A Good Medical Staff Committee Meeting

The senior medical staff of City Hospital met last night. The subject of the meeting was the Trust's Interim Reconfiguration proposals. It was the plan for Inpatient Paediatric beds and Emergency Surgery beds moving to Sandwell that was under the spotlight. Some very clear messages emerged from that meeting without dissent:

If a patient is brought to hospital as an emergency and they need to remain in hospital, it is not good medical care for them to be moved to another hospital for a non-medical reason. The transfer would put the patient at an increased and unnecessary risk.

If the Trust's plans were to go ahead this would apply to both the children acutely ill needing inpatient care, and surgically ill adults at City Hospital. This would affect at least 1000 children a year and this is a conservative estimate. A more realistic figure was thought to be 1800 children.

The doctors went on to hear of an excellent plan that would keep inpatient Children's Services on both sites, create greater equity in staffing between the two sites and save the Trust £500,000 annually. Sadly the Trust has not been prepared to listen to this plan to date. Common sense would surely dictate that they cannot afford not to look at it very carefully. It sounds like a win win deal!

A very helpful proposal was made by one of the senior doctors that had widespread support. The Royal College of Paediatrics and Child Health should be asked to review the Trust's plan on Paediatrics together with the one put forward by the City Hospital Paediatricians.

So all in all a good and constructive meeting. The senior doctors have been consistent in their view. In the recent ballot 97% of those voting rejected the loss of the inpatient beds in Paediatrics and Emergency Surgery at City Hospital. They have now expressed that concern within the Medical Staff Committee at City and spelt out the principal reason for that concern. It is an issue of risk to the patient as a result of an unnecessary transfer.

There was a representative of management at the meeting who wheeled out the usual Trust reasons for making the changes: the EWTD for junior doctors hours, Modernising Medical Careers, working in larger groups, recruitment and retention. However the consultants were having none of it and made it clear that these were not valid reasons for the form of reconfiguration proposed.

It became very clear during the meeting that the City Hospital doctors are a thoughtful bunch who wish to be engaged by the management in planning the future. They have the desire and the ability to sort out the Trust's future plans. Yes they need to get together with their Sandwell colleagues, but there has to be acceptance of preservation of good patient care on both hospital sites until this new hospital opens. The Trust's plans have put City Hospital patients in jeopardy not Sandwell's. Quite rightly City Hospital doctors must stand up for their patients and do all in their power to ensure that patient care is not threatened. We would expect no less of Sandwell doctors for their patients.

A Sign of Things to Come?

John Adler wrote in a recent letter to Ken Taylor:

"I was also disappointed that your letter to consultants took a very pessimistic view of the prospects for the new acute hospital which these plans are, in part, designed to prepare for."

Well perhaps John Adler should pay some attention to this story from the BBC. It shows that Ken Taylor is taking a realistic view, while the Trust delude themselves that the new hospital is a done deal when they have not even purchased the site.

As Ken constantly states: let's reconfigure the services when the new hospital is there. Otherwise you may end up with worse services at the original sites permanently.

Media Cover Independent Review

There was widespread media coverage yesterday of the decision by the new Secretary of State for Health, Alan Johnson, to refer the interim reconfiguration proposals on emergency surgery and trauma to an independent review panel. Phil Upton covered the story on Radio WM in the morning, interviewing both Ken Taylor and John Adler for their reactions to the news. Ken Taylor swatted away the claim by the Trust that this was old news, pointing out he had a letter dated 16th July from the recently appointed Alan Johnson. He believed the independent review was great news for the campaign, because it would allow us to put forward the case to a geniunely independent panel. Although Paediatrics has not been included in the review, the letter from Alan Johnson said that all significant reconfigurations would be independently reviewed, holding out hope that this may also be referred separately. Failing that, it is possible that the City Hospital Supporters Group will look for a judicial review.

Chief Exective John Adler put on a brave face, claiming he was looking forward to the opportunity to put forward the Trust's case to the independent panel and that this was actually old news being recycled from May. This is not strictly true, as although the plans were referred to the Secretary-of-State in May by the Birmingham City Council Health Scrutiny Committee, it is only this week that the referral to an independent panel has happened.

