I attended a special meeting of Greenwich council's Healthier Communities and Older People Scrutiny Panel last night, which had been arranged to allow Matthew Kershaw, the Trust Special Administrator (TSA) of South London Healthcare NHS Trust (SLHT) to present the draft recommendations for resolving the current financial problems of the trust and answer questions from councillors. The meeting was open to the public and they were also allowed to ask a small number of questions.
I tweeted as much as I could from the meeting before the battery ran out on my phone, and I took down the rest of my notes on paper. The collated tweets and written up notes are here.
The presentation was extremely slick, consisting of a video designed to hammer home just exactly how much financial strife SLHT is in (losing £1m a week...) and make it clear that (from Kershaw's perspective) the proposals in the report (including downgrading Lewisham hospital's A&E to an urgent care centre and possibly cutting maternity services there too) are essential to sorting out the mess. The questions from the public showed a lot of anger in many cases but they were unfocussed and didn't really call the TSA and his team out on the inaccuracies in the report. The councillors' questions were all fair enough, but they repeated each other and I felt they could have been much better prepared, perhaps agreeing beforehand who would ask what in order to make best use of the time. It all felt a little bit like they were relieved Kershaw wasn't suggesting that Queen Elizabeth Hospital A&E be closed.
Indeed, one of the councillors at the meeting intimated that Greenwich council had supported the recommendations in the last attempt to reorganise the health service in SE London, a Picture of Health, in 2008. He felt that the reason SLHT was in financial trouble now was that the recommendations had not been fully implemented. I found this a little confusing because there were four options put forward in a Picture of Health, all recommending slightly different things, but only one of them didn't recommend closing Lewisham's A&E and maternity services. It's more than a little worrying that Greenwich council is therefore by implication offering support for the current plan to close both these.
I should probably also say at this point that the whole report stands or falls on whether or not you believe that making these changes is the only way to sort out the financial mess. I contend that it isn't, so I'm coming at it from a completely different standpoint to Matthew Kershaw, who believes that it is.
There was an awful lot of management-speak and the presentation is carefully worded so it never says what is to be cut - that has to be worked out by deduction from knowing what services exist now and what is being proposed. To me it seems obvious it's been done like this to pull the wool over the public's eyes so that the changes can be rushed through under a process that's never been tried before. Several times in the meeting Kershaw and his team stated that things had to be done in the way they have been because of using this new process. In fact, of course, they chose to do it like this and if that means the consultation process isn't as good as it should be then they shouldn't have chosen this option.
Statements from the TSA like "the best way of providing care is when local doctors and nurses are providing local services to people." mean nothing when what is being proposed is precisely the opposite - to move services further away from a large group of people in SE London, not all of whom live in the borough of Lewisham, since Lewisham is the more easily accessible of the two A&Es across Greenwich and Lewisham for a significant number of people who live in the borough of Greenwich (a point some of Greenwich's councillors seem to have missed entirely).
Kershaw also stated that evidence suggests that to provide the best care we need to have consultants in A&E and maternity units 24 hours a day 7 days a week. That can't be done across seven hospitals with the staffing levels currently available but the solution is not to employ more doctors, it is to cut the number of hospitals providing these services to four, and reduce overall spend. This doesn't stand to reason, because those services are there to provide care to a population of people who need it - that population doesn't go away just because you cut the service. Lewisham's population is about 250,000 and its maternity unit deals with 4,400 maternities a year. Both these figures are rising not falling, and the units providing these services, to a similar number of people, at QEH are already overstretched.
Finally, a key comment from Matthew Kershaw, which is absolutely critical to understanding what is going on here (and what we can therefore hope to achieve) is that the consultation is not a referendum on the proposals, it is merely designed to refine and improve them, not change them. Depending on how optimistic your outlook is, that could mean that there is nothing we can possibly do to save Lewisham A&E and only a slim possibility of saving maternity services, or it could mean that the best possible outcome is that most of the proposals go ahead but the recommendation to cut the A&E at Lewisham is not accepted. It's my feeling that the only way this will happen is if we shame the government into deciding that Lewisham needs to keep its A&E. It is after all one of those that David Cameron himself promised to fight for back in 2007. In other words, we are reliant on the government wanting to save face with the public, which means we need to make a fuss and keep this in the public eye.
Kershaw ended his contribution to the meeting by pointing out that the Secretary of State has the final sign off on the proposals, so it's my view that representations to him need to be made forcefully and often by as many people as possible.
So as I ended my previous post on this, what can we do to stop this happening?
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. 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.
I can only reiterate that we cannot sit back and let this happen to us, we must do everything we can as individuals to stop it and put pressure on those of our elected representatives who aren't standing up for us and make them do so! They work for us!
Update 19 November: see 853 for another take on this meeting.