hospital closures in South London - add your comment to Guardian

[LondonMix]

Not sure how it will work but transfer if it turns out admission is necessary seems likely. The report says Guys has a well established urgent care services (pg 61 paragraph 157) but that might not be accurate, I have no idea!

Edited to add: Guy's describes the emergency service it offers as a UCC but unlike the one in Lewisham it doesn't appear it opens 24/7. Perhaps because of the close relationship and proximity with St Thomas?

http://www.guysandstthomas.nhs.uk/our-services/emergency-care/urgent-care-centre.aspx

buggie Wrote:

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>

> 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.

[Jeremy]

I don't even think the distance to the hospital is necessarily relevant. In some areas you might be able to travel 20 miles in half an hour. In London, it might take half an hour just to go five miles.

[Peckhamnearbe]

People reading this who are interested in the campaign to try to save Lewisham Hospital may be interested in this:

From: r.

BBC Question Time protest Goldsmiths College-Save Lewisham Hospital

This Thursday January 10th 5.30pm-9.30pm

more info: http://www.savelewishamhospital.com/bbc-question-time-protest/

Also http://brockleycentral.blogspot.co.uk/2013/01/close-lewisham-plan-sent-to-health.html

[Marmora Man]

Peckhamnearbe Wrote:

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

> People reading this who are interested in the

> campaign to try to save Lewisham Hospital may be

> interested in this:

>

> From: r.

> BBC Question Time protest Goldsmiths College-Save

> Lewisham Hospital

> This Thursday January 10th 5.30pm-9.30pm

> more info:

> http://www.savelewishamhospital.com/bbc-question-t

> ime-protest/

> Also

> http://brockleycentral.blogspot.co.uk/2013/01/clos

> e-lewisham-plan-sent-to-health.html

Focusing on one hospital (Lewisham) ignores the real problem that is how to ensure that the provision of care across South London is balanced, cost effective and efficient. The "Save Lewisham hospital" campaign in misjudged and based more on emotion that reason.

[Medley]

Nothing wrong with a bit of emotion when such crazy decisions are threatened.

Actually I think if you read through the responses from clinicians and medical staff on the SLH website, you'll find lots of reason.

What the SLH perhaps lacks is a fully worked-up alternative plan. That's the moan of Kershaw the administrator - apparently - that no one came up with a workable alternative.

This line of argument, for me, conveniently ignores the fact that this is precisely his/the Trust's/DH's/the NHS' job. It's not for local people to resist insane and unjust slashings of services and abandon their day jobs to work out what would be a better plan. What are all these managers paid for?

[LondonMix]

Peckhamnearbe

I've read the comments at the links you provided and I (genuinely) don't understand the arguments being made. Someone alleges the data in the studies is incorrect. Do you know which facts are seen as contentious?

Also, do those who want to save Lewisham's A&E believe that SE London needs 5 A&Es or do they agree that 4 A&E's and a 24/7 urgent care centre would be better but think that one of the other hospitals should lose their A&E instead? If it?s the latter, which of the other hospitals and why (geographical spread / population density / relative quality of the A&Es, statistics regarding how many people need to be admitted in the various A&E departments)? If it?s the former (5 A&Es being best) what?s the basis for this argument?

The draft report concludes that travel times to an A&E in SE London following the implementation of its recommendations would increase by 1, 2,and 3 min via ambulance, private car and public transport respectively. Do those who oppose the proposals disagree with this analysis or do they believe that the increased travel time is unacceptable from a health perspective? The specific analysis on the impact just on the population of Lewisham (pg 69) shows that journey times would still be within recommended guidelines (>95% of the population within 30 min of an A&E when travelling via blue light ambulance). Is this analysis being questioned?

Medley, besides calling the proposals insane, can you be more specific regarding your opposition?

[Otta]

Just going back to the thread title, what good is adding a comment to the Guardian website going to do anyone?

[simonethebeaver]

I haven't read the report yet, but am fairly surprised at that travel analysis. I can't really comment without reading it myself though, but my first reaction is how on earth it would only take 3 more minutes on public transport for someone using Lewisham to get to either Kings or Woolwich, or 2 mins in a car. (I know nothing about ambulance travel times at all.) This must be a calculated average of course, but I can't see how often it will actually be true.

[Marmora Man]

Medley Wrote:

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

> Nothing wrong with a bit of emotion when such

> crazy decisions are threatened.

>

> Actually I think if you read through the responses

> from clinicians and medical staff on the SLH

> website, you'll find lots of reason.

>

> What the SLH perhaps lacks is a fully worked-up

> alternative plan. That's the moan of Kershaw the

> administrator - apparently - that no one came up

> with a workable alternative.