The Birmingham Mail also ran it as a main story which can be found here.

Reasons for choice of Sandwell as Emergency Surgical site.

A further attachment with the letter on the Trust's Reconfiguration Plans:

Both City and Sandwell Hospitals are busy, large general hospitals serving deprived and diverse inner-city communities. The reasons for choosing Sandwell Hospital as the main emergency surgical site and City Hospital as the main elective surgical site were:
*The Trust already has a number of elective surgical specialties concentrated at City including ENT, Gynae-Oncology (the Trust is the tertiary centre for the Pan-Birmingham Network) and Ophthalmology.

*The Trust's elective surgical site requires greater theatre capacity than the emergency site. This level of capacity is available at City Hospital (in part due to six new theatres in the Birmingham Treatment Centre) but is not available within current facilities at Sandwell Hospital. Unless absolutely unavoidable investment in new theatres at Sandwell could not be justified in the context of the plans for a new acute hospital.

*Removing emergency surgery from Sandwell in addition to the elective surgical services already based at City and other services such as Urology which the Trust intends to concentrate alongside Gynae-Oncology would have resulted in a significant reduction in the general surgical service at Sandwell that would over time have become unsustainable.

*There are other A&E Departments in Birmingham (including at UHB and Heart of England NHS Foundation Trusts) providing possible alternatives for patients if necessary (although the Trust has designed its plans to minimise the risk of significant catchment loss.)

These reasons have been explained to the Overview and Scrutiny Committees and other key stakeholders as part of the pre-consultation and consultation process.

Some comments on this are required.
City Hospital Supporters feel very strongly that the communities served by both hospitals deserve at the very least fully supported Emergency Services at BOTH hospitals. The Trust's plans seem all about making elective surgery paramount at the expense of Emergency work at City Hospital. City Hospital is 1100 beds to Sandwell's 400. City sees far more emergencies and in particular far more surgical and trauma emergencies. Why are we compromising this excellent emergency service to fulfil some grand elective design ahead of the new hospital being completed?

Perhaps the most incredible statement of all time is for our Trust Board to be reminding the world that there are other A&E Departments in Birmingham such as UHB and Heart of England. Who are these people working for? Who are they representing? The Chair of the Trust made the same comment on the Politics Show on TV back in May. Can anybody have confidence in a Trust Board identifying other hospitals for its patients as part of its grand plan for the future?

The people of Birmingham and Sandwell need a management team that is standing up for their interests and providing at the very least good emergency services on both sites until they have produced the new hospital. We may be called City Hospital Supporters because that is the hospital that is under attack, but we would not wish to see Sandwell patients lose any of their emergency services. This ethos was enshrined in the letter from the Department of Health that approved the formation of the Trust with the merging of the two hospitals.

Attachment 2. Reasons for choice of preferred option in surgery.

This attachment also accompanied the letter from the Chief Executive.

1. The plan allows the concentration of elective general surgical specialties inpatient activity at one main site presenting the benefits of improved critical mass for future service development.

This advantage needs to be set against the very major disadvantage of not having properly supported emergency services on both sites, and in particular at the larger of the two hospitals namely City.

2. The plan allows the consolidation of elective inpatient orthopaedics alongside the elective general surgery to provide a major elective surgical site.

It seems elective work is taking precedence over emergency work. Surely this has to be seriously questioned with a hospital the size of City situated right in the centre of Birmingham and with the workload of its A&E Department? 103,000 referrals a year.

3. The plan separates emergency and elective workstreams enabling improved management of patients in a larger more focused emergency inpatient site.

At present City Hospital is able to deal with nearly all its emergencies in house giving a first rate service. Why are we undermining the service at City for something only to be achieved if and when this new hospital materialises?

4. The plan retains maximum possible local access for elective work with outpatients, day cases and 23 hour stay surgery retained at both sites.

The status quo or would retain a First Class Emergency Service on both sites. When the chips are down the people need a decent Emergency Service.

