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:

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