Briefing sent to Barking and Dagenham Councillors sent earlier today
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
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82.09
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87.34
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75.96
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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/
I asked Chris Bown the Interim Chief Executive of BHRUT to write an equality impact assessment for the decision to restrict care on the ambulatory care at Erica Ward to the elderly frail and he declined, stating it would be a “waste of time”.
How can BHRUT know if they are are treating King George patients fairly if they have not conducted a rigours review of their decision by publishing an equality impact assessment and then having it scrutinised by local authorities and the public?
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 2018
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87.61
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81.18
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90.74
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another reason for BHRUT to agree to my to produce a equality impact assessment.
It is also 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 ward 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
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Visiting times
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Speciality
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020 8970 8213
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10.30am to 7.30pm
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Orthopaedic rehab
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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.
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.
“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:
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.
10 - The below is an email from the NHS to me of 24th January 2019
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.
