idea of closing King George A&E for good.

Photos from 10 Downing St visit today & next task in campaign

Thank you to everyone attending today. Main task appears to be pushing for publication of "major piece of work" by BHRUT into whether population growth makes the 2011 decision to close KGH A&E invalid

Councillors from Havering, Barking and Dagenham and Redbridge to lobby Number 10

Councillors Canal and Steeting from Redbridge, Bartlett and Tarry from Barking and Dagenham and Dodin and Burton from Havering go to 10 Downing Street this Friday 26 September at midday to seek the support of the PM per the letter below.

Abandon the plan to close King George Hospital A&E 

We ask for your support in our campaign to improve care at the above hospitals which are in special measures for providing unsafe care. In order for care to be improved it is vital that the plan to close King George Hospital A&E is abandoned and a commitment made to keeping an A&E at the King George site. Medical staff do not want to work at Queens because there are concerned their already heavy workload will get worse if the closure happens. Staff do not want to work at King George Hospital in case they lose their jobs if the closure goes ahead.

The addendum attached provides more detail of what is happening in our two hospitals. The hospitals’ management is currently investigating the death of a child. Investigations are continuing into whether the competence of locum doctors was a factor.

Abandoning the A&E closure plan will help bring stability to our troubled hospitals and we look forward to your reply.

ENDs

Addendum

The parliamentary research paper 14/22 Accident & Emergency Performance England 2013/14: national and regional data of 14 April 2014 shows Barking and Havering and Redbridge University Hospitals Trust (BHRUT) to be the fifth busiest NHS trust in England along with ranking 144^th out of 145 trusts for 4 hour A&E waits. This suggests the growing population of this part of North East London needs more NHS resources. On 27 October 2011, the Department of Health announced the closure of King George Hospital (KGH) A&E along with the removal of the maternity unit. This plan was based upon a NHS Decision making business case dated 15 December 2010 which forecasts, at page 123, medical staff reductions of 25% by 2014/15. This has not happened. However, this 2010 plan still guides strategy at BHRUT per this extract from the September 2014 BHRUT AGM board papers at page 14 (our emphasis)

“The Trust’s clinical strategy seeks to improve quality of care, generate benefits in centralising acute services and strengthening staffing levels, while enhancing urgent care and out of hospital care where appropriate. It is underpinned by the clinically-led Health for North East London plans (HfNEL) set out by commissioners in 2010 following major public consultation.

In summary, the key elements of our clinical strategy (some of which have now been implemented) that were developed in line with HfNEL are:
Unplanned care: Stabilise its emergency care provision and performance at QH before implementing any plans to move emergency activity from KGH to QH. The ‘Front Door’ model is under review as part of the implementation plan. This will influence access and flow through the Emergency Department

Planned care: Maximise use of the Queen’s site for complex inpatient activity, and the use of KGH for day case, short stay elective and diagnostic activity, including developing a dedicated breast services unit on the KGH site

Integrated care: Relocate and develop additional intermediate and rehabilitation services at KGH and, subject to consultation, potentially centralise community services on the KGH site.

Maternity services: KGH maternity services were successfully moved to Queen’s in
2013, with an antenatal and associated service remaining at KGH

Children’s services: A focus for specialist paediatrics at Queen’s, with paediatric inpatients and the Special Care Baby Unit to move to Queen’s and paediatric day case, elective and planned diagnostics to be centralised at KGH. To develop a women’s and children’s unit at KGH that will aim to provide a fully centralised breast
service at KGH. END of Extract

The planned loss of 340 beds of KGH (page 92 of the decision-making case) along with the 25% medical staffing cuts would damage health care in North East London and needs to be abandoned as soon as possible.

There may be a tension between maximising use of Queens for complex care while leaving day cases at KGH and providing best care. Queens occupancy rates have been as high as 98% this year, when the December CQC report gives safe level of 85%. 

