Dear
Councillors
A
statement in the 31st January Clinical Commissioning Group Board
papers copied in the end of this post is being claimed as lifting the
threat to King George A&E (1). In fact, this statement merely
repeats a commitment made in November 2017 to review the closure
process. Since then, we have had a new plan published to close King
George A&E in October 2018, contained within the East London
Estates Strategy Plan (2). This plan downgrades King George to a
centre of excellence for the elderly without an A&E.
The
decision to deny ambulatory care to Redbridge residents, with the
exception of the frail elderly, begs questions about whether NHS
managers are committed to a fair review and instead continuing with
the closure process of King George A&E.
The
31st January CCG board papers make the misleading claim
that “there is no ambulatory care unit” at King George (3).
Photos of the ambulatory care unit at Erica ward at King George are
at my @andywalker945 twitter account. BHRUT did correctly go on the
record last year as saying that ambulatory care does exist at King
George but is just for the elderly frail (4). But by January 2019,
their position switched to say:
“King
George Hospital has never had an Ambulatory Care Unit, Therefore no
such equality impact assessment can be provided”
The
quote above extracted from the BHRUT document is also at my twitter.
So this month both BHRUT and the CCG claim there is no ambulatory
care unit at King George.
It
seems convenient for both BHRUT & the CCG to claim that there is
no ambulatory care unit at King George because it removes their
obligation to provide an equality impact assessment. Arguably BHRUT
should have consulted upon restricting ambulatory care at King George
because the original 2010 NHS decision making plan to close King
George provides at page 54.
“King
George Hospital Ilford to provide 24/7 urgent care and extended range
of ambulatory and planned care services”
An
equality impact assessment for the closure of Cedar Ward did take
place.
Why
an equality impact assessment for restricting ambulatory care is
indicated by NHS guidance HERE
states
that that ambulatory emergency care is clearly meant to be a
universal service for all patients. I quote:
“This
means providing a service where all
patients are considered for same day emergency care, with it being
the default position until otherwise proven. This
approach ensures the maximum number of patients benefit from rapid
access to the right treatment and ensures the benefits of same day
emergency care are maximised.” (My emphasis -same day emergency
care means ambulatory care)
So
why is BHRUT transferring such patients to Queens from King George
with the exception of the elderly frail? Their reason is "the
low levels of admitted adult patients" seems questionable until
a detailed equality impact assessment has taken place with due public
& political scrutiny.
Especially
when Queens is already struggling to cope more than King George. I
cut and paste the latest 4 hour waiting A&E times from the BHRUT
website.
01/11/18
|
82.09
|
87.34
|
75.96
|
Queens
has a 75.96% four hour waiting time, well below the safety benchmark
of 95%. The numbers of patients being denied care at King George for
ambulatory care may be small, but they will nonetheless be an extra
pressure on Queens. There is substantial evidence linking long waits
at A&E with worse patient outcomes including longer stays in
hospital and higher mortality rates per the link
https://www.nhsimas.nhs.uk/ist/how-to-stabilise-emergency-care-in-england/
So
I will be asking the BHRUT board tomorrow to produce an equality
impact assessment for their decision to deny ambulatory care at Erica
Ward for patients, with the exception of the elderly frail, and
transfer them to Queens instead.
The
article
https://www.theguardian.com/society/2018/nov/21/nhs-winter-crisis-can-be-avoided-with-ambulatory-care-say-doctors
implies ambulatory care is set to grow so putting more pressure on
Queens over time. The article lists “blood
clots, infections, seizures and anaemia” as among the conditions
suitable for ambulatory care and it seems completely baffling that
that such patients, with the exception of elderly frail, are being
transferred from King George to Queens.
A
small number of ambulatory care patients have to be admitted. So
sending these King George patients is putting pressure on bed
occupancy at Queens. I cut and paste the latest bed occupancy
statistics from the BHRUT website
- November 201887.6181.1890.74
Queens
is at 90.74% the safety benchmark is 85%. Going over 85% is linked to
increased risk of infections and other issues per the article here
https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/nhs-bed-occupancy-rates/
another
reason for BHRUT to agree to my request tomorrow to produce a
equality impact assessment.
It
is puzzling that none of the signs at King George nor any of the
guidance given to GPs by BHRUT about ambulatory care at King George
Hospital mention that the service is for the elderly frail only.
The
BHRUT website here
https://www.bhrhospitals.nhs.uk/care-of-the-elderly
regarding care of the elderly gives no mention of an exclusive
designed just for the frail elderly at Erica Ward.
Elsewhere
on the bhrut site where all the wards are listed Erica ward is listed
without ambulatory care today:
Ward
information
Telephone
|
Visiting
times
|
Speciality
|
|---|---|---|
020 8970 8213
|
10.30am to 7.30pm
|
Orthopaedic rehab
|
The
CQC report of published in June 2018 praises the work at Erica Ward.
