hospital closures in South London - add your comment to Guardian

[fl0wer]

http://www.guardian.co.uk/society/2013/jan/08/nhs-hospital-trusts-debt-dissolved-report

[LondonMix]

What are the implications of King's College hospital taking over Princess Royal hospital?

[Marmora Man]

I find the level of comment on the Guardian website to be usually just above 6th form politics debating society standard and often falling far short of that.

Therefore I'll not bother.

However, Kings College is a well run NHS Trust - its Board appears to communicate well with all levels of staff, it manages its financial and other resources effectively and is a part of the wider Kings Health Partnership where it has teamed up with St Thomas' & Guy's Trust (and will almost certainly amalgamate formally with this Trust - plans are well advanced). This enables it to generate efficiencies of scale in purchasing, resource utilisation and, more importantly, the location of clinical services in the immediate South London area of Southwark & Lambeth - so there will be / is one large and effective, well equipped cardiac surgery centre - ditto for strokes, neurosurgery and so on, rather than a multiplicity of less well equipped and staffed units trying to deliver more than they are capable of.

The KHP is also, with St Thomas' & Guy's an Academic Health Science Centre - one of just five in UK and on a par with the internationally renowned Johns Hopkins University Hospital in the USA.

There are undoubtedly problems at Kings - nothing is perfect but it has demonstrated over time that it can manage effectively in the political, economic and clinical maelstrom that is the NHS today. Therefore partnering the South London Trusts with Kings should lead to a sharing of knowledge, skills and ability - creating a more effective NHS service to the area covered by the South London Trusts. The only danger is that the Kings management team could lose focus on their own hospitals and services - but this is unlikely.

I therefore support the broad direction that the Matthew Kershaw has recommended. Having quickly reviewed the Guardian commentary - I find the level of knowledge and quality of debate to be even poorer that I expected it to be.

[LondonMix]

Yeah, I didn't even bother to read the comments. I understand the SLHT run hospitals will be now taken over be well run hospitals like Kings. However, I was wondering what the details were. For instance, Lewisham, another well run hospital, will close its A&E as part of its takeover of one of SLHT's hospital. It doesn't appear that any immediate loss of service in either Kings or the Princess Royal hospital is anticipated but it would be good to get a more detailed explanation of the takeover and its implications.

[Siduhe]

And that's the thing I still haven't quite understood - despite reading plenty of news articles. On what basis does it make sense for Lewisham Hospital (which isn't in debt) to close its A&E department rather than one of the poorly performing SLHT hospitals? Is it that the facilities are better at one of the SLHT hospital or is it about creating a business model which allows SLHT to service its ongoing debts (PFI in particular). I'm not looking for an academic debate about the rights and wrongs of PFI but if anyone can explain why it makes business sense to shut down a (by all accounts) well run and profitable hospital facility at Lewisham - I'd be grateful to understand the rationale better.

[Marmora Man]

I haven't looked at it in extensive detail but it can be argued that South London is over provided with A&E units and, frankly, with hospitals. I believe the review has taken the opportunity to rationalise services across the area and the three hospitals concerned to create a more logical geographical spread.

Undoubtedly, the fact that two of the three units have associated PFI debt to be serviced makes it more likely that they will survive as reducing their service offering has limited impact on contracted running costs - whereas in a non PFI unit closing services and selling off redundant property is an option - realising real capital and real P&L savings.

I spent much of my life in the West Country (Cornwall and Devon) in those two counties there are just 4 major hospitals (Truro, Barnstaple, Exeter & Plymouth) all approximately 45 - 50 miles apart. Here in East Dulwich we can walk to as many hospitals within 45 minutes. Yet the mortality and other key clinical indicators are no worse for the Devon and Cornish people - despite what can often be a long journey to hospital. A hospital on every doorstep in neither necessary nor a "more safe" no matter what local protesters may say.

[fl0wer]

What about grabbing the chance to raise the standard of debate in a national daily, by joining in and writing articulately about the things most important to us locally.

Furthermore, extra ideas we 'sow' in the comment threads are taken up week by week as journalists trace the evolving story by reading our posts for inspiration.

[Jeremy]

Can you really compare a densely populated capital to the rural south west?

[buggie]

There's also - at no point in the TSA report reference made to the very well established & used Paediatric A&E at Lewisham and how changes to the services would impact upon the families, especially given that they make up approx 1/3 of the total patients through the dept. Find the comments below the article very interesting as hadn't realised the other & seemingly conflicting interests do Matthew Kershaw.