>

> This line of argument, for me, conveniently

> ignores the fact that this is precisely his/the

> Trust's/DH's/the NHS' job. It's not for local

> people to resist insane and unjust slashings of

> services and abandon their day jobs to work out

> what would be a better plan. What are all these

> managers paid for?

Medley - you seem confused! You have pre-judged the decision as "crazy", insist that "It's not for local people to resist insane and unjust slashings of services and abandon their day jobs to work out what would be a better plan", describe Matthew Kershaw as an administrator but then ask "What are all these managers paid for?" implying that they are not doing their job.

All "those" managers have been paid for producing the report you apparently deplore - despite apparently not taking the time, or even considering your responsibility, to read.

[LondonMix]

Simonthebeaver, you are right. It is an average deterioration across SE London. The impact on the Lewisham population is much worse but still remains within guidelines for blue-light ambulance journeys which are 30 min for strokes and 45 min for major trauma. Following the implementation of the proposal, the journey times via blue light ambulance (both on average for Lewisham and for 95% of the people in Lewisham ) would remain well within these guidelines. Even by private car, the travel times appear okay for time sensitive cases (assuming of course that the guidelines are correct and the travel analysis has been done properly). All of this is on page 69 of the report.

[Siduhe]

Thinking about ED and the point buggie makes about impact on other local hospitals like Kings, I got a copy of the following exchange emailed to me today - courtesy of "They Work For You":

http://www.theyworkforyou.com/debates/?id=2013-01-08a.169.0&s=speaker%3A10326#g173.1

Am still working my way through the doc btw, but appreciate the continued info!

[LondonMix]

It would be great if someone could comment on the below:

? Closing Lewisham?s A&E wouldn?t drop travel time standards below national guidelines. It isn?t made clear if closing any of the other A&E?s would result in similar, better or worse changes relative to the Lewisham option.

? Lewisham (unlike most of the other hospitals with A&E?s) doesn?t appear to have any of these specialist care divisions: stroke, vascular, heart attack, major trauma. Can someone confirm this is true? You couldn?t close the other hospitals? A&Es that have these specialist units with without also shutting down the specialist care units which would have serious health implications for SE London

? Probably because Lewisham doesn?t have a specialist care division like Princess / Kings et al, the most serious cases are already diverted via the ambulance service to the neighboring hospitals. Therefore, 77% of cases coming through Lewisham?s A&E currently don?t require admission (fractures/ stiches/ burns/ etc) and could be dealt with by the proposed Urgent Care Centre that will be open 24/7. Urgent care centres have shorter waiting times for people suffering from the types of injuries they deal with as more serious cases aren?t constantly being prioritized.

? The 23% of cases currently treated at Lewisham that would now be redirected to other hospitals amounts to 70 patients a day. It?s not clear in the report whether or not it?s assumed that surrounding hospitals can easily absorb this or if its assumed that patients with less serious injuries will be redirected to Lewisham?s Urgent Care Centre so the system balances out.

? The report suggests SE London is lacking a centre specializing in non-complex elective procedures (hip and knee replacements) and that a new centre serving all of SE London should be developed at Lewisham. Placing the Elective Procedure centre at a non-A&E hospital should reduce waiting times across SE London since currently, appointments often have to be postponed / cancelled due to the need for staff to deal with emergencies. More complex / riskier procedures will still need to be performed at hospitals with full emergency capabilities.

[Pugwash]

As part of my job, I am required to assess Southwark residents who find themselves in non Southwark Hospitals. From camberwell by ordinary car during the day it can take upto an hour to get to QE Hospital in Woolwich (so around 30 - 45 mins from lewisham borders). Due to the poor transport links to QE most people arrive by car. To find a parking space it took me over an hour as my 'official hospital badge' at the time did not allow me to park anywhere not a KCH site, so had to join the wait with others

People living near the Lewisham end of Southwark i.e Forest Hill Road/Brenchley Gardens, Woodvale, Sydenham Hill usually get taken to Lewisham A & E rather than Kings and admitted to Lewisham Hospital. Under the new system they would go either to Kings, Bromley or Woolwich. Kings was on Red Alert last week and trying to discharge people quickly from the wards to free up beds - with more people arriving via A & E Kings could be overloaded

[LondonMix]

So you think the travel times are unrealistic and that closing Lewisham admissions will lead to a shortage in hospital beds?

[Pugwash]

I had a case this week where a lady fell in Penge, LAS were going to take her to Mayday A & E, son kicked up a fuss so LAS took her to Kings.If this happens to people in Lewisham - they are more likely argue for a Kings or St. Thomas's A & E rather than PRoyal or QE.

Many people when taken to A & E at Kings are often admitted for overnight stay in Observation or Clinical Decision Wards for further assessment - some are returned home others admitted.