“Erica
ward was piloting the ‘model ward’ approach. This was an approach
to monitoring performance by having ‘model ward boards’ where
ward compliance audits, patient outcomes, key performance indicators
and staffing levels were publicly displayed. The aim of the model was
to drive improvements and consistency.”
This
is very encouraging to see such good practice on the ward, but the
CQC appears unaware of ambulatory care at Erica Ward being restricted
to the elderly frail with other suitable patients being sent to
Queens.
A
photo of the CCG document planning ambulatory care is given below:
patients are being directed to Queens from King George, but the
numbers given being are not clear. (5) An average daily total of 22
means what exactly?
The
only public notice that residents and GPs have that BHRUT is
restricting access to Erica Ward for ambulatory care to the frail
elderly is the newspaper quote last year at point 4 below.
This
discrimination against disabled and other patients at King George who
are not elderly frail motivated me to ask Cllr Athwal at a recent
meeting if such discrimination is unlawful (6)
Cllr
Athwal replied that BHRUT were not acting unlawfully, however, it
begs the question: have BHRUT incorrectly told Cllr Athwal that no
ambulatory care unit exists at King George? After all, this is what
they have written to me per the extract above.
Regardless
of whether BHRUT can lawfully refuse younger people care at King
George and send them to Queens it dents confidence that the review to
be announced on 31st January will be a fair one. How can
NHS managers guarantee the review will be fair when a plan in 2018
has been published to downgrade King George and is being worked
through now? The closure of Cedar Ward was also part of this 2018
plan and has been completed.
Further
evidence of the review being flawed is that Wes Streeting MP is
reported to have said at a public meeting earlier this month that he
“hit the roof” about the new plan to close King George A&E
(7) I quote from the Barkingside21 blog reporting the meeting:
“It
would appear that he “hit the roof” on this development and had
meetings with “The Management” who say that the A&E will
remain open BUT
it
will be focussed on elderly care – falls, chest infections,
pneumonia etc, the things that elderly people suffer from. So,
it’s not going to be a “general” A&E.”
ENDs
So
the campaign to allow all residents to access ambulatory care at King
George, rather than just the elderly frail is a key turning point in
our campaign to save King George A&E. For the CCG and BHRUT to
falsely deny that ambulatory care exists at Erica ward is the latest
example of stealth tactics to run down King George A&E. Others
are listed below (8)
A
petition has been launched by North East London Save our NHS, a
non-party group, against the stealth closure of King George A&E.
A key point is notes:-
“Too
often A&Es have been closed and ‘care of the elderly’
situated in the hospitals, which are then allowed to run down,
operating ‘Cinderella' services. Bethnal Green Hospital and Mile
End Hospital in Tower Hamlets are just two local examples.“
(9)
It
would be great if you could sign and share this petition.
The
CCG reports that meetings have taken place with MPs and Cllrs about
King George. It must be right for the CCG to release minutes of these
meetings so the public can judge exactly what the proposed focus on
elderly care means. As the NHS is a public service, future meetings
between elected representatives and NHS managers need to be public
and allow public questions.
The
North East London NHS made bids for capital improvements last year
which were all refused in December, although other areas were
successful. I am on a promise from the NHS to publish these bids
(10), Why have substantial bids for public monies been made by
the North East London NHS been done with so little public
oversight? Where capital improvement money was going to be spent, how
much was bid for and for what purpose remains a mystery. More
transparency needs to brought to the process. Such secrecy only aids
speculation.
So
we still need to campaign to keep open King George A&E. We need
to
persuade
BHRUT to persuade the publish the cost of the options of:
- mid-wife led maternity unit at King George to cope with demand ,
- two new acute wards at King George to reduce pressure on Queens
- and more critical care beds at King George
- costs of providing universal ambulatory care at King George
I
hope you will join me and others on the 30th March to
campaign for King George A&E to stay open and prevent Queens
becoming even more overloaded. We will be outside King George
Hospital for 2pm to walk for a meeting at Ilford Town Hall for 3pm.
Regards
Andy
Walker
1-
This is the extract from the CCG board papers for their meeting of
31st January:
The
decision to replace the A&E at King George Hospital (KGH),
Ilford, with an urgent care centre was taken in 2011 as part of the
Health for north east London (H4NEL) plans. Many of the original
H4NEL issues remain – for example, we still have shortages of
paediatric and A&E doctors and nurses as well as growing demand
for emergency care. We need a new, fit-for-purpose model for
emergency care that addresses these issues and delivers the care that
local people need with the resources, including money, available to
us. Senior leaders in the local NHS have been holding open,
meaningful discussions with MPs and councillors and agree that we
need to consider other options for urgent and emergency care in the
context of a wider integrated health and care strategy. A new,
clinically-led model will now be developed as part of wider work on
the BHRUT Clinical Strategy. This will include setting out how
emergency care will be provided from King George hospital. We
agree that the proposals for King George A&E, as originally
described in H4NEL back in 2011, need to be reviewed. Working
together, we can look at what that means for services that may need
to be provided at the KGH site and elsewhere. As part of this work,
the local NHS is committed to engaging fully and openly with our
local population and other stakeholders as we discuss the local
challenge and develop the new clinical model and accompanying
strategy.” My emphasis ENDs
“Cllr
Athwal has described this statement as “a
real moment to celebrate that the threat of closure of our A&E
will be lifted”
is one example of a senior politician believing the campaign to keep
open King George A&E has been won.
