An MSLC Merry Christmas to you all

Dear readers,

The work of the MSLC continues apace both in campaigning to stop the ridiculous proposals to close Lewisham's maternity services and in its day-to-day work to oversee those maternity services we are so desperately trying to preserve.

Today the MSLC met for the first time since the proposal to close Lewisham Hospital's maternity services was announced.

At the meeting we discussed the TSA, the responses from Lewisham Hospital, Public Health and the MSLC lay membership. We considered how to keep up the pressure on the Department of Health to save the acute services of A&E and Maternity in Lewisham.

Here's a summary of our strategy:

The TSA: where we go from here.
The TSA consultation closed on December 13th. The TSA, Matthew Kershaw, will submit his recommendation to Jeremy Hunt, Secretary of State for Health, on the 7th January.

The final decision will be announced on the 1st February by Jeremy Hunt in parliament.

It is vital that we don't lose momentum with our campaign. We must take our case to the Department of Health and to our local MPs. The members of the MSLC will prepare their own letter to the DoH.

We shall also prepare a pro forma letter which you will be able to download from our facebook group for inspiration to send your own response.


Your MPs:

Jim Dowd - Lewisham West and Penge
dowdj@parliament.uk

Heidi Alexander - Lewisham East
heidi.alexander.mp@parliament.uk

Joan Ruddock - Lewisham Deptford
joan.ruddock.mp@parliament.uk

Or write to
Jeremy Hunt - Conservative Secretary of State for Health
huntj@parliament.uk

Andy Burnham -  Labour Shadow Secretary for Health
andy.burnham.mp@parliament.uk


For more information on the TSA's time-table please see http://www.london.nhs.uk/officetsa

Our area for concern will focus on two points:

1. The Unsustainable Provider Regime is an inappropriate use of legislation. The UPR was brought into law in order to deal with failing single hospitals. In the case of the TSA it has been used to reconfigure services throughout SE London. This is also the first time the UPR has been used and so we are providing a test case in one of the most highly deprived areas in the United Kingdom.

There has not been enough time to properly consult health professionals, service users, managers or commissioners or do the requisite work for this level of service reconfiguration.

2. The Lansley 4 Tests and Maternity Matters:


In 2010, the Secretary of State introduced ‘four tests’ to be applied to NHS
service changes. In producing the final report the TSA is required to take these
tests into due regard. If Lewisham loses its maternity services and A&E the Department of Health will strip Lewisham residents rights to its own minimum service agreement.

The Four Tests are summarised here:

1. The changes have support from GP commissioners

• Although we cannot answer on behalf of GP commissioners, there are a significant number of GP commissioners who do not support the TSA's recommendations.

2. The public, patients and local authorities have been genuinely engaged in the
process

• This is so far from the truth that it would be laughable should it not be so distressing.
• There have been a grand total of three public meetings convened by the TSA. 
• Many members of the public have reported that these meetings were undisciplined and obfuscatory.
• The two focus groups for maternity services were badly managed and, critically, badly planned so that they provided the only chance for service users as a group to express their disquiet at losing a local maternity service. 
• Seldom heard groups such as refugees, asylum seekers, travellers, young parents and other marginalised or disadvantaged groups were not consulted at all.

3. The recommendations are underpinned by a clear clinical evidence base

• Lewisham Hospital, Guys and St Thomas' and Kings reject option 1 (to disperse Lewisham maternity to St Thomas', Kings and Bromley).
• Lewisham Hospital have accepted a modified option 2 (to retain an obstetric led unit at Lewisham with minimal changes to services).

4. The changes give patients a choice of good quality providers

• If the Department of Health go for option 1 Lewisham women will not any choice at all. 
• St Thomas' and Kings are capped - this means that they cannot accept any extra women outside their area unless they are referred as high risk patients. 
• Women will be forced to use the service at Queen Elizabeth Hospital in Woolwich. 
• QE has been traditionally very unpopular with women due to its clinical reputation. 
• It is also nigh on impossible for many women in Lewisham to reach especially as 50% of Lewisham residents don't own a car and rely on public transport.

Maternity Matters
Maternity Matters was a commitment made in 2005 by the then government to offer women a wider choice in maternity care.

1. Choice of how to access maternity care 
2. Choice of type of antenatal care
3. Choice of place of birth - depending on their circumstances, women and their partners will be able to choose between three different options - a home birth, birth in a local facility, including a hospital, under the care of a midwife, birth in a hospital supported by a local maternity care team including midwives, anaesthetists and consultant obstetricians. For some women this will be the safest option.  
4. 4.choice of place of postnatal care

Thank you to everyone who came to the meeting this afternoon and many thanks for all of those who couldn't make it for your valuable contributions over the last few weeks and months.

