Nick Raynsford's response to an email from a constituent about the SLHT restructuring

I've agreed to put this up on my blog to put into the public domain Nick Raynsford's response to being asked to give a robust response to the planned "restructuring" of South London Healthcare NHS Trust.

Original letter:

16th November 2012

Dear Mr. Raynsford

Re: South London Health Trust consultation

Reviewing the press and local news in the hope of an official response and strong opposition to the damaging ‘restructuring’ planned for SLHT. Alas not, unlike Heidi Alexander, MP and Mayor Steve Bullock in the London Borough of Lewisham, who have given robust responses. If, under the proposals, Lewisham loses its Maternity and Emergency services, this will put an enormous strain on an already challenged Queen Elizabeth Hospital and the surrounding population.

I strongly opposed the government's "reforms" of the NHS, which will result in the dismantling and selling off to private companies of one of our most precious and valued institutions. The NHS is one of the fairest, most efficient and cost-effective health services in the world http://bit.ly/T6HDqR (The Guardian)

Yet, according to the Faculty of Public Health's risk assessment, the government’s reforms will lead to a loss of comprehensive care, reduced quality of care, greater expense and greater health inequality http://tinyurl.com/c4fx6n5 (risk assessment)

This is a national tragedy and I will not vote for anyone who does not oppose these deeply damaging reforms.

Yours sincerely,

**********************

Nick Raynsford's response (email dated 28 November, 9 working days after the original email):

Dear constituent,

Thank you for your communication about the future of South London Health Care Trust (SLHT).

As the MP for the Greenwich since 1992 and Greenwich & Woolwich since 1997, I have been involved in a series of discussions over the years with Ministers and senior NHS managers about the provision of healthcare services in South East London.

While there have been many advances and improvements in healthcare over this period, particularly as a consequence of the substantial increases in investment in the NHS under the last Labour Government, the structures responsible for the delivery of hospital services in our area have never proved entirely satisfactory and have been subject to frequent change. The most recent of these changes is less than four years old. That involved the creation of SLHT, taking over responsibility for the hospitals in Greenwich, Bexley and Bromley, at the same time as a reconfiguration of services was initiated in line with the A Picture of Health proposals.

In my view, SLHT made some progress in improving the standards of healthcare in South East London, notably in the treatment of stroke patients with the new unit in Bromley, and in the maternity service offered at the Queen Elizabeth Hospital, Woolwich (QEH). The new urgent treatment unit at Woolwich has worked well with the A&E department, improving both waiting times and the quality of patient care.

However, SLHT was less successful in tackling the financial deficit which affected all three Hospitals. The problem was compounded by the decision of Andrew Lansley, then Secretary of State for Health, to halt implementation of the A Picture of Health reconfiguration plans in summer 2010.

Because of the persisting deficit, and despite his own responsibility for some of this deficit, earlier this year Lansley announced the appointment of a Trust Special Administration (TSA) to take over SLHT. I took part in the NHS debate which followed closely on the announcement to speak out against the decision. You can read my speech by following the link: www.publications.parliament.uk/pa/cm201213/cmhansrd/cm120716/debtext/120716-0002.htm#12071631000897, or feel free to contact my office for a hard copy.

The TSA, Matthew Kershaw, was tasked with preparing a report setting out proposals for the future of healthcare in South East London. That report was published in October and makes a series of recommendations, of which probably the most significant for Greenwich and Woolwich are:

• South London Healthcare Trust to be broken up;
• QEH to become part of a new Trust also incorporating Lewisham Hospital;
• Main existing services to continue at QEH, but A&E at Lewisham to be closed and replaced with an urgent care centre; this would leave just four A&Es in South East London, instead of five currently;
• Maternity services either to be also reduced to four, at the four A&E sites (QEH, King’s, St Thomas’, Bromley) or for an obstetrics-led maternity unit to remain at Lewisham in addition to the other four sites;
• Queen Mary’s Sidcup (QMS) to be a ‘campus’, run by Oxleas Trust, but with elective surgery run by Dartford and Gravesham NHS Trust;
• The Princess Royal Hospital Bromley to become part of King’s;
• An extensive ‘efficiency’ programme, likely to result in substantial reductions in numbers of medical, nursing and ancillary staff;
• Additional financial support to help cover the additional PFI costs at QEH and Bromley, and the SLHT accumulated deficit to be written off.

We are now in the middle of the consultation period on these proposals. I have met twice with Matthew Kershaw and once with Tim Higginson, Chief Executive of Lewisham Trust, to discuss the implications of the report, as well as meeting the Chief Executive of Oxleas NHS Trust, and the Chair of the embryo Clinical Commissioning Group (CCG) and the Head of its Business Support Unit in Greenwich, formerly the Primary Care Trust, to understand their perspective on the proposals. I have also met with Trade Unions representing NHS staff working in affected hospitals, and written to the newly-appointed Health Secretary, Jeremy Hunt, to set out concerns and request a meeting.

The main issues of concern in my view are:

• The closure of the A&E at Lewisham and reduction to just four A&Es in South East London could seriously compromise patient safety and impose excessive pressures on the remaining A&E services; the A&E at the QEH is working very close to capacity already and could not absorb substantial additional pressures;
• Similar considerations apply to maternity services, though the proposed obstetrics-led unit at Lewisham would reduce the pressure
• The viability of the proposed arrangements at Queen Mary’s Sidcup is questionable, nor is it clear why the Dartford/Gravesham Trust has been invited to run the elective work at QMS;
• The proposed ‘pathology hub’ at the QEH which had been part of the SLHT future plans is now uncertain;
• Community services are run on a different basis in Lewisham and Greenwich. Lewisham Trust runs services in Lewisham, while Oxleas runs Community Services in Greenwich and Bexley. This division may prove unsatisfactory.
• The scale of the efficiency savings proposed and potential job losses is very challenging and could undermine the safety and effectiveness of services;
• The margin of viability of Matthew Kershaw’s proposals is very fine and could easily be undermined by events, as proved the case with SLHT;
• The achievement of the plan depends on very positive commissioning decisions by the inexperienced new Clinical Commissioning Groups;
• The viability of a new Lewisham/QEH Trust is therefore high-risk, and this could be further affected by the proposed merger of King’s, Guy’s and St Thomas’ to form a single mega-Trust, also incorporating the South London and Maudesley Trust and Bromley.

These and other issues will undoubtedly be discussed in detail over the next few weeks before the consultation closes. Details of the consultation process and how to take part can be found at www.tsa.nhs.uk. If you have no internet access, feel free to contact my office for a hard copy.

It will be vital to continue to keep strong public pressure on Jeremy Hunt and Matthew Kershaw to maintain high-quality NHS services throughout Southeast London. The I Love the NHS campaign, organised by local Labour Party members continues to make an important contribution, organising public meetings and raising awareness. Please visit www.ilovethenhs.org.uk/greenwich to keep up-to-date with activity locally and to add your name to the Greenwich People’s NHS Charter, which sets out what local people believe their health service should provide, and acts as a blueprint for how we wish to see NHS services run in Greenwich. I am also happy to send you details on how to become more involved if you would like to give up some of your time and join the campaign.

In the meantime, you have my full assurance that this issue will remain a major focus of my attention over the coming weeks.

Thank you again for contacting me regarding this extremely important matter.

Yours sincerely

Nick Raynsford MP

The Rt Hon. Nick Raynsford MP

Labour MP for Greenwich & Woolwich

House of Commons, London. SW1A 0AA

t:  0207 219 5895

f:  0207 219 2619

w: www.nickraynsford.org.uk