Lewisham Hospital gets its case argued

[Saffron]

LondonMix Wrote:

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> To those of you like SJ who believe this was just

> some Whitehall type proposal totally divorced from

> medical / clinical considerations please note that

> clinicians were very involved with coming up with

> the Kershaw's recommendations:

>

>

> 24. A clinical advisory group ? composed of

> clinicians from all NHS organisations in

> south east London, and a patient and public

> advisory group ? formed of

> representatives of Local Involvement Networks and

> patient councils ? have fed

> directly into a TSA advisory group.

> 25. An external clinical panel has provided

> additional scrutiny to the development

> of the draft recommendations. The panel was

> assembled to act as a ?critical

> friend?: an independent group that fully

> understands the context of the work and

> can provide constructive criticism and ask

> provocative questions. In carrying

> out its function, the panel has provided the

> programme with valuable insights,

> based on independent clinical expertise. It has

> played a key role in challenging

> the development of draft recommendations, for

> example, to emergency and

> maternity services and is supportive of the

> proposals and options in this report.

That doesn't get my vote my of confidence either because there are people who participated in these groups who have strong objections to the way the groups were run. AND, there are many clinicians outside these groups, who object, and whose views are equally valid.

[Saffron]

http://www.bbc.co.uk/news/uk-england-london-21269910

The A&E department at Lewisham hospital in south-east London is to be downgraded to an "urgent care" ward as part of cost-cutting measures.

Does that mean mat services were spared? That, at the very least, would be sensible, with Lewisham having a high rate of teenage pregnancy (the highest of any area in London?) and a large proportion of older mothers giving birth.

Sadly I think we can expect more closures of this type.

Time will tell.

[sedm]

Both A&E and maternity services downgraded - maternity services to midwife led centres, A&E will be running at 75% what it was previously. Lewisham loses A and E cover for any patient with life-threatening conditions. And women with a high risk pregnancy will have to go elsewhere.

[BeccaL]

What about women who suddenly turn out to be a high-risk pregnancy during labour - lots of blue-lighting to Kings, which obviously has the capacity to cope with a lot more difficult births... that on top of the 25% of patients who aren't seen at Lewisham - madness

[Otta]

What I don't get is why they can give ?36m to the other hospitals that will have to cope with the overspill. Why couldn't they use that money in other ways so that Lewisham could be left alone?

[LondonMix]

Saffron, I have not been as rude or aggressive with anyone in this thread as you've been with me. You should ask yourself why you can't discuss this without being unpleasant.

[LondonMix]

It's not safe to have full maternity services without an A+E. Midwife led centres exist throughout the UK and are considered safe in general. Even the report acknowledges though that the maternity services at other hospitals need to be expanded (with capital imvestment) to deal with the change in maternity services at Lewisham. On balance this was still considered the better option long term as structurally A+E's in South London is deemed over supply (again, I don't know if that is true).

[StraferJack]

" as structurally A+E's in South London is deemed over supply (again, I don't know if that is true)."

in your experience as a customer of A&E's generally, or with pregnant women you know, do they seem over or under supply?

Because people who use them appear to be saying they are undersupplied

[Otta]

What this is likely to mean is that quite a few women who go in to labour and spend 24 hours at Lewisham not doing much, before everything suddenly starts to go very wrong, will then have to be blue lighted to Kings or QEH (Poor women if they go there!).

I wonder what the effect will be on the ambulance service.

Oh well, it's done now, and it was always likely it would be, so we have to hope that it won't be a disaster. Much as a part of me would like it to completely fail and show this to have been a crap idea, I don't want people dying to prove me right, so I will hope that all of us doubters are wrong, and Mr Hunt in all his wisdom has it right.

I bet he couldn't wait to make the announcement!

[LondonMix]

Strafer by A+E I think they mean the stuff a UCC can't deal with. So, I don't know anyone who was having a heart attack and couldn't immediately be dealt with- but that's not say this might not be an issue, its just not my experience.

Long wait times for non-emergencies- broken bones etc- are chronically long and having a UCC should shorten waiting times.

I am concerned about the additional strain on the ambulence service. I also wonder how realistic it is to assume people from outside Lewisham will use the UCC to balance out the system. A specific policy (like exists between Guys and St. Thomas) will need to be implemented where they tell people with non critical issues they will have a shorter wait at Lewisham...

Only time will tell

[Huguenot]

It seems eminently sensible to set up working groups of healthcare professionals to design a health service for South London that meets community requirements and balances distribution of services appropriately.

I would expect this to be done bearing in mind the budget available, and that despite society's demand to have a hospital on every corner 'just in case' that this budget would reflect economic realities (and yes, that means there's a price tag on everyone's life).

It's also predictable that there would be a massive backlash against those working groups by people not in them, and that people would think they could design a better health system based on 'places I've been to and liked'!

I haven't got a clue what Saffron's on about in terms of using my noodle. Assuming that she means 'think about it', I have, and it seems self-evident that the selections of healthcare professionals and clinicians facing this task from an informed perspective are likely to deliver better results than layperson sentimentalists.