The MSLC lay members contact the local and national press

Dear local and national press,

My name is Jessica Ormerod, I am the lay chair of Lewisham Hospital's maternity committee. I hope that you might be interested in a story about the proposed closures at Lewisham Hospital.

I was invited by Lewisham Hospital to attend a meeting convened by Matthew Kershaw (Trust Special Administrator for South London Healthcare Trust) and his team. Matthew Kershaw himself wasn't at the meeting, billed as the TSA Maternity Services Workshop. However, when I arrived, the convenors (who appear to be headed by a woman called Penny Dash who works for Mckinsey's) recoiled from me in horror. I do not use these words lightly. I was greeted – very rudely – and asked what I was doing at the meeting, then told in no uncertain terms that I was not welcome even to enter the room. This somewhat embarrassing exchange was conducted in the corridor while others were attempting to sign into the meeting. The inauspicious welcome was succeeded by barely veiled requests for me to leave. Even my colleagues were drawn to one side to request my departure.

Naturally, I didn't leave, as I was intrigued as to why the organisers should be so keen to get rid of me. In the end, I was 'allowed' to stay on the proviso that I didn't speak throughout the meeting.

It rapidly became clear why I wasn't welcome as the other meeting attendees, all of whom were extremely senior medical professionals and hospital managers from GSTT, Kings, Lewisham, Bromley and Greenwich, were unanimous in their rejection of the proposal to shut down the very successful (and recently refurbished) A&E department and maternity service at Lewisham Hospital. The doctors, midwives, managers and commissioners all agreed that option 1 (to close maternity and A&E all together) would be seriously dangerous as there is not the capacity to incorporate the numbers of women at GSTT and Kings, which are the hospitals who will in reality – given the appalling public transport links as well as the alarming infection rates of Queen Elizabeth Hospital – have to deal with Lewisham residents.

It is deeply worrying that women should be forced to use any hospital they don't want to, but it is little short of monstrous to leave them with no access to A&E or proper maternity provision , unless they travel many, many miles from their homes. This is an area with high rates of poverty – 50% of Lewisham residents don't own a car. Are women in labour expected to get a bus? These are not families who are likely to call taxis! It will be Lambeth and Southwark's ambulance services that will pick up the tab.

The key point is that everyone at the meeting was passionately in agreement that the numbers used by the TSA are completely wrong and that should option 1 actually happen it would be horrendous for women and much, much more expensive for the tax payer: GSTT and Kings would not only have to find physical space which they don't have, but also they would need to employ double rotas in order to service the increased capacity.

The consultation process has been laughable. The TSA held two focus groups for women who are currently pregnant or have given birth within the last four months. The question that was posed to them was: what level of risk would you feel happy with in order to give birth at Lewisham. What?! An extraordinary way to gather women's views. The focus groups were arranged with less than a week's notice, they didn't provide childcare, they were not reflective of the diverse ethnic and social community of Lewisham. And no wonder because they relied on contacting the local NCT group (who contacted me, as lay chair of the MSLC) to fill their quotas. How anyone can describe this as a consultation is beyond me. Quite clearly, Matthew Kershaw and his team do not feel it necessary to find the time or energy to seek the views of the women whose lives will be thrown into upheaval and who will be subjected to real risk should their recommendations come to reality.

I hope that you will be able to help me to get a more open debate about these very unwelcome proposals. The fact the TSA team were so unwilling to include the lay chair in a ‘workshop’ on Maternity Services speaks for itself – clearly the real determination was to close the discussion down. 

Yours sincerely,

Jessica Ormerod

Lay Chair Lewisham MSLC

MSLC Response to the TSA

Dear Readers,

This is the MSLC's response to the lunatic proposals put forward by the TSA, Matthew Kershaw.

Please support us by posting your comments.

Thanks to all Lewisham MSLC's amazing service users!

Jessica 

Dear Matthew Kershaw,

Introduction

This paper is part of the response of Lewisham Maternity Service Liaison Committee (MSLC) to the draft report of the South London Healthcare Trust Service Administrator (the TSA) on health services in SE London.

MSLCs act as a multi-disciplinary forum bringing together the different professions involved in maternity care and a diverse range of user representatives in order to ensure that maternity services commissioners and maternity care provider units take account of the views of women and families using the service.¹

In Lewisham we have a particularly active MSLC which is chaired by myself, a service-user and a vice-chair also a service-user. Our focus has been on a number of things but we have made it our priority to concentrate on feedback from women and familes as to the care they receive and we have made a point to hear this feedback from all women including those who are disadvantaged or marginalised.