5. The plan retains maximum possible cover for the elective site including:
- on-call consultant surgeon and orthopaedic surgeon
- on-call surgical registrar
- junior doctor presence on site through HaN team
- out-of-hours access to emergency theatre
- full anaesthetic cover

But means about 12 patients a day who are acutely surgically ill or traumatised will have to make an unnecessary journey to Sandwell Hospital in order to find a bed. Their relatives will have to travel further to see them.

6. The plan retains maximum possible local access for emergency surgery through a 24 hour Surgical Assessment Unit at the elective site to provide good local assessment services.

People not only need good access for emergency surgery they need to remain in the hospital they have been admitted to unless there are over-riding medical reasons for a move.

Attachment 1: Reasons for service reconfiguration in advance of new hospital - surgery.

This has been sent out to everybody on the 6th July from the Chief Executive.

1. Changes to the Medical Workforce. Both MMC and the next stage of EWTD implementation have a significant impact on junior doctor numbers in key specialties including surgery. This makes it increasingly difficult to cover two sites in the way we do now. The effect of MMC is already becoming apparent.

The Paediatricians and the Surgeons assure City Hospital Supporters that these are not valid reasons for losing their beds to Sandwell. They are able to put forward plans that would provide cover on both sites and not be more expensive than the Trust's proposals.

2. Critical Mass for Future Development. Many of our services (especially surgical services are too small at each site to have a sufficient critical mass for future development.

It is very unlikely that this applies to City Hospital. However the reason for the new hospital is to bring services together on one site. The sooner the new hospital is built the sooner this can happen. However this is not going to happen imminently and emergency services should not be compromised while the community waits for its long overdue new hospital.

3. Recruitment and Retention. Continuing to recruit and retain the best clinical staff in a competitive labour market requires services that are large enough to attract high quality individuals.

Medically there has continued to be no significant problems recruitng doctors. The Trust were not too bothered about retention when they lost a large number of nursing posts recently in order to help solve the financial problem.

4. Productivity improvements. The next stage of productivity improvements required to ensure best use of resources will be supported by larger inpatient services.

Now this is a new one. Sounds like the supermarket approach. Is it a justifiable reason for making patients suffer an extra ambulance journey and for relatives to travel further? City Hospital Supporters do not think so. This is a gain to be made when the new hospital opens.

5. Preparation for the new hospital. The new hospital will require single clinical teams working in new ways; bringing services together now prepares for this.

Very unconvincing. Time enough to start on that when the new hospital is actually being built assuming it happens. There is absolutely no guarantee that it will.

Responding to some key points.....

Dear Mr. Adler,
Thank you for your letter of the 11th July. The City Hospital Supporters Group ballotted the consultants at City Hospital, the far larger hospital serving a very diverse multi-ethnic population because that is the hospital faced with losing its inpatient Paediatric, Emergency Surgery and Trauma beds. It is the sick children and surgically sick adults needing to stay in City Hospital longer than 24 hours that will have to face the additional ambulance journey to Sandwell with relatives forced to travel further. The ballot showed that those voting (an absolute majority of the members of the Medical Staff Committee)were almost unanimously opposed to these plans. This sends the Trust Board a very clear signal indeed.

Turning to the "very pessimistic view" taken on the new hospital I would choose the word "realistic". The Trust Board are very optimistic portraying the new hospital as very much "a done deal" when it is no such thing. The land has not been bought, the finance has not been secured, very real concerns about the ability of the local health economy to afford another large PFI in the Birmingham conurbation with the Coventry experience only too fresh in our minds, and the new hospital would be the last piece in the jigsaw after establishing all the new builds and services in the community to ensure that the future hospital is not too large. If we apply the legal concept of reasonable doubt, then there has to be reasonable doubt that the new hospital will be achieved until we have some concrete evidence (literally)with it actually under construction. Planning for working together on one site can take place until then, followed by any necessary service modification during the construction but keeping the needs of patients and their families uppermost in our minds.

