Monday, 23 September 2013

10 reasons why I am maintaining the hospital rage

Back in May, I wrote about the threat to St Helier Hospital in my pocket of South West London. Under the "preferred option" cobbled together by a group under the Better Service, Better Value (BSBV) umbrella, we have the prospect of both St Helier and Epsom hospitals losing A&E and maternity units. St Helier would also lose its renal unit and paediatric intensive care and its hip fracture clinic, considered the best in the country by the National Hip Fracture Database, is also in danger because it is attached to the A&E unit.

Nobody with even a passing interest in the politics of the NHS would be surprised to know that this is all about money, in particular, saving money across a swathe of hospitals that serve an area of London where the population is both growing and ageing.

Since May, there has been a small victory. The consultation period was going to take place over the summer holidays, when people are often away and when consultations such as these are not meant to take place. This has been postponed until at least November. At this rate, it might just keep getting pushed further and further back until the next election rolls around and it may then become a moot point.

But this is not a time for complacency. It would be an anti-climax if it did become a moot point. However, the whole sorry process may not be abandoned and campaigners need to maintain the rage and keep up the pressure. Since May, the @Save_St_Helier Twitter feed has been very busy with challenging questions being asked of whoever manages the BSBV Twitter feed.

These 10 points are reasons why I am still angry as are so many people in my area.

1. BSBV claims that existing staff will be better deployed rather than either any investment in new staff or any job losses to save money (despite the whole process being about saving money). This may sound reasonable until you realise that it wouldn't matter if there was one gigantic hospital to serve the area or there was a little hospital on every street, the fact remains that there simply are not enough members of staff. The whole plan does nothing to address the issue of not enough junior doctors going into emergency medicine.

2. BSBV is extremely GP-heavy in its membership. While the rhetoric about more care in the community and a smaller number of A&Es again sounds laudable, one of the biggest issues is, quite simply, access to GPs. It is easy to bash GPs as lazy but when people have to wait a week for an appointment, it is obvious why many non-urgent cases end up overburdening A&E departments. We need more examination of innovative solutions such as group consultations for patients at risk of diabetes. This is working well at a GP clinic in Smethwick and it is this sort of creative thinking that prevents more cases of diabetes and reduces pressure on A&E departments.

3. If St Helier and Epsom lose A&E and maternity departments, the already-overburdened St Georges Hospital in Tooting will receive a massive multi-million pound upgrade. If you ever visit St Georges, you will find that parking is a nightmare and it is hard to see where the hospital can expand significantly without the compulsory acquisition of neighbouring homes. When asked how the cost of such a huge upgrade was arrived at, we were simply told "capital estimates". There has been no response to the question of whether these estimates were based on real quotations from architects or construction companies. We have been told that such massive work will "pay for itself in five years". We are still not sure if this is five years from now or five years from 2016, when St Helier and Epsom are slated to be downgraded under the preferred option, or five years from whenever construction might start at the already chaotic St Georges site.

On nine occasions in one 12-month period, St Georges had to divert ambulances to St Helier because it could not cope - BSBV is alarmingly calm about this and claims that the upgrade to St Georges will mean this won't be a problem if St Helier is A&E-free. I wish I knew where they keep their crystal ball.

And remember, the money needed to upgrade St Georges so it has any hope of coping with an increased flow of patients is taxpayers' money.

4. The plans to upgrade St Georges are made even more farcical by the fact that St Helier is in the midst of a massive upgrade. Already, £5 million has been spent on St Helier's A&E and £2 million on maternity and there is a big banner across the front of this Art Deco monolith proclaiming the hospital is in the midst of a £219 million upgrade. There have been no satisfactory answers as to what will become of this ongoing project if St Helier is downgraded. The giant banner really needs to come down with much fanfare as it is lulling local residents into a false sense of security about the hospital's future.

And remember again, the money already spent upgrading St Helier is taxpayers' money.

5. Mr Hassan Shehata is one of the best obstetricians in the country. He is the Joint Director of Women and Children's Services for the Epsom and St Helier NHS Trust. He has been instrumental in the creation of RCPG guidelines for maternal care. Yet he is being ignored by BSBV. This is probably because he has repeatedly and publicly stressed the urgency of getting women in labour to hospital quickly, especially when things go wrong. Here is a letter he wrote for the local paper about how in some cases, five minutes can be the difference between a good and bad outcome for some women. But if St Helier and Epsom lose their maternity units, women in labour, an event that can change for the worse very quickly, will have to travel for much longer than five extra minutes to get to a maternity unit.

Indeed, just last week a local woman gave birth in the car park of Epsom Hospital where she was then fortunate to be taken in to receive excellent medical care by that hospital's maternity unit. BSBV have not responded to my question as to whether she would have had the same outcome if she had to travel all the way to St Georges. Maybe the BSBV crystal ball wasn't working that day.

