A new consensus on saving KGH

Today St John's Seven Kings hosted a meeting of the Save King George Hospital campaign. The following was my contribution to the debate:

With Andrew Lansley’s decision to make the closure of A&E and Maternity Services at King George Hospital conditional on the Barking, Havering and Redbridge University Hospitals NHS Trust achieving the recommendations in the Care Quality Commission’s report, we reach a new and more complex stage in the campaign opposing the Trust’s plans.

Our consensus to date has been simple and clear; to oppose the closure of A&E and Maternity Services at King George. Now, though, we are also faced with the broader issue of campaigning for a better NHS deal overall for local residents. The two issues are tied together because the closure of A&E and Maternity Services at King George is conditional on the Trust achieving the targets set in the CQC report. Achieving those targets will improve the NHS deal for residents locally but will result in the closure of the services we wish to retain at King George.  

That seems a Catch 22 situation and there is indeed an element of dark comedy and bleak farce to the decision to close A&E and Maternity Services at King George Hospital. Something that Mike Gapes captured very well in the parliamentary debate he called on the matter. He said:

“… the [CQC] report makes it clear that although services at King George were reduced over the years, it has not led to efficiency savings. All it has done is reduce the quality of care in a hospital that serves my constituents and those of a number of other MPs. The cost of doing that has not led to improvements in efficiency; on the contrary, it has contributed to the ongoing deficit problems in the dysfunctional trust.

There we have it. The Secretary of State receives a report from the IRP recommending the endorsement of NHS London’s vision to downgrade services at King George hospital in Ilford. He then receives a report saying that there are two hospitals in the trust, covering 750,000 people in the community in the three boroughs, one of which is doing badly and there are criticisms of the other. He therefore endorses the recommendations to cut the services at the hospital that is doing better, on the aspiration, but with no evidence, that it will lead to a miraculous Stakhanovite improvement in the services at the bigger, supposedly better and more expensive hospital in the long term. You really could not make it up.”

On this basis, how can the Barking, Havering and Redbridge University Hospitals NHS Trust expect to reverse the situation, including delivering a better Maternity and A&E service - with the 25% less staff outlined in the closure plans and a rapid increase in the populations of the boroughs it serves - when the A&E service at Queens Hospital has been found to be approaching collapse by the CQC and large numbers of pregnant women are being diverted away from Queens/King George because existing staff cannot cope? Clearly, there needs to be tight, accurate monitoring of the improvements in service that the trust will claim as they seek to address the CQC targets. Ensuring that that occurs and that claimed improvements are real improvements should, presumably, be part of our campaign in its next phase.

Essentially, we need a new consensus for our campaign. Do we continue to campaign simply and solely against the closure of A&E and Maternity Services at King George or do we broaden our campaign to include a better NHS deal for our residents? Suggestions, which others have made for doing the latter, include:

 

1) Asking for a monthly report detailing how the trust is working towards meeting the targets set in the CQC report and holding quarterly meetings to discuss progress.

 

2) Seeking assurances that the two month deadline for caesarian sections to be brought back into the Trust to prevent women having to travel to Hackney is on track to be met.

 

3) Ask for A&E temporary closures to be published on the Health for NE London website within 48 hours. 

 

4) Seeking support for a research study into the mortality rates for people taken to Urgent Care Units who are then transferred to a proper A&E against those who go straight to an A&E.

So, how to take forward the campaign? That, I suggest, is the key question facing us today. It is also a key question facing us as we reflect on other successful community campaigns in this area as several of the key organisers involved in those campaigns are no longer able to take that work forward as they once did. I’m thinking of the three founder members of TASK particularly. As a result, there is a need to reassess how community campaigns are organised in future: whether we continue with single issue campaigns; whether we utilise local community groups like Resident’s Associations more effectively; whether we join a broader campaigning coalition like London CITIZENS, as Chris Connelly was suggesting before his move. I suggest a meeting be organised in the New Year to explore this issue with all those locally who are concerned to see improved facilities and resources in the local area.

That is a side issue though to today’s meeting and I hope and anticipate that through the inputs of other speakers we will hear ideas and proposals which can build a new consensus to take this vital campaign, which is about the future of health services in this area, further forward.

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Kids in Glass Houses - Gold Blood.

In the wake of the Lansley decision

After years of campaigning, petitions to the top of government and marches through the streets, the decision most of us were dreading was delivered on Thursday: King George Hospital’s accident and emergency unit and labour ward will close.
Here is a brief summary of the situation in the post Lansley decision on our local NHS from Helen Zammett of the Save KGH campaign.

Health authorities have been quick to seize on the news that Andrew Lansley has accepted the Independent Reconfiguration Panel’s recommendation to adopt Health for North East London’s plan for our local hospital trust to reduce health services at King George Hospital and increase services at Queen’s Hospital Romford ... but it’s not going to happen yet.

The CQC has demanded that before any changes can be made, a lot of work needs to be done to overcome severe failings in the current health service provision. So serious are these concerns to patient safety that the CQC has imposed emergency measures to move planned caesarean sections from Queens to the Homerton in Hackney, Queens has been restricted to 20 births a day and Kings to 7 and women from Essex will have to re-book with Essex hospitals.

When announcing his decision, Andrew Lansley said: “Patient safety and quality of care must be our top priority. I support the CQC’s findings and the decisions taken by the local NHS to support safe care at the Trust. When we can be sure that these decisions have resulted in sustainable improvements in the quality of services for local people, the next set of decisions ... will be implemented.”

