Monday, July 23, 2018

Redbridge Town Hall booked for save KGH A&E Rally on 17th November

Delighted to report that Redbridge Town Hall has been booked for a save King George Rally on 17th November 2018 for a 3pm start.

The meeting has been prompted by BHRUT's refusal to confirm King George A&E is to stay open.

More on this here Council attack BHRUT

Back in November 2017 we were given the commitment below as part of the review into closing King George A&E.

The full document is here PWC report

It seems reasonable for East London politicians, faith groups and resident associations to call for a "new clinical model of emergency care" to be developed across North East London.

It is baffling why BHRUT appear to have no intention of carrying out this work.

If it is a resource issue and BHRUT managers simply to not have the resources to produce this substantial piece of work then the board need to be given the funds to do the work themselves or contract it out.

Wednesday, July 18, 2018

Council attack BHRUT over King George A&E & Canvassing for Town Hall meeting this November

I missed that the start date had been brought forward for cabinet yesterday.

Well done to the Council for issuing a press release attacking BHRUT for failing to support keeping open King George A&E open.

Cllr Santos said: “It’s disappointing that the NHS has not given an assurance to keep the A&E department open as part of its revised proposals for King George Hospital." 

The full statement is at:

I have made a provisional booking for a save King George Hospital Meeting at Redbridge Town Hall for 10th and 17th November. I go to the Redbridge Health Scrutiny Committee to get some feedback from Councillors this evening for the best date.

I will also draw Councillors attention to the large increase in emergency admissions at King George and Queens Hospitals taken from

The big increase in admissions below has to be a driver causing the deterioration in performance  King George and Queens last winter. Although performance has improved there is still an issue in May 2018 of 41 ambulance delayed handovers per the extract below taken from the BHRUT site.

The large increase in admissions, with an even bigger increase expected to come with our growing population, means the review into the future of King George A&E must recommend extending King George to provide more beds, doctors and nurses.

Emergency Admissions at King George & Queens Hospitals

Year to June 2018
july 2O17 4549
August 2O17 4734
September 2O17 4818
October 2O17 5036
November 2O17 5075
December 2O17 5017
January 2O18 5050
February 2O18 4494
March 2O18 5181
April 2O18 5009
May 2O18 5317
June 2O18 5113
Total Emergency Admissions end June 18 59393

Year to June 2017
july 2O16 4127
August 2O16 4344
September 2O16 4298
October 2O16 4617
November 2O16 4507
December 2O16 4693
January 2O17 4568
February 2O17 4282
March 2O17 5142
April 2O17 4790
May 2O17 4880
June 2O17 4560
Total Emergency Admissions end June 17 54808

Year to June 2016
July 2O15 4920
August 2O15 4461
September 2O15 4608
October 2O15 4546
November 2O15 4545
December 2O15 4758
January 2O16 4753
February 2O16 4263
March 2O16 4385
April 2O16 4091
May 2O16 4327
June 2O16 4099
Total Emergency Admissions end June 16 53756

Tuesday, July 17, 2018

BHRUT still in favour of closing King George A&E despite huge increase in emergency admissions

The photo below is from Redbridge cabinet papers which meets this evening:
It shows BHRUT refusing to accept the Redbridge Council recommendation to keep open King George A&E. Matthew Hopkins, the BHRUT Chief Executive made it clear that at the BHRUT AGM on 4th July 2018 that the board would be implementing their clinical services strategy below.

BHRUT clinical services strategy

The strategy includes closing King George A&E per the extract here.

The article here Emergency admissions: why are they growing so fast?  claims a 50% growth in emergency admissions over last 15 years. The author argues success with heart and stroke patients is a key driver, as rather than dying, these patients survive but go on to present at A&E with serious conditions in the future. Heart and stroke patients surviving longer is a another reason why KGH A&E needs to stay open. Back in May 2016 NHS statistics show BHRUT with 4,327 emergency admissions, but by May 2018 the figure had increased to 5,317 emergency admissions, a huge 22.8% increase. The new developments going up in East London have to be the main cause of the increase
NHS statistics show 493,191 emergency admissions in May 2016 for the whole of England increasing by May 2018 to 534,118. This is a smaller increase of 8.2% due to the smaller population growth in England as against the BHRUT catchment area.

Yesterday, the Seven Kings & Newbury Park Residents Association supported a public meeting this autumn to call for King George A&E to stay open. I will ask Cllr Athwal this evening if he would like to speak at the proposed meeting.

Thursday, July 12, 2018

Photos & Videos from today outside 10 Downing Street

Cllr Rodwell sent her apologies due to having to look after her sick daughter, we wish her daughter well.

Below are photos and Facebook videos, the letter is at

 Keith Prince AM Cllr O'Flynn Cllr Dodin Cllr Deon Burton Bob Archer - Secretary Redbridge Trades Council

Letter to be delivered to 10 Downing Street today on Critical Care Beds at Queens and King George

The Rt Hon Theresa May MP
Prime Minister
10 Downing Street
SW1A 2AA    
Re: Appeal for additional Critical Care bed funding  at Queens & King George Hospitals

Dear Prime Minister

We write regarding the critical bed units at Queens & King George Hospitals, managed by Barking Havering & Redbridge University Hospital Trust (BHRUT).