I don't understand how the other local hospitals will cope (having worked st one of them very much on the front line for a decade until recently). On a simple map, I can see how downgrading Lewisham would make sense as it appears encircled by the other hospitals, however, if population density was also shown I wonder if it would change the perception, also, given deprivation levels how much more difficult it could be for families to access facilities if they are so much further away.

[Jessie]

Kings A&E deal with many stabbings and shootings, as I imagine Lewisham do. Not so much Devon and Cornwall I should think.

[buggie]

MM: If Devon & Cornwall had similar deprivation/transient immigrant population let alone similar population then fair comparison, but I don't think it's comparable in any way.

I could've said similar of Suffolk where I grew up, but again the population is incomparable to round here.

[LondonMix]

In the article it says Kershaw recommends that the Department of Health is supposed to provide additional funding to the two SLHT hospitals with PFI arrangements to cover those costs until those contracts end. Therefore, it doesn't appear the decision to close Lewisham A&E is related to that debt.

I don't like reading the comments section as its usually filled with incorrect information (which is just one of its sins).

Siduhe Wrote:

-------------------------------------------------------

> And that's the thing I still haven't quite

> understood - despite reading plenty of news

> articles. On what basis does it make sense for

> Lewisham Hospital (which isn't in debt) to close

> its A&E department rather than one of the poorly

> performing SLHT hospitals? Is it that the

> facilities are better at one of the SLHT hospital

> or is it about creating a business model which

> allows SLHT to service its ongoing debts (PFI in

> particular). I'm not looking for an academic

> debate about the rights and wrongs of PFI but if

> anyone can explain why it makes business sense to

> shut down a (by all accounts) well run and

> profitable hospital facility at Lewisham - I'd be

> grateful to understand the rationale better.

[Siduhe]

Thanks to all - the striking thing to me is that none of us (who all seem reasonably well informed and interested) know what the actual rationale is for closing Lewisham rather than the SLHT facilities. I absolutely get what MM has said about oversupply of services in the area, but I've been looking on and off at various articles and reports, and no-one seems to be able to articulate why Lewisham A&E (and not SLHT).

I obviously need to do some more digging, but appreciate any more insight people have - mostly curiosity on my part. I'm all for looking at and taking hard decisions based on analysis and evidence, but it is surprisingly difficult to work out what the position is here (at least for me!)

[LondonMix]

I've just skimmed the full draft recommendation and this seems to be the reason in simple terms. Lewishim will continue to have a 24/7 urgent care facility which is basically A&E cases that don't require hospital admission. Currently 77% of visits to Lewisham's A&E fall into that category so the logic is that the other hospitals can absorb the remaining 23% of cases that do need full admission.

http://www.tsa.nhs.uk/sites/default/files/TSA-DRAFT-REPORT-WEB.pdf

157. The urgent care services at Guy?s Hospital and Queen Mary?s Hospital Sidcup

are already well established. The draft recommendation is for University

Hospital Lewisham to have a 24/7 urgent care service that will treat around

77% of the people currently attending the A&E and urgent care services

there45. This is because the vast majority of patients with urgent care needs do

not need to be admitted. The types of conditions the services will be able to

treat include:

? Illnesses and injuries not likely to need a stay in hospital;

? X-rays and other tests;

? Minor fracture (breaks);

? Stitching wounds;

? Draining abscesses that do not need general anaesthetic; and

? Minor ear, nose, throat and eye infections.

[Zebedee Tring]

I note that Lewisham has recently finished upgrading its A&E department, at considerable expense I believe. It would be a total waste of scarce NHS resources to close this facility in what is a deprived area.

But we're all in this together, and we need the money to fund cuts to income tax for those top earners who have had such a hard time in recent years, so of course it will be worthwhile.

[LondonMix]

Not every decision is as simple as income tax cuts for the wealthy. This trust is a disgrace. Not only is it hemorrhaging money, the health outcomes for the community it serves are significantly worse than neighboring areas. Do you honestly think everything should go on as is regardless of the case for breaking up the current trust and handing it over to NHS trusts that are delivery much better service (from a health perspective to the community and a cost perspective for the tax payer)?

[Siduhe]

LM thanks - will take a look at that document.

