More press

To catch up with all the latest in the media go to www.savelewishamhospital.com

20,000 people march to Save Lewisham Hospital

Wow! What an afternoon that was. We're back from the march and recovering from the huge crowds with a lovely cup of tea. The kids are making an NHS boat and chanting, 'Save Lewisham Hospital, Save the NHS!'...

I've just had a look on google for publicity about the march and here are the amazing results!

The Standard's piece on the Olympic nurses

South London Press

The Daily Mail

LBC

The Guardian

The Standard...again!

Fantastic photo from the BBC

And on ITV

The Save Lewisham Hospital Campaign is hotting up

The campaign is gathering momentum by the day.

Check out these three short films from the people of Lewisham:

The Campaign's flash mob on the Department of Health

A fantastic version of Steps' Tragedy!

Check out Simone Boothe's snowy journey to Woolwich from Bellingham

Polly Toynbee BIGS UP the Lewisham Hospital March

Save Lewisham Hospital suggested letters

Some great suggestions for letters from the campaign for you to download.

Check them out here!

Write to Jeremy Hunt again!The MSLC have written a letter for you to send to Jeremy Hunt. Keep it as it is or change it as you see fit!

Jeremy Hunt

Secretary of State for Health

Department of Health

Richmond House

79 Whitehall

London SW1A 2NS

Your address

date

Dear Jeremy Hunt,

I am writing to you about the proposed closures at Lewisham Hospital of Accident and Emergency and Maternity Services.

You and David Cameron have confirmed that no closure will take place if the proposed service reorganisation does not meet the Secretary for Health's Four Tests. As I understand it Matthew Kershaw and his team's recommendations do not fulfil the requirements set out.

Despite an enormous budget that escalated dramatically, the TSA did not provide adequate resources to properly engage with Lewisham's diverse population and so you have not received a fair representation of our needs.

My family rely on the acute services provided at Lewisham Hospital. We demand that these services are kept local for the Lewisham population. The result of closure will be that people will delay going to A&E so their health will suffer because they won't receive the medical attention they require when they are most at need.

I also believe that women in Lewisham should be able to give birth in Lewisham in the safe knowledge that the delivery will be supported by the best medical attention they require.

It is unacceptable that an entire London Borough be asked to travel to Woolwich to receive emergency care. It will be very dangerous to burden the surrounding areas with the extra capacity of Lewisham patients.

I have heard much about patient choice over the last few weeks. Matthew Kershaw's recommendations reduce choice for our entire community.

I urge you to take our views into account. The recommendations do not have the support of patients, doctors, GP commissioners or the public.

Yours sincerely,

Lewisham Resident

Read Lewisham's MPs case against the TSA's recommendations

THE TRUST SPECIAL ADMINISTRATOR’S REPORT ON SOUTH LONDON HEALTHCARE NHS TRUST AND THE NHS IN SOUTH EAST LONDON
THE CASE AGAINST RECOMMENDATION 5: SERVICE RECONFIGURATION (CLOSURE OF THE A&E AND MATERNITY SERVICES AT LEWISHAM HOSPITAL)

Prepared by Heidi Alexander MP, Jim Dowd MP & Rt Hon Dame Joan Ruddock MP

Legal & Financial Case against the proposals
As the three Members of Parliament representing Lewisham constituencies, we wish to set out the reasons why we believe the Secretary of State for Health should reject proposals from the Special Administrator to the South London Healthcare Trust (SLHT) to close the A&E and maternity services at Lewisham Hospital.
We question whether the Trust Special Administrator (TSA) has the power in law to make recommendations which affect Lewisham Healthcare NHS Trust, and whether the Secretary of State, in response to these recommendations, has the power to take a decision which results in the loss of A&E and maternity services at Lewisham Hospital – a solvent, successful hospital which is not part of the Trust to which the TSA was appointed.

The TSA’s recommendation to close A&E and maternity services at Lewisham represents a significant reconfiguration of services in South East London. We note that the Government’s own guidance to TSAs states that the Unsustainable Provider’s Regime should not be used as “back-door approach to service reconfiguration” – this is exactly what is happening in South East London. It is our view that proposals relating to Lewisham Hospital such as those which have been made by the TSA are subject to the provisions of Section 244 NHS Act 2006 and relevant regulations. We do not believe that the Secretary of State has power to act on the recommendations of the TSA in so far as they relate to Lewisham Hospital. However, even if that is not the case, we do not accept that the proposals meet the Government’s Four Tests for service configuration (see below).

