Tories Endorse NHS Proposals to Disembowel Lewisham Hospital

In the end, then, the massive grassroots struggle to save Lewisham Hospital from government-backed destruction on the advice of the NHS’s own senior officials — which led to two massive demos, in November, and last weekend (see here and here) — proved not to be an end in itself, but just the beginning of a larger battle.

Yesterday, Jeremy Hunt, the health secretary, broadly approved the proposals to close Lewisham Hospital’s A&E Department, replacing it with an “urgent care centre,” unable to deal with emergencies, and have other frontline services, including its maternity services, severely downgraded. The proposals were put forward just three months ago by Matthew Kershaw, an NHS Special Administrator appointed last summer by the former health secretary Andrew Lansley to deal with the bankrupt South London Healthcare Trust, and his recommendations regarding Lewisham came as a shock and surprise to the 250,000 residents of the borough.

Their — our — surprise was understandable. After all, Kershaw had been appointed to make recommendations regarding the fate of the South London Healthcare Trust, based in Greenwich, Bexley and Bromley, and not Lewisham, which is an independent trust. In addition, the SLHT was crippled by PFI debt — which, incidentally, is so monstrously disproportionate that it should have been declared illegal — whereas Lewisham was solvent, but this apparently made no difference to the would-be butchers of NHS services.

Kershaw recommended that the South London Healthcare Trust “be dissolved, with each of its hospitals taken over by neighbouring NHS and Foundation Trusts.” Specifically, he recommended that Queen Mary’s in Sidcup “be transferred to Oxleas NHS Foundation Trust and developed into a ‘hub’ for the provision of health and social care in Bexley,” as Jeremy Hunt described it in his decision. He also recommended that the Princess Royal in Bromley be taken over by King’s, and proposed the merger between Queen Elizabeth Hospital and Lewisham Hospital that ignited righteous indignation in the borough of Lewisham, whose 250,000 residents are now supposed to join the 500,000 in Greenwich and Bexley who already rely on the Queen Elizabeth Hospital in Woolwich (part of the bankrupt trust) to provide their A&E services.

As the South London Press reported on January 15, after Matthew Kershaw’s final report was issued, Dr. John O’Donohue, a consultant physician at Lewisham Hospital, said, “These plans are a travesty. They are unsafe, rushed and unjust. But most of all they will disadvantage the people of Lewisham, who will have to travel further to already overcrowded A&E and maternity units, which, ironically, have themselves been diverting ambulances and pregnant women to Lewisham in recent days due to lack of capacity.”

At the time, a spokesman for Lewisham Healthcare NHS Trust conceded that the trust supported merging with Queen Elizabeth, but added, “However, we do not agree with the TSA’s prescriptive approach to service change, which would result in local emergency services being closed and maternity services being downgraded. As a successful organisation, we would like to determine the future of services ourselves and we would include proper engagement with the public.”

In reaching his decision on Matthew Kershaw’s recommendations, Jeremy Hunt acknowledged that “the public campaign surrounding services at Lewisham Hospital has highlighted just how important it is to the local community,” adding, “I respect and recognise the sense of unfairness that people feel because their hospital has been caught up in the financial problems of its neighbour.”

The Lewisham A&E non-closure scam

However, contrary to the impression given by various news outlets yesterday — “London A&E unit spared the axe,” was the Evening Standard‘s tagline on its cover — Lewisham’s A&E has not been saved. In dealing with the proposals for Lewisham, Jeremy Hunt consulted with Professor Sir Bruce Keogh, the medical director of the NHS, and, on A&E, as he explained in his decision:

Sir Bruce was concerned that the recommendation for a non-admitting Urgent Care Centre at Lewisham may not lead, in all cases, to improved patient care. While those with serious injury or illness would be better served by a concentration of specialist A&E services, this would not be the case for those patients requiring short, relatively uncomplicated treatments or a temporary period of supervision. To better serve these patients, who would often be frail and elderly and arrive by non-blue light ambulances, Sir Bruce recommends that Lewisham hospital should retain a smaller A&E service with 24/7 senior emergency medical cover.

A “smaller A&E service” might sound like a victory, but in reality it is no such thing. In Matthew Kershaw’s initial proposals, it was envisaged that 70 percent of the 120,000 people admitted to Lewisham’s A&E every year would still be seen in the urgent care centre, but that the other 30 percent — the cases requiring acute care — would be taken elsewhere. That figure has now been adjusted to allow for the care of 5 percent of those patients — 6,000 a year — who require “short, relatively uncomplicated treatments or a temporary period of supervision,” but that is no victory at all.

As the Save Lewisham Hospital website explained, “Mr. Hunt’s words seemed to have offered a partial reprieve of the A&E, he says to the benefit of the frail and elderly — which instead of an urgent care downgrade is to be reduced to a 25-bed facility. But look beneath the surface and very little has changed from the Kershaw recommendations.” The campaign quoted Lewisham A&E consultant Dr. Chidi Ejimofo, who said, “An A&E of the type described is little more than an Urgent Care Unit – patients will still have to be transported to other hospitals because we will no longer have acute provision here.”