Before the Health4NEL’s plan can be implemented, the CQC has told the Trust to develop an action plan to address the 73 recommendations which it has said are needed to ensure a real and sustainable improvement in patient safety and experience. They will then monitor how the plan is applied and progress made before any of Health4NEL’s plan can be activated.

The main problems which will need to be overcome first are:

• Maternity is considered the worst concern – poor service culture, staff shortages especially midwives and paediatricians, lack of learning from maternal deaths and incidents, abusive behaviour by some staff to patients and colleagues, lack of leadership by senior management.
• A+E unsafe working practices, delays and bottlenecks, struggling to cope with the volume of patients, especially during winter, lack of staff – in July 2011 there was a 31% vacancy of A+E consultants.
• Radiology insufficient radiography cover, low standard of work, inappropriate patient facilities due to lack of beds.
• Delays in day surgery and radiology treatment affecting the impact of treatment and care.
• Staff shortages less than 50% of staff at Queens are permanent, high levels of staff turnover, sickness, recruitment difficulties, high levels of vacancies – in June 2011 there was a 18% vacancy of nurses.

Other problems include poor response to complaints, lack of governance, lack of senior management expertise, lack of education and training, unprofessional behaviour of some staff.

It is unlikely that these problems will be solved quickly. Cynthia Bowyer the Chief Executive of the CQC said: “We have been forcing the Trust to address issues on a short term basis but we have real concerns about safety in the mid to longer term.”

The biggest obstacle to the implementation of the changes is capacity. Health4NEL’s plan is based upon reducing the number of patients at Kings and increasing them at Queens. However, it is clear that Queens is not coping with its current level of patients, so that the CQC supports a recommendation to permanently cap the number of maternal patients admitted to Queens.

This is why the CQC intervened with its emergency measures to reduce the number of maternity patients at Queens now. Maternity capacity levels are now becoming a problem at Whipps Cross and Newham hospitals, which will need to have additional facilities provided to cope with any increase in maternity patients. Queens capacity problems are also evident in A+E, radiology and day surgery.

To compound the problem, the Trust’s workforce strategy for 2010-2015 states: “To achieve the cost reduction plan the Trust anticipates that the headcount will need to reduce by circa 850 FTE (including temporary staff).” The CQC has found an increase in patient throughput. As this staffing reduction is part of Health4NEL’s case for supporting its plan, it shows a fatal flaw in this strategy.

The one good thing that has come out of all this is that there is formal recognition of concerns which have been dismissed or ignored in the past.

However, the bad thing that has come about is the adverse publicity about Kings and particularly Queens, which will make future recruitment even more difficult.

Once the Trust has been able to demonstrate to the CQC that it has solved its problems on a sustainable basis, the Health4NEL plan can go ahead ... but are these problems solvable given the rise in population, lack of finance, staffing difficulties? If they are solvable, how long will it take?

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Jonathan Richman and the Modern Lovers - Hospital.

Andrew Lansley, are you listening?

I've sent the following comment to Andrew Lansley's listening exercise on his NHS reforms:

"I have fundamental concerns about these proposed changes to the NHS and I think Andrew Lansley needs to go back to the drawing board.

For example, I am concerned that proposals to make competition the priority within the NHS would undermine our health service. The NHS should focus on cooperating to provide quality patient care, not on competition. The role of the regulator, "Monitor", should reflect this.

It can be demonstrated that the introduction of competition in the provision of public services, such as the tendering out of Local Authority services, has not led to cost savings, greater efficiencies or improvements in services but instead has resulted in reduced levels of service, waste of resources and increased bureaucracy. The ethos of the 'market' contradicts the ethos of 'public service' and, if introduced, will inevitably erode the government’s “duty to provide” a comprehensive health service.

Dropping this duty would erode the foundations of the NHS and would lead to the 'cherry picking' by private companies of NHS services. Such “cherry picking” must be fully ruled out, and the mechanism for preventing it must be clearly established."

You can send your own comment by clicking here.

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Athlete - Wires.

Save King George Hospital campaign

Following this morning's services, there was a planning meeting held at St Paul's Goodmayes for The Save King George Hospital campaign. The campaign is a multi-party, multi-faith campaign to persuade Andrew Lansley, the Secretary of State for Health to stop the closure of A&E and maternity services at King George Hospital, Ilford.

Proposals to close vital services at Redbridge's only hospital have been approved. There will be no A&E and no maternity services provided resulting in a reduction in beds from 400 to 50. This means that most people who live in Redbridge will have to go to Queen's Hospital Romford. The effect will be:

• much longer travel times to get to a hospital, especially important for ambulances to get to A&E. Queen's Hospital Romford is 4½ miles from King George Hospital in Goodmayes along the A12, the worst A road in Britain;
• Queens Hospital will serve 700,000 people while inner London hospitals will each serve an average of just over 200,000;
• one hospital (Queens) will serve three boroughs, while the inner London boroughs will each have their own hospital;
• Queens will be unable to cope as this is already the case with ambulances frequently turned away because the hospital is full;
• no baby will be born in future in a Redbridge hospital;
• Redbridge will lose its maternity service while Barking has a new maternity unit;
• Redbridge will no longer have a major hospital while Barking and Dagenham will each get a community hospital.

This information comes from the campaign which is organising a public meeting, to be addressed by Iain Duncan Smith MP, Ken Livingstone, other faith and community speakers, at Ilford Town Hall on Friday 8th April, 6.00pm, at Ilford Town Hall.

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Sham 69 - Angels With Dirty Faces.