We understand from Lewisham Healthcare NHS Trust that they did provide an alternative approach to the TSA’s proposals. The Trust, as part of its Expression of Interest for working with Queen Elizabeth Hospital (QEH), outlined that – as an organisation with a track record of success – it should be allowed to work with GPs, patients and partners to decide what needs to be done to meet the financial challenges in the future. This approach was not pursued by the TSA.

The TSA’s report shows that significant savings can be made without closing emergency and maternity services in Lewisham. Accepting only five of the six recommendations (excluding recommendation 5 on service reconfiguration), the TSA’s figures show there will only be a financial gap of just £1.7 million from a breakeven position. The proposed new organisation would need support initially to deal with the costs of integration and improve efficiency at QEH. But as a successful organisation, Lewisham Healthcare could work to close the £1.7 million gap without resorting to the destruction of vital services.

Figure 29 of Appendix M shows that the TSA service reconfiguration proposals (as per recommendation 5) deliver only £19.5 million of savings at a cost of £195.2 million – a ten year pay-back period. In addition, Kings would receive £31.5 million in non recurrent support and £58.7 million in capital (the Princess Royal and King’s investment combined) and benefit by £7.5m annually from the re-provision of services from Lewisham.

Service Reconfiguration and why these proposals fail the Government’s Four Tests
Both the Secretary of State for Health and the Prime Minister have repeatedly stated that changes at Lewisham Hospital will not go ahead unless the four tests that Government have set for service reconfigurations have been met. We believe that TSA’s proposals fail each of these tests. We list the reasons below:
1. Support from GP Commissioners
(i) The proposal to close the A&E and maternity services (with the consequent sale of over half of the Lewisham Hospital site) is not supported by Lewisham’s Clinical Commissioning Group (CCG).
(ii) Two thirds of Lewisham GPs have signed a letter to the Prime Minister setting out their opposition to the plans.
(iii) The Lewisham CCG and local GPs do not accept a clinical case has been made for these proposals and do not believe that the proposed Urgent Care Centre model will work. They state that local GPs will be inclined to refer patients to hospitals with emergency departments for specialist opinion, with a consequential impact on the number of patients who present at a Lewisham UCC.
(iv) Lewisham CCG and local GPs are also sceptical of the assertion that acute admissions can be reduced by 30% over 5 years – resulting in a situation where acute capacity will still be required but will not exist. There is no evidence to back up the assertion, upon which these proposals are predicated, that acute admissions can be reduced by 30% through the implementation of a community based care strategy.
(v) The TSA uses quotes from other SE London CCGs as evidence of GP Commissioner support, yet no change is proposed to the provision of emergency and maternity services in the areas which these CCGs directly cover.
2. Strengthened Public and Patient Involvement
(i) The public and patient involvement has been flawed. The 30 day public consultation on the TSA’s draft recommendation, whilst required by statute, is not consistent with Cabinet Office Guidelines nor does it meet the requirements of Section 242 of the National Health Service Act 2006, as would be required by a major reconfiguration.
(ii) The consultation was woefully inadequate. The consultation questions were opaque and confusing. There was no clear question about Lewisham A&E and no question at all about the sale of over 50% of land and buildings at Lewisham. Numerous people who attempted to reply to the consultation online have told us that they simply gave up.
(iii) Final recommendations in the report to the Secretary of State about services at Lewisham were not even included in the public consultation on the draft proposals (for example the midwifery-led birthing unit and the paediatric ambulatory service).
(iv) Important assumptions contained in the draft report, such as the percentage of patients who would continue to be treated at an Urgent Care Centre at Lewisham, have been proven to be erroneous.
The final report of the TSA suggests 50% of Lewisham A&E patients would still be treated at the UCC. The draft report suggested it would be 77%. Hospital doctors from Lewisham, based on an analysis of their caseload, suggest this figure is closer to 30%. This has an obvious impact on the additional capacity required at neighbouring hospitals to cope with displaced work from Lewisham, and means that the consultation proceeded on an incorrect and flawed basis.
3. Clarity on the Clinical Evidence Base
(i) The report assumes that the better health outcomes associated with the centralisation of major trauma, stroke and complex vascular conditions will be replicated with respect to other medical emergencies (for example pneumonia, meningitis, sickle-cell crises), yet there is no clinical evidence to support this.
