Lewisham Hospital's trust board want to retain all its services
With responses to the three-month consultation on the reorganisation of hospital services in south east London due in by tomorrow, LINDA PIPER looks at the responses from some of the major players.
THERE are just two days left for
people to make their views known on the A Picture of Health proposals.
Three options are on the table from the four primary care trusts in Bexley, Bromley, Greenwich and Lewisham which commission healthcare for the four boroughs, on how services could be reorganised to make the best use of NHS funds.
In all three options, Queen Mary's Hospital, Sidcup, would lose all its acute services - A&E, maternity and children's in-patient care - but become a centre for planned surgery.
Also in all three options, the Princess Royal University Hospital in Farnborough and Queen Elizabeth Hospital in Woolwich would become the A&E centres for the area, with maternity units and in-patient children's wards, but would send elective surgery patients to Sidcup.
Under option one, Lewisham Hospital would continue to admit medical but not surgical emergencies, would have a midwife-led birthing unit, but no in-patient services for children.
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Option two would see the hospital retain all its emergency services while option three would create a Lewisham Hospital with similar services to those proposed for Queen Mary's.
The A Picture of Health team revealed last week only around 7,000 of the 700,000-plus households who received the consultation documents had, so far, replied to it.
Queen Mary's Hospital has the most to lose from the A Picture of Health proposals
Queen Mary's
QUEEN Mary's Hospital, Sidcup, has most to lose from the A Picture of Health proposals.
As the only non-Private Finance Initiative (PFI) hospital, the NHS gets immediate financial gains from any cutbacks there.
A reduction in services could also free up surplus land for sale.
Under all three proposals, it will be stripped of its emergency services and become a centre for planned surgery.
Its board favours option three, which leaves only two emergency centres, in Farnborough and Woolwich, as the only one to achieve the clinical aims of the shake-up.
However, chief executive Kate Grimes warned keeping two centres for planned surgery - at Sidcup and Lewisham - was a risk for Queen Mary's as there may be pressure to concentrate it all at Lewisham.
She said the hospital had been fighting for a planned surgery centre.
As a non-PFI hospital, the options for Queen Mary's future were limited if it loses its emergency work. She said the board's response would be different if there were any moves to close the hospital.
BEXLEY Council, whose residents stand to lose the most from A Picture of Health proposals, says it cannot support any of the options.
It has already formally complained about the consultation document,
saying it was too difficult to understand and there were no choices for Bexley people as all of the options proposed downgrading Queen Mary's Hospital, Sidcup.
In its formal response to the consultation, Bexley criticises the lack of
detailed information on how Queen Mary's would operate as a borough hospital, and the lack of a detailed plan for the community services to be provided.
It says the lack of A&E services in
Sidcup will negatively impact Bexley residents and will not provide them with a better service.
It is also worried about the capacity at the Woolwich and Farnborough hospitals to cope with extra patients.
And it strongly opposes the removal of the maternity unit from Queen Mary's which it says will reduce choice.
Families will have to travel further and there are concerns about the ability of the Princess Royal and Queen Elizabeth to cope with additional numbers.
Bexley questions the wisdom of closing higher dependency neonatal units at Sidcup and Lewisham and concentrating them at Woolwich and Farnborough, which currently function at a lower level.
It also opposes closing in-patient children's wards at Queen Mary's.
And it has concerns about access to other hospitals for Bexley people,
especially via public transport.
The council concludes: "We feel
strongly the outcome of this consultation is pre-determined and the changes are being driven by finance rather than patient care.
"It appears the future of Queen Mary's has been sealed because of the inflexible PFI contracts in place across south east London."
Bromley
ALL three A Picture of Health options
retain all emergency services at Farnborough's Princess Royal Hospital.
The hospital's board, Bromley Hospitals Trust's preferred option is three which would see emergency centres reduced to Farnborough and the Queen Elizabeth Hospital in Woolwich.
This option would see Queen Mary's, Sidcup, and Lewisham hospitals stripped of all their emergency services, and instead become borough hospitals and centres for planned surgery.
But the trust says transitional arrangements might need to be made to achieve it.
In its formal response it says while people may find it difficult to accept service cuts at their own hospitals, the money saved could help pay off historical debts - the Princess Royal owes £99m.
It also suggested surplus land, most likely at Queen Mary's, could help pay off the debts.
The trust proposes two other options.