Unless there is some arrangements made a Lewisham patient could come to Kings, stay on Obs or CDU, and admitted. It could be that once patient assessed as needing further in patient stay, a lewisham resident from Blackheath, would be transferred back to Lewisham Hospital.

I gather from the paper today that over the festive period, mums in labour were sent to QE and PR as Lewisham and Kings maternity Units were full. There is a danger that medical information readilly available at one hospital would not be so easily accessed at another.

[LondonMix]

Ah, I see. So your concerned Kings in particular will be the favoured choice of Lewisham residents so the other A&E's will be underused while Kings is overused. I suppose policy and coordination will be necessary to tackle that and the draft recommendation doesn't really address this.

[Marmora Man]

Generally speaking individuals don't choose which A&E to use - unless they are "walking wounded" in which case there are, generally, not urgent. If transported by a blue light ambulance (ie an urgent life threatening case) the LAS and LAS despatchers will ensure the patient goes to the most appropriate A&E that has sufficient capacity and expertise to treat the patient in good time. Choice seldom comes into it.

Equally - patients are only admitted for an overnight stay if it's clinically necessary - the individual hospital or geographic location won't change the probability of any patient requiring an admission.

This thread seems to be generating a high degree of angst - the report makes clear that there will no overall diminution of NHS services to South London as a whole - but that by rationalising and relocating services the services will cost less and therefore provide better value. Inevitably there will be some that will be adversely affected by the changes - but the duty of NHS planners is to ensure an equitable service for the total population rather than a personalised service to individuals.

Of course, once admitted to hospital or placed under the care of a clinician THEN the service must be personalised.

[Bouncy]

"Generally speaking individuals don't choose which A&E to use - unless they are "walking wounded" in which case there are, generally, not urgent."

This is not true of babies and children, who are bought in to the nearest hospital / hospital it is quickest to reach by their walking parents / carers. Babies and children deteriorate rapidly and cannot properly articulate what their symptoms are - hence the need for them to be seen as quickly as possible by medical staff who are qualified to assess them. I believe the threatened closure will include the specialist children's A and E at Lewisham, and dread to think what the consequences of this may be.

[LondonMix]

Are you saying you believe the distance children will have to travel to A&E and the quality of care they will receive in the other hospitals is life threatening?

I find that hard to believe. If a child is suffering from a major trauma any responsible parent would call an ambulance or drive if they thought that would be quicker and had a car (and ambulance times to A&E, if the stats are correct, would remain well within clinical guidelines even if Lewisham's A&E closes). If its not clear to the parents that a child's injury is quite that serious, I imagine they would go to Lewisham's Urgent Care Centre where they would be assessed quickly (because as you say children have priority) and then transferred via ambulance to another hospital if necessary. Other SE London hospitals have Paediatric A&E departments (Kings and Queen Elizabeth I believe). Do you have any specific cases where the time delay (essentially the time for the ambulance transfer between Lewisham and its closest A&E) would have grave consequences beyond what is considered acceptable?

[Marmora Man]

Bouncy Wrote:

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

> "Generally speaking individuals don't choose which

> A&E to use - unless they are "walking wounded" in

> which case there are, generally, not urgent."

>

> This is not true of babies and children, who are

> bought in to the nearest hospital / hospital it is

> quickest to reach by their walking parents /

> carers. Babies and children deteriorate rapidly

> and cannot properly articulate what their symptoms

> are - hence the need for them to be seen as

> quickly as possible by medical staff who are

> qualified to assess them. I believe the threatened

> closure will include the specialist children's A

> and E at Lewisham, and dread to think what the

> consequences of this may be.

This is typical of what I described as emotional response - quote "I dread to think what the consequences of this might be". Taken at face value it would require a specialist paediatric A&E unit within 15 minute walk of every household with children - which is patently daft.

If a child is severely ill - call an ambulance which will be staffed by qualified paramedics. The paramedics will assess, stabilise and care for the child as it travels (within 30 minutes) to the most appropriate centre. It is not practical for every hospital to offer every specialist service.

[buggie]

Something of note could be that hospital to hospital transfer is seen as lower priority than similar category 999 call as the patient is understandably deemed to be in a place of safety/has ready access to emergency medical attention. While possibly not a daily event, when it does happen it can be stressful to patient, family & staff also having a knock on effect to the effective running of the department.

But, for management/DoH it's more the statistics of how frequently this could occur that matters - it would be interesting to see what the stats are in areas that have downgraded to UCC/minor inj units what their transfer out rates are & what the patient journey is for those patients (I know I've seen stories in the papers of distraught families where it didn't go so smoothly).

Anecdotally, there is great variation in what families feel is sick enough for an ambulance - great majority of parents present of their own means & will often travel to where they feel the best care will be - completely understandable, but means if you're a high profile hospital you see families from further - funnily enough some of the worst at using their local and travelling further are often senior dr's & managers!