(ii) The standards of care delivered at Lewisham’s A&E are high and have consistently outperformed other local emergency departments. For example, in 2010/11 and 2011/12 the emergency departments within SLHT failed to achieve the 4 hour standard, yet Lewisham consistently exceeded it. The quality of care given to newborn infants and children in Lewisham is also high and it has been the only London District General Trust to gain an “excellent” rating from the Health Care Commission in recent years.
(iii) Consultant involvement in both pre-operative decision-making and surgical supervision, noted as a key component of good emergency care by the TSA in paragraph 49 of Appendix K has been recognised by London Health Programmes in their 2012 survey as being present at Lewisham, but not at other hospitals (excluding Kings) (p. 71 of final report).
(iv) The proposals will lead to larger maternity units on fewer sites in South East London when there is no evidence that “bigger is better” in respect of maternity care. The Borough of Lewisham’s population is forecast to grow by 49,000 in the next 20 years, much of this driven by an increased birth rate (a 4% year on year increase is predicted). Lewisham has a high rate of teenage pregnancies and the percentage of older mothers is also above the national average. Continuity of care, with women having ante-natal care provided in Lewisham but having to go to another hospital to give birth will be seriously compromised as a result of these proposals and would require additional staff added to the consultant obstetric rota at King’s and then QEH as births on each of those sites exceed 8,000.
(v) During the TSA process, the output of the clinical panels has been used as a proxy for clinical evidence. However clinicians in Lewisham have told us that no dissent was allowed in panel meetings, no votes were taken and that the output of these panels should not be relied upon as clinical evidence.
4. Consistency with current and prospective patient choice
(i) Closing the A&E and maternity services at Lewisham and replacing them with a UCC and a midwifery-led birthing unit significantly reduces choice for the residents of Lewisham. Figures 40, 41 and 42 in the TSA’s final report show that the number of A&Es that will be within 30 minutes of people in South East London, travelling by either ambulance or using other modes of transport, falls. Journey times for people in Lewisham to A&Es will increase.
(ii) Whilst the proposed UCC at Lewisham will be an option for patients with minor injuries, it will not be a meaningful choice for a patient with an undiagnosed complaint needing specialist assessment or possible admission.
(iii) The proposed midwifery-led birthing unit at Lewisham will not be a choice for any woman who wishes to give birth safe in the knowledge that obstetricians would be available as a back-up. It may lead to more home deliveries and the hard to reach population will find it harder than ever to get access to timely care.
(iv) Closing Lewisham’s A&E and maternity services will have a disproportionate negative effect on socially and economically deprived groups, which make up a significant proportion of Lewisham’s population. The Health and Equality Impact Assessment in the final report, which purports to consider this point, was not included in the consultation. It cannot therefore properly have helped form the recommendations, but instead appears simply as a post-rationalised justification for them. This is a further example of the flawed nature of the consultation process.
Conclusion
The proposals to close A&E and maternity services are dangerous and ill-conceived. Destroying a successful hospital by closing vital services is not in the best interests of the people of Lewisham, nor is it financially necessary. It would only make a saving of £12.2M (the approximate cost of Lewisham’s recently refurbished emergency department). Figure 47 of the final report details the saving for each of the TSA’s 6 main recommendations. If nothing is done, there will be a financial gap of £75.6M by 2015/16. However, if five of the six Recommendations are accepted (excluding recommendation 5 on Service Reconfiguration), the TSA’s figures show there will be a financial gap of just £1.7M from a break-even position. Additionally, the TSA service reconfiguration proposals (as per recommendation 5) deliver only £19.5 million of savings at a cost of £195.2 million – a ten year pay-back period. An alternative to solve this gap has been proposed.
We urge the Secretary of State to reject Recommendation 5 and to retain a full admitting A&E and full maternity service at Lewisham Hospital.
For more information:
Heidi Alexander MP (Lewisham East) – 020 7219 7099 – heidi.alexander.mp@parliament.uk
Jim Dowd MP (Lewisham West and Penge) – 020 7219 4617 – dowdj@parliament.uk
Joan Ruddock (Lewisham Deptford) – 020 7219 4513 – joan.ruddock.mp@parliament.uk

ITV London News cover the cuts 14th Jan 2013

Lewisham mums and pensioners talk to the press about why the proposed cuts to our hospital are so dangerous.

Check out the story here The ITV News Story

The second letter to Jeremy Hunt

Dear Jeremy Hunt,

Last week in parliament you told Andy Burnham and the House that you would not close Lewisham Hospital's A&E department or the full acute maternity service if the TSA's recommendations do not fulfil the Secretary of State for Health's Four Tests.