6. One of the oft-repeated comments from BSBV is that there are better outcomes for some patients if they spent longer in an ambulance and are taken to specialist A&E units, such as specialist stroke, trauma or cardiac units. This is already happening. It won't be something new that will suddenly start happening after St Helier and Epsom lose A&E units. But for the many, many cases, such as asthma attacks, bumps to the head or serious but not necessarily life-changing fractures, the nearest A&E is generally the best place to be. It is all well and good to constantly cite the case of star footballer Fabrice Muamba as an example of a patient surviving because he went to a specialist cardiac unit further away from where he collapsed - but his is an extreme case. And any similar cases to his are already being treated in this way.

7. If St Helier and Epsom lose A&E departments, they will be downgraded (and it is a downgrading, no matter which way you cut it...) to Urgent Care Centres (UCC). It is hard to get a clear definition from the NHS website as to exactly what treatment you can expect from a UCC. When I asked Dr Marilyn Plant, joint medical director for BSBV, about when patients should go to a UCC, she replied that this should happen when a patient "feels" their condition is not life-threatening. Right. So bad luck if you rocked up to the UCC rather than an A&E because you "felt" that your chest pain was a spot of nasty indigestion when it was in fact a heart attack. Whoopsie!

8. And while we are on the subject of these UCCs we can expect if St Helier and Epsom lose A&E, they may not be open 24/7 like A&E departments are. Understandably, this has scared a lot of people. So I asked BSBV about this. Here's the really freaky news - BSBV cannot guarantee that any new UCC will be open 24/7 and it is up to local Clinical Commissioning Groups (CCG) to determine opening hours based on "clinical need". Firstly, BSBV is, as they are fond of reminding us constantly, largely made up of CCG members across a number of trusts but at the same time, BSBV is not prepared to commit to a guarantee of 24/7 opening hours. Secondly, it again seems like a case of the BSBV crystal ball working overtime. The minimum requirement for UCC opening hours is just 12 hours a day. It is intriguing that BSBV is confident people might not need urgent medical attention outside of certain hours. Because that's how it always works in real life...

9. As we are maybe - or maybe not - leading up to the consultation period, it has also become difficult to get any straight answers about what this means for the ongoing privatisation of the NHS. Croydon Hospital, one of the hospitals affected by the BSBV review, already has an UCC run by Virgin. But if anyone dares ask if St Helier or Epsom will also have privately run UCCs, the answers are vague and unclear. Indeed, Dr Marilyn Plant herself was interviewed on video for the local paper and she kicked off proceedings by saying she didn't want to talk about privatisation. We get told that any facilities will still be free at point of use for patients but we are not getting any confirmation as to whether such facilities will end up making people like Richard Branson even wealthier. Many CCG members across the trusts involved in this saga have declared interests in companies such as Virgin, Assura and Harmoni. Is it a crazy coincidence that these people are decision-makers who are involved in determining how money is spent?

Once again, this is taxpayers' money.

10. Finally, the cost of the whole BSBV programme is a bone of contention that campaigners are, quite rightly, not prepared to bury. I aksed for a breakdown of costings - with a figure of £11 million being bandied about, I wanted details. But instead I was given a very basic breakdown of phases two to five of the programme, a grand total of a not-insignificant £6 million pounds but no breakdown of the first two phases. I asked again today about this and got another load of fobbing off - I was told this information wasn't kept by BSBV (because, hey, why would they bother to keep a record of how they're spending our money - that's just nuts!) and that it was on an old website but not the new website and then I was told to make an FOI request. Which isn't always free and can take at least 20 days. Finally, I received word today from BSBV that they would soon share this information.

This is the tweet they sent:

"It's a perfectly reasonable request though, so will access and publish phases 1 and 2 figures on our website."

Good to know that is is "a perfectly reasonable request" to access information about how taxpayers' money has been spent on a programme aimed at saving money in ways of which many clinicians are raising serious doubts.

I eagerly await this full breakdown of how £11 million has been spent. I do wonder if the salaries of the communications team will be outlined in this breakdown. This would be the team that blocked a local doctor's Twitter account but is not explaining why. Good to see that people being paid with our money are stifling free and open discussion at our expense.

If you have read this far, congratulations. I just hope that at least one journalist on a national newspaper or the BBC or Channel 4 or Sky News picks it up and runs with it too. I can only do so much from my little blog but I couldn't simply do nothing.

Image courtesy of Noel Foster.


  1. Am I right in thinking Jeremy Hunt has been told he exceeded his powers in closing this hospital? If so, congratulations on the victory, although I suspect he'll come back for another try shortly.


  2. Sadly, no. That victory was for Lewisham Hospital - and we are so pleased for them. Lewisham campaigners have helped us too, which is brilliant. We also have undertakings from two council leaders in the area to join forces for a judicial review, if required. The fight for St Helier and Epsom is far from over!