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.
Regards
Andy
Walker
3
Critical care in the emergency
department: patient transfer at:
4 Just say Sepsis at:
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