Wednesday, November 21, 2012

Are maternity services the key to saving Lewisham hospital?

I attended another meeting on the proposed changes to healthcare in South East London this morning - this time a public consultation meeting with the Trust Special Administrator (TSA) at the Greenwich Forum. It wasn't brilliantly attended (around 40-50 members of the public in all) and we were treated to the same slick video I watched at the Greenwich council meeting last well, all designed to pull the wool over our eyes.

I felt I was better prepared for the meeting myself though, and asked a question of the TSA, which was how much money in millions of pounds a year would be saved by downgrading Lewisham's A&E to an urgent care centre. The TSA, Matthew Kershaw, responded by giving me the figure for all the organisational changes proposed at Lewisham and these are expected to yield savings of £17m per annum. When pressed, he was unable to provide a figure for the A&E alone stating that it was in the draft report (I can't find it though).

This question was followed by some detailed questions on maternity services, when it became apparent that there is a difference of clinical opinion on the best option for Lewisham. At the moment, the TSA is undecided on whether to retain an obstetric and co-located midwife-led birthing unit at Lewisham or to close it. The maternity unit at present deals with 4,400 deliveries a year, with this projected to be 5,000 in three years time when the changes would be fully implemented.

In outlining the plans for maternity care in Lewisham, Jane Fryer (Chief Medical advisor to the TSA) made it clear that there is a difference of clinical opinion on two things:

1. Whether or not a maternity unit needs a full admitting A&E on site.

2. Whether or not it is feasibly possible to redistribute the expected 5,000 deliveries a year across the other four sites in South East London where deliveries would take place (King's College Hospital, St Thomas' Hospital, Queen Elizabeth Hospital and Princess Royal University Hospital).

So, back to the money issue - getting rid of maternity and A&E at Lewisham "saves" £17m a year, according to the TSA. I argue that this is not strictly true. It gets £17m a year off the books of the new Lewisham and Woolwich Trust but not all that money is saved. Whatever proportion of that covers maternity would need to be redistributed to the other four hospitals that would be expected to take on Lewisham's births. And Fryer herself admitted this morning that they would not be able to do this on current staffing levels.

This is why we need to see the split in the projected savings between cutting maternity services and cutting A&E. It will then (I suggest) become pretty obvious that the saving is not much of a saving at all.

We can argue that:

1. Lewisham needs a full maternity service to cater for the 5,000 deliveries a year coming from its local population.

2. This service needs to be supported by a full admitting A&E.

And I think it's very possible to argue that only a vanishingly small amount of money is actually saved in the NHS in London as a whole by getting rid of both of these.

Respond to the consultation here. The deadline is 13 December 2012.

Update 22 November. Listen to the audio from this meeting here. My question starts at about 55 minutes and the questions on maternity services are shortly after that.

1 comment:

Roger Gartland said...

Dr. Jane Fryer spoke at the Scrutiny and Overview Committee meeting of Greenwich Council on Thursday 15 November at Woolwich Town Hall and described clinician support for the proposals as "enormous".

Appendix E of the full Draft Report has a different picture. At paragraph 77, the Report describes divided and undecided clinical opinion:"At a further meeting of the external clinical panel on 22 October 2012 a conclusion was not reached and the panel recommended that further work is undertaken to examine each option in more detail. The basis of this recommendation was that there are different views on the expected population growth and birth forecasts within south east London over the next 3-10 years and agreement should be reached so that correct capacity requirements can inform the final recommendations. Further work is required on the detail of the two proposals so that a more thorough clinical assessment can be made; and that broader engagement in exploring these options should be sought through the consultation process.".('Evaluation of hospital service configuration options for south east London').