This is an extract the 2013 CQC report for Queens Hospital

Intensive/critical care

The patients and relatives we spoke to in the intensive care unit (ITU) felt that they had been well cared for and involved in making decisions about their treatment. The service was well-led by a team who had identified the risks and challenges the service faced and were monitoring them. However, there was a lack of patient flow in and out of the service due to delayed discharges and high bed occupancy in other parts of the hospital. This affected the service’s ability to provide responsive and effective care to all patients. Once admitted to an intensive care ward, patients received safe and effective care from caring, qualified staff. Extract ends

Medical staff do want to work at a Trust whereas such large efficiency savings are planned because it means their jobs will be at risk. As a consequence BHRUT employs  large numbers of locum staff which is not only expensive, but increases the risk of poor patient care. The extract below is from page 115 of the September BHRUT ordinary board meeting (our emphasis)

At the meeting held in June the Panel heard two cases that had occurred within the Children’s Directorate. There were a number of issues that the Panel is seeking further assurance on and this has been requested from the Directorate.
The first case discussed was a child with complex medical problems who attended the emergency department. The other case was a neonatal death that occurred within SCBU3. Actions that the Panel has requested following review of these investigation reports are:· Establish an alert system on Symphony4 to immediately identify children with
complex medical needs.· Complete a gap analysis on competencies and capabilities on Inra-Osseous
cannula usage.· Produce a flow chart that demonstrates the level of care escalation process within
Paediatrics.· Examine the level of competencies of locum doctors covering shifts within the
Trust and how this is assured. Extract Ends

BHRUT is not certain about the level of competence of locum doctors. This will not encourage the public to think our hospitals are safe.

However, there are grounds for optimism that BHRUT is considering abandoning support for the KGH A&E closure plan along with the large bed and staffing reductions entailed. At page 14 of the AGM papers.

Although the Trust is committed to following through on the above elements and delivering them, before embarking on any other aspects, we have asked for a major piece of work to take place to look again at the data – including projected population and demand – that was used to develop the original Health for North East London proposals. Extract ends

BHRUT may be concerned that closing KGH A&E is no longer feasible due to larger than expected population growth. A very welcome development. This major piece of work to be completed as soon as possible. It seems difficult for the review to show that closing KGH A&E is feasible and needs to be abandoned before winter pressures. Dropping the KGH A&E plan is a vital part of making our Hospitals safe again.

References

1The parliamentary research paper 14/22 Accident & Emergency Performance England 2013/14: national and regional data of 14 April 2014

NHS Decision making business case dated 15 December 2010

September 2014 BHRUT AGM papers

September 2014 BHRUT ordinary meeting papers

2013 CQC report for Queens Hospital

Invitation to Councillors to Visit 10 Downing Street

Councillors in Barking & Dagenham, Havering and Redbridge were written to last week per the below

 

Dear Councillors

We are writing to all Councillors in Redbridge, Havering and Barking and Dagenham to ask if you would like to come to deliver a letter to 10 Downing St on 12:00pm on Friday 26th September 2014 asking for the closure of King George Hospital A&E to be abandoned and the return of maternity to the King George Hospital site.

We would welcome Councillors from all three boroughs and all parties to attend.
The link here

http://www.bbc.co.uk/news/uk-england-london-13005433

shows the last time in April 2011 a letter was handed to 10 Downing Street on the issue.

The decision to close King George Hospital A&E was made in October 2011. However, the A&E remains open, but both Queens and King George Hospitals have been put into special measures for being unable to provide safe care at all times.

Queens and other London maternity units regularly close their doors as they are unable to cope with demand. BHRUT has identified a shortage of child beds locally which puts children at risk of poor care. The purpose of the photoshoot outside number 10 will be to seek to persuade the government to abandon the plan to close King George Hospital A&E and reopen the maternity unit.

The closure plans damages health care in our hospitals because medical staff do not want to work at King George Hospital A&E when it is due to close, nor do staff want to work at Queen's when thousands of extra patients are due to be sent to a hospital that cannot cope safely with the existing demand.

