Response to TSA Consultation - Submitted by Dame Joan Ruddock MP
The Process:
The TSA process was never in my view expected to lead to a review of a sub-regional health economy, but rather to deal with a single health trust in severe financial difficultly.
No one should expect a mere 75 day exercise to come up with a major reconfiguration of the health economy for South East London. No one would have expected that proposals to deal with the insolvency of SLHT would encompass swingeing cuts to the services of another Trust which is well run, solvent and serves a growing population of over 270,000 people.
The brevity of the consultation period of 30 days has put enormous pressure on the hundreds of professionals in the Lewisham health community who rightly needed to be consulted. For the public the process has been extremely difficult and at the meetings undertaken by the TSA team the picture presented of how health services are – and might be accessed –is far removed from the realities of life in Lewisham. The online questionnaire is extremely difficult to use and can only be completed by back referencing the report. Case histories used to illustrate community care transfers exaggerate both the good and the bad.
Demographics:
It has been widely accepted within the NHS that local populations vary significantly in their health status and life expectancy, with continuing attempts being made to adjust resources to meet existing inequalities.
My constituency contains some of the most deprived wards in England and Lewisham as a whole is ranked 16th highest out of 326 English local authorities. It has a huge range of ethnicities and languages spoken, giving rise to specific health needs.
Any reconfiguration of local services has got to take account of these demographics yet no health equalities impact assessment has been undertaken, which fundamentally undermines the draft report’s proposals for Lewisham.
Closure of Lewisham Accident and Emergency Department:
This is an astonishing proposal that takes no account of patterns of usage previously analysed on several occasions including under the ‘Picture of Health’ proposals of four years ago.
Throughout the consultation the TSA has made much of the fact that people with the most serious emergencies e.g. heart attacks and strokes are already bypassing Lewisham hospital for specialist centres such as St Thomas’ and Kings. Everyone agrees that is appropriate, and indeed according to the report only three blue light ambulances deliver emergencies to UHL each day.
Such references are not relevant to the vast majority of the 120,000 annual visits to the A&E Department. People walk or arrive by bus, by taxi, by car frequently brought by relatives and with local GPs making many of the referrals. Neither the patients nor the GPs know if an admission might be necessary. Very few people in Lewisham would ever think of going to the Queen Elizabeth at Woolwich and as ‘Picture of Health’ demonstrated, around 70% of emergency patients who would have been admitted at Lewisham would go to Kings or St Thomas’ if Lewisham A&E were closed.
It is extremely difficult to use public transport from most parts of Lewisham to Woolwich and the travel times between UHL and QE Woolwich quoted in the report have been greatly underestimated.
It is impossible to envisage other existing A&Es coping if Lewisham were to close. All other units are operating at capacity already. The loss of the A&E department means the loss of the ICU unit currently operating at an annual occupancy of 95%. It also means the loss of acute medical services dealing with elderly admissions – the very people least likely to be best supported away from familiar surroundings and family members. Furthermore the closure of the department and the replacement by an Urgent Care Centre would mean the loss of the children’s A&E as well.
No convincing evidence is produced to suggest that the 70% of patients that would be displaced by closure of the A&E could be accommodated safely elsewhere. Instead it is proposed that community care services can keep as many as 30% from needing to access Lewisham A&E.
Community Care and integrated pathways
The report takes no account of the fact that Lewisham partners have worked extremely hard to integrate local services. Successes are already apparent and every effort is being made to avoid emergency admissions. Breaking these networks will arguably result in more people facing emergencies dealt with elsewhere, with an adverse impact on continuing care.
The report asserts that 30% of the work of a full accident and emergency department can be transferred to community services. The report offers no evidence for this and the Department for Health have been unable to produce such evidence.
Maternity Services
Maternity services at Lewisham Hospital have improved over the years and with the new facilities have become a popular choice for local women. Women want and need their care throughout pregnancy and birth to be local, integrated and offering choice (except in very complicated cases).
