Monday, November 21, 2016

Inviting MPs to support a march

Following the public meeting last Thursday I have written the below to MPs in Redbridge, Barking and Dagenham and Havering seeking their support for a march.

Dear MPs

The attached tender document states that Barking, Havering and Redbridge University Hospital (BHRUT) is seeking a "business case for full closure" at King George Hospital. BHRUT is not saying whether this document is genuine or not, but it seems virtually certain to be so, My questions about the document remain unanswered, although I have put in Freedom of Information requests. The timetable is below:

Issue of Invitation to Tender
27th September 2016
Closing Date for Questions
3rd Oct 2016
Tender Return Deadline and initial review/evaluation of tenders
4th Oct 2016
Evaluation of tenders
10th Oct 2016

I quote from the "invitation to tender"

"NELAR has agreement as part of the NEL STP, to commence work on the development of a business case for full closure, the completion of ED service centralisation at Queen’s Hospital and the development of an enhanced Urgent Care Centre at King George Hospital. The Trust has committed to developing a Business Case by March 2017. The format of this Business Case is yet to be confirmed with NHSE/NHSI, but it is likely to constitute an OBC/FBC conforming to using a five case model.
The Trust is seeking expertise from the market place in developing the Business Case by the end of February 2017 with approval process during March 2017 to enable implementation to commence as soon as possible in 2017. Suppliers are invited to provide sufficient information with supporting evidence to meet the requirements. All requirements are mandatory."
The basis for the tender is the "2010 the HfNEL Decision Making Business case" which is referenced in the tender which is attached for ease of reference.
Page 123 of the plan shows the closure meaning the loss of 25% of BHRUT medical staff. 
Steps have already been taken to close KGH A&E with 115 acute beds cut since 2011. I go into detail here Crammed King George Hospital shows why bed cuts need reversing

Community beds for rehabilitation have been opened on the KGH site at the expense of acute beds. Now 272 acute beds remain at KGH, should they be closed it seems inevitable that various safety benchmarks such as the 4 hour A&E waiting time and cancer waits will get worse at Queens and other hospitals.
There is substantial academic work which suggests long waits in A&E departments lead to worse patient outcomes.

"There is strong evidence that the symptoms felt in emergency departments led to worse patient outcomes. We know, for example, that patients run a 43 per cent increased risk of death after 10 days if they are admitted through a crowded accident and emergency (A&E) department. (Richardson DB, 2006) Waiting for admission in A&E is also associated with significantly longer hospital length of stay – on average 2.35 days longer where a patient stays in A&E for more than 12 hours. (Liew D, Kennedy M, 2003)
We know that speed of treatment is vital in many conditions. For example, people with the most severe form of pneumonia have less than a one in two chance of surviving. Those chances improve considerably if effective treatment is started early.  However, research suggests that delays of more than four hours in administration of antibiotics to patients coming into hospital with pneumonia can affect 70 per cent of patients on days when an A&E is crowded. (Pine JM et al, 2005)This undoubtedly affects mortality."
& From


The Effect of Emergency Department Crowding on Patient Outcomes

Background: An extreme excess of patients exceeding the capacity of emergency departments (EDs) to provide care is an emerging threat to patient safety and health systems worldwide.
Aim: The purpose of this literature review was to investigate the effects of emergency department crowding on patients outcome.
Method and Material: A comprehensive search of the medical literature in Pubmed/ MEDLINE database was performed to identify all original articles that were published or available on-line between January 1, 2003, to January 1, 2013, and related to the concepts of ‘‘emergency department’’ and ‘‘crowding’’ or ‘’overcrowding’’.
Results: Of the 1327 studies that were initially retrieved, 484 were excluded because they had no relevance to the topic and 843 after checking for eligibility criteria. From remaining 61 articles, a total of 35 studies were finally included in the review. The three main categories that were constructed based on the studies, were delays in treatment interventions, increased medical errors or adverse events and increased mortality.
Conclusions: The body of literature in aggregate strongly suggests that ED crowding is associated with potential of poorer performance and adverse clinical outcomes, including mortality. Further research is needed to fully understand the precise mechanism through which crowding adversely affect patient care. Policies must also be targeted to adapt of emergency care system in the fluctuation of inputs for better care that translates into better outcomes for patients visiting EDs..

Author(s): Filippatos George and Karasi Evridiki

BHRUT rarely hits the 95% 4 hour safety margin and has worse than average mortality rates. I quote from the 24 November2016 Basildon and Brentwood CCG Board papers which are attached.
"• The CQC returned and inspected the same areas on Friday 16 September 2016 at both Queens Hospital and King Georges Hospital. They did not provide any feedback on that occasion. The CQC informed the trust that they would carry out a further announced inspection on 11- 12 October 2016. This would focus on governance and the well-led domain • BHRUT have reported an overall 55% staff appraisal rate. • Turnover of registered nurses has increased to 17.05% when compared to June (16.77%). This is the highest it has been in the past year. The turnover of registered Midwives has increased to 20.22%, from June (19.78%). • Septicaemia, Pneumonia and Respiratory Failure have higher numbers of observed deaths in comparison to expected with Pneumonia triggering an internal alert. • BHRUT are above the national average (PST) for all falls and falls" (my emphasis)"
The previous MP for Ilford South, Lee Scott said that patients would die unnecessarily as a consequence of  King George A&E. The evidence points to unnecessary deaths now at both Queens and King George Hospital due to a combination of a rising population and bed and staffing cuts at King George.
There was a public meeting on Saving King George A&E last Thursday to which Cllrs from three boroughs and across the political spectrum attended. There is support for a march in the spring to say no to the proposed closure of King George A&E.
Saturday 4th March may be the best time to hold the march, maybe from Queens or Havering to Town Hall to a rally at Redbridge Town Hall.
I have coped in Matthew Hopkins, Chief Executive of BHRUT in case he should wish to comment especially on the "Septicaemia, Pneumonia and Respiratory Failure have higher numbers of observed deaths in comparison to expected with Pneumonia triggering an internal alert." quote from the CCG papers.
I would be grateful if you could let me know if you could make the afternoon of the 4th March, or if not perhaps supply me with some alternative dates. 
Press reports say 4000 in Devon and 6000 in Grantham have tuned out for their A&E. It would be great if we could a big turn out here as well.


Andy Walker
120 Blythswood Road

IG3 8SG 07956 253088

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