Regards

Bob Archer Bill Howe Andy Walker
C/O 120 Blythswood Road IG3 8SG 07956 263088

PS since writing the above Andy attended the BHRUT board meeting and AGM.

Page 115 reports a death at the special care baby unit (SCBU3), the text is copied below. The emphasis is mine

At the meeting held in June the Panel heard two cases that had occurred within the
Children’s Directorate. There were a number of issues that the Panel is seeking further
assurance on and this has been requested from the Directorate.
The first case discussed was a child with complex medical problems who attended the
emergency department. The other case was a neonatal death that occurred within
SCBU3. Actions that the Panel has requested following review of these investigation
reports are:
 Establish an alert system on Symphony4 to immediately identify children with
complex medical needs.
 Complete a gap analysis on competencies and capabilities on Inra-Osseous
cannula usage.
 Produce a flow chart that demonstrates the level of care escalation process within
Paediatrics.
 Examine the level of competencies of locum doctors covering shifts within the
Trust and how this is assured. Extract Ends

BHRUT clearly has doubts about the competency of locum doctors at KGH and Queens. The proposed closure of KGH A&E along with a reduction in medical staff of 25% over 4 years (page 123 of the attached decision making business case) has to be a factor in why medical staff do not want to work at either Queens or KGH on a permanent basis.

Although the targets in the decision making business case are not being achieved, it still determines strategy at BHRUT.

This is from the AGM papers at page 14 (my emphasis)

The Trust’s clinical strategy seeks to improve quality of care, generate benefits in
centralising acute services and strengthening staffing levels, while enhancing urgent
care and out of hospital care where appropriate. It is underpinned by the clinically-led Health for North East London plans (HfNEL) set out by commissioners in 2010 following major public consultation.

In summary, the key elements of our clinical strategy (some of which have now been
implemented) that were developed in line with HfNEL are:
Unplanned care: Stabilise its emergency care provision and performance at QH
before implementing any plans to move emergency activity from KGH to QH. The
‘Front Door’ model is under review as part of the implementation plan. This will
influence access and flow through the Emergency Department

Planned care: Maximise use of the Queen’s site for complex inpatient activity, and the
use of KGH for day case, short stay elective and diagnostic activity, including
developing a dedicated breast services unit on the KGH site

Integrated care: Relocate and develop additional intermediate and rehabilitation
services at KGH and, subject to consultation, potentially centralise community
services on the KGH site.

Maternity services: KGH maternity services were successfully moved to Queen’s in
2013, with an antenatal and associated service remaining at KGH

Children’s services: A focus for specialist paediatrics at Queen’s, with paediatric
inpatients and the Special Care Baby Unit to move to Queen’s and paediatric day
case, elective and planned diagnostics to be centralised at KGH. To develop a
women’s and children’s unit at KGH that will aim to provide a fully centralised breast
service at KGH. END of Extract

However, there are grounds for optimism that BHRUT is considering abandoning support for the KGH closure plan along with the large bed and staffing reductions entailed. Futher on at page 14 (my emphasis)
 

Although the Trust is committed to following through on the above elements and
delivering them, before embarking on any other aspects, we have asked for a major
piece of work to take place to look again at the data – including projected population
and demand – that was used to develop the original Health for North East London
proposals. Extract ends

BHRUT may be concerned that closing KGH A&E is no longer feasible due to larger than expected population growth. A very welcome development.

Finally, 4 hour waiting times at A&E, a vital key performance indicator, and one of the reasons Queens and KGH A&E were found unsafe last year and the trust put into special measures remain well below the recommended safe level of 95%. Mr Russell, BHRUT deputy Chief Executive spoke of a deteriorating position for the August figures at the ordinary board meeting yesterday. The exact figure will be published shortly.

A&E sign update

I attended BHRUT board meeting today to hear that BHRUT has asked TFL for A&E icon on the sign per post below.

TFL still have not sent anything to Redbridge Council on this.

Safety reasons mean TFL need to get an A&E icon on sign ASAP.