Local demographics mean that the maternity population of Lewisham is considered high risk with approximately 2,500 births each year in the highest category of risk. Lewisham currently has all the expertise and facilities to care safely for the 4000+ births taking place there each year. Neither of the proposals in the report would improve the delivery of maternity services for local women. On the contrary women excluded from Lewisham would not want to travel to Woolwich and if a ‘low risk’ unit only were to be retained at Lewisham the safety of those giving birth would be compromised by the removal of the ICU and A&E services.
The latest ONS interim population projections based on the 2011 Census show Lewisham’s population increasing by 16% from around 277,000 to around 321,000. There would have to be a considerable expansion of services at Queen Elizabeth and at Kings and St Thomas’ if Lewisham lost its current consultant led maternity department. There is no logic in destroying a safe, quality, popular local service and having to build up facilities elsewhere which local people do not want.
Children’s Services
The population of Lewisham is young with a quarter under the age of 20. In response to local needs the local NHS Trust has established a Children and Young People’s Service to include both hospital and community services in the borough. These services are highly regarded and much used by local people. Lewisham is the only London DGH to be recognised as providing ‘excellent care’ by the Health Care Commission and Lewisham’s safeguarding services achieved a rating of ‘outstanding’ by Ofsted this year.
Over 30,000 children use the children’s A&E each year. Only 30% of these users are seen in the Urgent Care Centre. Closure of Lewisham adult A&E service means the closure of the children’s facilities as well. The report fails to take account of the impact of the loss of this facility on a vulnerable population. No other local hospital has facilities available to treat tens of thousands of children and young people who would no longer be able to access services at Lewisham.
Value for Money
A new wing was added to Lewisham hospital four years ago. A new birthing centre was opened two years ago and a £12million refurbishment of the A&E department was completed in April this year. Until the TSA process, the hospital was on track to achieve Foundation Trust status in line with current government policy.
The TSA proposals would destroy recent investments and force the sale of more than half the land on site for relatively small and uncertain capital receipts. The future plans for the site then require significant capital investment with virtually no benefit to local people.
Conclusion
I conclude that the TSA’s prescriptive proposals for Lewisham Hospital NHS Trust would be hugely detrimental to the health and well being of my constituents. I question whether his remit allows him to make these proposals and urge him to remove them from his final report to the Secretary of State.
The TSA process was never in my view expected to lead to a review of a sub-regional health economy, but rather to deal with a single health trust in severe financial difficultly.
No one should expect a mere 75 day exercise to come up with a major reconfiguration of the health economy for South East London. No one would have expected that proposals to deal with the insolvency of SLHT would encompass swingeing cuts to the services of another Trust which is well run, solvent and serves a growing population of over 270,000 people.
The brevity of the consultation period of 30 days has put enormous pressure on the hundreds of professionals in the Lewisham health community who rightly needed to be consulted. For the public the process has been extremely difficult and at the meetings undertaken by the TSA team the picture presented of how health services are – and might be accessed –is far removed from the realities of life in Lewisham. The online questionnaire is extremely difficult to use and can only be completed by back referencing the report. Case histories used to illustrate community care transfers exaggerate both the good and the bad.
Demographics:
It has been widely accepted within the NHS that local populations vary significantly in their health status and life expectancy, with continuing attempts being made to adjust resources to meet existing inequalities.
My constituency contains some of the most deprived wards in England and Lewisham as a whole is ranked 16th highest out of 326 English local authorities. It has a huge range of ethnicities and languages spoken, giving rise to specific health needs.
Any reconfiguration of local services has got to take account of these demographics yet no health equalities impact assessment has been undertaken, which fundamentally undermines the draft report’s proposals for Lewisham.
Closure of Lewisham Accident and Emergency Department:
This is an astonishing proposal that takes no account of patterns of usage previously analysed on several occasions including under the ‘Picture of Health’ proposals of four years ago.
Throughout the consultation the TSA has made much of the fact that people with the most serious emergencies e.g. heart attacks and strokes are already bypassing Lewisham hospital for specialist centres such as St Thomas’ and Kings. Everyone agrees that is appropriate, and indeed according to the report only three blue light ambulances deliver emergencies to UHL each day.
