Another bogus statement by BHRUT on their website today

BHRUT have issued another misleading statement on their website today. For their claim to say that type 1 A&E is set to remain at King George to be taken seriously, the following six tests need to be met.

The failed 2018 £49M bid to close King George A&E as type 1 unit which is referred to in the six tests and this post is HERE

Six tests

1 - An explicit undertaking that King George A&E will remain a type 1 unit regardless of their ongoing clinical services review. The reason for this is BHRUT have shown they are quite willing to produce secret type 1 closure plans while publicly stating they are supposed to be engaged in a genuine review. In view of BHRUT's previous deceptions and the current deception in their statement of 17^th July 2019 about them “never” suggesting a type 1 A&E closure we need to nail down their most recent guarantee.

2- Write to Mr Hancock, the Secretary of State for Health, seeking the withdrawal of the 2011 closure plan to be announced in parliament. The 2018 £49M bid to close KGH A&E as a type 1 unit relied upon the 2011 decision at page 10 in the paragraph numbered 4. As long as the 2011 decision stands King George A&E is under threat. Two West London A&Es were recently saved by Mr Hancock in parliament, we need the same to happen for KGH A&E.

3 - Planning permission for Queens to be extended in order to close King George as a type 1 unit was passed in 2018 per page 10 of the £49M closure bid. BHRUT need to provide an undertaking that this application will not be proceeded with. Rather an option for extending King George with a new wing for more acute beds and mid-wife led maternity unit needs to be explored to cope with the growing East London population as part of the clinical service strategy going on now.

4 - https://www.eastlondonhcp.nhs.uk/downloads/ourplans/estates/STRATEGIC_ESTATES_PLAN_summary.pdf page 15 still lists KGH as centre of excellence for elderly this is an unacceptable closure type 1 option and needs to go.

5 Full disclosure of how far this transformation listed at page 12 of the £49M bid to close KGH as a type 1 unit has already gone. Page 12 of the £49M bid talks of “clinical pathways” We need complete disclosure of far the Type 1 closure has gone, with a view to lobbying for these partial closures of the Type 1 service at KGH to be reserved and so stop the apparent overloading of Queens.

6 – Ambulatory care at King George to be a universal all age service This is a key aspect of the closure plan we know about. As preparation for type 2 specialist A&E service for the elderly at King George Hospital, ambulatory care is restricted to the elderly frail. This is unacceptable, a key test of BHRUT goodwill on this issue is whether they will commit to providing an all age ambulatory care service at KGH.

The key passage from the BHRUT's bogus statement of 17^th July is:

“The A&E at KGH will continue to be a consultant-led service, open 24 hours a day, with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients (currently known as a Type 1 A&E department). We have never suggested otherwise.” (my emphasis)

For BHRUT to imply they have not planned to close King George A&E as a type 1 unit in the past is pure sophistry. So their new claim to say KGH A&E is safe as a type 1 unit needs to be scrutinised very carefully. Their current pledge of 17.7.19 is inadequate for the reasons below.

Due to campaigners efforts, the failed 2018 £49M bid, which was agreed in 2016, was published this April which proposed to close King George A&E as a type 1 facility.

This secret 2016 plan to close KGH A&E HERE as a type 1 unit is shown at page 7 as the preferred closure option which closes King George A&E as a type 1 unit and replaces it with urgent care centre and the development of a “centre of excellence” for the elderly. This downgrades KGH to a type 2 & 3 A&E. A complete contradiction of their “We have never suggested otherwise.” claim

Key extracts from the 2018 £49M plan to close KGH A&E as a type 1 unit

Page 10 sets out why the Trust believes that the closure plan “would not further public consultation” as it is based upon the original closure plans of October 2011.

Page 11 describes the plan as “radical”

Page 12 states the plan has “already partially commenced”

Page 13 Sets out the radical nature of the plan to “transform the care of the elderly and frail patients” to produce a “home first” model of care. “The new model of care” seeks to identify these patients through “screening mechanisms”

P14 sets out that ED & UCC activity is expected to grow to c365,000 per annum in ten years at both sites.