We are writing to point out that Matthew Kershaw and his team have totally failed to meet the criteria set.

First, there must be clarity about the clinical evidence base underpinning the proposals.

Lewisham's Obstetricians and Gynaecologists have publicly stated that they will not support a stand-alone birth centre. The women of Lewisham put their faith in the expertise of these senior clinicians. We do not believe that a stand-alone centre is safe.

Many women in Lewisham will be considered as too high risk to use the facility and that due to the unpredictability of childbirth the few women who can use it will often require transfer. This will be dangerous in view of the travel time required to reach the proposed acute service at Queen Elizabeth in Woolwich.

The recommendations put much emphasis on the need for all hospitals to provide 24-hour consultant cover. There is evidence that this is not required for safety of patients. If you take this argument out of the recommendation, then the need for a huge maternity hub can no longer be defended.

Second, they must have the support of the GP commissioners involved.

GPs have unanimously and publicly told the Trust Special Administrator and Department of Health that they are against the proposals. As users, we put our faith in our GP commissioners who are experts in the field. Since they categorically do NOT support the proposals, the recommendations have absolutely no credibility

Third, they must genuinely promote choice for their patients.

The recommendations will reduce choice for maternity users.

We believe that the option of home birth will no longer exist, as women will not want to use a service that is not backed-up by a local acute service.

Women in the community have stated that they will not use a stand-alone facility due to the high risk of not having an acute service on site. It will become a very expensive facility for very few women.

A large percentage of Lewisham maternity users will be forced to use Woolwich as they will be considered too high risk to use a stand alone birth centre. Already a high proportion of the population are transferred to hospitals such as St Thomas' and Kings, and this proportion will only increase, since the criteria for using the birth centre on the same site as the level 3 service is already very limited. A large portion of the population will therefore have no access at all to a local maternity experience.

It is known within the medical profession and within the community that continuity of care suffers with an increase in the number of 'hand overs' between professionals. All Lewisham residents will suffer as they will receive antenatal care in the community, care in labour by another set of midwives and then yet another change with postnatal care, which will take place both in the hospital and within the community. This will be made even more complicated by many women choosing to use other hospital trusts for the actual birth.

There are serious safe-guarding and child protection implications involved with such hugely complicated care packages.

Fourth, the process must have genuinely engaged the public, patients and local authorities

We insist that you acknowledge the fact that there has neither been enough time nor resources allocated to have genuinely engaged with the public, patients or local authorities.

We have already outlined in detail the many instances in which there has not been a proper consultation. Please refer to our letter dated 10th January 2013.

We contacted Matthew Kershaw during the consultation period to share our concerns that the women we represent had not been properly consulted. We were offered a one-to-one meeting with a member of the TSA team at 8pm on the night before the deadline for public responses to the consultation. No-one can claim that this was a serious attempt to garner women's views.

The service-users of Lewisham's Maternity Service Liaison Committee demand that Matthew Kershaw's absurd and dangerous recommendations should be consigned to the rubbish bin where they belong.

Yours sincerely,

Jessica Ormerod

Service-user Chair Lewisham MSLC

Lewisham in the press

Momentum is building: the proposed closure is getting a lot of press.

Here are some of the articles:

The Guardian

The Mail on Sunday

The Standard

The Standard again

And The Standard again!

And catch up on the debate between Jeremy Hunt, Heidi Alexander and Joan Ruddock onThey Work for You.

The Lewisham MSLC are proud to present our Annual Report 2012. Read all about our achievements over the last year.

Lewisham MSLC Annual Report 2012

If you are interested in joining the MSLC or have any suggestions for areas you would like us to focus on then get in touch with us on our facebook page Lewisham MSLC or you can email jessica@ormews.com.

The MSLC write to Jeremy Hunt

Dear Jeremy Hunt,

I am writing to you as the Lay Chair of the Lewisham Maternity Service Liaison Committee (MSLC) regarding the inappropriate use of the Regime for Unsustainable NHS Providers to reconfigure health services in South East London.

I am very concerned about the Regime’s apparent intention to harvest the vital services from Lewisham Hospital in order to save the ailing Queen Elizabeth Hospital. We believe that this is an at best dubious and quite possibly actually unlawful use of the legislation, and we would like to take this opportunity to inform you that should this case come to Judicial Review, we shall support the rejection of the recommendations.