City Hospital Supporters are delighted that you are going to continue working closesly with the clinicians. A major problem to date is that although there may have been close working it has not influenced the Trust Board's proposals. It is my clear understanding that the Paediatricians at City Hospital and the majority of the Surgeons are opposed to their patients moving to Sandwell Hospital. They have put forward plans for retaining the beds at City that would be perfectly viable in terms of the EWTD on junior doctors hours and with MMC and would not be more expensive than the current proposals. I have checked my facts with key people before writing this letter. It is time that these plans saw the light of day so that all can judge their viability for themselves.

The only aspects of reconfiguration that worry City Hospital Supporters are those affecting inpatient Paediatrics at City and Emergency Surgery and Trauma beds. We believe that over the remaining weeks of summer there is an opportunity for the Trust to modify its position on these services by heeding the results of its own formal consultation, the consultant ballot verdict, the views and evidence of the clinicians directly involved, and the concerns of the Health Overview and Scrutiny Committee of Birmingham City Council.

Yours sincerely,

Dr.K.G.Taylor MD.,FRCP
On behalf of the City Hospital Supporters Group

Ms. D. Lee, DOH Secretary of State Private Office
Mr. T. Shaw, Independent Reconfiguration Panel
Councillor Alden, Birmingham Overview and Scrutiny Committee
Ms. C. Bower, West Midlands Strategic Health Authority
Dr. S. Bradbrook, Heart of Birmingham PCT
Mr. R. Bacon, Sandwell PCT
Mrs. S. Davis, SWBH
Mr. R. Kirby, SWBH

John Adler's Ballot Response

The following letter was sent to Ken Taylor by the Chief Executive of Sandwell & West Birmingham Hospitals NHS Trust in response to the recent ballot, which saw 95 out of 98 City consultants who voted voting against the interim reconfiguration proposals, a majority of 57% of those who could have voted. The original version is available here.

Sandwell and West Birmingham Hospitals NHS
NHS Trust
City Hospital
Dudley Road
Birmingham
B18 7QH

Tel: 0121 554 3801

http://www.swbh.nhs.uk/

Tel: 0121 507 4847
Fax: 0121 507 5636

Dr. K.G. Taylor
‘Redstacks’
1 Priory Road
Halesowen
West Midlands B62 0BZ
11th July 2007

Dear Dr. Taylor,

Re: City Hospital Supporters Group Ballot

Thank you for your letter dated 23rd June 2007 setting out the outcome of the ballot of City Hospital based consultants organised by the City Hospital Supporters Group.

I note that your ballot did not include the substantial body of consultants based at Sandwell who are also affected by these changes. I was also disappointed that your letter to consultants took a very pessimistic view of the prospects for the new acute hospital which these plans are, in part, designed to prepare for.

As you know, the Trust has developed its proposals for change with significant clinical input over the last 18 months in order to reach a considered assessment of the best option for each of these services. This has included detailed consideration of the options with the clinicians directly involved as well as a number of opportunities for the wider clinical body to contribute. We will continue to work closely with clinicians as we develop our plans further.

Finally, I would like to take the opportunity to confirm how the Trust intends to proceed. We will be continuing to ensure our clinicians are engaged in the process of developing our plans. We will in this way proceed with changes where either there is no significant argument or where there are clear operational reasons for needing to deliver the change as quickly as practical. This includes the changes to pathology (move to City), neonatal care (move to City), inpatient paediatrics (move to Sandwell) and the first stage surgical changes (inpatient urology, vascular and breast cancer will move to City). The proposals for emergency surgery and trauma are subject to the Secretary of State’s decision and we will continue to work on the detail of our plans in this area with clinicians pending the outcome of the review. This approach was agreed by the Trust Board last week.

I trust that this letter confirms the current position.

Yours sincerely,
John Adler
Chief Executive
cc: Ms. D. Lee, DOH Secretary of State Private Office
Mr. T. Shaw, IRP
Councillor D. Alden, Birmingham OSC
Ms. C. Bower, West Midlands SHA
Dr. S. Bradbrook, Heart of Birmingham PCT
Mr. R. Bacon, Sandwell PCT
Mrs. S. Davis, SWBH
Mr. R. Kirby, SWBH

Ken Taylor will be posting a response to this later today.