The service-user members of our MSLC have met and we would like you to consider this response as representative of the views of the service-user members as due to the short consultation period, we have not met as a whole MSLC in the time given.

Our response to Options 1 and 2

We have read, with interest, your recommendations which we believe, if carried out, will have an alarmingly detrimental impact on the women and families we represent.

There are four key areas that we would like you to consider:

1. a woman's freedom of choice as to where to give birth (at home, in a midwife-led unit or obstetric led unit)
2. a woman's right to access maternity services locally
3. equal access to maternity services for all women and infants, regardless of their ethnicity or income.
4. how we think you can save money whilst still providing a safe and happy service to women and their families

1. A woman's freedom of choice as to where to give birth

Maternity Matters requires that all women should have, ‘choice of place of birth. Depending on their circumstances, women and their partners will be able to choose between three different options. These are:
• a home birth
• birth in a local facility, including a hospital, under the care of a midwife
• birth in a hospital supported by a local maternity care team including midwives,
anaesthetists and consultant obstetricians. For some women this will be the
safest option.' (Maternity Matters, 2007, p.5)

Neither option as outlined in your report will ensure that this standard is met. Indeed, neither option meets the Secretary of State's own Four Test stipulation that, ‘patients have a choice of good quality providers’ (TSA Draft Recommendation, 2012, p.22).

2. A woman's right to access maternity care locally

Option 1 would almost entirely rule out all of the above choices:

• the choice of home birth would be ruled out for most Lewisham residents because we believe women would be worried about the time it would take to move to a hospital if something went wrong in labour.
• the choice of birth i.e. a local midwifery-led facility would simply not exist.
• birth in a hospital supported by a ‘local maternity care team’ would also not exist

Your proposals as they stand mean less choice for all Lewisham residents. In any document produced by the Department of Health, patients and service users may see the word 'local' repeated time and again. If option 1 comes to fruition, Lewisham residents will no longer have access to a useful local maternity service at all. For many women, getting to Queen Elizabeth – particularly if they are in the early stages of labour – is simply not a feasible option, even if they wanted to use the services, which is highly questionable. For many women getting to St Thomas' or King's is a challenge, although less so than Queen Elizabeth Hospital.

3. Equal access to maternity services

Our third point is that the recommendations will have a seriously negative impact on health equality in the borough of Lewisham. This area of London houses some of the nation’s poorest and most vulnerable families. Many Lewisham residents are refugees, asylum seekers, travellers, young and highly impoverished families.

In this response we have included the view of Lewisham Refugee and Asylum seekers. They have told us that they are really worried that they may not be able to afford the fares to travel longer distances to whichever hospital they are booked at and even if they have some antenatal care in the community, they will still need to go to hospital for scans and some appointments. They are worried that when they are in hospital their families will not be able to visit them. Remember these women are unbelievably fragile with many who have fled persecution and torture. A large number have mental health issues and some have been able to use the caseload system at Lewisham where they get continuity of care from one or two midwives who can get to know them and ensure they get all the help they need. They do not have to keep repeating their story and this care will enable them to have the best start possible as parents under very difficult circumstances.

This applies to many other groups including young parents and families who simply do not have much money or support. Marginalised and disadvantaged women live all over SE London therefore adding more women to Kings and St Thomas’ will impact on the care their population receives.

We feel that your recommendations do not take any account of the major financial impact that this will have on the most vulnerable. There are a myriad of other challenges that will face these vulnerable families if we lose any part of the maternity service currently provided by Lewisham Hospital.

4. How we think you can save money

We think you can still save money by adopting the amended version of Option 2 which the staff at Lewisham have put forward.

We would like to state categorically that it is our understanding from directly consulting the community that most women will not use Queen Elizabeth Hospital. Women will flow to the already straining services provided by St Thomas' and King's Hospitals. This will mean that their births will hit the number which we understand will mean they have to employ another tier of doctors and various other services.

In addition to that, our members have all agreed that women will travel to the unit they are giving birth in much earlier than they need to for fear of getting caught in traffic or on the bus. If they are having pain they will call an ambulance and you will have the cost of that and women being on labour ward when they are not in full labour. We know that there is then an increased chance of women having ‘interventions’ as there will not be the space for them to be left in peace. However, women will not want to go home and wait for labour to get going naturally for fear of being stuck on the journey or leaving it too late. All of this will cost you more money that what is proposed in amended Option 2.