In addition, the Londonist website, which explained how “the plan for Lewisham is now a bizarre fudge that we think might actually be a worse idea,” stated that the amended A&E plans “will cause confusion among residents and ambulance services about the best place to go, and even more patients being blue-lit around London. It’s being billed as a ‘smaller A&E’ but in reality is still the original Urgent Care Centre with some inpatient beds and a misleading name.”

Furthermore, the plans for Lewisham will impact negatively on surrounding hospitals, as five MPs — Harriet Harman, Kate Hoey, Simon Hughes, Tessa Jowell and Chuka Umunna — explained in a letter to Hunt on January 15 regarding the added stress that will be faced by King’s College Hospital, in Camberwell, in which they also disputed the claim that just 30 percent of A&E cases would be referred elsewhere, pointing out, instead, that it would actually be 54 percent:

It is now acknowledged that most of the patients who would otherwise have used Lewisham A&E will come to King’s. This will have a major impact on the service provided in King’s A&E. It simply will not be possible to maintain the high standard of service which King’s seeks to provide in A&E, and in particular in paediatric A&E.

We estimate the following, based on NHS figures: 54 per cent of patients — or 65,000 people — who would otherwise have gone to Lewisham will come to King’s A&E — that is an increase of almost 45 per cent for King’s A&E. As it is, there is a small but concerning increase in waiting times at King’s A&E. If Lewisham A&E closes it is inconceivable that King’s would be able to maintain what is a much improved service for our constituents.

Of those 65,000 extra A&E patients approximately 12,200 will be likely to be admitted to King’s as emergencies — that is an almost 45 per cent increase in emergency admissions at King’s. That will place a further pressure on inpatient beds at a time when King’s management have raised with us their concerns about capacity at King’s. They say they are already looking to take on extra capacity at Princess Royal in Bromley to deal with outpatients and non-emergency admissions. To accommodate the additional emergency admissions even more non-emergency admissions will have to be moved out of King’s to Princess Royal University Hospital in Bromley. For our constituents — many of whom do not own a car — the journey from Camberwell to Princess Royal in Bromley would mean a journey of at least a bus and a train lasting more than an hour and costing £5.50.

Lewisham’s 4,000 abandoned mothers

On maternity, Jeremy Hunt’s approval of Matthew Kershaw’s proposals for a stand-alone midwife-led birth centre are also a disaster. At present, around 4,400 women a year give birth in Lewisham Hospital, but with the loss of emergency support just 10 percent of future Lewisham mothers will be able to give birth to their children in the London Borough of Lewisham.

In addition, mothers’ lives will be at risk, as will those of other A&E cases who can no longer be treated in Lewisham. As Dr. Louise Irvine, the chair of the Save Lewisham Hospital campaign, explained, “As a GP I can state unequivocally that these proposals are going to cost lives.” The campaign’s website added, “Mothers whose labour runs into difficulty will be forced to endure a blue light ambulance trip to an unfamiliar hospital in the manner of decades past. We already know that we have mothers who are members of our campaign whose lives and whose babies would have been lost in these circumstances.”

The campaign also explained, “Crucially, Sir Bruce Keogh’s estimates of travel times immediately throws this into doubt — another 1-3 minutes extra travel to Woolwich can only be achieved in a private jet or an emergency helicopter! Our campaign’s real time travel film [see below] shows that this is closer to 2 hours (one way) than 2 minutes by public transport.”

In their letter to Hunt on January 15, the five MPs mentioned above also wrote, “We estimate that if Lewisham maternity services close then there will be 3,235 more births at King’s to add to the existing 6,000 births, an increase of 54 per cent of births at King’s. There is simply not the capacity at King’s for a 54 per cent increase in births. It would not be fair on the mothers, the babies or the staff. There are already mothers who want to give birth at King’s who have to go elsewhere — some are referred to Lewisham.”

Lewisham’s paediatric services also face the axe

On another topic of huge importance to the people of Lewisham — Lewisham Hospital’s excellent paediatric record (the treatment of children) — Jeremy Hunt also consulted Sir Bruce Keogh, and described his advice as follows:

On the issue of paediatric care, Sir Bruce recognised the high quality paediatric services at Lewisham and that any replacement would have to offer even better clinical outcomes and patient experience. His opinion is that this is possible but dependent on very clear protocols for primary ambulance conveyance, a walk-in paediatric urgent care service at Lewisham and rapid transfer protocols for any sick children who would be better treated elsewhere. He is clear that this will require careful pathway planning and need to be a key focus of implementation.

On the surface, this perhaps sounds reassuring, but as Dr. Tony O’Sullivan, Lead Paediatrician at Lewisham Hospital, explained, “Mr. Hunt stressed that this will involve careful handling and careful planning. This is politician’s cover for introducing these measures without any consultation with local paediatricians or the College of Paediatrics. He repeatedly said that these measures would improve standards. The destruction of our exemplar childrens’ service is the not the way to do that and we will be addressing this at the earliest opportunity.”