It is accepted that critical care beds not only improve mortality rates but also lead to better recoveries from serious illness. Unlike general admission beds, the number of critical care beds has been increasing.

So we note with concern that both units were frequently full last winter. King George was full 12 times this February and Queens was full 5 times in February. In addition, both units were full on the same three days in February. Although March and April (the most recent figures we have) see an easing of pressure on the units, there are still high occupancy rates and days when the units are full.

Some of the beds at Queens are extremely specialist, dealing with the most seriously ill patients being flown in from across North East London, Essex and Kent. For ease of reference we copy from the BHRUT website the detail of the excellent work this unit does at this end of this email.

BHRUT have not disputed NHS statistics on the website, showing more cancelled operations in the first quarter of 2018 in comparison to the first quarter of 2015.

Our concern is that unless more critical care beds are opened this coming winter, the situation is likely to get worse. The North East London, Essex and Kent populations are growing all the time which is bound to put even more pressure on the two units.

We welcome the Government's recent announcement of more funding for the NHS as well as the fact that more critical care beds were opened in 2017, but we note that the units still cannot cope during busy periods.

Last week BHRUT lost an arbitration case costing £26M and have a reported deficit of around £60M. Unless central government helps tackle this debt it would seem highly difficult for BHRUT to open the additional critical care beds it needs.

We request that you look into this matter and find a way to help BHRUT open more critical care beds this coming winter at King George & Queens Hospitals.

Yours Sincerely

Keith Prince AM Havering & Redbridge
Cllr Michael Deon Burton Havering Council
Cllr Nic Dodin Havering Council
Cllr Denis O'Flynn
Cllr Emily Rodwell Barking & Dageham
Bob Archer Redbridge Trades Council

Extract from BHRUT website below

Queen’s Hospital is the main neurosurgical referral centre for North East London and Essex. We have a helicopter landing pad, and accept neuro trauma patients from Essex, Kent and London Helicopter Emergency Medical Service.
Our neuro critical care department is a state-of-the-art 12 bed sub speciality intensive care unit staffed by six consultants, as part of a multi-disciplinary team with specialist neuro ITU nurses, physiotherapists, pharmacists, speech therapists and dieticians.
The unit admits both neurosurgical patients (e.g. head/spine injuries and post elective neurosurgery) and neurology patients (e.g. Guillian Barre syndrome, Myaesthenia Gravis, Status Epilepticus, Acute Stroke and Encephalitis).
A daily consultant intensivist led ward round is the focus for patient management discussions and clinical decision making. In addition, daily review of patients by a consultant microbiologist provides high quality advice as well as promoting excellent standards of infection control.
Support by colleagues in neurosurgery, neuroradiology and neurophysiology ensures rapid access to diagnostic opinion and intervention. There is also access to a variety of specialist non-neuroscience opinions from colleagues throughout the rest of the hospital.
We are an elite training centre for specialist neuro anaesthesia and neuro critical care training in London. The high quality training that we delivery means we are one of the most popular training centres in London for junior doctors. The unit also provides training for non specialist neuro nurses within the region.
The neuro critical care specialises in advanced monitoring of the brain using techniques such as intra cranial pressure, transcranial doppler, brain tissue oxygen monitoring and pressure reactivity Index. This enables us to deliver the most modern and highest quality care.
Our unit participates in multi centre and single centre research trials, to try and improve understanding of critically ill patients with brain dysfunction. We recently took part in the RAIN study (Risk Adjustment in Neurocritical Care). 
We are one of the few hospitals in the country which follow the guidelines recommended by National Institute of Clinical Excellence for a sub speciality ITU follow up clinic. This is run by Dr De La Cerda, to identify and solve any outstanding problems from your stay.

Saturday, July 7, 2018

1) One space left for visit to 10 Downing Street, 2) BHRUT plunge a further £26M into debt 3) Report back for BHRUT board and annual general meetings 4) NHS meeting on 11th July 2018

I have written the below to Councillors in Barking & Dagenham, Havering & Redbridge

Dear Councillors

1) One space left for visit to 10 Downing Street, 2) BHRUT plunge a further £26M into debt 3) Report back for BHRUT board and annual general meetings 4) NHS meeting on 11th July 2018

One space left

I am pleased to report that Councillor Emily Rodwell has made a late application to be part of the team to say more funding should be found for critical care beds for King George & Queens Hospital on 12th July (now at 12:30pm). Either or both of Bob Archer of Redbridge Trades Council or Meenakshi Sharma of Ilford Noise will drop out if the police pass Cllr Rodwell in time. I do not expect the police to take any shortcuts, but because Councillors are elected representatives it would seem straightforward to confirm their identity. It would be great to have a total of six elected representatives on the 12th so do let me know if you can make it, even it is not until the 11th July

The local press are covering the campaign with letters in the Wanstead and Woodford Guardian and Romford Recorder this week and an article in the W&W Guardian and an internet version (1)

BHRUT plunge a further £26M into debt

This appears dreadfully unfair, King George & Queens need more money to cope with a growing population, not less. More on this at article published yesterday (2) This seems bound to make it more difficult for BHRUT to fund the extra critical care beds they need.