A huge amount of time, energy and money has been invested in the once failing maternity service provided at Lewisham, which is now a flourishing environment highly valued by the women and their families who are, in steadily increasing numbers, using both the birth centre and the obstetric-led unit. As your report notes, the population of SE London is growing exponentially, schools are being asked to increase their capacity year on year; it is utter lunacy to recommend that a thriving maternity unit which serves an already dense (and growing) population be closed or its services reduced.

It's hard to find words to express the depth of our concern that the lives of Lewisham women and their babies would appear to be at risk for a cost-cutting exercise in bureaucracy to camouflage a failing Trust.

It is clear from your report that your recommendations are financially driven, but it is wrong that the vital organs should be snatched from Lewisham Hospital in order to save the ailing Queen Elizabeth Hospital.

Yours sincerely,

Jessica Ormerod

Lay Chair Lewisham MSLC

1 DH MSLC Guidance 2006

Hot on the heels of cake and closure

How can I follow from a nipple cake and the announcement that maternity services in Lewisham might close?!

For now let's hand over to someone else: you.

Sign your name against the proposal to close Lewisham A&E and maternity services.

More exciting news is that Lewisham MSLC has a web page on the hospital website. You can take a peek here.

Impact of pfi gone wrong in SE London

The impact of the failed Private Finance Iniatives at Queen Elizabeth and Princess Royal leading to unstainable debt across South London Health Care Trust will bring pressure on services provided at Lewisham Hospital.

The draft report is published today by the Office of the Trust Special Administrator. Read the summary recommendations or full report.

Just two of the recommendations that maybe of interest to YOU:

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.

There will be a public meeting held at Lewisham hospital on Thursday 8 November.


The public consultation runs from 2 November - 14 December tell them what you think here

Farewell, and Thank you

So after nearly two years chairing the MSLC, I have stood down from the role and on the 18 October Jessica was elected as the new chair. So this post is really a little refresher over what we have achieved in the last two years and opportunity to thank all of those involved in the MSLC and in making huge improvements to maternity services in Lewisham during that time.

So what do I think the major achievements have been during my time steering our Committee?

1. The opening and huge success of the Midwife led birth centre
2. The introduction of robust process for monthly Walking the Patch visits
3. Midwife attendance and promotion of ante natal careat two Lewisham People's Day 2010 and 2011
4. A programme of outreach sessions with seldom heard groups to help build up the picture of what matters to users of maternity services. Sessions have included, young parents, refugee women, and dads as a few examples and a plan for more
5. Supporting the Trust to achieve the first stage of unicef baby friendly status
6. Promoting breastfeeding welcome in Lewisham
7. Informing and supporting Lewisham Healthcare Trust with their refurbishment and improvements to Labour Ward and Post natal ward to be completed in 2013

Our priorities for this year on top of our core business have focused on working with the Trust on:

• Normalising birth
• Supporting women with mental health needs
• Infant feeding

Hope you like the boobies cake to celebrate the launch of baby cafe local in Lewisham.
We certainly enjoyed them... yummy!

I have had the great privilege of working with truly dedicated maternity professionals and a just as dedicated group of service user representatives committed to improving the information and services available along with ensuring engagement of women in informing how services are shaped in the future.

So thank you team...

So what are my hopes for the future, I am wishing Jessica the best of luck in her knew role but know she doesn't really need it.... I am hoping that with the changes in commissioning of health services the MSLC has a key role to play in supporting the commissioners to target resources with the needs of Lewisham families, that the MSLC continues the outreach work and possibly looks to hold some themed events on 'home birth' or 'post natal' care for example as larger parent forum events in partnership with the Trust. That the MSLC revisits some of its key themes like; normalising birth and mental health in 2013 to check in on progress with Lewisham Healthcare Trust.

Thank you for reading!

Themes for 2012

I promised an update on the themes for the mslc meetings throughout 2012. These have been informed by the highest scoring priorities for the committee to focus on when we had our training in 2012:

1) normalising childbirth (February)
2) improving care to women with mental health issues (June)
3) breast feeding and UNICEF baby friendly status (October)

Along with these meetings the committee will meet in April, August, and December.

If you have a specific interest in these topics and want to attend do contact me if you are not already a member of the mslc.

We are looking to increase the participation of service users on the committee so if you want to be part of making a positive difference to families having babies in Lewisham do get in touch.

A reminder of other things happening this year;

Our continued programme of focus groups with - dads, lesbian and gay parents, women with mental health issues

Ongoing walking the patch visits on mat 5

Mslc service user involvement in the refurbishment plans for labour ward and mat 5.

Would be lovely to hear from you

Penny



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