Lewisham's maternity services then and now

Back in 2007 and again in 2008 I experienced Lewisham hospital's maternity services first hand, with the births of my children. The first time around I will be honest and say I didn't have a great time, and I've blogged about it before, in the context of a survey that was done in 2007 into the quality of maternity services and in particular women's experiences and perceptions of how they were treated. I felt I was treated quite badly while I was there, with midwives that were rude and insensitive, and little to no help with breastfeeding.

Second time around I was hopeful that things might be better - was that the case? Well, my blog post from shortly after Claud was born suggests a bit of a mixed bag. Breastfeeding support was pretty variable, but I was more prepared and more determined myself on that front, and the midwives were much more supportive, if a little brusque.

But of course, all of that is a long time ago in the context of changing services, and I think it's fair to say that the hospital trust has responded to the results of the survey in 2007 by making major changes to maternity services. The "building your trust" section of their website sets out in detail the things they've done, which include:

1. Building a new mother and baby centred birth centre, which opened in 2010 for non-complex deliveries. (Anyone know how much this cost? All wasted if it is closed as per one of Kershaw's recommendations...)

2. Employing more midwives

3. Increasing postnatal support (which was my major issue with the care I received)

4. Setting up a range of specialist clinics.

(It has to be said that they could do with having a quick overhaul of their website though - there are quite a few broken links floating around!)

There is no consensus that maternity services in Lewisham could or should be closed. And any changes would certainly not be being made because it would be better for the women who give birth at Lewisham hospital! This comment was posted on an earlier post of mine on this subject and I think it is quite telling:

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."

Don't be fooled - Lewisham hospital handles 4,400 births a year, projected to rise to 5,000 a year within three years. There isn't space to accommodate these anywhere else in SE London and indeed on occasions the maternity unit at Lewisham becomes full as it currently stands. This point was made by a midwife from the hospital at the public meeting on 8 November.

We need to keep campaigning to keep the maternity unit open, and for it to be accompanied by a full admitting A&E in the interest's of patient safety.

Make sure you respond to the consultation (help with that here) and attend the public meeting tomorrow if you can.

Save Lewisham hospital march

I marched yesterday with around 15,000 others to tell Matthew Kershaw exactly what I think of his plans to destroy Lewisham hospital by taking away its A&E and maternity services. These are the pictures I took on the march and at the rally in Ladywell Fields afterwards.

Jeremy Hunt take note, we will not take this lying down! The next public meeting is at the Broadway Theatre in Catford on Wednesday 28th November at 7pm.

Greenwich consultation meeting audio

I was able to record the whole of the meeting at the Greenwich Forum yesterday. Hear the whole thing here. You can hear my question at about 55 minutes.

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.

Meeting of Greenwich Council and the Trust Special Adminstrator - what next?

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.

Save Lewisham Hospital!

Unless you've been living under a rock for the last couple of weeks you won't have failed to notice that Lewisham's hospital is once again under threat. The administrators of a neighbouring trust - South London Healthcare Trust (SLHT) have produced a report recommending the closure of Lewisham's A&E and maternity services.

Save Lewisham A&E, a group set up by local organisations, residents, doctors, nurses, therapists and patients, arranged a public meeting at the hospital last night where Heidi Alexander, MP for Lewisham East, Sir Steve Bullock, Mayor of Lewisham and Dr Louise Irvine, a local GP and BMA council member, amongst others, spoke about the proposals and what can be done to tackle them.

So what are the proposals? From the executive summary of the Trust Special Administrator's report:

•  Queen Mary’s Hospital Sidcup should be developed into a Bexley Health Campus providing a range of services to the local population, including day case elective surgery, endoscopy and radiotherapy. The facility should be owned by Oxleas NHS Foundation Trust and services should be provided by a range of organisations.
• Vacant and poorly utilised premises should be exited (leases) or sold (freeholds). The NHS should engage with the local authorities in Bromley and Bexley in the process of selling surplus estate to ensure its future use maximises regeneration opportunities.
• On an annual basis until the relevant contracts end, the Department of Health should provide additional funds to the local NHS to cover the excess costs of the PFI buildings at Queen Elizabeth Hospital and Princess Royal University Hospital.
• There should be a transformation in the way services are provided in south east London. Specifically, changes are recommended in relation to community-based care and emergency, maternity and elective services:

1. Community Based Care – The Community Based Care strategy for south east London should be implemented to deliver improved primary care and community services in line with the aspirations in the strategy. This will enable patients to receive care in the most appropriate location, much of which will be closer to, or in, their home.
2. Emergency care – Emergency care for the most critically unwell patients should be provided from four sites - King’s College Hospital, St Thomas’ Hospital, Queen Elizabeth Hospital and Princess Royal University Hospital. Alongside this, services at University Hospital Lewisham, Guy’s Hospital and Queen Mary’s Hospital Sidcup will provide urgent care for those that do not need to be admitted to hospital. Emergency care for those patients suffering from a major trauma (provided at King’s College Hospital), stroke (provided at King’s College Hospital and Princess Royal University Hospital), heart attack (provided at St Thomas’ Hospital and King’s College Hospital) and vascular problems (provided at St Thomas’ Hospital) will not change from the current arrangements.
3. Maternity care – There are two options under consideration to ensure that a high quality of care is provided for women needing to be in hospital during pregnancy and for women when giving birth. Obstetric-led deliveries could be centralised in line with critical emergency care across King’s College Hospital, St Thomas’s Hospital, Queen Elizabeth Hospital and Princess Royal University Hospital; alternatively, there could also be a ‘stand-alone’ obstetric-led delivery unit at University Hospital Lewisham. All other maternity care will continue to be provided in a range of locations across south east London.
4. Elective care – An elective centre for non-complex inpatient procedures (such as hip and knee replacements) should be developed at University Hospital Lewisham to serve the whole population of south east London. Alongside this elective day cases procedures should continue to be provided at all seven main hospitals in south east London; complex procedures should continue to be delivered at Kings’ College Hospital, Princess Royal University Hospital, Queen Elizabeth Hospital and St Thomas’ Hospital, and specialist procedures at Guy’s Hospital, King’s College Hospital and St Thomas’ Hospital. Outpatient services should be delivered from a range of local locations.

• In order to deliver this transformation programme, South London Healthcare NHS Trust should be dissolved and other organisations should take over the management and delivery of the NHS services it currently provides. In addition to the proposals for Queen Mary’s Hospital Sidcup outlined above:

1. The Queen Elizabeth Hospital site should come together with Lewisham Healthcare NHS Trust to create a new organisation focused on the provision of care for the communities of Greenwich and Lewisham.
2. There are two options for Princess Royal University Hospital. The first is an acquisition by King’s College Hospital NHS Foundation Trust, which would enable the delivery of service change, enhance the services offered at the site and strengthen the capacity of the site to deliver the necessary operational improvements. This is the preferred option at this stage. However, an alternative option is to run a procurement process that would allow any provider from the NHS or independent sector to bid to run services on the site.
3. It is important that these new organisations are not saddled with the issues of the past. To this end, it is recommended that the Department of Health writes off the debt associated with the accumulation of deficits at South London Healthcare NHS Trust. By 31 March 2013, this is estimated to be £207m.

So what does this mean? Lewisham hospital's A&E would be closed and only an urgent care centre would remain. Although the TSA claim this would deal with 80% of those patients currently seen, the reality is likely to be rather different since many people would simply head straight to the hospital with an A&E department. Patients would be expected to use Queen Elizabeth Hospital A&E in Woolwich, a site which is almost completely inaccessible by public transport. Two options are being looked at for maternity services, one of which would keep them and one which would cut them. Given that Lewisham handles 4,400 maternities a year, it's clear that this service is needed, as is a full A&E to be there in case anything goes wrong.

I attended the meeting last night and posted tweets covering the main things that were said.

Needless to say Lewisham's residents want to fight this. So what can we do?

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. First at Woolwich Town Hall next Thursday (15th November) between 5:30 and 7:30pm as the Trust Special Adminstrator Matthew Kershaw addresses Greenwich Council on these proposals (I'm not sure when or if he's addressing Lewisham Council....). Then 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.

It's vital that we each do what we can to help.

Save the Catford Bridge Tavern

There's still time to put in your objection to the planning application to turn the Catford Bridge Tavern into retail units with flats above it. There have been 375 objections so far, including my own. We simply can't afford to lose what is now quite definitely the area's best pub! Another shop would add nothing to the area, whereas with the pub as it is now, the area already feels a lot nicer and safer when you're waiting there for a bus home late at night.