[Husker]

Otta Wrote:

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

> What I don't get is why they can give ?36m to the

> other hospitals that will have to cope with the

> overspill. Why couldn't they use that money in

> other ways so that Lewisham could be left alone?

Exactly! Lewisham is a good performing hospital that has had a considerable amount of money spent on modernising it recent years but it is now being clobbered because two other hospitals can't manage their budgets properly.

[JulieP]

I have only briefly read through the document. My concern would be the 30% who do need admission (not including maternity service users) who will need to be admitted to King's or QEH. The ?36m (as far as I can see) is capital to spend on changing buildings etc. Will these two hospitals be expected to take in what would be the equivalent of 3+ wards without any extra on going funding to pay for staff / other running costs?

[Bouncy]

Londonmix: I don't think that Saffron has been 'rude' or 'aggressive'; I think she has responded in frustration to your seemingly gratuitous tendency to hijack threads on important issues about which people feel strongly, and (again seemingly gratuitously) dogmatically to employ fallacies or repetitively to continue to state a position which ignores the actual evidence to which they explicitly refer: see e.g. http://www.eastdulwichforum.co.uk/forum/read.php?29,965498,980041#msg-980041

Why am I jumping in to your argument? Because I too have read the evidence and positions of informed people (see e.g. http://www.savelewishamhospital.com/specialists-say-no/), and I feel that you are undermining that evidence and those informed positions, and that your red herring ploy in undermining Saffron's position by inaccurately labelling her argument is worth noting.

[LondonMix]

I never said any such thing. I asked what her alternative was after she said there was a viable one. I didn't realise some of you feel those with differing views aren't allowed to participate in discussions on important issues.

I've repeatedly expressed various concerns about the proposals, said I wasn't an expert while presenting the information detailed in the actual proposal.

Instead of making this thread about me, let's please just stick to the very important issues at hand.

[Huguenot]

That's a peculiar attack Bouncy, I saw no thread hijacking by LondonMix on the thread you linked to - just a mild disagreement with your position.

Likewise, I've seen nothing from LondonMix which is dogmatically repeating a position that ignores evidence.

What you have in the Save Lewisham Hospital campaign is one view on the situation from a local perspective, and in the working group report a slightly different perspective given the regional requirements and budgets.

Threads are not reserved for people who agree with you.

[LondonMix]

That's very true regarding the letters H. I was struck by this in the letter from the maternity unit. On so many points they agree with the draft, except with the final conclusion. For example, they and the external clinical panel agree that without a full A+E only a midwife led centre would be viable. They also agree that this would significantly reduce the number of women who could give birth at Lewisham and that the other hospitals don't have capacity to take on the additional high-risk mothers. For the clinicans who wrote the letter this is reason to keep both the A+E and the maternity services unchanged. The report believes this is reason the change to a mid-wife only centre and expand capacity at other hospitals as the travel distances aren't too onerous.

From the ED letter, we can see that some of the concerns they raise have now been incorporated in the final configuration. They say that the admission stats (and therefore the effectiveness of a UCC to handle workload)on Lewisham underestimate the need for emergency doctors who are the only ones who treat patients from midnight to 8am. Their specific expertise prevents the need for admissions and some cases require an Ed physician to assess them or they would automatically have to be transferred even if admission isn't required. I believe as a result, ED doctors will now be retained 24/7 in the plan announced yesterday along with other changes.

[Bouncy]

Hi Huguenot - absolutely, threads are not reserved for people who agree with me! On the thread I referred to, Londonmix repeatedly ignored the concrete fact that Simonethebeaver and I referred to, which underpinned and explained our point, in order to continue to make an alternative point. It seemed that a similar process was at work here, and that was what I was taking issue with. Of course we can all hold alternative views and ideologies; that's what makes discussion interesting. I'm not contesting that! But it's useful to differentiate between evidence, ideologies, and argumental strategies - especially when the issues being debated are so important.

[LondonMix]

That is a wildly inaccurate characterisation of that thread Bouncy. I didn't understand something regarding the allocation of school places. Once you explained it, I totally accepted it was true that religious families had a better chance of attending a local school as you suggested. I simply said I would sooner advocate for the creation of more quality primaries to address the underlying issue (a shortage of local places) rather than ban faith schools (and I am not religious). How that fits how you just described the thread is hard to understand.

Again, if I have misunderstood something or made a mistake in this or any thread just point it out. This personal argument with me is not necessary.

[Chillaxed]

Gonna stick up for LondonMix here. I do not know enough about the Lewisham Hospital issue to make any sort of substantive comment, but I have read LM's comments on this and other threads and see no 'gratuitousness' or 'dogmatic employment of fallacies'. Rather, he or she seems to be highly engaged in local issues and willing to take the time to research the topic. For mine, being well informed and using logic and reason to make a point does not equate to gratuitousness or condescension.

[Otta]

Intereswting that the day after this announcement they are talking on the radio about the ambulance service struggling against cuts and failing to meet targets.

This'll help!

[Saffron]

No surprises there.