“Next
week a proposal to lift the closure will be considered by the Joint
committee of the Clinical Commissioning Groups for Redbridge,
Barking& Dagenham and Havering.” Is a quote from the Redbridge
Labour website of 25th
January
2019, reviewing the “proposals for King George A&E” does not
lift the threat to our A&E.
2
- The
East London Health & Care Partnership plan is available at
http://eastlondonhcp.nhs.uk/wp-content/uploads/2018/10/18_10_NEL-ELHCP-Strategic-Estates-plan.pdf
3
- “Andy Walker questioned whether GPs are continuing to refer
patients to King George for ambulatory care for eight conditions
listed here on the BHRUT site. SR responded that there is no
ambulatory care unit at King George Hospital.” is taken from
Redbridge Clinical Commissioning Board papers of 31st
January
in the minutes regarding public questions.
4
- The following quote is taken from:
https://www.ilfordrecorder.co.uk/news/health/king-george-hospital-to-close-cancer-unit-in-november-1-5742725
“Due
to the low levels of admitted adult patients from the Emergency
Department at King George Hospital, a full ambulatory care unit is
not required and we do not believe it would be the best use of our
resources.
“It
is more effective to centralise this service at Queen’s Hospital.
Any increase in admissions or ambulatory support is monitored daily.
However, due to the levels of demand from our frail elderly patients,
we do offer a dedicated ambulatory care service for these patients at
King George Hospital.”
5
Extract from September Redbridge Clinical Commissioning Group Board
papers below. The extract states no ambulatory service at King George
with patients transferred to Queens: development appears to mean
either closing any existing unit or not providing a unit at King
George. This seems misleading as there was an ambulatory unit at King
George for the frail elderly all along.
6
– The question tabled at full council was:
As
the Leader made an “unequivocal
commitment” to campaign for King George on the 2nd
November
will he seek legal advice about whether the BHRUT
proposal to send patients requiring ambulatory care, with the
exception of the frail elderly, from King George to Queens,
discriminates unfairly against Redbridge residents and so is
unlawful?
Reports
what Wes Streeting said, at time of my writing, Wes has not
challenged the accuracy of the blog.
8
– I list examples over the years of where it seems BHRUT have been
less than straightforward with residents:
Blue
lights for children being stopped at KGH -
https://www.guardian-series.co.uk/news/rbnews/11209265.No_children_A_E_policy_a_disgrace___council_leader/
http://savekinggeorgehospital.blogspot.com/2016/11/why-have-bhrut-put-out-tender-to-close.html
this was a secret plan to close KGH A&E per save KGH Blog led to
march 2017 protest
July
2018 CCG board papers show a plan to close King George A&E at
night. The plan appeared to have been stopped by Jeremy Hunt MP. I
can find no earlier mention of this plan which should have gone to
councils first. I quote “Subject to Secretary of State approval
overnight closure of King George Hospital is expected to commence
from September 2017”
BHRUT
used to alternate board meetings between King George & Queens as
a sign of commitment to King George. Around 1 in 3 now take place at
Queens. The reason given by BHRUT regarding room availability strains
credibility: I quote from BHRUT email of 5.6.18.
“When
we made that decision there was a shortage of suitable rooms at KGH
because they had been booked out, in advance, for educational
purposes.
In
the future it remains our intention to hold an equal number of
meetings, where practicable, at both sites."ENDS
This
makes it slightly harder for Redbridge residents to challenge cuts at
King George
Removing
the right to notice questions at board meetings make it more
difficult for the public to hold the board to account, The
introduction of a 4 notice day rule has seen public questions
plummet. I am usually the only member of the public to question the
board.
Bed
numbers use to be listed each month at King George & Queens, this
was ended recently so making making it more difficult to track bed
cuts at King George.
Unlike
the CCG, BHRUT refuses to allow recording and publication of board
meetings, when key reports are often verbal it makes it more
difficult to hold the board to account as there is no record of what
was said.
9
-
https://www.change.org/p/mps-and-councillors-across-north-east-london-stop-the-closure-by-stealth-of-a-e-at-king-george-hospital
is the petition re the stealth closure
10
- The below is an email from the NHS to me of 24th January
2019
Nelenquiries
(NHS NEWHAM
CCG) <newccg.nelenquiries@nhs.net>To:andy.walker@talk21.com
24
Jan at 13:25
Dear
Andy,
This
information will be included in the updated questions and answers log
and uploaded to websites, along with the minutes of the meeting,
within a month following the meeting (by 9 Feb 2019).
Many
thanks
This
is hardly working openly with residents.
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