Such references are not relevant to the vast majority of the 120,000 annual visits to the A&E Department. People walk or arrive by bus, by taxi, by car frequently brought by relatives and with local GPs making many of the referrals. Neither the patients nor the GPs know if an admission might be necessary. Very few people in Lewisham would ever think of going to the Queen Elizabeth at Woolwich and as ‘Picture of Health’ demonstrated, around 70% of emergency patients who would have been admitted at Lewisham would go to Kings or St Thomas’ if Lewisham A&E were closed.
It is extremely difficult to use public transport from most parts of Lewisham to Woolwich and the travel times between UHL and QE Woolwich quoted in the report have been greatly underestimated.
It is impossible to envisage other existing A&Es coping if Lewisham were to close. All other units are operating at capacity already. The loss of the A&E department means the loss of the ICU unit currently operating at an annual occupancy of 95%. It also means the loss of acute medical services dealing with elderly admissions – the very people least likely to be best supported away from familiar surroundings and family members. Furthermore the closure of the department and the replacement by an Urgent Care Centre would mean the loss of the children’s A&E as well.
No convincing evidence is produced to suggest that the 70% of patients that would be displaced by closure of the A&E could be accommodated safely elsewhere. Instead it is proposed that community care services can keep as many as 30% from needing to access Lewisham A&E.
Community Care and integrated pathways
The report takes no account of the fact that Lewisham partners have worked extremely hard to integrate local services. Successes are already apparent and every effort is being made to avoid emergency admissions. Breaking these networks will arguably result in more people facing emergencies dealt with elsewhere, with an adverse impact on continuing care.
The report asserts that 30% of the work of a full accident and emergency department can be transferred to community services. The report offers no evidence for this and the Department for Health have been unable to produce such evidence.
Maternity Services
Maternity services at Lewisham Hospital have improved over the years and with the new facilities have become a popular choice for local women. Women want and need their care throughout pregnancy and birth to be local, integrated and offering choice (except in very complicated cases).
Local demographics mean that the maternity population of Lewisham is considered high risk with approximately 2,500 births each year in the highest category of risk. Lewisham currently has all the expertise and facilities to care safely for the 4000+ births taking place there each year. Neither of the proposals in the report would improve the delivery of maternity services for local women. On the contrary women excluded from Lewisham would not want to travel to Woolwich and if a ‘low risk’ unit only were to be retained at Lewisham the safety of those giving birth would be compromised by the removal of the ICU and A&E services.
The latest ONS interim population projections based on the 2011 Census show Lewisham’s population increasing by 16% from around 277,000 to around 321,000. There would have to be a considerable expansion of services at Queen Elizabeth and at Kings and St Thomas’ if Lewisham lost its current consultant led maternity department. There is no logic in destroying a safe, quality, popular local service and having to build up facilities elsewhere which local people do not want.
Children’s Services
The population of Lewisham is young with a quarter under the age of 20. In response to local needs the local NHS Trust has established a Children and Young People’s Service to include both hospital and community services in the borough. These services are highly regarded and much used by local people. Lewisham is the only London DGH to be recognised as providing ‘excellent care’ by the Health Care Commission and Lewisham’s safeguarding services achieved a rating of ‘outstanding’ by Ofsted this year.
Over 30,000 children use the children’s A&E each year. Only 30% of these users are seen in the Urgent Care Centre. Closure of Lewisham adult A&E service means the closure of the children’s facilities as well. The report fails to take account of the impact of the loss of this facility on a vulnerable population. No other local hospital has facilities available to treat tens of thousands of children and young people who would no longer be able to access services at Lewisham.
Value for Money
A new wing was added to Lewisham hospital four years ago. A new birthing centre was opened two years ago and a £12million refurbishment of the A&E department was completed in April this year. Until the TSA process, the hospital was on track to achieve Foundation Trust status in line with current government policy.
The TSA proposals would destroy recent investments and force the sale of more than half the land on site for relatively small and uncertain capital receipts. The future plans for the site then require significant capital investment with virtually no benefit to local people.
Conclusion
I conclude that the TSA’s prescriptive proposals for Lewisham Hospital NHS Trust would be hugely detrimental to the health and well being of my constituents. I question whether his remit allows him to make these proposals and urge him to remove them from his final report to the Secretary of State.