Before you make your decision, please focus on these three critical areas:

1. The Regime for Unsustainable NHS Providers is being wrongfully employed
It is clear from the Statutory Guidance for Trust Special Administrators appointed to NHS Trusts (DoH, 2012) that the reconfiguration of services outlined in Matthew Kershaw's Draft Report falls outside the remit of the Regime. This is explicitly stated on page 6: 'The regime does not provide a back-door reconfiguration of services'.
Moreover, it is claimed that:

19. The Regime is intended to protect patients and staff from failing services, ensuring good local services for all patients.

It is unjustifiable that in order to save Queen Elizabeth Hospital, Lewisham residents' access to high-quality, safe and effective services should be removed.

I refer to p. 7: PRINCIPLE 1 - Patient interests must always come first. The most important consideration is the continued provision of high-quality, safe and effective services so that patients have the necessary access to the services that they rely on.

The Regime has not been 'credible' or 'workable' (p. 7 Principle 5). Despite the fact that the TSA held public meetings, there was no attempt to give sufficient resources to adequately consult service users – particularly the large quota of seldom-heard groups resident in Lewisham. This is despite the essential principle in the Statutory Guidance 'that patient interest should come first'.

Women who attended the two hastily organised focus groups reported that the organisers overtly suggested that Lewisham medical staff were against the proposals because they wanted to save their jobs. This is an example of the clear determination of the TSA to shut down open discussion and does nothing to encourage confidence that the Regime is either open or independent.
The experience I had when attending a meeting convened by the TSA team and Mckinseys, which claimed to be a 'workshop' with senior clinicians, commissioners, midwives and managers across South East London Service Providers, was breathtakingly patronising and dismissive.

'The Trust Special Administrator is required to undertake an equality impact assessment, observing equality legislation and principles, and demonstrating that due regard has been paid to the equality duty of the Equality Act 2010. The equality assessment should apply to both patients and staff. It is recommended that the assessment is undertaken early on in the Regime to allow the Trust Special Administrator to identify, for example, groups with protected characteristics that may be affected and which the Trust Special Administrator’s draft report can take into account'. (p.13). However, the assessment managed by Deloittes will not be published until the Final Recommendation has been submitted. It thus cannot be used to influence his decision and therefore he won't have complied with the statutory regulation.


2. The Secretary of State's four tests will not be met
It is stated that,
'local reconfiguration plans must demonstrate support from GP commissioners, strengthened public and patient engagement, clarity on the clinical evidence base and support for patient choice. These tests were set out in the revised Operating Framework for 2010-11. For example, it is important that there is strong clinical evidence that the recommendations will deliver safe and effective care.

Lewisham Healthcare Trust, amongst others, has responded to the TSA that there will be a seriously negative impact on the delivery of safe and effective care on the residents of Lewisham. There is clear evidence that women and infants will be put at serious risk should Lewisham Hospital lose its acute services.

It is also a fact that clinicians, commissioners, managers, midwives and service users were not given the opportunity to contribute substantively to the models used by the TSA in his draft report. The overwhelming majority do not support the recommendation.

It is indisputable that The Secretary of State's four tests have not been met.

3. Maternity Matters has been completely disregarded.

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)
I refer to the words 'local facility'. A local facility is not one that requires a woman to travel a minimum of 40 minutes in labour in order to give birth. It is very likely that home birth will disappear as a viable option and it is also evident from consulting with women that they will not use a midwife-led birth centre that is not supported by an acute service on site.
It is therefore plain that the recommendation will not be compliant with Maternity Matters.


In the TSA's haste to conjure a cost-cutting exercise in bureaucracy to camouflage a failing Trust, the rights of women in Lewisham to a local and coherent maternity experience has been totally overlooked.

Yours sincerely,


Jessica Ormerod
Service-user Chair Lewisham Maternity Service Liaison Committee


More about MSLCs: In Lewisham we have an active MSLC. The committee is a multi-disciplinary forum bringing together 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. It is in this capacity that the service user members draw your attention to the depth of our concern for the welfare of the women and infants we represent.

Write to Jeremy Hunt

If you would like to write to Jeremy Hunt we've written something that might help get you started. Please add your own experiences or send as it is.

The address to send it to is - 

Jeremy Hunt

Secretary of State for Health

Department of Health

Richmond House

79 Whitehall

London SW1A 2NS

Dear Jeremy Hunt,

I am writing to you as a Lewisham resident who has not felt included in the consultation process.

I rely on Lewisham Hospital's acute services and I urge you to reject the dangerous recommendations put forward by Matthew Kershaw and his team.

With regards,

xxxx

Lewisham Resident