[buggie]

Lewisham isn't part of the failing trust though, it's worked hard to get balanced & must be doing ok as the TSA want it to take on QEH when the SLHT is split.

LondonMix Wrote:

-------------------------------------------------------

> Not every decision is as simple as income tax cuts

> for the wealthy. This trust is a disgrace. Not

> only is it hemorrhaging money, the health outcomes

> for the community it serves are significantly

> worse than neighboring areas. Do you honestly

> think everything should go on as is regardless of

> the case for breaking up the current trust and

> handing it over to NHS trusts that are delivery

> much better service (from a health perspective to

> the community and a cost perspective for the tax

> payer)?

[Salsaboy]

My other half works at the PRU as a specialist nurse. The reason for closing down Lewisham A&E is that there are too many in the area. The A&E at the PRU is the nearest to the M25 and so would never be closed. In south London you have Kings, Croydon, Lewisham, PRU, St.Thoams's.

Somethings gotta give. Just happens to be Lewisham this time.

Most of Queen Mary's at Sidcup will also close and the land sold off to service the PFI debt, as will some of the services at QE in Woolwich.

[LondonMix]

Yes, I have to read the doc more carefully but from what I understand they want the SE to have fewer full blown A+E's with admission capability based on current demand. The remaining A+E hospitals should each have specific specialties (so you will be taken to the hospital specialising in strokes if you are having a stroke). It think they allocated A+E's to the hospitals that were furthest along the route of having the best specific established specialist care unit. Don't take my word though as I haven't read it in detail, nor am I saying their decision might not be wrong. I just think jumping in with comments on income-tax isn't neccessary in the context of this debate.

[buggie]

Need to have a look at the full report (reading for once toddler in bed!), but how will an UCC without admission facilities work?

Is often only after full assessment/initial treatment that you know if a patient will need to be admitted or not.

Would patients found to be more seriously ill/injured need to be transferred out to another hospital for full A&E treatment which is what happens at QMH Sidcup (?in what order compared to pt's already at the A&E) and (in worse case) then being transferred back to UCHL for admission as nil room at the other hospital.

LM: Guys doesn't have an UCC, it has a minor injuries unit which I believe has had it's opening hours cut in recent years.

[Zebedee Tring]

No London Mix, I don't think everything should go on as it is - of course not. However, as Lewisham has recently finished upgrading its A&E department at considerable expense, I think that it would be a total waste of scarce NHS resources to close this facility so soon. And what is more, the hospital is located in a densely populated and deprived area.

[LondonMix]

I don't necessarily disagree. I just don't assume that those making the decision didn't take this into account. The upgraded facilities will probably still be used for the 24/7 urgent care facility that will operate in place of the A+E and is basically an A+E without admissions. Given 77 percent of Lewisham's A+E cases fall into that category hopefully it won't be wasted. Moreover, if there is a need to reduce A+E's and an opportunity to make sure each of the remaining A+E's have a unique specialization within SE London, this rationalisation might be of greater value on balance. There are rarely decisions that don't have trade-offs.

[Marmora Man]

buggie Wrote:

-------------------------------------------------------

> MM: If Devon & Cornwall had similar

> deprivation/transient immigrant population let

> alone similar population then fair comparison, but

> I don't think it's comparable in any way.

>

> I could've said similar of Suffolk where I grew

> up, but again the population is incomparable to

> round here.

It seems you misread me - I wasn't referring to quantity or range of services but the distance necessary to travel. We do not need so many NHS hospitals all trying to deliver the same services within the same few square miles. Rationalisation and specialisation DOES make sense - but too many media commentators prefer to lead on emotion (finding someone to say "my son / daughter / wife / mother would have died if the local A&E had been closed) rather than lead and inform the debate.

[LondonMix]

Yes, having read through the document more carefully it appears that the 4 hospitals that are to remain A+E's with full admission capabilities have specific specialist treatment units within their A+Es that will continue to serve all of South East London (major trauma, hyper acute stroke, emergency vascular and heart attack all of which already exist as specialist care units in 3 of the hospitals). The urgent care unit that will replace the A+E at Lewisham will be open 24/7 and will be able to deal with the vast majority of the types of emergencies (77%) Lewisham hospital currently manages via its A+E unit. Additionally, the plan is to create a new unique treatment facility at Lewisham. It would be an Elective Care centre serving all South East London for non complex procedures such has hip and knee replacements.