A Ray of Hope??

An e-mail came to all inboxes at City Hospital and presumably to all healthcare workers throughout the country on the 4th July. It was from the new Health Secretary Alan Johnson and he was announcing a wide-ranging review of the NHS led by a surgeon who will continue to practise his craft.

This is most welcome news. What better way to convince the front line troops than with a person who knows what it's all about leading the way. May be some common sense can now effectively influence the decisions taken at the top of government.

Policy must be evidence-based with clinicians from both primary and secondary care, patients and local community representatives in the driving seat. From all my experience of talking to patients not one has said that that they want more choice. They want to see the local GP when they are ill, preferably before they get too ill. Seeing the same GP with some continuity of understanding of the problem as well as care would be good. Patients want to be seen at the local hospital for serious common garden complaints. They would prefer to have the children, themselves and their elderly parents cared for in the same hospital.

They would like the hospital to be clean, free from infection, the food to be adequate and edible without the need for the family to bring in extra rations. It would be good not to be taxed for parking the car in some grotty flooded car park especially when they are elderly, infirm and supporting sick family members.

They also find it hard to understand that the treatment you can get depends on where you live. Not only do people have to move address for the schools in 2007 but also to get the treatment they need. They wonder can it really be a NATIONAL Health Service?

The consultants feel sidelined and ignored. Primary Care Trusts now decide what they are going to buy. Let us be clear Primary Care Trusts do not represent GPs in my experience. They have their own agenda and I have great sympathy with my GP colleagues. When the GPs sit down with the consultants and work out what is best for patient care and where it should be done most effectively and economically we will really be reforming the NHS. I am hearing about patients with diabetes being denied a specialist foot clinic at the hospital in spite of developing gangreneous toes. I hear diabetic patients with renal failure may be discharged to primary care. This is going back to the past, not forward to the future. In parts of the country specialist nurses are being lost.

Much more money has been invested which is fantastic but I fear that much has been wasted. All these Trust Boards, all the non-productive people that are not contributing to patient care, all those management consultants, all the glossy brochures, all those organisations set up to monitor this and that, all those collecting data to determine if targets are being met, all those working in public relations and communications.

The NHS now has a business ethos. Money rules the roost. Looking after patients who are vulnerable and ill is something very special. We need an NHS that has a caring ethos but with business sense. Trusts are not accountable to local people. The Labour Government made a big mistake abolishing the Community Health Councils. They stood up for the health needs of the local community and gave the providers of health care a hard time when things were not right. They were the local watchdogs of the health service. Bring them back. It is true wisdom to recognise when mistakes have been made and then to correct them.

Turning to our vitally important local issue. I have today written to Secretary of State Alan Johnson setting out the key issues regarding the Interim Reconfiguration proposals and copied the letter to Professor Sir Ara Darzi. I am hoping that this will lead to referral of both Paediatrics and Emergency Surgery to the Independent Reconfiguration Panel. If this happens then I hope the evidence will speak for itself.

Race for Health

A news item in the 30th June British Medical Journal caught my eye. Race for Health is an organisation sponsored and funded by the Department of Health. Surinder Sharma the National Director for the Equality and Human Rights Group is the Department of Health's sponsor.

"The programme is led by the Primary Care Trusts and it aims to create an NHS in which the health needs of black and minority ethnic people drive the services they receive. Its focus is on three key areas: workforce development, commissioning, service improvement."

This has great relevance to City Hospital at the moment. Why is the Heart of Birmingham Primary Care Trust agreeing to commission an emergency service that will clearly be disadvantageous to the ethnic minority population served by City Hospital? Having to move hospital if you are a child or a surgically ill adult and need to stay in hospital longer than 24 hours is a worse service than at present. Why would they want to purchase such a service? If they cannot improve the service they could at least maintain the status quo while awaiting the wonderful new hospital.

Interestingly there are 15 pioneer Primary Care Trusts. One of these is the South Birmingham PCT. Perhaps Heart of Birmingham PCT needs to take a leaf out of their neighbour's book?

If you want to find out more visit the website www.raceforhealth.org.