Trust Board Meeting Review (10th May 2007)

The following is an account of the public Trust Board Meeting on Thursday at which the Trust decided to ratify the interim reconfiguration plans for Sandwell & West Birmingham Hospitals NHS Trust, which plans to replace the current emergency inpatient paediatric and general and trauma surgery beds at City Hospital, Birmingham with a 24-hour Paediatric Assessment Unit, and a 24-hour Surgical Assessment Unit.

The Trust Board met at 2.30pm on Thursday 10th May with the public present in order to ratify proposals arising from both Towards 2010 and the Reconfiguration of Services. At the start of the meeting the Chair announced that the public could speak at the start of proceedings, but after that they would have no opportunity to ask questions, comment or seek clarification. Effectively they were being asked to comment on material that had not been presented to the meeting. Several members of City Hospital Supporters were present and took the opportunity to complain about this most unorthodox and undemocratic method of conducting business, and made their views on the proposals before the Board known. It seemed from what was said at the meeting that there had been a previous private meeting of the Board.

QUAD the organisation based at Warwick University were asked to present their findings on the two consultations. We then had a pseudo-scientific presentation of methodology and results. There was no mention of how they checked the questions for their suitability and validity. There was no mention of the reading age required and if it matched the reading age of the population under study. It was accepted that the ethnic mix of the respondents to the questions in the two booklets did not match the ethnic mix of the population served by City Hospital, consequently ethnic minorities were significantly under-represented. However although the process was flawed one message emerged very clearly that the population resoundingly rejected losing inpatient Paediatrics and inpatient Emergency Surgery from City Hospital. A more carefully performed study accurately representing the ethnic mix of the actual patient population is likely to have made these results even more spectacular.
The Board went on to receive a paper on Paediatrics creating a sub-regional Neonatal Unit at City for complex cases, and a more basic unit at Sandwell. Inpatient Paediatrics were to move to Sandwell with a 24 Hour Paediatric Assessment Unit at City. Two Sandwell Consultant Paediatricians told the Board that this was the way to go. There are three General Paediatricians at City Hospital plus Neonatologists but not one of them attended the meeting. Were they invited to attend and give their views? The Board accepted what they were told virtually without question and the paper was passed unanimously.

They then considered Emergency Surgery. Another paper was produced setting out the plans to move inpatient Emergency Surgery from City to Sandwell and establish a 24 Hour Surgical Assessment Unit at City. This paper was introduced by Dr. Hugh Bradby the Medical Director and Sandwell-based Gastroenterologist. He went on to ask Mr. Peter Ahee Director of A&E at City to outline the differences patients would observe if the Trust’s paper were implemented. Mr. Ahee told it as it is. If you were a sick child admitted to the Paediatric Assessment Unit or an adult admitted to the Surgical Assessment Unit, if it became clear that you needed to stay in hospital longer than 24 hours you would be moved to Sandwell. This would amount to two thirds of the children and two thirds of the adults admitted to these units. No questions were asked by the Board on what would happen if Sandwell beds were full although the hope was expressed that Birmingham Children’s Hospital might help out and I believe someone is going to have a word with them. Mr. Ahee also pointed out that the Specialist Surgical Registrar would be allowed to reside at home overnight provided he could return in 20 minutes. The Chief Executive thought that the Surgical Registrar should be required to remain resident in the hospital while the situation is risk assessed possibly up until 2009.
The Director of Surgery at City who is a Trauma and Orthopaedic consultant was called and he recommended the proposals to the Board, although he clearly stated that he was only speaking on behalf of Trauma and Orthopaedics. Then a Sandwell General Surgeon was asked to speak and he told the Board why they should vote for the proposals with great enthusiasm. An Anaesthetist, I believe from City Hospital also seemed content with the arrangements. No General Surgeon emergency or otherwise based at City Hospital was called by the Trust to speak about the subject in which they have the expertise, and which directly concerned them. The Board passed the second paper unanimously.

It is for the public to decide on the evidence presented, which I believe I have recollected correctly, if the fateful decisions taken by the Trust Board are sound. Was it a reliably designed consultation that was robust and accurately reflected the views of all the population affected? Do the decisions take due account of the very clear views expressed by the consultation data available flawed as it is? Why did we not hear from at least one Paediatrician and one General Surgeon based at City giving their honest professional views? Add to this the fact that two thirds of children and two thirds of surgical patients admitted to the respective 24 hour Assessment Units will be moved to Sandwell or elsewhere within 24 hours these decisions have got to be unacceptable. The emergency care provided for the people of Birmingham will not be as good as at present as a result of these decisions. There were four other options that were rejected in favour of the current option, and we believe that two of those options would have met the aspirations of the local community and the results of the consultation.

City Hospital Supporters would welcome a reconfiguration that would improve services to patients, and we believe this can be achieved. The Trust’s current reconfiguration will involve a diminution of existing emergency services at City Hospital.

Consequently City Hospital Supporters are calling on the Birmingham Health Overview and Scrutiny Committee at their meeting next Friday 18th May to reject the Board’s plans and refer them to the Secretary of State for Health who in turn would arrange for them to be reviewed by the Independent Reconfiguration Panel. This arrangement formed part of the conditions for approving the merger of City and Sandwell Hospitals set out in the letter shown above sent to the Chairman of City Hospital NHS Trust Richard Steer by the the Parliamentary Under-Secretary for Health at that time Yvette Cooper.
City Hospital Supporters would wish to present evidence to this Panel.

Ken Taylor on behalf of City Hospital Supporters 15/05/07