Thursday, January 31, 2013

Save Lewisham Hospital A&E...Saved???

"Confusion' over Lewisham A&E future" (Steve Ford - Nursing times 31.1.13)

Accident and emergency services will remain at Lewisham Hospital but on a “smaller” scale than at present, the health secretary has announced. However, the neighbouring South London Healthcare Trust is to be broken up. The financially challenged trust is to be dissolved by October 2013 to address the risk it carries for ongoing patient care and the pressure it is placing on other parts of the NHS, Jeremy Hunt said today.

Meanwhile, following advice from NHS medical director Sir Bruce Keogh, Mr Hunt said he had decided that Lewisham Healthcare Trust would retain its A&E – though on a smaller scale than at present. South London was the first trust to be subject to the new NHS failure regime for organisations viewed as financially unsustainable.

Currently, the trust is losing more than £1m every week and by the end of this year, is expected to have an accumulated debt of more than £200m. Matthew Kershaw, former Department of Health head of provider delivery, was appointed as a special administrator last July to look into the future of the trust and its surrounding health economy. He published his final recommendations earlier this month, advising the government that South London should be broken up, but also that Lewisham’s A&E should be downgraded to an urgent care centre.

The threat to Lewisham’s A&E services sparked widespread protests from the public and NHS staff, culminating in a rally on Saturday. Mr Hunt announced today he had chosen to broadly accept the majority of Mr Kershaw’s recommendations. South London Healthcare Trust will be dissolved, with each of its hospitals – Queen Elizabeth Hospital in Woolwich, Queen Mary’s in Sidcup and the Princess Royal in Bromley – taken over by a neighbouring hospital trust.

Mr Hunt said he understood the financial rationale for downgrading Lewisham A&E, but “in the interests of local patients” had imposed some additional clinical safeguards proposed by Sir Bruce Keogh. As a result, Lewisham Hospital will retain its ability to admit patients with less serious conditions, and will continue to have 24/7 senior medical emergency cover – allowing it to remain open as a working A&E department treating up to 75% of the patients who currently use it.

Patients with much more serious conditions or higher risk pregnancies will be taken to Kings, Queen Elizabeth, Bromley or St Thomas’ because they are more likely to have a better result. Mr Hunt said: “The longstanding problems at South London Healthcare NHS Trust must not be allowed to compromise patient care in the future. Hundreds of millions of pounds have been spent on paying for debt rather than improving patient care for the local community in South East London. “What is in the clinical interests of patients in South East London has been at the heart of my decision making process, and as a result I have followed clinical advice to keep open the A&E in Lewisham.”

Sir Bruce added: “Healthcare in South East London is at a turning point. We need to strike the right balance between ensuring that all patients have access to the best possible specialist treatment whilst providing safe, effective and convenient services close to home . “I expect that balance to result in about three quarters of patients currently seen in Lewisham A&E continuing to receive complete care at Lewisham Hospital and about a quarter being transferred for more specialist treatment elsewhere.”

But Mike Davey, a nurse and Lewisham Unison branch secretary, said: “The [health] secretary needs to urgently clarify what is meant by a smaller A&E, as the London Ambulance Service will be reluctant to bring patients to an A&E that does not offer a full range of A&E services. “Is this proposal just an urgent care centre or a fully fledged and supported A&E Department,” he said. “The secretary of state has caused more confusion and the whole process is a shambles.” NHS

Confederation chief executive Mike Farrar said: “We need to learn the lessons from this case and others. The answer is to start discussions earlier, with doctors and leaders clearly explaining the case for change. “Otherwise we will find ourselves perpetually in a situation of trench warfare, with staff, politicians and patients all coming out in opposition on the streets.”


NHSWorker said...

The question to ask is – what is the purpose of a large "consultation" exercise?

a) To get lots of ideas so that a really sensible plan can be formulated, based on what really matters to local patients (many of whom will have taken part),

or …

b) To add credibility to the plan that has already been formulated (and may be utter nonsense that no ordinary person would have come up with) on account of the large scale of the “consultation’ exercise.

Note the processes are different:

in a) – consult, plan, decide

in b) – plan, decide, consult

I think we know what we are getting all round the country, don’t we?

The problem is that the plan usually has basic flaws. A good example is that travelling further will result in amazingly better care when you get there - as you have quoted above from Sir Bruce. Apart from a few niche areas already in place such as major trauma (by helicopter) there is no evidence for this (it may sound right to the men in suits but that doesn’t mean it’s true). Indeed if you close an A&E, the mortality experience (and no doubt disability in survivors) increases overall with increased travel times. Read these:

(academic paper that reached the same conclusion)

Something less than an A&E is just that - either a minor injuries unit/urgent care centre/walk in centre or the slippery slope towards that (because, as you say, ambulance personnel will second-guess and go to a "proper" A&E miles from where the patient lives.

John Gray said...


this is from an article in nursing times not me?

Anonymous said...

The same patronising and condescending style of "journalism" we have come to expect from the so called "Lewisham Hospital Worker" here John. I guess anyone who uses quotes from the Daily Mail can't really expect to be taken seriously. Pity the rest of the parasites don't all go running across to Unite where I'm sure they would all feel far more at home in an ever dwindling minority.