P17 sets out the aim of “consolidating certain services” onto one “principal site” rather than two by providing “emergency care at QH and geriatrics at KGH”

So not only has BHRUT planned to close King George A&E as a type 1 unit since 2016, it has actively working towards the closure and deceiving the public, elected representatives and staff at the same time.

Three examples of deception follow:

(1) Deceiving Mike Gapes and other elected representatives

An email dated 1^st March 2019 to Mike Gapes MP and other elected representatives from a BHRUT manager states:

The Wave 4 Capital Bid was not a bid to close King George Hospital (KGH)  A&E Department. The £49m was to make a range of improvements to urgent and emergency care at both hospitals, including the emergency department at KGH, as well as increasing the size of our assessment units and rearranging some of the ward configurations - again across both sites - to improve patient flow.

This email above is an example of BHRUT deceiving elected representatives.

It is a deception because the the £49M bid which was published on 11^th April 2019 is clearly a plan to close King George A&E as a type 1 unit. The extract below is from page 4. Bullet points one and 2 make it clear that emergency ambulances are  no longer to go to King George Hospital.

The extract from page 7 below makes it clear that KGH is to become a Enhanced Urgent Care Centre at bullet point 1 under option 2 with a Ortho-Geriatric Receiving Unit at bullet point 3 and so KGH becomes solely a type 2 unit and 3 unit

Page 17 below consolidates emergency care at Queens in first sentence below

Page 18 below again talks of consolidating ED services at Queens.

Page 25 below shows at first bullet talks of the “elimination of the need” of a fourth Emergency Department in NE London. The paragraph of the bottom of the page shows the plan means Queens becomes one of the largest A&Es in the country.

(2) Jane Milligan's deceptive statement of 29th November 2017

The second example of BHRUT deception is the statement by by Jane Milligan of 29 November 2017, this was spun in the press as a watershed moment by Wes Streeting MP. I and all other campaigners welcomed it too. It has been copied from the BHRUT website.

Dear partner/stakeholder,

I wanted to update you on the latest position regarding the A&E department at King George Hospital in Goodmayes. As you will know, the decision to replace the A&E with an Urgent Care Centre (UCC) was taken in 2011 and much has changed since then. Our east London population is growing and ageing, demand for NHS services continues to increase, and we face ever-increasing challenges as a healthcare system.

Following on from the recommendations in a strategic review undertaken recently by PWC, we now need to consider more options for the way we deliver urgent and emergency care across our communities. This will allow us to look at how this care is provided locally, taking these challenges into account. It is important we consider how we deliver these services across both King George and Queen’s hospitals to enable us to deliver care in the best way for patients. Exploring more options will enable us to do this. This is now an opportunity for us to work with our clinicians, patients, partners and stakeholders to develop a plan to make it easier for people to access the right services, deliver care sustainably, and address the challenges such as an ageing population and increasing demand on A&E services.

The model we finally adopt must provide excellent, safe patient care and meet the needs of local people now and well into the future. In the meantime, the existing A&E at King George hospital will continue to operate as now. I will continue to keep you updated of further developments.

Kind Regards,

Jane Milligan Chief Officer NHS Tower Hamlets CCG and Executive Lead for East London Health and Care Partnership (NEL STP) ENDs

This statement is more BHRUT deception. The reality is the new closure plan was agreed in 2016 per the extract below from page 7 of the £49M King George closure plan per the first sentence.

At page 10 below the depth of the sophistry becomes clear. BHRUT say the new closure plan is not “fundamentally different” from the 2011 plan and spent money on legal fees in autumn 2017 to keep the new plan secret! The current public position of BHRUT is this is not a closure plan, this extract shows BHRUT believes the exact opposite. The final sentence on the last line is a corker, showing what we thought was a genuine review into the future of King George A&E per Jane's letter of 29.11.2019 above was really a sharing of the “current status of the project” to close King George A&E!

What is jaw dropping is that Wes Streeting MP led a February 2018 Redbridge Council working party into the future of King George A&E and Jane Milligan hid from Wes that a new closure plan was agreed in 2016!

