Unless you've been living under a rock for the last couple of weeks you won't have failed to notice that Lewisham's hospital is once again under threat. The administrators of a neighbouring trust - South London Healthcare Trust (SLHT) have produced a report recommending the closure of Lewisham's A&E and maternity services.
Save Lewisham A&E, a group set up by local organisations, residents, doctors, nurses, therapists and patients, arranged a public meeting at the hospital last night where Heidi Alexander, MP for Lewisham East, Sir Steve Bullock, Mayor of Lewisham and Dr Louise Irvine, a local GP and BMA council member, amongst others, spoke about the proposals and what can be done to tackle them.
So what are the proposals? From the executive summary of the Trust Special Administrator's report:
- Queen Mary’s Hospital Sidcup should be developed into a Bexley Health Campus providing a range of services to the local population, including day case elective surgery, endoscopy and radiotherapy. The facility should be owned by Oxleas NHS Foundation Trust and services should be provided by a range of organisations.
- Vacant and poorly utilised premises should be exited (leases) or sold (freeholds). The NHS should engage with the local authorities in Bromley and Bexley in the process of selling surplus estate to ensure its future use maximises regeneration opportunities.
- On an annual basis until the relevant contracts end, the Department of Health should provide additional funds to the local NHS to cover the excess costs of the PFI buildings at Queen Elizabeth Hospital and Princess Royal University Hospital.
- There should be a transformation in the way services are provided in south east London. Specifically, changes are recommended in relation to community-based care and emergency, maternity and elective services:
- Community Based Care – The Community Based Care strategy for south east London should be implemented to deliver improved primary care and community services in line with the aspirations in the strategy. This will enable patients to receive care in the most appropriate location, much of which will be closer to, or in, their home.
- Emergency care – Emergency care for the most critically unwell patients should be provided from four sites - King’s College Hospital, St Thomas’ Hospital, Queen Elizabeth Hospital and Princess Royal University Hospital. Alongside this, services at University Hospital Lewisham, Guy’s Hospital and Queen Mary’s Hospital Sidcup will provide urgent care for those that do not need to be admitted to hospital. Emergency care for those patients suffering from a major trauma (provided at King’s College Hospital), stroke (provided at King’s College Hospital and Princess Royal University Hospital), heart attack (provided at St Thomas’ Hospital and King’s College Hospital) and vascular problems (provided at St Thomas’ Hospital) will not change from the current arrangements.
- Maternity care – There are two options under consideration to ensure that a high quality of care is provided for women needing to be in hospital during pregnancy and for women when giving birth. Obstetric-led deliveries could be centralised in line with critical emergency care across King’s College Hospital, St Thomas’s Hospital, Queen Elizabeth Hospital and Princess Royal University Hospital; alternatively, there could also be a ‘stand-alone’ obstetric-led delivery unit at University Hospital Lewisham. All other maternity care will continue to be provided in a range of locations across south east London.
- Elective care – An elective centre for non-complex inpatient procedures (such as hip and knee replacements) should be developed at University Hospital Lewisham to serve the whole population of south east London. Alongside this elective day cases procedures should continue to be provided at all seven main hospitals in south east London; complex procedures should continue to be delivered at Kings’ College Hospital, Princess Royal University Hospital, Queen Elizabeth Hospital and St Thomas’ Hospital, and specialist procedures at Guy’s Hospital, King’s College Hospital and St Thomas’ Hospital. Outpatient services should be delivered from a range of local locations.
- In order to deliver this transformation programme, South London Healthcare NHS Trust should be dissolved and other organisations should take over the management and delivery of the NHS services it currently provides. In addition to the proposals for Queen Mary’s Hospital Sidcup outlined above:
- The Queen Elizabeth Hospital site should come together with Lewisham Healthcare NHS Trust to create a new organisation focused on the provision of care for the communities of Greenwich and Lewisham.
- There are two options for Princess Royal University Hospital. The first is an acquisition by King’s College Hospital NHS Foundation Trust, which would enable the delivery of service change, enhance the services offered at the site and strengthen the capacity of the site to deliver the necessary operational improvements. This is the preferred option at this stage. However, an alternative option is to run a procurement process that would allow any provider from the NHS or independent sector to bid to run services on the site.
- It is important that these new organisations are not saddled with the issues of the past. To this end, it is recommended that the Department of Health writes off the debt associated with the accumulation of deficits at South London Healthcare NHS Trust. By 31 March 2013, this is estimated to be £207m.
So what does this mean? Lewisham hospital's A&E would be closed and only an urgent care centre would remain. Although the TSA claim this would deal with 80% of those patients currently seen, the reality is likely to be rather different since many people would simply head straight to the hospital with an A&E department. Patients would be expected to use Queen Elizabeth Hospital A&E in Woolwich, a site which is almost completely inaccessible by public transport. Two options are being looked at for maternity services, one of which would keep them and one which would cut them. Given that Lewisham handles 4,400 maternities a year, it's clear that this service is needed, as is a full A&E to be there in case anything goes wrong.
I attended the meeting last night and posted tweets covering the main things that were said.
Needless to say Lewisham's residents want to fight this. So what can we do?
1. Respond to the consultation. This is absolutely critical, we need to beat the administrators at their own game, so responding to this is key. Don't fall into the trap of the leading questions, answer carefully and include your thoughts as write in answers. I will post my responses here too. Save Lewisham A&E have also produced a webpage setting out how to respond.
2. Demonstrate. First at Woolwich Town Hall next Thursday (15th November) between 5:30 and 7:30pm as the Trust Special Adminstrator Matthew Kershaw addresses Greenwich Council on these proposals (I'm not sure when or if he's addressing Lewisham Council....). Then on 24th November there is a march starting at Loampit Vale at 2pm and moving to the hospital for a hands around our hospital demonstration at 3pm.
3. Sign the petitions. There are two petitions, one set up by Heidi Alexander MP and another on the e-petitions website.
4. Attend one of the public meetings and tackle the TSA directly on this.
It's vital that we each do what we can to help.