It suggests keeping the existing Alan Cummings day surgery unit at the Princess Royal, because patients would be close to an emergency unit if complications arose.
And it says this would add to the hospital's income and help keep it financially viable.
The trust claims considerable investment would be needed to modernise Queen Mary's for elective surgery.
Bromley also suggests retaining its three
operating theatres at Orpington Hospital, to create an orthopaedic surgery unit for all four boroughs.
Under current proposals this work would transfer to Sidcup.
Lewisham
LEWISHAM Hospital's trust board says retaining all its current functions is the only viable option for Lewisham.
It says removing surgical emergencies, a doctor-led maternity unit and children's wards from the hospital under option one would save little cash when compared to retaining all
emergency services, as in option two.
The trust says it believes people in Lewisham would seek treatment in inner London hospitals, rather than the Princess Royal in Farnborough or Queen Elizabeth in Woolwich.
It says the likely hospital of choice, King's College in Denmark Hill, does not have the capacity to deal with an influx of
patients from Lewisham.
There are also concerns options one and three, which would cut services at Lewisham, could increase health inequalities.
The trust concludes: "Option two is the only option which meets the health needs of the local population."
Consultants' views
A GROUP of 24 consultants at Queen Mary's Hospital, Sidcup, have responded to the consultation, taking a different view from their
hospital board.
The group has major concerns the changes will not improve the financial state of the hospital trusts in the four boroughs and could require more, not less, investment.
It says consideration should be given to buying out the PFI projects, which will lessen the debt permanently in the long-term.
The group also has some clinical reservations about the proposals, such as reducing A&E departments to two, and reducing doctor-led maternity units.
Its 16-page response signals the group's "deep unease" about the consultation proposals.
Councils
BROMLEY and Greenwich councils say they will not be making a separate response to the A Picture of Health consultation on behalf of residents.
Instead they will be putting forward their views as part of a combined submission from the joint overview and scrutiny committee for all four boroughs.
Lewisham Council has also declined to make its response public, but did give News Shopper an extract from it.
Lewisham Mayor Sir Steve Bullock favours option two which will preserve all of Lewisham's emergency services.
The extract says: "The specific proposals in the paper do not set out clearly enough how new community care services and basic care pathways will evolve.
"The failure to adequately consider patient flows to inner London hospitals also make it difficult to assess any of the options comprehensively.
"As a result, I believe option two is the only option which provides an opportunity to further explore and secure an appropriate balance between primary and acute care in the future without damaging existing excellent provision."
Royal College of Nursing
THE Royal College of Nursing (RCN) has told the councils' joint overview and scrutiny committee it has a number of concerns about the proposals.
This include problems of access for patients and staff if they have to travel further for services.
RCN's London regional operational manager, Nora Flanagan, said there were clinical advantages in putting experts together in larger hospitals and for separating planned from emergency surgery.
She expressed concerns about the ability of a reduced number of A&E departments to cope with the volume of patients and the proposed reduction in doctor-led maternity units.
She said the RCN had not chosen any option but would be "putting cautions" on some of them.
Royal College of Midwives
THE Royal College of Midwives (RCM) says some of the A Picture of Health proposals on maternity units were a "denial of choice" particularly for Bexley and Lewisham.
RCM team manager Pat Gould said it could not support the closure of the Queen Mary's, Sidcup, unit proposed under all three options.
She said the RCM was concerned options one and three would also leave Lewisham, which has an increasing population and high levels of health inequalities, without a unit.
The RCM will "totally oppose" the closure of the Lewisham maternity unit and says if Queen Mary's has to close, it should be replaced by a widwife-led unit.
Mrs Gould added: "Women in all four boroughs should be able to access a local unit."
Posted by: Unconsulted, Chislehurst on 3:35pm Thu 10 Apr 08
I don't know anyone that's received a consultation document. Were they posted out or hand-delivered? I downloaded a copy and it's not surprising so few have been returned. A more incomprehensible document would be hard to design. I don't think they were really interested in the opinions of the public.
PFI projects have been good for the privately-owned builders but a disaster for public services.
I don't know anyone that's received a consultation document. Were they posted out or hand-delivered? I downloaded a copy and it's not surprising so few have been returned. A more incomprehensible document would be hard to design. I don't think they were really interested in the opinions of the public.
PFI projects have been good for the privately-owned builders but a disaster for public services.
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