Report back for BHRUT board and annual general meetings on 4th July

This was over 3 hours of meetings so I concentrate on information relating to critical care beds. I asked about critical care beds at the end of the ordinary meeting. Answers were provided, but I cannot accept the “surgical step down beds” at Queens when critical care beds are full are anything other than second best. Unanswered questions about these “surgical step down beds” remain as follows:

A: Why are no “surgical step down beds”provided at King George? King George has more 100% bed occupancy days for critical care beds. Perhaps King George patients are taken to Queens when the critical bed unit at King George is full, but this seems to be add a very small, but still real chance,of worse care due to transport meaning inferior care. I quote from Emergency Medical Journal “Critically ill patients have a high risk of morbidity and mortality during transport.” (3)

B: Do these “surgical step down beds” at Queens provide the same level of care as the critical care beds? That is the same level of expert staffing and intensive monitoring of patients. Critical care beds are not just for those recovering from operations, they are necessary for sepsis, stroke and other conditions.

The report “Just Say Sepsis! A review of the process of care received by patients with sepsis” commissioned by NHS England states:

The reasons given included lack of available critical care beds
dictating management decisions and missed opportunities for intervention. Of those patients admitted to critical care 70% required support of their cardiovascular system, 78% of their respiratory system and 26% support of their renal system (Table 7.52).
An example is given of the power of a critical car bed and the intensive monitoring copied below:
An elderly patient with a history of ischaemic heart disease, hypertension and 40 years of smoking was admitted with pneumonia and acute kidney injury. A diagnosis of pneumonia and sepsis was made in the emergency department. The patient was put on a sepsis pathway and transferred to critical care. Within 30 minutes of arriving in hospital the ‘sepsis six’ had been completed. Relatives were informed of the patient’s condition and escalation of care discussed. The patient required ventilatory support for three days in critical care. The patient made a full recovery and was discharged from hospital 10 days later. The Reviewers considered that this patient had received prompt care that was at a standard that should be expected for all patients. The relatives were kept informed throughout the admission and the severity of the sepsis was identified early and documented clearly in the case notes”.
It must be of concern that when all the critical care beds are full at both King George & Queens, patients will not be getting the care outlined above.
Matthew Hopkins told the board that A&E attendances are running at around 950 a day in July. He is concerned that this could be a significant risk to safety. Matthew reported on 25th June on twitter that BHRUT had 162,096 adult visits to A&E four years ago. If 950 A&E attendances a day were sustained, and with population growth and the continuing GP shortage it may well be in the near future, it will mean more than 300,000 adult visits. This seems bound to mean more critical care beds as well as more general and acute beds are required.
The AGM included a presentation by Matthew Hopkins mentioning how good the recent CQC report was. It is very encouraging that BHRUT is moving forward. However, BHRUT has not challenged the statistics I sent to Barking and Dagenham Councillors showing more cancelled operations in the first quarter of 2018 than the first quarter of 2015 (5) The CQC visited King George and Queens from 23 Jan to 15 Mar 2018 (6). There only two mentions of critical care in the CQC report at pages 14 & 15, both in the past tense from 2015. It is baffling that the CQC did not visit both critical care departments in 2018, as back in 2015 they had concerns about them, making the finding of “requires improvement”.

NHS meeting on 11th July 2018

The NHS Joint Commissioning Committee Meeting meets on 11 Jul 2018 12:30 – 14:30 Unex Tower, 5 Station Street, Stratford, E15 1DA.

It comprises all seven North East London (NEL) CCGs – City and Hackney, Newham, Tower Hamlets, Waltham Forest, Barking and Dagenham, Havering and Redbridge 

And lists its purpose as

 Purpose of the Joint Commissioning Committee The JCC is comprised of members of the Governing Bodies (GB) from Barking & Dagenham CCG, City & Hackney CCG, Havering CCG, Newham CCG, Redbridge CCG, Tower Hamlets CCG and Waltham Forest CCG to jointly commission goods and services for the residents of the City of London Corporation and London Boroughs of Barking & Dagenham, Hackney, Havering, Newham, Redbridge, Tower Hamlets and Waltham Forest.
Of course, what "jointly commission goods and services for the residents" is open to interpretation.
I will ask a question at the meeting to lobby for funding for more critical care funding for KGH & QH. At the very least, I will look for the committee to publish a review of how many critical care beds are required at King George and Queens or across North East London to improve performance on last winter. Local authorities send representatives to this meeting. Perhaps you could consider asking your representative to speak up on the issue on the 11th.


Andy Walker

3 Critical care in the emergency department: patient transfer at:

4 Just say Sepsis at: