BHRUT maintains hospitals safe

I asked the following questions earlier today at the BHRUT board meeting of Matthew Hopkins, Chief Executive of BHRUT who referred them to his deputy Steve Russell.


a) If he agrees that the non-maternity beds need to go back into KGH?
b) Has BHRUT identified what beds have been lost from KGH since the publication of the HfNEL KGH A&E closure plan
c) Will BHRUT publish separate bed numbers for KGH and QH on their website each month so that bed numbers can be tracked accurately in future?

Pleased to report that BHRUT will be reporting bed numbers each month on their website. However, BHRUT is unable to describe what type of bed has been removed from KGH. 86 KGH beds in total have been closed since 2010 and it seems that BHRUT accepts not all of these are maternity.

Steve said there were no plans to put any beds back into KGH which is a disappointment because both KGH and Queens consistently fail to reach 95% 4 hour waiting times and have long periods when the bed occupancy is more than the recommended 85% bed occupancy level.

Steve disputed my assertion that Queens and KGH are unsafe. I say this because of the consistent failure to reach the 95%  A&E 4 hour waiting times.

I quote from a Guardian Article http://www.theguardian.com/society/2013/nov/06/accident-emergency-overcrowding-costs-lives-doctors

Dr Cliff Mann, the CEM's president, said: "There's clear evidence from America and from the UK that if you have overcrowded emergency departments then the mortality rates for patients going through that department increases."

The BHRUT board papers mention the case of a patient who was waiting on a trolley for 12 hours before found a bed. Delays like these must increase the risk of poor patient outcomes.

BHRUT distributed a paper on how overcrowding increases the risk of poor care at their October meeting. The link is here http://savekinggeorgehospital.wordpress.com/2014/10/07/report-from-bhrut-board-meeting-exit-block-kills-at-queens-and-king-george-ae/

The pledge made by Andrew Lansley, the then Secretary of State for Health, back in 2011 about no changes to KGH until it was safe to do so, appears to not only been broken but also contributed to QH and KGH being unsafe. I hope our MPs and Councillors and will ask questions about this.

BHRUT need to provide more information on what beds have been lost from KGH.

Will BHRUT agree that beds cut from King George Hospital be replaced?

At the end of this post is a extract from a recent BHRUT document, it shows that at 11 November 2014 there were 301 beds at King George Hospital (KGH). The HfNEL (Health for NE London) KGH A&E closure document approved by Andrew Lansley, the then Secretary for Health in 2011 shows 387 beds at KGH, an extract is here http://savekinggeorgehospital.blogspot.co.uk/2014/12/why-have-228-beds-gone-from-queens-and.html This is a loss of 86 beds from KGH, not all of which appear to be maternity, at time of writing BHRUT are unable to identify what type and numbers of beds have been closed, ie maternity, child. adult etc. 

In a response to six Councillors from three boroughs going to 10 Downing Street, asking for the KGH A&E closure plan to be scrapped, the Department of Health (DoH) in a letter dated 17 October 2014 said the "HfNEL scheme be allowed to proceed. However, in doing so, he also said that no changes were to take place until he was assured that the quality of services...had improved" further on the DoH say "There has been no downgrading of services at King George Hospital." The DoH letter is at the same post as the HfNEL extract.

It seems very difficult to reconcile these statements by the Prime Minister's representatives of no changes at KGH with bed closures which, on face of it, have contributed to the decline in care and placing into special measures of KGH and Queens.

I will be asking Matthew Hopkins, the Cheif Executive of BHRUT the following questions at the board meeting of 7 January:

a) If he agrees that the non-maternity beds need to go back into KGH?
b) Has BHRUT identified what beds have been lost from KGH since the publication of the HfNEL KGH A&E closure plan
c) Will BHRUT publish separate bed numbers for KGH and QH on their website each month so that bed numbers can be tracked accurately in future?

Extract from December 2014 BHRUT document

 

 

Topic 4: Bed numbers

Andy Walker suggested we had closed over 200 beds. He had looked at a document from 2010, health for north east London decision making business case p91-92 that states in 2010-11 there were 387 beds at King George Hospital and 740 at Queen’s Hospital.

An FOI that we replied to on 11 December 2014 we stated that on the 11 November 2014 the number of adult medical and surgical beds we had was 620 at Queen’s Hospital and 279 at King George Hospital. 3 We explained that Andy was not comparing like with like. The table below explains the breakdown of our beds. We also explained that in some specialties it is quite right that there is a reduction in beds, for example, cardiac patients. Due to advances in technology people are seen and treated much more quickly in some specialities and do not need to spend long periods of time in hospital, which may have historically been the case.

We are currently identifying what data was used to inform the Health for NEL business plan to help explain the difference. At that time maternity services were run from King George and NELFT also now manage some of the beds that we were previously responsible for.

Table 1: Available beds at December 2014 (overnight beds only – day case beds are excluded)

Queens Hospital		King George Hospital		TRUST Total
Medical and surgical Beds (inc. assessment units and specialist beds)	620		279		899
Adult Critical Care (incl. neuro)	32		8		40
Neonatal Critical Care Beds	25		0		25
Paediatric Beds	25		14		39
Maternity Beds	63		0		63
TOTAL	765		301		1066

 

Meeting with BHRUT today

Paul McGeary, Gwen Nneji and I had a meeting with Steve Russell BHRUT Deputy Chief Exective and Rachel Royal Communications Director. The issue of bed closures was discussed. BHRUT disputed the figure of 228. BHRUT have promised to supply their figures by Thursday.

On another issue Ross Lydall of the Evening Standard claims in his blog that BHRUT is among the 10 worst trusts in the country. An extract from his blog http://rosslydall.wordpress.com/2014/12/12/ae-crisis-three-london-trusts-named-among-10-worst-in-country-for-delays/ follows

"Three London hospital trusts were named today as among the worst 10 in the country for A&E delays as figures showed the NHS was under the heaviest winter pressure for a decade.

A total of 436,229 people sought emergency help across the country in the week ending on Sunday [December 7] – almost 30,000 more than the average for the same period last year.

In London, the trusts that run Northwick Park, Ealing and Charing Cross hospitals again fell far short of Government targets to see patients within four hours – adding further controversy to the decision to close two neighbouring casualty units in September.

Severe delays were also reported at the east London trust that runs Queen’s hospital in Romford and King George in Ilford, where only 76 per cent of patients attending the main A&E units were seen in time."

Why have 228 beds gone from Queens and King George Hopsitals?

I wrote the below to Cllrs in Havering, Barking and Dagenham and Redbridge earlier today

Is the Secretary of State being ignored over 228 bed closures at Queens and BHRUT?

 

On 29 September Councillors Canal, Streeting, Bartlett, Tarry, Dodin and Burton went to 10 Downing Street to say the proposed closure of King George A&E should be scrapped. The Department of Heath sent back the attached letter to me of 17 October. I confess not to even forwarding the letter to Councillors at the time as it had the usual mention of a guarantee from the Secretary of State that:

 

“...no changes were to take place until he was assured that the quality of services across maternity and A&E within Barking, Havering and Redbridge University Hospitals NHS Trust had improved”

And

 

“There has been no downgrading of services at the King George Hospital”

 

Pages 91 Page 92 of the 2010 NHS decision making business case attached shows 740 beds at Queens and 387 beds at King George Hospital in 2010-11.

 

A Freedom of Information letter from BHRUT of 11 December 2014 shows 620 beds at Queens 279 beds at King George Hospital at 11 November 2011.

 

This means losses of 108 beds from King George Hospital and 120 from Queens. And a total loss of 228 beds or 20.2% of the total since 2010.

 The 2010 NHS target for the end of this year to achieve the closure of King George A&E in 2014 was a cut of 250 beds given at page 91. BHRUT is only 22 beds behind the 2010 target.

NHS statistics cut and pasted to http://savekinggeorgehospital.wordpress.com/2014/11/23/9746-nhs-beds-lost-since-2010-no-more-should-go-from-bhrut/ show 110,568 general and acute beds 2010 being cut to 103,690 in 2014, a reduction of 6.2%. It seems clear local residents are being treated unfairly when it comes a fair deal from the NHS.

 

These bed cuts at our hospitals suggest the plan to close King George A&E is going ahead without democratic oversight promised by Mr Lansley, the Secretary of State in 2011. The public were told earlier this year there are no plans to close King George A&E in the foreseeable future. These bed cuts appear to undermine this claim.

This large reduction in our local NHS is impacting upon patient care. The BBC at http://www.bbc.co.uk/news/health-25055444 report 4 hour waiting times at Queens and King George of 76.4%, the national average is 87.7%, the safe level is 95%. The bed occupancy rate at Queens was 94% on 11 November and at King George it was at 97.1%, both well over the safe level of 85%. The NHS website gives the most recent national average bed occupancy of 87.6%.

 

Another NHS benchmark is Referral to Treatment within 18 weeks. I wanted to check if BHRUT was also behind average here, but cannot report because BHRUT has not filed the October return,  A poor showing here has the ability to impact on death rates.

I have put in a FoI for the number of medical staff employed by BHRUT in our hospitals on 1^st January 2010 and how many are employed today using the same methodology used by the NHS when at page 123 of the attached decision making business case. Page 123 of this staff shows 25% of the medical posts to go by next year since 2011 and I am concerned we may have lost a large number of medical staff as well as beds.

 

I have a meeting with BHRUT on Tuesday 9:30, it seems an ideal time to ask questions about whether Mr Lansley’s promise is being adhered too. Please let me know if you can attend too.

 

If no evidence of can be provided of these large bed cuts being signed off by Mr Hunt the Secretary of State for Health, then there appear grounds for asking him to reverse the bed cuts as part of the improvement plan for Queens and King George Hospitals. 

 

Both QH and KGH seem to have been "downgraded"

 

Regards

Andy Walker 07956 263088

 

Mike Gapes, Lee Scott & Wes Streeting speak out

Ahead of the Friday 14 November meeting for 730pm at Barkingside Library the platform speakers have their say below

Lee Scott MP says

We have worked together long and hard on the ‘Save King George Hospital’ campaign and have a very robust case to make on health provision in the area. The great strength of our local effort is that it has, so far, been non-party political. Our factual case has been argued and presented in the same way regardless of which party happened to be in power at the time.

Mike Gapes MP says

In 2011 Andrew Lansley the then Health Secretary announced plans to close  both the accident and emergency and maternity at  King George hospital within around two years.  Despite a growing young population Ilford's maternity services were closed in 2013. Mothers are now forced to go to Queens Hospital Romford. However the A and E closure has been delayed because Barking, Havering and Redbridge University Hospitals NHS Trust, covering both Queen’s and King George hospitals, cannot cope with existing demand, and it would not be safe to do so.    It also has a huge deficit and has been put in special measures.  In Parliament I pressed the current Conservative Health Secretary Jeremy Hunt to drop the closure plans. But he has refused to do this.  I will continue to campaign to save our A and E at King George hospital and to improve other local NHS services.

Cllr Wes Streeting, Deputy Leader of the Council and Cabinet Member for Health & Wellbeing said:

“It’s important that people are aware that the plan to close A&E at King George Hospital is still very much alive. Delay isn’t good enough: we want to see the plan abandoned. It’s clear that Queen’s isn’t suitable for our growing population and I will continue to fight to save our local A&E.”

Notice of next Save King George Hospital meeting

Notice of Save King Hospital Meeting

Vison Suite Ilford Town Hall Tuesday  4^th November at Midday

Agenda

1) Minutes of previous meeting

2) Matters arising

3) Discussion on how to make the public meeting of 14 November at Barkingside Library a success.

4) Department of Health letter in response to deputation to 10 Downing Street

5) Update on deputation to visit Department of Health to present case for abandoning closure.

6) Discussion on inability of BHRUT and consequently Redbridge Council to publish comprehensive Key Performance Indicators. While some information is published by BHRUT, it is out of date. On the morning of 30 October, BHRUT is publishing information about July at http://www.bhrhospitals.nhs.uk/about-us/our-performance.htm

Bed occupancy rates, one of the KPIs used by the by the Care Quality Commission to determine if a hospital crosses the clinically safe threshold, do not feature at all on the BHRUT page. On time comprehensive publication of KPIs is a pressure to ensure that KGH bed closures in preparation for closing KGH A&E improve the service as promised. If any KGH bed closures lead to death rates rising then it seems likely that the doctors, nurses and beds would go back into KGH.

Neither bed numbers, nor  an easy to understand death rate, feature on the BHRUT KPI page.

David Oliver writes at http://m.hsj.co.uk/5075988.article that the:

“The best evidence for large scale quality improvement is about clinically led standards of care; clinically led innovations in models of service delivery, linked to transparent publication of data on processes and outcomes; and a community of practice and peer support from clinical leaders.” (my emphasis)

Comprehensive timely publication of KPIs should also a  means for helping BHRUT get out of special measures, the mystery is, why are they not being published?

7) Any other business.

Public Meeting Friday 14 November Barkingside Library

Public Meeting 7:30pm Friday 14 November Barkingside Library

MPs Mike Gapes and Lee Scott along with Cllr Wes Streeting, Redbridge Council Health spokesperson will say why the plan to close King George A&E needs to be abandoned must be the recommendation of the major piece of work commissioned by BHRUT into the feasibility of closing KGH A&E.

The September BHRUT AGM papers annouce the major piece of work below:



Key risks to the strategy

HfNEL focused principally on quality, with financial sustainability considered f

or northeast London as a whole, and due to the loss of income and significant capital

development needed at Queen’s, the overall impact of the changes on BHRUT’s

financial position is expected to be negative. Implementation of the changes is

predicated on significant productivity improvements that have not yet been realised,

including reduction in length of stay to create sufficient bed capacity at Queen’s to

deal with the additional activity it will see.

Although the Trust is committed to following through on the above elements and

delivering them, before embarking on any other aspects, we have asked for a major

piece of work to take place to look again at the data – including projected population

and demand – that was used to develop the original Health for North East London

proposals. ENDs My emphasis