A legal challenge?

As we wait for these questions to be answered, it strikes me as significant that the legality of Matthew Kershaw’s recommendations was not mentioned by Jeremy Hunt, despite it being obvious that it involved a certain deviousness to decide that his remit for the SLHT extended to the whole of the NHS in south east London, and, specifically, to the destruction of NHS services in Lewisham. I have written previously about my disappointment with the senior NHS officials advising Kershaw, and their understanding that they were trying sneak through a major reorganisation of services using the deliberately short timeframe for dealing with bankrupt trusts as cover, and I am not reassured by the manner in which Jeremy Hunt tried to brush the issue aside.

In his decision, he wrote that, “as a consequence” of Kershaw’s six proposals for breaking up the SLHT, the Special Administrator “also recommended that services be reconfigured beyond the confines of South London NHS Trust, across all of South East London.” Quite where the authority for this decision came from is not explained, and I fervently hope that the Mayor of Lewisham, Sir Steve Bullock, will now launch a formal legal challenge, as he has threatened to do since the proposals were first announced at the end of October.

In a statement yesterday, Bullock said, “The Secretary of State is riding roughshod over the people of Lewisham. These plans have been roundly rejected by local people, by the staff who work in the hospital and by local GPs. The Secretary of State has pressed ahead regardless by downgrading maternity services and emergency services at Lewisham Hospital. But let me be clear, this is not the end of the matter. I do not believe that the TSA had the statutory power to make recommendations about Lewisham Hospital and the Secretary of State therefore has no power to implement them. I will be talking to our lawyers and we will also of course need to talk to our colleagues at Lewisham Hospital in order to fully understand the implications of Mr Hunt’s statement.”

Why none of this needs to happen

In conclusion, for now, I am left with a handful of figures that simply don’t add up. Matthew Kershaw has already conceded that it will “cost £195m by 2015-16 in transition and capital costs, but admit[ted] that the move would take until then to start generating a £19.5m annual payback,” which prompted Dr. John Miell, a consultant endocrinologist at Lewisham, to state, in exasperation, “it’s fiscal nonsense and financial madness to do this. How can you tell the taxpayer that it’s sensible to spend £195m to get £19.5m savings a year? It’s completely unfair and ridiculous to penalise a successful, high-performing, viable NHS trust to bail out a PFI-burdened and debt-laden neighbour.”

Furthermore, in Jeremy Hunt’s decision it is made clear that, to compensate for the downgrading of maternity services, “£36m of additional investment has been earmarked to ensure there is sufficient capacity at the other sites,” and, on A&E, “an additional £37m of investment will further expand services” at the hospitals that will deal with the “more serious conditions” that Lewisham will be unable to tackle — namely, King’s, Queen Elizabeth in Woolwich, the Princess Royal in Bromley and St. Thomas’s.”

When we are dealing with a minimum of 30,000 accident and emergency cases, and 4,000 mothers, surely it makes sense to spend that £73 million on Lewisham Hospital, rather than proceeding with the hugely expensive closure of Lewisham’s services, and all the damaging disruption — and the occasional risk of fatalities — that it will bring?

This makes more sense, doesn’t it? Or am I missing something, like the fact that everyone involved has decided to ignore any argument, however sensible, that detracts from the policy that they have all agreed on — that, out of the five hospitals in south east London, only four can continue to be supported as fully-functioning hospitals with A&E departments and full maternity services, and Lewisham was chosen for the axe long ago?

As we have shown over the last three months, we will not take these proposals lying down, and we will not begin to do so now. As Dr. John O’Donogue, a Consultant Physician at Lewisham Hospital, has explained, “This is a travesty — a dangerous injustice. Taking a high performing hospital out of the heart and soul of our community is nothing short of vandalism.”

Andy Worthington is the author of The Guantánamo Files: The Stories of the 774 Detainees in America’s Illegal Prison (published by Pluto Press, distributed by Macmillan in the US, and available from Amazon — click on the following for the US and the UK) and of two other books: Stonehenge: Celebration and Subversion and The Battle of the Beanfield. To receive new articles in your inbox, please subscribe to my RSS feed — and I can also be found on Facebook, Twitter, Digg, Flickr (my photos) and YouTube. Also see my definitive Guantánamo prisoner list, updated in April 2012, “The Complete Guantánamo Files,” a 70-part, million-word series drawing on files released by WikiLeaks in April 2011, and details about the documentary film, “Outside the Law: Stories from Guantánamo” (co-directed by Polly Nash and Andy Worthington, and available on DVD here — or here for the US). Also see my definitive Guantánamo habeas list and the chronological list of all my articles, and please also consider joining the new “Close Guantánamo campaign,” and, if you appreciate my work, feel free to make a donation.