Saturday, February 17, 2007

CHSG Response to Interim Plans



This document has attracted our greatest attention because it is about reducing services especially at City Hospital which is the much larger hospital serving the most deprived population. It is also the City Centre Hospital and its A&E Department has a fine reputation with some 100,000 plus referrals per year. Indeed the merger of City and Sandwell Hospitals was only approved on the 8th March 2002 by the Parliamentary Under Secretary of State for Health Yvette Cooper after Birmingham MPs had met with her presenting a paper about the importance of ensuring the continuance of City Hospital’s A&E Department in its present form. A letter was written by Ms. Cooper to the then Chairman of City Hospital NHS Trust Mr. Richard Steer and a copy is appended to this response. It is noted that the first condition in her letter states “will continue to provide the full range of clinical services to support local Accident and Emergency Services.” The second condition states “neither of them is under threat of closure nor is either expected to become under threat as a direct or indirect result of merger.” The third condition states “should there be proposals for service reconfiguration these will be the subject of feasibility studies involving key stakeholders, public consultation and national independent scrutiny. Furthermore in the future all NHS organisations will be required to consult local authority overview and scrutiny committees on proposals for service reconfigurations. These committees will have the statutory powers to refer those proposals to the Secretary of State if the consultation process is inadequate or the merits of the proposal are not in the interests of local people.”


· Moving inpatient emergency general surgery, trauma and children’s beds from City Hospital to Sandwell will adversely affect the service provided by City Hospital’s A&E Department.

· At present if a patient is seriously injured or has a serious surgical problem he or she may be brought to hospital in an ambulance or by relatives in a car. The patient is brought into A&E and is seen assessed and treated by the A&E Team. If surgery is required it can be performed as speedily as required on site by the duty surgeon and then the patient can move seamlessly to a Critical Care or High Dependency bed and hopefully on to an appropriate ward for full recovery. This is ideal patient care in the local hospital all under one roof. The community can depend on receiving high quality care speedily in their local hospital.

· If the emergency surgical and trauma beds were moved from City Hospital patients arriving there would have to face being patched up and then transported elsewhere which is not coherent medical care. How would they be transported and with what type of escort? Would doctors and nurses be required and if so how feasible would that be? How would that effect their risk of survival and recovery? Indeed the Trust state in their document that ambulances and GP referrals will be directed to Sandwell and presumably if they do not have beds to other hospitals further away. Although some of the geographical distances to these other hospitals may not be great the speed of access depends on having roads that are not blocked with traffic. Having blues and twos on does not mean that ambulances can fly over traffic jams. Again the relatives would have to travel further afield with many of them using a rather poor public transport system, or if they are more affluent in cars. The cost of travel on public transport is another important issue. If there were no duty surgeon at City with a support team then patients could not even be operated on there so would have to be exported to other surrounding hospitals Furthermore this would put patients with upper gastro-intestinal bleeding that may need surgical intervention at risk. This would mean the gastroenterological service moving to Sandwell with knock on consequences for medical patients coming to City Hospital as emergencies.

· What has been said in the point above also applies to children if their beds were moved from City to Sandwell. Can this be sensible for a hospital seeing nearly 20,000 paediatric referrals a year? Remember Birmingham is already short of general paediatric beds. Although we have the Birmingham Children’s Hospital this is a regional specialty hospital on a site constrained for space. There is great pressure on its beds and often patients are referred to City from BCH because they are short of beds. Indeed the shortage of children’s beds in the city has meant City Hospital has had to send children needing admission to New Cross Hospital Wolverhampton and Worcester. Is this good care for local people? Does it make sense to reduce beds in Birmingham further? Why are they offering a Part-Time 12 Hour Paediatric Assessment Unit when currently children can be seen at any time of the day or night and be fully sorted out? Could the planners be saying well at certain times of the day we see relatively small numbers of children so why provide a full service? We believe the people of West Birmingham would say every single child is precious and deserves the same level of care as every other so give us a 24 hour service with every child being treated equally. No doubt planners have children. Would they be happy for them to receive an inferior service because the child became ill at an inconvenient time? How many of these planners actually live in West Birmingham? The Trust are proposing an inequitable service for which there is absolutely no justification. City Hospital Supporters believe equity of care must be afforded. In fact it is our understanding that cost is not really the issue so why are they proposing a Part-Time Paediatric Assessment Unit????

· What will the changes give us asks the Trust in its consultation document?
Maintain local access they say but surely the true facts point to the very reverse being the case.

Tackle the urgent problems in some specialties. They refer elsewhere in the document to the European Working Time Directive for junior doctors, they also mention elsewhere Modernising Medical Careers and recruitment and retention.
In fact the doctors working in the relevant specialties at City Hospital assure us that recruitment of consultants, junior doctors and nurses is not a problem. They also state that concerns about the EWTD and MMC have been over-played by the Trust.

Change services to help deliver the vision for improved NHS care.
If services are being reduced as described above how can this relate to a vision of improved NHS care?

Apparently the main benefits of the proposals are to:

Improve clinical services and make sure they are safe and can meet modern day requirements..
This just does not square with the reality of what they are proposing.

Help attract and keep the best staff.
The only reason the Trust has lost staff is that they have deliberately reduced the staff complement by 540 including medical and nursing posts in an effort to reduce the financial deficit of circa £15 million. Furthermore when the Trust advertised for a qualified Children’s nurse at City recently there were 70 suitable applicants. I am reliably assured that there is keen interest in the consultant surgical posts becoming available in the Trust. There are plenty of men and women of great quality who relish working in the very challenging and worthwhile environment of City Hospital.

Enable services to develop and support the long-term vision for health services.
They are repeating themselves.

Let junior doctors work fewer hours and meet European Regulations.
Not an issue according to informed sources.

Make better use of resources including investment in new equipment.
Not supported by any evidence presented.

We now need to turn to the consultation process itself which is vexatious. In effect we have had two consultation processes rolled into one which is very confusing for the public. They were both launched on the 20th November closing on the 15th February. As a result of public pressure the consultation on reconfiguration has been extended until the 15th March.

In order for this consultation to be meaningful the people in the community not only need to appreciate what is proposed but understand the implications for their healthcare. We believe that expecting them to phone up for two booklets or try and download them or complete them online is just asking too much. On the 3rd February the Trust were approached by City Hospital Supporters Group and asked to place the green booklets “Shaping Hospital Services for the Future” on every ward and in every outpatient clinic. The response was an interesting one, they thought “the suggestion was a good one and they would check if there were enough copies left.” This response says it all? The people attending the hospital as patients and their relatives are the very people that will be most affected by the changes. Surely those are the people the Trust want to hear from? Many of the people around City Hospital do not have access to computers and the key reasons for them having poorer health than more affluent areas will seriously impair their ability to respond to this confused, poorly thought out and executed consultation process. The truth of the matter is that if they knew about, and understood what is proposed, it is very unlikely that they would approve it.


City Hospital Supporters Group believe that the Trust has not produced any convincing evidence for the proposed changes that would effectively downgrade services at City Hospital and undermine its A&E Department. We are firmly of the view that services should remain as presently configured, and then when the new hospital is built, provided it is of an adequate size both City and Sandwell Hospitals can move into it. This may take significantly longer than the six years forecast by the Trust. While the people of West Birmingham and Sandwell await their new hospital they deserve at the very least to continue to receive the current level of service
We believe that we have shown that this consultation process has been inadequate, and there are no merits in this proposal for the local people and it is certainly not in their interests. We believe that it would not stand up to national independent scrutiny and unless it is significantly modified it should be referred to the Secretary of State for Health.

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