The working paper report chaired by Wes runs to 110 pages and at page 4 lists contributions from ten BHRUT managers. It was prompted by a petition presented by me to Redbridge Council in January 2017. Not only was the plan hid from Wes and Cllrs, the new closure plan being also being implemented during the time Wes and Redbridge Councillors were preparing the report. Bullet point three below from page 12 of the closure plan explains why the ambulatory care ward at Erica Ward is restricted exclusively to the elderly frail as a small part of the plan to close King George A&E. The £1M works at Queens Hospital for additional facilities were completed in January 2018 per the first paragraph below were completed before publication of the Redbridge Council report of February 2018.

(3) The deceptions about ambulatory care at Erica Ward

The third example of BHRUT deception is about restricting  ambulatory care at Erica Ward at King George Hospital to the elderly frail. Ambulatory care means same day emergency care, it is not to be confused with care provided by ambulance. When challenged about this BHRUT gave two responses. One response was to say ambulatory care at King George did not exist per the Freedom of Information request below.

BHRUT did withdraw denying the existence an ambulatory care unit after I sent them a photo of it below:

The second deception was the statement below in the Recorder of 18th October 2018

 “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.” ENDs

We now know that refusing entry to younger patients at Erica Ward and so referring them to Queens was part of the new plan to close King George A&E per page 12 of the plan copied above at point 2 stating " A new pathway". 

The 27.9.18 extract from Redbridge Clinical Commissioning Group below could be a rough indication of the numbers going to Queens as a decision to exclude younger patients from Ambulatory care at King George. It is difficult know precise numbers. This is because when I challenged Chris Bown to produce an equality impact assessment of the decision to exclude younger patients from ambulatory care at a recent BHRUT board meeting he refused to do so.

How the target of closing King George A&E is damaging care

Page 66 of the Redbridge Council report of February 2018 shows around 160 beds cut from BHRUT as part of the preparation for closing KGH A&E. Page 23 of the same report shows an approximate drop in admissions at King George from 1500 a month in 2015 to 1300 a month by 2018.

This substantial capacity cut is a cause of the dismal type 1 performance stats at Queens and King George per the below.

Too many patients are being sent to Queens. There is evidence that long waits at A&E lead to worse patient outcomes, including longer lengths of stay and higher death rates per the link https://www.nhsimas.nhs.uk/ist/how-to-stabilise-emergency-care-in-england/

I quote:

There is strong evidence that the symptoms felt in emergency departments led to worse patient outcomes. We know, for example, that patients run a 43 per cent increased risk of death after 10 days if they are admitted through a crowded accident and emergency (A&E) department. (Richardson DB, 2006) Waiting for admission in A&E is also associated with significantly longer hospital length of stay – on average 2.35 days longer where a patient stays in A&E for more than 12 hours. (Liew D, Kennedy M, 2003)

We know that speed of treatment is vital in many conditions. For example, people with the most severe form of pneumonia have less than a one in two chance of surviving. Those chances improve considerably if effective treatment is started early.  However, research suggests that delays of more than four hours in administration of antibiotics to patients coming into hospital with pneumonia can affect 70 per cent of patients on days when an A&E is crowded. (Pine JM et al, 2005)This undoubtedly affects mortality.

The type 1 stats above are truly dreadful, they can be no doubt that we need more beds at King George in order to relieve the pressure on Queens. There has a been a recent drop in life expectancy

per the link 

https://www.theguardian.com/society/2019/jun/23/why-is-life-expectancy-falling

It has to be a concern that the national deterioration in A&E waits will have played a small, but nonetheless, real part in declining life expectancies.

Earlier this week Councillor Zammett makes the case for BHRUT opening more beds at a Health Scrutiny meeting HERE  The recording is poor, but you can hear it maximum volume on a desktop. BHRUT are clearly refusing to back the call for more beds. I would encourage readers to come to our meeting this Saturday at 3pm at Ilford Town Hall to say not only must King George A&E be saved but that our hospital needs a new wing to cope with the growing East London population.

I look forward to hear from BHRUT if they are willing to comply with the six tests.